SUMMARY:

• Conducted a high level business analysis involving complex business requirements and processes.
• Conducted user interviews at both in - house and client locations. Gathered, analyzed and created an approved requirement list (ARL).
• Worked in close collaboration with the Project Manager and business users to gather, analyze and document the business requirements (BRD). Effectively communicated with both technical and non-technical users and produced project documentation.
• Participated in project planning and keeping management in alignment with scope and recommended resolutions for all assignment-specific issues.
• Partnered with internal business teams in defining business processes and associated system requirements.
• Performed gap analysis by identifying existing technologies, documenting enhancements to meet the end state requirements.
• Performed feasibility analysis for web mobile applications on multiple platforms.
• Designed and developed Use Cases, Workflow Diagrams, RACI charts and Project Schedule diagrams using MS Visio.
• Responsible for search engine optimization for the project (SEO and SEM).

TECHNICAL SKILLS:

• In-depth knowledge of all the phases within the Software Development Life Cycle (SDLC) such as Requirements, Analysis/Design, Development and Testing.
• Expertise in Agile, RUP, Scrum, Waterfall SDLC (Software Development Methodologies).
• Extensive experience in conducting Joint Application Development (JAD) sessions. Gather, synthesize and prioritize requirements using interviews, document analysis, requirements workshops, site visits, and surveys.
• Provided optimum service to policyholders, negotiated fair settlements and identified fraudulent claims.
• Profound understanding of insurance policies like HMO and PPO and proven experience with HIPAA 4010/5010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim-status),834(Benefit-enrolment), 835(Payment/remittance advice) and 837(Health care claims).
• Proficient in testing ANSI X12 version 4010/5010 EDI transactions and Eligibility (270, 271, 276, 277, 278, 834, 837 I/P, 837D, 835 remittances and NCPDP claims).
• Good working knowledge in X12 HIPAA EDI standards (v4010/4010A1) and v5010 standards, NASCO and HL7.
• Worked in various healthcare areas like Enrolment, Benefits, Claims, Providers, Medicare and Medicaid.
• Good knowledge on CPT/ICD diagnosis codes and procedure codes, ICD-9 and ICD-10 codes.

PROFESSIONAL EXPERIENCE:

Confidential, Denver CO

Business / Data Analyst

• Conducted a high level business analysis involving complex business requirements and processes.
• Conducted user interviews at both in-house and client locations. Gathered, analyzed and created an approved requirement list (ARL).
• Worked in close collaboration with the Project Manager and business users to gather, analyze and document the business requirements (BRD). Effectively communicated with both technical and non-technical users and produced project documentation.
• Participated in project planning and keeping management in alignment with scope and recommended resolutions for all assignment-specific issues.
• Partnered with internal business teams in defining business processes and associated system requirements.
• Performed gap analysis by identifying existing technologies, documenting enhancements to meet the end state requirements.
• Performed feasibility analysis for web mobile applications on multiple platforms.
• Designed and developed Use Cases, Workflow Diagrams, RACI charts and Project Schedule diagrams using MS Visio.
• Responsible for search engine optimization for the project (SEO and SEM).
• Coordinated with the development team and helped them understand the requirements. Worked with cross-browser problem areas with development team.
• Captured all the issues received from the stakeholders in an issues list and addressed the same in the respective meetings.
• Used internal request system to open, track and modify the bugs opened against each of the projects and worked on the analysis of the same.
• Conducted feasibility study by studying the current functionality and then identifying the gaps existing with regard to new functionality.
• Used power point presentations for conducting walkthroughs with the stakeholders and created end user manuals.

Environment:: Java, J2EE, SQL, XML, MS Office, MS Visio, MS Outlook, Windows XP

Sr. Business Analyst

• Involved in Business functionality review meetings and Use-Case Analysis.
• Validated HL7 ADT (Admit Discharge Transfer) and HL7 ORU (Observation Result Message) message types for various Hospital Information exchanges.
• Worked on Business Functionality, Use Case Specifications, Risk Analysis, Documentation and Build Verification.
• Testing of HL7 Message Validation and sending of ADT Messages like ADT A01, ADT A04 and ADT A08.
• Mapped the requirements to test cases (Traceability matrix).
• Prepared and Processed the HL7 ADT and ORU messages through Core point and attain Clinical lab results and other data in Clinical Portal.
• Validated HIPAA (4010 to 5010 Conversion) rules and HL7 Standards.
• Designed and implemented basic SQL queries for QA testing and report/data validation.
• Analyzed the System Requirements, Functional requirements and Business Requirement Documents.
• Performed Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Created the As-Is Model and To-Be Model of the system and performed a complete GAP analysis to identify problems and inconsistencies with the business specification and the existing system.
• Applied an in-depth knowledge of healthcare systems and healthcare business for the development of complex processes and projects in hospital information exchange.
• Determined alternate methods, procedures, and changes in processing methods and practices.
• Extensively used HP Quality Center for mapping Requirements, test planning, executing test cases and tracking defects.
• Coordinated with the entire team acting as a scrum master to see team delivers highest quality of deliverable.
• Worked within a growing knowledge of HIPAA 837, 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, and Medicaid. Experienced with different life sciences disease codes.
• Performed Data mapping and data translation in HL7 version 2.2.
• Involved in the meeting with business Process Owners, SME (Subject Matter Experts) and store users for Requirement gathering in Definition Stage.
• Participated in manual testing and UAT with the development team and QA team.

Environment:: Rational Requisite-Pro, UML, MS Project, HL7, Manual testing, Quality Center 10.0, Agile, Java, J2EE, IBM WebSphere, Web services, XML, Oracle 10g, SQL, TOAD, EDI X12 4010 & 5010, MS Office 2010, UNIX and Windows XP.

Sr. Business Analyst

• Actively involved in Complete Business Requirement capture.
• Actively participated in designing RTM (Requirement Traceability Document) and SSD (Solution Specific Document).
• Created Business Requirement Document-BRD.
• Involved actively in Use Case Creation and Business Case Template.
• Completed the User Acceptance Testing along with the Test Team.
• Participated in Business Checkout and successfully completed Business Implementation.
• Coordinated with the entire team as a single point of contact in taking weekly status meetings and checked the status of the team creating a detail report and delivery to the project manager.
• Central point of contact for all Training Modules, Work flows, Business Process.
• Worked Closely with Subject Matter Consultants (SMC’s) to understand the Complete Business Process, Document the key Requirements, Data Elements of Unemployment Insurance.
• Involved in designing and developing Work Flow Diagrams, Data flow diagrams and Physical Data base design.
• Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing, Medicaid & Medicare.
• Claims Transactions according to the HIPAA 5010 standards.
• Involved in Designing the Test Scenarios and Test Cases with the Test Team.
• Played a crucial role in interacting all necessary stakeholders to define functional requirements relative to the Life Health Claim System.
• Conducted JAD Sessions with various stakeholders to develop the structural design of the application enabling it to meet the required business standard.
• Identify all the gaps in requirements and track them to closure.
• Clarified client requirements, business needs and project scopes, via feedback sessions and client meetings, in collaboration with all stakeholders.
• Developed UML models for modeling static and dynamic aspects of Wealth management portal.
• Worked on mapping State Farm business requirements with FINEOS out of box system functionalities.

Environment:: Lotus Notes, Rational ClearCase, MS Visio, MS Project, ICD-9, ICD-10, UML Rational Rose, Quality Center 10.0, SoapUI 3.0, Web services, Agile, SharePoint, Java, J2EE, WebSphere, Java Script, Eclipse, Hibernate, XML, Oracle 10g, SQL, TOAD, MS Office 2010, UNIX and Windows XP.

Sr. EDI Business Analyst

• Reviewed technical documentation to understand the Business logic and technical aspects system.
• Gathering requirements from SME’s and Stakeholders in order to get a better understanding of client business processes.
• Developed test plans, status report for the management review for complete end-to-end testing for SOA.
• Responsible Forward Mapping and Backward Mapping analysis of ICD-9 & ICD-10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).
• Worked on agile methodology using Scrum.
• A rticulated Business Requirements from User Interviews and then converted requirements to Business Requirement Documents (BRD) and System Requirement Specifications (SRS).
• Participated in JAD sessions for requirement gathering, analysis and design.
• Created transaction sets and mappings in various ANSI X12 EDI formats like X12 837, X12 835 (Remittance Advice), X12 834, X12 270/271, X12 276/277 and X12 278.
• Involved in maintaining Requirements Traceability Matrix (RTM) using Rational Requisite Pro.
• Involved in GAP analysis of 270 and 271 transactions from EDI X12 4010 to EDI X12 5010.
• Worked to build extensions for FACETS Members, Claims, and Billing and enrollment applications.
• Involved in migrating EDI X12 4010 transactions to EDI X12 5010 transactions.
• Experience in compliance testing of EDI X12 5010 level 1 and level2 messages.
• Created test scenarios for 5010 repository to ensure maximum test data coverage and to reduce burden of manually created ANSI test data.
• Validated claims status in NASCO model office.
• Checked HIPAA compliance using EDIFECS tool.
• Tested new developments of X12 837 claims, 835 payment files.
• Used Portico, Inspector (Initiate) to check provider and subscriber information.
• Mapping requirements with Test plan in Quality Center.
• Responsible for checking the error reports in NASCO model office.
• Interacted with the UAT team to solve issues related to the defects.
• Test results are documented using MS Word and maintained Excel sheets for personal tracking of the defects.

Environment: Rational Requisite Pro, MS Visio, Quality Center 9.0, Agile, Java, J2EE, Struts, IBM WebSphere, Web services, XML, XML Spy, Oracle 10g, SQL, SQL Developer, MS Office 2007, UNIX and Windows XP.

EDI Business Analyst

• Analyzed, defined and designed the system requirements for the Medicare Independent Verification and Validation (IV&V).
• Responsible for maintaining HIPAA compliance.
• As a member of the Medicare IV&V team conducted an assessment of Medicare Part A claims processing system.
• Involved in building up a new Medicare insurance policy using Power Managed Health Services (MHS) for Private Fee for Service (PFFS).
• Improved process for payment of Medicare Secondary Payer claims through revised workflows.
• Updated and modified progress and resources allocation in MS project for the team.
• Designed and created GUI for the Electronic claims submission.
• Responsible for problem analysis, re-searching solutions and presenting recommendations.
• Worked with the 820 Medicare reconciliation applications.
• Created and maintained Gantt chart for project analysis.
• Regularly monitored and reported project status for review of upper management.
• Utilized EDI translation software to convert the files into a format that could be imported into the company's ERP.
• Involved in the development of test plans, test cases and expected results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
• Validated the reports and files according to HIPAA enforced standards.
• Apply new approaches and concepts to improve the productivity and efficiency of Facets testing.
• Worked with XML files created using XML schema.
• Created transaction sets and mappings in various ANSI X12 EDI formats like X12 837, X12 835, X12 834, X12 270/271, X12 276/277 and X12 278.
• Developed test cases and test scripts for system and UAT testing.
• Reported and tracked bugs using Quality Center and discussing about the bugs in the weekly status meetings.
• Developed and executed manual test scripts using test plan and test lab sections of Quality Center for System, Integration and Regression testing of the application and followed up until it resolves.
• Maintenance and updates of various files and documentation using Word, Excel and Access.

Environment:: Manual testing, Quality Center 9.0, MS Project, Visual Studio Team System (VSTS) 2008, C#.Net, ASP.Net, XML, XML schema, MS SQL Server2005, SSIS, T-SQL,MS Office andWindows XP.

BA/QA Tester

• Analyzed the business requirement documents, Functional specification documents to prepare Test cases and effort estimation.
• Acted as Scrum team member for the agile core process team applying Scrum principles.
• Performed Manual Testing, System Testing, Acceptance Testing, Functional testing and database testing for verifying application functionality.
• Performed functional testing, system testing, and integration testing and end-to-end testing.
• Created test cases in Quality Center and made sure all the functionalities are covered.
• Developed Test Evidences, Test summary Report documents and uploaded to Share Point.
• Performed Manual Testing for the entire application by executing the test scripts.
• Checked the integrity of the database by writing and executing several SQL Queries.
• Used Quality Center in reporting and tracking the defects.
• Created Requirements Traceability Matrix and tracked the testing progress through all the test cycles until the successful sign off.
• Created daily status reports and distributed with the stake holders and the project team.
• Positive and Negative Test scenarios were created and tested to test the functionality.
• Created test plan, test cases and test condition matrix for feature testing.
• Developed and executed manual test scripts using test plan and test lab sections of Quality Center for System testing, Integration testing and Regression testing of the application.
• Used Quality Center for test plan execution and defect tracking.
• Created SQL scripts to change data and validate service response.
• Responsible for preparing the user documentation and helping the users in UAT.
• Maintenance and updates of various files and documentation using Word, Excel and Access.

Environment:: Quality Center 9.5, Manual testing, RUP, MS Visio, Agile, Java, J2EE, JBoss, Struts, Spring, AJAX, iBatis, XML, Oracle 10g, SQL, TOAD, MS Office 2007 and Windows XP.