SUMMARY:

• Experienced and versatile Business/Quality Analyst with 8+ years of extensive experience as a Business/Quality and Data Analyst, in different domains, primarily in Health care & Financial services domains.
• Proficient in Manual/Automation Testing, Functional/Regression/Integration/System /E2E and Backend Testing with expertise in HP QC/ALM, HP Quick Test Professional (QTP), Selenium, RFT and TAO for Executing Automated test scripts for Regression Testing using VB Scripting & Debugging, Descriptive Programming, Data Driven Frameworks and Keyword Driven Frameworks.
• Extensive experience in developing Automation Frame Work. Interact with the development team, Test Planning, Monitoring Test Progress, Reporting the Business & Testing requirements and Test Metrics
• Experienced in working with various tools like OOD Visual Basic - used for requirements gatherings in business.
• Sound knowledge of Medicaid, Medicare Healthcare policies, benefits, plans and medical products and well-versed in EDI - HIPAA transaction code implementation - 834, 820, 837, 835, 270, 271, 276, 277, 278, 999 and experience working with member eligibility and enrollment modules and claims processing applications
• Vast Experience in Project Management, Business Analysis, Business Modeling, and Data Modeling.
• Extensive experience in conducting Gap Analysis, Business Process Re-engineering.
• Provided SDLC Methodology and project management and oversight for developing ASP Web Site for Health Care and Employer Market Place
• Proficient in authoring Business Requirement Documents (BRD) into System Requirement Specifications (SRS) and identifying interface and business process specifications.
• Good understanding of ACA and HIX
• Extensive working knowledge on EDIFECS and Specbuilder
• Excellent knowledge of Project Management, Testing methodologies and Global Delivery Environment
• Extensive experience working with Requirement management tools like Caliber-RM and Requisite Pro
• Worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Participated in all agile team related activities such as Sprint Planning, Estimation / Grooming sessions, daily stand up meetings, EOSD, and Retrospectives
• Worked with Senior Management to identify strategic goals, objectives, scope, budgets and process for internal and external development and managing out-sourcing of development on budgets
• Experience with Microsoft Access, Visio, Project and Excel or similar tools
• Strong data management skills including understanding of requirements determination, data organizational structures, organized testing approaches report design and development.
• Strong understanding of health care analytics and ability to effectively interface with employees at all levels.
• Excellent organizational, verbal and written skills to understand interpret and communicate ideas, including the ability to succinctly present the results of their own analysis utilizing Microsoft PowerPoint or similar tool.

TECHNICAL SKILLS:

Web Technologies: ASP.Net, VB.Net, XML, HTML.

Testing Tools: QTP, TFS, RFT, TAO, Clear Quest, Quality Center, Win Runner, SOAP UI, Selenium, UFT, Load Runner

Data Warehousing: Informatics, Power center, IBM Datastage, Ab-Initio, SSRS and QlikView

Operating System: Windows NT 4.0/XP/2000/98, UNIX, Linux ES 5/4, OS/390

Databases: Oracle 9i, Teradata, SQL Server, RDBMS, Ms Access, Mainframe

Languages: Java, Visual Basic 6.0, DB2, SQL Server 2000, C, C++, SQL.

Design Methodologies: OO Design, OOPS, Agile, Rational Unified Process (RUP), UML, JAD, TQM.

Design Tools: Rational Rose, Rational Requisite Pro, Rational Clear Case, Rational Clear Quest, Spec Builder, PVCS Tracker 6.8, Clear Case.

Project Management Tools: Ms Visio 2003, Ms Excel, Ms PowerPoint, Ms Office, MS Project, MS Word, TOAD, Crystal Report, MS SharePoint, MS FrontPage 2000, Oracle EBS

PROFESSIONAL EXPERIENCE:

Confidential, Austin, TX

Senior EDI Systems Analyst(BA/QA)

Roles & Responsibilities:

• Developed the wireframe and mockups for the prototype of the web based application in MS Visio
• Created Mapping/Crosswalk documents for mapping data flow between systems and rules/validation documents for different processes involved in the system.
• Worked with the Data Warehouse development team to identify business objects and their attributes and relationships.
• Provided mapping, and gap analysis for HIPAA codes sets and EDI transaction processing between Trading Partners and Regence
• Developed data mapping documentation to ensure accurate data representation in the new system.
• Responsible for EDI Implementation for the newly implemented MTP program and Demonstrated deep knowledge of the Software Development Lifecycle (SDLC)
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 837-(I,P&D) and others. Resource for mapping documents, transaction sets requirements, EDI development and Design and conversion of legacy EDI formats.
• Identified changes needed to make X12 transactions HIPAA compliant.
• Adhered data transition of the Claim Status and Eligibility as per the EDI standard
• Developed an implementation guide for Partners for EDI X12 837p transactions
• Assisted in the design of EDI solutions and represented Enterprise EDI team with regards to EDI/XML industry standards
• Facilitated JAD sessions & online meetings with the end user, business, developers & testers to make sure the requirements are captured accurately
• Analysed and helped define “AS IS” and “TO BE” systems and have worked closely with business process owners and stakeholders, engineers and architects
• Created XML Schemas for different EDI transaction sets and strong in EDIFECS Transactions.
• Interacted closely with the project managers and the business, subject matter experts, analysts, architects and the development teams to gather business requirements through a variety of techniques (e.g., workshops, work sessions and interviews) to prepare detailed requirements specification and use case documents.
• Gathered requirements and prepared Use Case/Functional Design Documents by interviewing customers, users, Managers and SME’s.
• Documented the Business process flow as per the UML standards using Use Case Diagram, Activity Diagram and Sequence Diagram in Rational Rose & MS Visio
• Created Comprehensive requirement with all the data requirement
• Developed Requirements Traceability Matrix(RTM) between the Use Cases and the Test Scripts
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality and tested the same
• Participated in Sprint Planning, selecting User stories for each sprint from Testing Perspective & Attended daily scrum standup meetings, story pointing meetings, playback sessions, Group meetings of onshore and offshore to escalate the issues, Product Demo meetings to the State Business Users.
• Responsible for maintaining Testing tasks in Rally, sharing the RTMs, Daily Testing Status documents to the project leads and team members in SharePoint.
• Executed Validation Testing and Integration Functional Testing User Stories using Soap UI.
• Verified & validated data Integrity by ETL to and from OLTP Databases, Flat Files, Enterprise Data Warehouses and Data Marts.
• Created Test data using Specbuilder
• Supported other testers to create, process and evaluate claims in Facets
• Documented the process flow & Business Use Case for the 837p EDI transactions & tagged them in Requisite Pro
• Used SQL scripts to verify the backend integrity of the application
• After successful development and testing of the product, participated in product release and deployment to end-user using manual testing with trading test partners.
• Performed post-deployment verification per deployment procedures and verified the results.

Environment: J2EE, .Net, UML, Business Objects, Rational Clear Quest, Clear Case, Informatica, XML, Web 2.0, RDBMS, Rational RequisitePro, MS Word, MS Visio, MS Project, Web 2.0, Oracle EBS

Confidential, Minneapolis, MN

Senior Business Systems Analyst

Roles & Responsibilities:

• Developed the wireframe and mockups for the prototype of the web based application in MS Visio
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835, 837, 270 and 271
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 278/278, 820, 834, 271U, 835, 837-(I,P, &D), 835 Remittances and others. Resource for UB04 and CMS1500 billing formats, transaction sets requirements, EDI development and Design, X12 protocols through Version 5010 and Errata; conversion needs and understanding of legacy EDI formats.
• Identified changes needed to make X12 transactions HIPAA compliant.
• Adhered data transition of the enrollment process, COB, Claim Status and Eligibility as per the EDI standard 834, 835, 837, 277 and 271.
• Created Mapping/Crosswalk documents for mapping data flow between systems and rules/validation documents for different processes involved in the system.
• Worked with the Data Warehouse development team to identify business objects and their attributes and relationships.
• Developed data mapping documentation to ensure accurate data representation in the new system.
• Solely responsible for EDI Implementation for the new redesigned EOB.
• Assisted in the design of EDI solutions and represented Enterprise EDI team with regards to EDI/XML industry standards
• Facilitated JAD sessions & online meetings with the end user, business, developers & testers to make sure the requirements are captured accurately
• Analyzed and helped define “AS IS” and “TO BE” systems and have worked closely with business process owners and stakeholders, engineers and architects
• Proficient in Membership, Claims and Billing with knowledge in Group, Subgroup, Class, Plan and Category
• Worked on ICD conversion from 9 to 10. Complete a review of existing documentation for orders, referrals, and reports and compare it to the clinical details needed for ICD-10
• Performed General Equivalence Mapping (GEM) to assist in converting any ICD-9-CM-based application to ICD-10-CM/PCS.
• Created XML Schemas for different EDI transaction sets.
• Interacted closely with the project managers and the business, subject matter experts, analysts, architects and the development teams to gather business requirements through a variety of techniques (e.g., workshops, work sessions and interviews) to prepare detailed requirements specification and use case documents.
• Gathered requirements and prepared Use Case/Functional Design Documents by interviewing customers, users, Managers and SME’s.
• Documented the Business process flow as per the UML standards using Use Case Diagram, Activity Diagram and Sequence Diagram in Rational Rose & MS Visio
• Created Comprehensive requirement with all the data requirement
• Developed Traceability Matrix between the Use Cases and the Test Scripts
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality
• Supported the testers to create, process and evaluate claims in Facets
• Documented the process flow & Business Use Case for the EDI transaction 835, 837 & tagged them in RequsitePro
• Provided mapping, and gap analysis for HIPAA codes sets and EDI transaction processing between Trading Partners and Regence
• Used SQL scripts to verify the backend integrity of the application
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality
• After successful development and testing of the product, participated in product release and deployment to end-user using manual testing.

Environment: J2EE, .Net, UML, Rational Clear Quest, Clear Case, Informatica, XML, Web 2.0, RDBMS, Rational RequisitePro, MS Word, MS Visio, MS Project, Oracle EBS, Web 2.0

Confidential, Hartford, CT

Business Analyst

Roles & Responsibilities:

• Worked with eBilling and EDI HIPAA Claims (837/835/834) processing.
• Documented the process flow & Business Use Case for the EDI transaction 835, 837 & tagged them in RequsitePro
• Participated in Bug-Review meetings with software developers, QA engineers, managers to check for 834 / 837 claims and suggested enhancements to the existed application from business perspectives and provided solutions to existing bugs
• Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet
• Converted X12 data to XML (using DI) and verify the data by performing schema validations.
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Coordinated with the EDI team in developing and documenting the detailed testing work plans and created the various testing documents for the assigned EDI transactions
• Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
• Gather detailed business and technical requirements and participate in the definitions of business rules and data standards.
• Involved in requirement gathering and relational database design and implementation of star-schema, dimensional data warehouse using Erwin.
• Transform disjointed data from several different sources including Business Objects, Spreadsheets, Remedy and other management tools.
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis
• Documentation completed include business requirement documents (BRD), functional specifications document (FSD), technical specification document, joint requirement document (JRD), high level design documents (HLD), use cases, gap analysis, test scripts, training materials.
• Worked closely with Membership and Claims teams
• Facilitated JAD sessions to document the technical and functional requirements and provided overall assistance in areas such as group readiness planning and issue escalation and resolution process.
• Experienced in writing many story cards and actively involved as a Scrum Master for many of the Scrums
• Worked with XML in creating Schemas based on different XSD’s.
• Closely worked with the testing team to do Load and Performance testing.
• Implemented business and data modeling using Ms Visio to develop the business architecture for the application and created use case diagrams, activity diagrams, state transition diagrams, sequence diagrams, data flow diagrams and collaboration diagrams using Rational Rose.
• Served as a liaison between the project and groups, always promoting a positive message about system enhancements and facilitating the transition from one application to another.
• Prepared Deployment plan, Entry criteria, Exit criteria, Target user list, Go Live support plan, Deployment activities plan and other Deployment related documents.
• Actively involved in User Acceptance Testing, Go Live Support call and to keep track of the issue log following up on Go live calls in assisting the Project Manager.

Environment: Windows XP, Java, .Net, Ms Project, Ms Visio, Rational Rose, Rational Requisite Pro, Clear Quest, Clear Case, Agile, RDBMS, Informatica.

Confidential, Tampa, FL

Business Analyst

Roles & Responsibilities:

• Work on 834 and 835 projects, including syntax and business rules for X12 HIPAA 4010 validation for loops, segments, elements, qualifiers and code sets. Create export and XML processes for Lotus Notes. Create EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors
• Analyzed the security implementation of the application with respect to users perspective
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions
• Documented the business requirements into high-level requirements document.
• Gathered the requirements and transformed them into high-level Process-Flow Diagram using PowerPoint.
• Involved in Managing Data modeling project from Logical design and implementation of Sybase Database
• Identified source systems, their connectivity, related tables and fields and ensure data suitably for mapping.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Created Error Files and Log Tables containing data with discrepancies to analyze and re-process the data.
• Developed business process models in RUP to document existing and future business processes.
• Troubleshot the designed jobs using the Data Stage Debugger
• Created a task plan for the team identifying the key deliverables and the respective deadlines.
• Supported users with word processing, spreadsheets, relational databases and presentation software. Created and developed the TO-BE system presentations using PowerPoint.
• Analyzed the business requirement as per the HIPAA rules and regulations
• Adhered data transition of the payment and remittance advice as per the EDI standard 835.
• Created mapping/crosswalk documents for mapping data flow between systems.
• Generated SoDa report from the Sequence diagrams to show the sequence of interactions between the actor, boundary and the system using RationalRose and created Use Case Realization.

Environment: J2EE, .Net, UML, PDS, Share Point, NET, UML, MS Visio, RDBMS, SQL, SQL Server, HTML, Dreamweaver, Informatica, Mercury Quality Center, Test Director, MS Suite.

Confidential, Carmel, IN

Business Analyst

Roles & Responsibilities:

• Gathered Business Requirements interacting with the Agents, Medicare Users, Business Users and SME’s.
• Provided SDLC Methodology for developing EDI applications used by hospitals to completely automate payments posting for Medicare, Medicaid and commercial payers electronic payments files.
• Analyzed the business requirement as per the HIPAA rules and regulations.
• Created AS IS and TO BE documents to show the current and proposed functionalities of the system.
• Accomplished experience from requirement analysis till deployment, using highly efficient RUP Methodology process of software development.
• Documented high level Use Cases and derived detailed low level System Use Cases and Functional Designs from it.
• Developed Traceability Matrix between the Use Cases and the Test Scripts.
• Follow a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensures that critical requirements are not missed.
• Assisted the UI designer in creating html for user interfaces via Dreamweaver.
• Closely monitored development team to make sure, the software application fits within the architecture and has the required behaviors.
• Developed detailed Test plan, Test Cases, Test scripts for testing the functionality, GUI and security testing.

Environment: .NET, UML, MS Visio, SQL, SQL Server, HTML, RDBMS, Dreamweaver, Mercury Quality Center, Test Director