SUMMARY:

• Over 11 plus years of work experience as Project manager, Business Analyst and Lead Quality Analyst on large and time boxed projects with strong domain knowledge in Health Care Provider and Payer, Commercial, and Investment Banking, and Travel & tours industries on their onsite and offshore projects.
• Having excellent knowledge and expertise on research, finding and project planning type of work for different healthcare organizations.
• Worked as a SME on Medicaid Management Information Systems (MMIS ), Medicaid Information Technology Architecture (MITA) including Medicare, Medicaid, Medicare Advantage, MediGap, and also worked on MMIS Design, Development, and Implementation (DDI).
• Extensive experience in writing user stories, organizing technical review meeting, attending Story Grooming Session and facilitating to development and QA teams for more clarification and coding support.
• Extensive experience in writing test cases, handling testing activities, executing test activities, and writing test report. About 8+ years of work experience in managing, handling and executing test cases for different projects under the agile scrum software development methodology. Also having considerable amount of experience on waterfall methodology as well.
• Having work experience and expertise level knowledge on different claim adjudication systems e.g. Bluechip, FEP Express, FACETS, Magic, Coordinator Mouse, PREP, BlueSource, TSO, Availity, VDR, and also used Clarity PPM, Sharepoint 2013 and 2010, Lotusnotes, Webex, citrix, and NetMeeting for communication and information.
• Worked on Accredited Standards Committee X12 ( ASC X12) standard EDI transactions and integration (270/271 Benefit Inquiry - Eligibility, 276/277 Status Request- payment advise, 278 Request for Review/Response, 834 enrollment, 835 Payment/Advice, 837 Claims integration, 837P Claim: Professional, 837I Claim: Institutional, and 837D Claim: Dental).
• Well known and having sound understanding and hands on experience on comprehensive health reform, Affordable Care Act (ACA) Obama Care, Life and Disability insurance, and medical claim policies and requirements including benefits, membership, enrollment and implementation . Also, worked on Special Needs Plans (SNPs/Snips) under the Medicare program to expand coordinated care for vulnerable seniors, insurers and managed care plans.
• Worked on different claim processing tools including Inter-Plan Teleprocessing Services (ITS), Health Reimbursement Arrangements (HRA), Flex Saving Arrangements (FSA), BlueCard Program, BlueExchange transactions, and Health Savings Account (HAS).
• Worked as a Business Process Analyst and provided support for diagnosing and improving business processes and increasing efficiency. Analyzed different tasks include analyzing past trends, monitoring workflow, making predictions, developing business process models, recommending enhancements and assisting the management in making decisions.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements and documented and assisted the QA Team with the Test Plan. Also worked on different types of testing in different environments e.g. UAT, UIT, and SIT testing including regression, parallel, load runner and many of other testing techniques.
• Worked on Defects management including analysis, retesting, verifying, and approving process. Used Rally and HP QC /ALM for testing purpose. Worked as a HP QC administrator as well.
• Extensive knowledge and working experience in Software Development Life cycle (SDLC), Project Life cycle, Business Process Modeling (BPM), Joint Application Development (JAD), Six Sigma and in Software Development Methodologies including Rational Unified Process (RUP), Waterfall, and Agile.
• Extensive knowledge in converting business requirements into UML diagrams using Rational Rose and MS Visio and also managing and tracking those requirements.
• Experience in process modeling using Use Cases, Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams.
• Extensive experience in producing documents like Business Requirements Documents (BRD), Functional Requirement Specifications (FRS), Software Requirement Specifications (SRS), Creating Request for Proposals (RFP), creating Requirements Traceability Matrix (RTM).

TECHNICAL SKILLS:

Business Tools: Epic, Retalix, Proxis Store Manager Classic, TeleTracker Business Suite, Amadeus, Sabre, NotePad++, Adobe Acrobat, Business Explorer, Rally, Toad, Data Warehousing, WCM, Adobe CQ5, Lotus Notes, Availity, BlueChips, FEP Express, Kofax, SharePoint, Sabre GDS, amadeus.

Testing Tools: HP Quality Center/ALM, SoapUI, REST API, QTP/UFT, Load Runner, Rally, JIRA

SDLC Methodologies: Waterfall, Agile Scrum, RUP, Six Sigma

Claim Adjudication support Tools: BlueChip, FEP Express, Epic, VDR data System, BlueSource, Coordinator Mouse, ezclaim, ARC Memo Manager, PUTTY, WinSCPFinancial: SAP/FICO, Quick Books Pro, ARC Manager, MS Excel Financial, Double Entry Book Keeping System tools: General Ledger, Profit and Loss Account, Balance Sheet, Bank Reconciliation, Forecasting and Budgeting, Oracle ERP, ADP, Paychecks, ResortSuite, MemberPride.

PROFESSIONAL EXPERIENCE:

Confidential, NY

Sr. Business Analyst

Responsibilities:

• Worked as a Scrum master and Sr. Business System Analyst for Integrated centralized Healthcare Calendar and the whole healthcare environment e.g. closest healthcare facilities and their activities, social organizations, sports, health and fitness, educational institutions, financial organizations, private and public community events, fun providing centers etc and other all social networks.
• Instructed and modeled core agile principles of collaboration, prioritization, team accountability and visibility; ensured consistent application of scrum methodologies across the enterprise. Also, organized and facilitated sprint planning, daily stand-up meetings, reviews, retrospectives, release planning, demos and other Scrum-related meetings.
• Lead and managed project activities, resources, human resources, and carried out other HR jobs e.g. supervision, evaluation, and reporting activities. Also organized daily stand-ups, managed scrum ceremonies, planned for next sprint, kept track of burn down and increased strength of team components and resolved issues.
• Handled all the activities of the SDLC of the project “Integrated Healthcare Calendar” for facilitating to stakeholders including developers, quality analysts, users and others to move forward aggressively.
• Built a system to Pro-Active Members and Passive Members to get involved with the project product (Integrated Healthcare Calendar) and made them aware of advantage of the product.
• Worked on Microservice-oriented architecture (SOA) architecture to work on project development activities. Also worked on SOA Testing including creating test cases to executing test cases and dealing with the defect cycle.
• Documented process flows and developed requirements for functional improvements and enhancements.
• Keep batch tracking records for each and individual files that used for testing purpose. Also follow up with the Citibank for payment status.
• Worked as a SME on HL7, ICD 9 and 10, Medicare, Medicare Advantage, MediGap, MMIS, HIPAA, HIE, EDI Transactions, EHR and all other compliances to accommodate healthcare compliances to the healthcare centralized calendar.
• Followed the Agile Scrum SDLC Methodology and coordinated the project team for JAD and BRD Sessions through documentation to the development, testing and implementation phases.
• Prepared Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan. Also worked on different types of testing in different environments e.g. UAT, UIT, and SIT testing including regression, parallel, load runner and many of other testing techniques.

Hardware/Software: MS SharePoint, Cristal Report, VDR, Availity, Cognos, MSP, MSPP, JIRA, Confluence, CM Mouse, System Magic, SharePoint, MS Visio, XML, SQL, MS Project Professional, MS Project, Lotus Notes, WebEx, and Microsoft Office package.

Confidential, Dallas, TX

Sr. Business Analyst

Responsibilities:

• Worked as a system integration BA for SynXis CRS to Olson, and SynXis CRS to Property Management System (PMS) along with different channel connects e.g. Voice Agent (VA), CRM, and other operating partners e.g. AVAYA, TREC and Ecommerce platforms.
• Worked on Financial Application Upgrading project including Oracle based Property Management System (OPMS) and Enterprise resource Planning (ERP) Financials and Human Capital Management (HCM) applications.
• Lead daily stand-ups and scrum ceremonies for two scrum teams. Work with product owners to groom the backlog and plan sprints. Track, escalate and remove impediments. Report at daily Scrum of Scrum meetings. Track burn down, issues and progress in Version One. Work with component teams to resolve issues.
• Assisted team with making appropriate commitments through story selection, sizing and task definition and participated proactively in developing and maintaining team standards, tools and best practices. Also, Facilitated as a Scrum Masters to its offshore teams in India.
• Organized and facilitated sprint planning, daily stand-up meetings, reviews, retrospectives, release planning, demos and other Scrum-related meetings.
• Taught the team to create clear and concise epics/stories, and defended stories in to the backlog meeting.
• Implemented ‘Planning Poker’ Scrum methodology to plan for product backlog by filling the wish list (numbers).
• Instructed and modeled core agile principles of collaboration, prioritization, team accountability and visibility; ensured consistent application of scrum methodologies across the enterprise.
• Implemented Issues Tracking in Version One to effectively track impediments against user stories.
• Resolved a complex infrastructure issue by creating and utilizing a professional network of Scrum Masters, Product Owners and Technical Leads within Sabre.
• Established the automated loyalty management systems for optimization of goodwill and revenue. For the purpose, established the loyalty driven automated pricing systems for Wyndham line of hotels where customized ‘Free Night Stay (FNS)’ and ‘Point and Cash Redemption (PAC)’ were established as of major Loyalty tools for its dynamic pricing.
• Worked on System Integration among SynXis CRS to Olson, and SynXis CRS to Property Management System (PMS) along with different channel connects e.g. Voice Agent (VA), CRM, and other operating partners e.g. AVAYA, TREC and Ecommerce platforms.
• Worked on functional flow of integrated application system including ERP Financial, Home Office and Vendors applications. Also, created change request and complete the change management cycle.
• Handed over project artifacts and sat with development and testing team to facilitate them.
• Attended one to one meetings, conference call meetings, client site meetings, and used other means of communication to gather project requirements.
• Having extensive experience on writing User Stories, attending ‘Technical Review’ session, defending user stories in ‘Grooming Session’, and participating the ‘Sprint Planning’ session.
• Conducted interviews, meetings and JAD sessions with project management, technology people, business people, users, advisors, and finance people during the Requirement Gathering process. Reviewed the Business Requirement Documents (BRD) with the cross functional team to analyze the High Level Requirements.
• Provided continue support to development and QA teams. Developed process flow depicting business activities, and performance metrics, also worked on utilization of COTS products.
• Started working on High level requirement (HLR), and as directed by HLR Worked on requirements gathering using interviews, document analysis, requirements workshops, surveys, site visits, business process descriptions, use cases, scenarios, task and workflow analysis.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.
• Involved in various business operations and helped the organization to achieve cost-effective services with increased quality, efficiency and satisfied customer service.

Hardware/Software: Altove XML SpyAPI, CA Rally, Sabre GDS, Amadeus, team SharePoint, Oracle Financials, ERP Tools, ADP, Paychecks, Control Center, XML, SOAP UI, SQL, Sabre Outlook, Primavera, Oracle SCM, Travel Spec Documents, VB Scripting, and Microsoft Office package.

Confidential, Denver, CO

Sr. BSA/Scrum Master

Responsibilities:

• Started working from HLR (High Level Requirement). Coordinating project team, and following Structured Approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed.
• Implemented Agile Scrum Methodology throughout the organization to improve communications between technical and product management teams to provide more transparency across different departments.
• Worked with stake holders / product owners to prioritize the requirements for sprint. Empowered teams to self-organize and grow cross-functionality and facilitated scrum ceremonies (release planning, grooming, sprint planning, retrospectives, daily stand-ups, etc.
• As Kaiser was working with state Government’s Health and Human Services (HHS) for its Medicaid health insurance plan, I worked on Re-engineering, Designing, Developing & Implementing Medicaid Management Information Systems (MMIS) for different Kaiser states.
• To retrieve and send out recently loaded batches to different trading partners e.g. Relay Health, Apria, MedQuest, Stratos and others. Worked with trading partners on Health Reimbursement Arrangements (HRA), Flex Saving Arrangements (FSA), and Health Savings Account (HAS).
• Leveraged extensive industry and domain experience to identify and suggest best practices. Developed process flow depicting business activities, and performance metrics, also worked on utilization of Modified off-the-shelf (MOTS) and Commercial off-the-shelf (COTS) Products.
• Worked as a SME on HL7, Medicare, Medicare Advantage, comprehensive health reform, Affordable Care Act (ACA), and medical claim policies and requirements including benefits, membership, enrollment and implementation. Worked on MMIS Design, Development, and Implementation (DDI) as well.
• As Kaiser has the healthcare payor and provider roles, worked on all most all of the EDI transactions including (270/271 Benefit Inquiry- Eligibility, 276/277 Status Request- payment advise, 278 Request for Review/Response, 834 enrollment, 835 Payment/Advice, 837 Claims integration, 837P Claim: Professional, 837I Claim: Institutional, and 837D Claim: Dental).
• Prepared Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams, DFDs and class diagrams. Proficiently working on java, XML, VB Scripting, and Unix, and also worked on SOAP UI, Rally and HP QC and QTP as well for different test cases.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan. Also worked on different types of testing in different environments e.g. UAT, UIT, and SIT testing including regression, parallel, load runner and many of other testing techniques.

Hardware/Software: EPIC - TAP 110 (Core) and TAP 112 (Claims and Contracts), Epic Hyperspace and Text, Rally, java, Linux, PUTTY, CRM, Availity, WinSCP, Notepad ++, Adobe CQ5, Citrix, Kofax, SharePoint, HEDIS, MS Visio, MS Project Professional, MS Project, Lotus Notes, WebEx.

Confidential, Denver, CO

Business / Quality Analyst

Responsibilities:

• Accomplished in establishing strong partnerships by proactively supporting knowledge sharing within team and across division; interested in continuing to liaise between executive, management, and cross-functional technology teams.
• Created business use case, functional (FRS) and technical specifications for Wealth Management Centre.
• Worked extensively with SMEs in understanding and documenting their requirements pertaining to completion of Wealth Management cycle.
• Consolidated the information gathering process for loan modification terms by updating proprietary settlement applications and the mortgage servicing platform, also reduced corporate security risk by migrating third party vendors from the mortgage service platform to a more secure in house application.
• Reduced negative impacts to existing processes and internal applications by facilitating meetings with business partners and documenting business requirements for application and process updates.
• Planned and defined system requirements to Use Case, Use Case Scenario and Use Case Narrative using the AGILE methodologies.
• Followed The Information Technology Infrastructure Library ( ITIL ) 2011 edition described processes, procedures, and tasks to establish a baseline for planning, implementing, and measuring the project activities.
• Followed the holistic approach to cover Cash Management, Investment Banking, Mortgages, and Wealth Management.
• Created different diagrams and charts including Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio during the project planning phase.
• Scheduled meetings with developers, system analyst and testers to collaborate resource allocation and project completion. Performed UAT on business requirements, technical specifications and product knowledge.
• Interviewed business experts, asking detailed questions and carefully recording the requirements in a format that can be reviewed and understood by both business and technical communities.
• Utilized Rational Unified Process (RUP) to configure and develop processes, standards, and procedures.
• Analyzed and prioritized user and business requirements as system requirements that must be included while developing the software.
• Played a Major role in Interface testing both functionally and manually, and also developed strategies with Quality Assurance group to implement Test Cases in HP QC/ ALM.

Hardware/Software: VM Wire Player, VLC Player, Managementservlet, Unix, java, Oracle 11g, WebEx, NetMeeting, ShareDrive/SharePoint, USAMail, Customized Outlook, MSP, HPQC/ALM, HP Diagnostics, QTP, Visio, PPP, Rational Rose, Clear Quest, Microsoft Project, Oracle, UNIX, MS Excel, MS Access.

Confidential, Abilene, TX

Business System Analyst

Responsibilities:

• Modified and used Project Templates to gather the requirements and carry on the project. Also w orked on legacy transformation methodology including the tasks, models and techniques especially on UAT, UIT and SIT Environments. Also lead the QA team to execute the mainframe testing together with databases, screens, reports and auxiliary files.
• Worked on BlueChip and FEP Express for the organization’s healthcare plan administration. Also, experienced on claims adjudication to provide the best claims management service.
• Started working from the beginning of its Medicaid Program. Kept continue working on strategic planning and analysis of the project, and its threats and opportunities.
• Implemented the holistic Medicaid Management Information System (MMIS) that comprised of Medicaid Claims, Providers network and utilization of Medicaid. The project covered the MMIS processes claims, supports coordination of benefits, assists in surveillance and utilization review of claims payments, generates government and management reporting, and provides case management tools
• Worked as a SME on Affordable Care Act (ACA), HL7, Medicare, Medicare Advantage, MediGap, HIPAA, HIE, HEX, EDI Transactions, EHR and all other compliances.
• Coordinated the project team for JAD and BRD Sessions, and documentation for different projects including SOA model projects.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Prepared Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Worked on different claims and claim adjudication systems including Inter-Plan Teleprocessing Services (ITS), Blue2 Blue, Health Reimbursement Arrangements (HRA), Flex Saving Arrangements (FSA), BlueCard Program, BlueExchange transactions, and Health Savings Account (HAS).
• Documented and assisted the QA Team with the Test Plan. Also worked on different types of testing in different environments e.g. UAT, UIT, and SIT testing including regression, parallel, load runner and many of other testing techniques.
• Worked on Defects management including analysis, retesting, verifying, and approving process. Also, Worked as a HP QC administrator.

Hardware/Software: FEP Express, Availity, BlueChip, PRAP, VDR, Rally, BlueSource, Availity, CM Mouse, System Magic, SharePoint, MS Visio, MS Project Professional, MS Project, Lotus Notes, WebEx, and Microsoft Office package with Blue’s Outlook Express and Blue’s Link.

Confidential, Detroit, MI

Business System Analyst

Responsibilities:

• Modified and used Project Templates to gather the requirements and carry on the project. Also w orked on legacy transformation methodology including the tasks, models and techniques.
• Worked as a SME on Medicare, Medicaid, EDI Transactions (270/271 Benefit Inquiry- Eligibility, 276/277 Status Request- payment advise, 278 Request for Review/Response, 834 enrollment, 835 Payment/Advice, 837 Claims integration, 837P Claim: Professional, 837I Claim: Institutional, and 837D Claim: Dental), HL7, HIPAA, PHI, EHR, HIE,, ICD 9 &10, and all other compliances. Also, worked on Medicaid Management Information Systems ( MMIS ), and Medicaid Information Technology Architecture (MITA)
• Worked on web server IIS (Internet Information Services) 7.5 to create and manage Web sites, and share and distribute information over the Internet. Also worked on SQL Server Reporting Services (SSRS) 2005 and 2008 R2 to prepare and deliver a variety of interactive and printed reports
• Coordinated the project team for JAD and BRD Sessions. Also, followed the SOA model for architectural design. Used MS Project 2010 for entire project life.
• As the company has group members around the US and the world, specially the auto manufacturing employees, worked on Inter-Plan Teleprocessing Services (ITS), BlueCard Program, BlueExchange type of transactions for social security randomization project.
• Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, information needs and insured that critical requirements are not missed
• Coordinated activities between business unit and technical staff, developed new methods, policies, and procedures to meet the business needs.
• Prepared Functional Design Specifications (FRS) employing Use case scenarios, sequence diagrams, DFDs and class diagrams.
• Identified and clearly defined functional issues and supported IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.
• Documented the Requirement Traceability Matrix for tracing the Test Cases and requirements.
• Documented and assisted the QA Team with the Test Plan .

Hardware/Software: SharePoint, MS Visio, MS Project Professional, MS Project, FACETS, Lotus Notes, MS Project, java, ITS, WebEx, and Microsoft Office package with Blue’s Outlook Express and Blue’s Link.

Confidential, New York City, NY

Business Analyst

Responsibilities:

• Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
• Reviewed the Business Requirement Documents (BRD) with the cross functional team to analyze the High Level Requirements. worked on Adobe WCM tool that facilitates to create a browser-based user interface. Also, worked on Workflow Management of Web Content Management (WCM) to act on how content is published, when it is published and who will publish.
• Developed process flow depicting business activities, and performance metrics, Conducted interviews, meetings and JAD sessions with financial advisors during the Requirement Gathering process.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Developed Company customized Sharepoint and Sharedrive to work with offshore people.
• Responsible for chargeback debit memo department, Investigates cause of debit memos and handled relevant correspondence to the airlines, hotels, car renting companies, banks, credit card companies, customers and other line agencies for settlement of the chargebacks. Also worked on Fixed Periodic Income, Investment, and Audit and Support activities to complete the finance part of the project.
• Used different software e.g. ARC Manager—software for electronically process and settle memos, Sabre Online-- unique workflow application, and Amadeus - leading transaction processor, to analyze the company’s outstanding debit memos and possible recovery.

Hardware/Software: ARC Memo Manager, Amadeus Ticket Quota System (TQS), sabre software, Lotus Notes, Oracle SCM, QuickBooks Accounting Software, Adobe WCM, Project Management, and