SUMMARY:

• 7 years of professional experience in Reimbursement Analyst/Dynamic Business Analyst/ Quality Assurance and Software testing. In depth knowledge of Software development life cycle, testing methodologies
• Good understanding of various domain of Health Care.
• EMR system and EDI transactions for claim process, ICD 9 to ICD 10 conversion knowledge from healthcare domain.
• Worked with ANSI X12 5010 and ANSI X12 4010 standards for transactions like 837 (medical claims), 835 (Payments & Remittance advice), 270 (eligibility inquiry) and 271 (eligibility response).
• Proficient in Application Testing and health care Web based Application testing.
• In - depth knowledge of all QA Phases that include Manual, Functional, System, Unit, Integration, End-to-end, Business Process testing.
• Followed the Agile methodology, Waterfall methodology. Analyzed and incorporated User Stories in different release plans for the sprints in Scrum process.
• Strong skills in writing complex SQL Queries using SQL Server /Oracle Databases. Analyzed entity relations for Oracle and SQL Server Databases.
• Coordinated with QA team to develop Test Plans and Test Cases.
• Experience with analyzing methods such as Verification & Validation, GAP analysis, analysis, Risk analysis, Impact analysis, Business Project analysis, Process Flow analysis and Failure analysis.
• Hands on experience of 837I, 837P, 277 and 835 HIPAA file formats including the HIPAA 5010 for health care billing.
• Experience in system conversions (Mapping, Migrating, Enhancement) such as HIPAA X12 4010 codes to X12 5010 codes and ICD-9-CM codes to ICD-10-CM in Medicaid, Medicare, Procedural and Diagnostic codes and Claims processes.
• Excellent negotiation and problem solving skills.
• Excellent analytical, decision-making, and organizational skills coupled with good co-ordination and interpersonal skills.
• Excellent written and verbal communication skills. Demonstrated team leading and integrative learning skills in many professional and volunteering projects.
• Experience in developing Use case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams using MS Visio.
• Experience in the financial services industry with emphasis on Investment management, risk management, wealth management, derivative securities. Participated in JAD sessions with superior organization and presentation skills.
• Familiar with HP Quality Center to design and develop test plans and test scripts and good at quickly learning technologies and systems
• Experience working on database-centric projects (Data Warehouse, data mapping, data migration)

WORK EXPERIENCE:

Confidential, Basking Ridge, NJ

Senior Business System Analyst/ Associate Project Manager

Responsibilities:

• Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders to identify the system, operational requirements, and proposed enhancements.
• Participated Joint Application Development (JAD) sessions with all IT group members and State for communicating & managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Gathered business requirements from business users such as Mass Health, CCA and drafted business requirement specification (BRS).
• Wrote Business Requirements Specification (BRS) and Use Case Specifications, Systems Requirement Specification (SRS) with the Business Group and the IT project group members.  
• Identified all necessary Business and System Use Cases from requirements, created diagrams. Understood the Business Logic, User Requirements and test-objectives to develop Test plans, Test cases, Use Case Scenarios.  
• Assisted in developing test scenarios, test scripts and test data to support unit and system integration testing.
• Involved in comprehensive testing of the system to check it satisfies functional specifications.
• Analyzed and synthesized results from   Joint Application Development (JAD),   proposed alternative tasks and transformed those into Business Requirement Document (BRD)
• Experience in conducting   GAP analysis ,   User Acceptance Testing (UAT) and Requirement Traceability Matrix   (RTM)
• Worked on EDI Transactions Enrollment-834 and Claims 837P/I
• Coordinated with the developers and IT architects to design X12 Transactions for Clients from Extracts received from Claims Engine
• Contributed to build business dashboards to create use cases and associated KPIs on Fraud, waste and Abuse, Plan Management, Customer Service Management and Claim Adjudication.
• Created use case slides and maintained documentation on current status and key decisions regarding their business issues
• Gathered and analyzed business requirements and produced specification documents for new project request on Business Intelligence dashboard. Acted as liaison between business unit and development team to develop, communicate and modify design as per requirement
• Performed comprehensive analysis on projected data on KPI Charts to bring more valued dashboards by presenting realistic data
• Worked with business team to understand business logic behind each report
• Analyzed and compiled an itemized list of components that will need to be configured before the deadline
• Developed gap analysis document, logical and physical design and remediation plan
• Developed high level system models by analyzing the existing models and incorporating the suggested changes.
• Experience with Tableau
• Engaged with business to analyze, evaluate, design, integrate, build and test customizations and integration from CRM Siebel to third-party applications and Carriers
• Associated with SIEBEL CRM Functional management team and with the business users to refine scope and high level requirements for the project.
• Wrote queries in databases like   Oracle ,   SQL .
• Concrete understanding of Business Requirement gathering, Business Process flow, Business Process Modelling and Analysis, design documentation.
• Worked with Project manager in tracking deliverables, goals and timelines.
• Assisted in building up Project plans
• Worked on Agile Methodology and biweekly scrums
• Experience with Rally and Updating user Stories

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio, UI, UML, Agile, SQL, PL/SQL, ALM, Tableau

Confidential, Manhattan, New York

Senior Business Analyst

Responsibilities:

• Supported all aspects of departmental programming implementation, from ITG development to testing of the finished product in multiple systems: Mainframe and Internet applications .
• Identified, researched and resolved Claim system problems.
• Recommended and/or initiated systems corrections or modifications.
• Executed all tests, record and report test results, communicate issues via an issue log and conducting post-implementation monitoring.
• Served as the liaison with the supervisors and Managers in the Claims Operations concerning the business requirements, planning, testing and communication of projects.
• Recommended system enhancements required for contract implementation.
• Assisted in training of corporate personnel on new system functions/changes, as needed. Assisted Manager in developing and achieving department’s goals and strategies.
• Sessions conducted with managers to understand the business goals the project will address  
• Assisted users to understand how they do their jobs and what they need from data systems to boost their performance
• Translated business goals, user needs and process improvements into data management functions and requirements.
• Explained the capabilities and limitations of data systems to business users as the project is designed and built
• Created User Stories and guides to inform the development as to what is needed by the business and in what form
• Provided guidance on project scoping to meet stakeholders' requirements.
• Interview, guide, and lead discussions with senior level clinical representatives to form Business Use Cases  
• Translate business requirements and programming specifications in a form that can be easily understood by the development team  
• Wrote Test Cases and performed User Acceptance Testing, performed defect management using ALM.
• Interacts with SMEs to ensure that any proposed solutions are technically feasible within the functionality of the system.
• Performed gap analysis for upgrading from ICD-9 to ICD-10 codes.
• Coordinated with market BAs and business owners to gather requirements.
• Responsible for identifying and maintaining a clear and measurable software development process that is deployable throughout the enterprise using SDLC.
• Involved in preparing “BRD” Business requirement Documents for 5010.
• Followed the AGILE methodology for the entire “SDLC”.
• Prepared “FSD” functional specification document for 5010 from 4010A.
• Extensively worked with different phases of SDLC involving preparation of Business Analyst Test scripts, Low effort low complexity work forms for IT testing and UAT approvals.
• Expertise in ICD-9 to ICD-10 Conversion and creating a crosswalk between ICD-9 to ICD-10.
• Acted as a primary liaison between business/market BAs/ and developers.
• Prepared and modified Requirement Specification Documents for different markets.

Environment: MS Word, MS Excel, MS-Visio, Microsoft SQL Server 2008, MS Project, mainframe, IBM WebSphere, HTML, XML, Notepad++,Oracle, MySQL, SQL Server, ALM.

Confidential, Boston, MA

Lead Production Analyst

Responsibilities:

• Conducted interviews, live meetings and JAD sessions with business users and Subject Matter Experts (SME’s) to understand and gather requirements for the To-Be system.
• Analyzed the pre-existing documents to have a better understanding of the present system.
• Worked on HIPAA EDI transactions such as 835(medical claim payments), 837(medical claims), 276(claim status), 277(claim status response), 278(Health care service review information), 270(eligibility inquiry), 271 (eligibility response).
• Used SDLC methodologies like the RUP and the waterfall.
• To-Be process with Client Subject Matter Experts and addressed GAPs in processes.
• Developed standardized claim testing, involved in implementation and QA process.
• Worked in Agile methodology and participated/facilitated daily scrum meeting and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using MS Visio.
• Presented to Stakeholders the root cause of the analysis as to why the claims were failed to load in Database
• Performed Impact analysis for readiness of ICD-10 conversion.
• Execute Reconciliation Queries daily to identify number of 835 claims entered into the system and failed due to HIPAA errors or duplicity
• Worked on changes regarding new CMS directives and proposed changes to be made in the current system.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped.
• Assisted in writing test case scenarios for regression testing and end-to-end testing.
• Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
• Assisted end users and IT staff in the use of data to satisfy informational and reporting requirements and in implementation and usage of SQL and DBMS.

Environment: SQL Server, Rational Rose, Rational Requisite Pro, Rational Clear Case, Rational Clear Quest, UML, Rational Suite, MS Visio, MS Project, MS Office, JIRA

Confidential, Needham, MA

Production Analyst/ QA Analyst

Responsibilities:

• Developed strategic plan documents and project management policies.
• Processed insurance claims through the Preferred Provider Organization (PPO).
• Developed standardized Health Management system testing, involved in implementation and QA process. Worked on Claims Adjudication, Claims Pre-pricing and Claims Logging.
• Conducted Joint Application Development (JAD) sessions to develop an architectural solution that the application meets the business requirements, resolve open issues and change requests.
• Completed time estimates for all technical items, assigned work, and monitored developers’ progress and produced timely status reports for upper management.
• RUP methodology and documented the requirements using Rational Requisite Pro.
• Worked with the SME’s to define business critical needs and analyzed the possible technical solutions.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Conducted joint requirements planning (JRP) sessions as a facilitator to gather requirements from the business area and to discuss different critical success factors .
• Worked on Reporting tool to work on monthly and quarterly reports.

Environment: Rational Suite (Rose, Requisite Pro), Windows XP/2000, SQL, XML, HTTP, MS-Project, MS-Office Suite, MS Visio, Win Runner, Load Runner, Test Director (Mercury Interactive), Java, Gemini XML,UML,Agile., Crystal Reports, Adobe Acrobat, PL-SQL, Oracle 9i, SDL

Confidential, Jacksonville, FL

QA Analyst

Responsibilities:

• Reviewed Business Requirement Documents and the Technical Specification.
• Created various scenarios to verify and compare results between different Modules.
• Documented the entire Test Cases, Assessment Report, and Test Results.
• Involved in different phases of Test effort like Integration testing, Regression testing, and User Acceptance testing.
• Analyzed the performance by generating transaction response time graphs and reports, monitored Quality Center to close the bugs/cases as and when developers fix the bugs.
• Follow up with UAT Users of any defect / requirement related issues, identify, classify and add more information to better track defect.
• Managed the encountered bugs during the testing process by entering them to the Quality Center.
• Reviewing the documents carefully and attended walk through with business for data requirements and process.
• Formed data sheets and reports and graphs in Quality center
• Worked efficiently with Subject matter experts to gather, identify, specify and document complex
• business requirements
• Developed and executed test cases scenarios and followed up defects using Quality Center.
• Involved in Statistical and Reimbursement Analysis and drawing out the conclusion.
• Worked on Claim routing and claim processing in Diamond
• Used SQL navigator to query the database and to derive the information from production
• Interacting with other teams in walk through to resolve issues
• Worked on EDI transactions like 837 and 835 according to HIPAA compliance
• Good working experience in analyzing changes and identifying areas of applications to be regression testing.
• Performed data analysis and data validation and report validation
• Validated the pricing, billing and benefits of the health claims according to HIPAA billing policies and compliance.
• Also worked closely on denial claims
• Updated the database on Provider contracts used in claims
• Efficient in working team and issue resolving through team process meetings
• Knowledge of Medical claims coding- ICD-9 and ICD-10
• Assisted with user testing of systems User Acceptance Testing, developing and maintaining the test plan, test conditions and test cases to be used based on business requirements and technical specifications and quality procedures, and ensuring that proper document is in place.
• Performed manual testing on different modules of the application by executing the test cases and data mapping
• Through Knowledge of Medical Terminology

Environment: SAP, Quality Center 10.0, MS-Office, MS-Visio,, UAT, Quick Test Pro 8.2, SDLC, Windows XP, OS, JIRA

Confidential, Hempstead, New York

Non-Paid Internship-Health care Analyst

Responsibilities:

• Analyzed of business requirements and functional documents
• Involved in development of test plan, test schedules, test cases based on high-level and detailed designs.
• Created Test Plan, Test Cases and Test scripts for some of the modules of the application under test (AUT) using Test Director.
• Interacted with Business teams and Developers to understand business requirements and bug fixes.
• Defined and performed the test strategies and associated scripts for the verification and validation of the application and ensured that it met all defined business requirements and associated functionality.
• Documented the daily defect status using Test Director.
• Conducted Regression Testing and GUI Testing on the e-commerce application using QTP
• Utilized Test Director for communication with the production personnel, developers and team members.
• Observed different meetings held for renovation of the Emergency Department and equipment purchasing
• etc.
• Studying and maintaining reports on word, scanning and distribution, filing, photocopying, record Keeping, and report compilation.
• Gathered the knowledge of HIPAA transactions and code set standards such as 837, 835.
• Worked with team in gathering information
• Knowledge about EDI transactions and claim processing life cycle
• Worked closely on equipment purchases, billing and collection processes, and implement quality
• measures
• Worked closely on Revenue cycle and high dollar accounts
• Worked on various graphs and charts on excel for revenue cycle.
• Worked on outcome and operation Reports
• Wrote SQL queries to check proper data population in application tables.
• Participated in status meetings to report issues. Communicated with developers through all phases of testing to prioritize bug resolution.
• Worked with developers to reproduce errors and resolve software anomalies.
• Coordinated between various teams to insure consistency and accuracy across test plans, user manuals and training materials.

Environment: Win Runner, Test Director, MS Office Suite, Windows XP, .Net, XML, Java Script, Oracle, Windows 2003 and Crystal Reports.

Confidential

Assistant Medical Officer

Responsibilities:

• Assisted the Chief Medical Officer in the administration of the department.
• Conducted Hospital rounds at least twice in a week and ensure that proper cleanliness and decorum is maintained in the OPs / Wards / Kitchen / First Aid Posts.
• Responsible for carrying out periodic inspections of the Dispensaries at least once a week.
• Conducted surprise inspections of Hospital / Dispensaries / First Aid
• Ensured that discipline is maintained in all sections and submit report to the Chief Medical Officer.
• Responsible for making alternate postings/duty arrangements when required.
• Worked as cost control officer of the Medical Department. Followed the budget and minimize wasteful expenditure.
• Responsible for controlling the expenditure on overtime, rest day wages, holiday wages by ensuring judicial deployment of the officers and staff.
• Responsible for receiving any complaints from the patients and taking necessary steps to rectify the same.
• Responsible for examining cases for extension of sick leave beyond 3 months.
• Responsible for managing the referrals of patients to outside hospitals (Outpatient/Inpatient), Scan Centers and Labs.
• Examined and certify for payment the bills related to outside hospitals and Scan Centers.
• Dealt with all reimbursement claims of the working / retired employees and certify the bills for payment.