SUMMARY:

• Over Eight years of experience as a Sr. Business Analyst/Quality Analyst.
• Solid understanding of Business Requirement gathering, Business Process flow, Business Process Modeling and Analysis, design documentation.
• Experience in all phases of the Software Development Life Cycle (SDLC) including Requirement gathering, Design, Development, Testing and Deployment.
• Organized Joint Application Development (JAD), workshops and interview sessions.
• Expertise in Documentation and Review of Software and Business/Technical Requirement Documents.
• Managed complex business initiatives to balance requirements for functionality, efficiency and quality.
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837,270,271,276,277,834,835, NCPDP and ICD9 - ICD10 with FACETS.
• Experienced with Rational tools like ReqPro, Clearquest, Clear Case, Rational soda, Rational Rose.
• Experienced working in Obama care, Medicare and Medicaid projects.
• Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents.
• Experience in working on the Content Management software solutions including Microsoft SharePoint Server 2013/2007 and OpenText Livelink.
• Design and review of various documents including the Software Requirement Specifications (SRS), Business Requirements Document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Strong experience with MS Visio for creating visual representation of Software/Data Architecture, Use Case diagrams (specially in an Agile environment), Sequence diagrams, Class diagrams, Business Process Flows and basic flowcharts.
• Extensive experience in configuring data mapping of files using Edifecs Specbuilder.
• Through knowledge of various phases of Edifecs Specbuilder- Analyzer and Mapper.
• Conducted JAD Sessions to develop an architectural solution that the application meets the business requirements, resolve open issues, and change requests.
• Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document for the Functional, Security, and Performance Testing.
• Excellent written and verbal communication.
• Consistently demonstrated ability to achieve tight deadlines.

TECHNICAL SKILLS:

Operating Systems: Win 98/XP/Vista/Windows 7, UNIX, LINUX, Mac.

Languages: C, C++, Java, SQL, HTML, XML, C#, VB, ASP, .Net

Databases: Oracle, MS SQL server, MS Access, MY SQL

Tools: MS Office Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clearquest, WinRunner, LoadRunner, WebSphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD and Test Director, MMIS, JIRA, Facets4.82, Facets5.1x.

Industry Standards: HIPAA 5010, ICD 10, PPACA (Patient Protection and Affordable Care Act)

EXPERIENCE:

Confidential, Albany, NY

Sr IV&V Analyst/ Quality Assurance

Responsibilities:

• Support all phases of the MMIS during the implementation cycle and/or maintenance and operations as assigned.
• Tested (Validated and Verified) Louisiana Medicate Management Information System (MMIS) and Integrated Eligibility System (IES) based on CMS requirements and State policies.
• Supported Independent Verification and Validation process based on CMM, CMMI, Six Sigma, PMBOK, IEEE industry standards and IT best practice.
• Provided guidance, review and testing based on HIPAA standards.
• Validated and Verified State Requests for Information (RFIs) and Request for Proposals (RFPs) of all healthcare related projects.
• Participated in Independent Verification and Validation(IV&V) Testing
• Lead a validation (IV&V) effort that comprises of 10 test resources. This effort includes IV&V/UAT for three CMS applications.
• Manage and facilitate meetings that include pulse check on Validation and UAT readiness of the environments, build status, defect management and triage process, daily UAT calls to provide daily UAT status to all the stakeholders. Facilitate the Go/No Go decision call at the end of the UAT test cycle.
• Develop customer deliverables in accordance with contract requirements and company documentation standards.
• Research and provide recommendations to the client on critical business decisions
• Review and assess documents and artifacts for quality, completeness, compliance, and effectiveness
• Review Functional specification for accuracy and thoroughness and recommend quality improvement for production optimization, performance risk mitigation, system integration activities.
• Work within the QA team to provide ongoing consultation (identification of Noncompliance Issues and Concerns, Recommending Corrective Actions, Identifications of Lessons Learned for Process improvement) and project management support.
• Review MDW project artifacts from SDLC’s start to end stage from FRD, Assessment workbook, PDD, PCR, RTM, Test Package, to ROCs & Invoices, and document the observations & findings using standard Cognosante checklists and comment matrices.
• Drive improved quality of products and services through application of the methodology, continuous improvement, and dynamic and progressive approach.
• Collaborate with QA Project Manager and QA team to develop, implement, and improve innovative QA capabilities, approaches, and services.
• Identify, monitor, manage, report and escalate QA risks, issues, and recommendations related to the MMIS/Data Warehouse.
• Develop QA deliverables as assigned.
• Interact effectively with customer business technical team members.
• Ensure identified processes and methodologies are executed and followed
• Employee is expected to undertake any additional duties as they are assigned by their Manager.
• Work on the Service Level Agreements and generate monthly performance reports and identifying the penalties for the SLAs not met.
• Used and developed SQL queries to acquire or modify data from SQL database and access database.

Confidential, Charleston, WV

Senior Business Analyst

Responsibilities:

• Worked with client to gather Business/Technical Requirements, Approval of CR (Change request), Design and Implementations for State MMIS.
• Worked with team members to perform Independent Verification and Validation (IV&V) or new fiscal agent contract.
• Helped conduct Independent Validation and Verification (IV&V) of Virginia’s Medicaid system.
• Responsible for designing future state processes for new MCO and transaction between MMIS and MCO.
• Active member for the policy review to implement the blueprint requirements for Medicaid/MMIS, Medicare, CHIP and Tax Credits benefits per CMS guidelines.
• Act as a liaison between the client, and other support groups (State of Virginia’s Medicaid, Medicare, Stake Holders, External Vendors, Sister Agencies, CMS, etc.
• Worked on creating State based Rule requirement document with Rule ID (CFR number).
• Gathered business and functional requirement for eligibility determination for SNAP, TANF and Medicaid program.
• Assisted IV &V (Testing team) in understanding the various business rules across the applications
• Created functional design for SNAP, TANF and Medicaid eligibility programs.
• Worked on Child Support Incentive Benefits delivered through Electronic Benefit Transfer.
• Researched on state based rules, configuration to be implemented in integrated eligibility system.
• Worked on Facets, EDI claims 837 Submissions and Transactions.
• Gained extensive experience in designing/modifying the CICS screens for various areas such as Enrollment, Billing, Provider Record and Reimbursement Status in MMIS.
• Wrote clear, concise detailed System Requirements Specification (SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance.
• Experience in implementation of CPT codes changes in the current claim processing modules in MMIS.
• Works on Various Claims Analysis (Medical, Pharmacy, and Institutional) and provided federal audit reports to CMS.
• Worked on JIRA which include Defects Management, Test Plan and Dashboard.
• Talking to the client based on requirements of that particular defect, uploading document required, checking history, status notes, setting up resources to handle and fix it.
• Worked on Rational Requisite Pro application to handle various requirements including Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.
• Point of Contact of the Content Management software solutions including Microsoft SharePoint Server 2013/2007 and OpenText Livelink.
• Provided online support to users for various applications such as IPCS (Internet Professional Claims Submission).

Environment: HP ALM, JIRA, Salesforce, MS Office, Windows 7, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOAP, XML, MMIS, Agile

Confidential, Fargo, ND

Senior Business Analyst

Responsibilities:

• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
• Claims Examiner III, IV&V.
• Involved in Independent Verification and Validation of Requirements (IV&V) to ensure that all the requirements are satisfied and meet the security objectives.
• Responsible for integrating with FACETS. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Interact with current MMIS vendors and collected necessary information regarding their creative and industry best practice solutions.
• Work with a few state MMIS. Medicare, CMS clients and state PMOs.
• Analyzed a wide range of FACETS configuration change requests for the purposes of determining the technical scope of the change, its impact on existing systems configuration.
• Participated in the CORE (Committee on Operating Rules for Information Exchange) compliance process for the company.
• Responsible for gap analysis in updating existing Claims Management System and Involved in testing new CMS. Also, accountable for Claims Resolution/Reimbursement.
• Works closely with the MMIS testing team to ensure that test scenarios and test cases fully represent the requirements being tested for assigned projects.
• Assist supervisor with special projects, work flow and motivation.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Worked on the PPACA for various mandates such as Grandfather Rule, Rescissions, D-26, Pre Ex-19, Preventive Care, Operating Rules, and Early Retirees Fund etc.
• Wrote test cases and test scripts for the User Acceptance Testing.
• Performed Requirement Analysis and developed Use Cases and Activity Diagrams.
• Traced High Level Requirements (HLR) to Detailed Level Requirements (DLR) using MKS Integrity.
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
• Conducted meetings with SME's to understand current business process and performed Gap Analysis to meet future business needs.
• Partner with IT team to plan and prepare future state architecture for SharePoint and enterprise content management technology solution.
• Created and managed project templates, use case project templates, requirement types and traceability relationships in MKS Integrity.
• Developed Systems Specifications document to define the impact of the new requirements on the existing system.
• Developed and managed creation of product documentation to communicate features, benefits, positioning and impacts to different audiences and ensured that documentation deliverables from various groups are produced as needed.
• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.

Environment: SQL, Rational Unified Process (RUP), Facets, Rational Requisite Pro, Rational Rose, Clear Quest, Microsoft Visio, Windows Vista, Mercury Test-Director, Share Point

Confidential, Colorado Springs, CO

Senior Business Analyst

Responsibilities:

• Aided Valuable Information’s in the collection of User Requirements and Business Requirements to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system.
• Conducted AS-IS and TO-BE analysis and assisted in developed process models and systems integration structure.
• Conducted and facilitated Joint Application Development (JAD) sessions to reduce time spent in moving information between stakeholders and team members.
• Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Rational Quality Manager.
• Identified critical areas of business risk and modified business processes to reduce risk by using the Risk-Management Process.
• Knowledge of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Worked with Source system Subject Matter Expert (SME) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• As part of the data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.
• Involved in various types of Audits and the Financials involved through different stages.
• Gained Compliance audit experience due to exposure to the legal/audit consulting groups.

Environment: MS Office, Rational Quality Manager, My SQL, MS Project, MS Visio, .Net, Mainframes and Windows XP

Confidential, San Francisco, CA

Business/Requirements Analyst

Responsibilities:

• Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
• Attended the training sessions provided by Confidential to make sure that have an understanding of all the modules in QNXT for example: Members, Providers, Claims, Utilization Management, Finance, Underwriting etc.
• Had meetings with business users and managers to understand the process what is required/to understand the AS IS process and providing them with the best solutions
• Conducted JAD sessions with management, SMEs, developers and users for open and pending issues.
• Was involved in the documenting the BRDs for letters to be sent out to members. Had meetings with developers and managers to make sure that letters are coming out of QNXT using SSRS. Users were able to generate letters from reporting services or letters were sent directly to folders using subscription.
• Was involved in QA the reports/letters before user testing and was communicating with developers if correction needed.
• Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users, and the errors discovered were fixed and then verified via regression testing.
• Used SharePoint to for documentation and saved all the BRD, Sign off documents and other documents in it.

Environment: MS Office, Quality Center, SQL Server, MS Project, MS Visio, Unix, J2ee, Java, XML, Water fall, Windows XP