SUMMARY

• 7+ years of IT experience in Business Analyst /Data Analyst /QA in understanding business needs and implementing technology solutions in various domains.
• Worked in systems integration, planning, architecting and implementing standards - based solutions for enterprise-wide systems. Database and Data Warehouse modeling, Data Analysis, Data Profiling, Data Migration, Data Conversion, Data Quality, Data Governance, Data Integration and Metadata Management Services and Configuration Management.
• Ideal facilitator in linking business and technical needs, worked closely with IT and application managers for gathering requirements, handling budget constraints and delegation of work.
• Experience working across various SFDC/Salesforce implementations covering Sales Cloud (CRM), Service Cloud applications.
• Experience and good Knowledge on Provider, Clams, PIUR, CRM, Drug Rebate and Finance Module.
• Well versed in Health Insurance Portability & Accountability Act (HIPAA) standards.
• Extensive knowledge using UML diagrams (Use Case, Activity, Sequence) using MS Visio and IBM Rational Rose.
• Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D).
• Experience on KEES Eligibility Application, Member Eligibility, Chrono Notes, Provider Enrollment, Beneficiary Web Portal (KMAP Portal).
• Extensive experience with claim transactions, HIPPA Batch transactions, Provider Enrollment subsystem, Beneficiary subsystem, trading partner and managed care.
• Excellent working experience with Billing, Claims, Commission, Finance and CRM Applications.
• Proven ability to communicate effectively with clients, team members and senior management to provide critical solutions that meet needs of the business.
• Drawing project mockups on Visio. Use Microsoft project for time tracking and project tracking.
• In-depth understanding of the AS-IS and TO-BE business processes, GAP analysis, feasibility analysis and experience in converting business requirements into user stories and acceptance criteria for preparing Test Plans.
• Experience in Synchronization, Data-Modeling, Data Extraction, Transformation, Data Loading, Scheduling, Monitoring, and Reporting in a cloud scenario.
• Possess good knowledge in Unit Testing, Test Coverage, and Code Review.
• Good understanding of Software Development Life Cycle (SDLC) in Waterfall and Agile (Scrum) Methodologies.
• Come up with Mitigation plans for product failure and risk analysis.
• Hands on experience on making the Test plan, reviewing Test Procedures for User Acceptance Testing (UAT) Manual testing (GUI, Field Validation and Functionality Testing) of UI & Web Applications.
• Good understanding of CRM business process like Campaign Management, Lead Management, Account Management and Case Management.
• Experience in Database Programming and Development using MS SQL Server, Oracle, MS Access and good experience in SQL, PL/SQL, Triggers, Views, Cursors, Functions and Stored Procedures.
• Exceptional verbal and written communication skills with the ability to interact and liaison at all levels within an organization as well as with offshore resources

TECHNICAL SKILLS

Languages/ Standards: SQL, XML, UML, Java, Dot Net, PL/SQL

Methodologies: Agile, Waterfall, RUP, Iterative

CMS Tools: IBM Filenet, Sharepoint, Documentum

Microsoft Office Tools: Access, Project, Power Point, Word, Excel, Visio and Outlook

Defect Tracking Tools: HP Quality center (ALM), Remedy, Rational Clear Quest, Jira

Total Quality Management: Six Sigma Techniques

Operating Systems: UNIX, Windows 95/98/2000/XP/VISTA/7/8/10

PROFESSIONAL EXPERIENCE

Confidential

Sr. Business Analyst / QA

Responsibilities:

• Acted as a as a liaison between business stakeholders and Technical team to translate business requirements into functional requirements and technical specifications.
• Participate in the elicitation, documentation, analysis and validation of business processes, systems and solution requirements.
• Works with users to understand Business problems and Experience in both agile and waterfall methodology.
• Acted as a Product owner in an agile team responsible for gathering requirements from business stakeholders and converting them into user stories.
• Expertise in performing test on the provider module like PE, PM, Workflow, Managed Care, MCO portal and the RI (Reverse Integration).
• Mainly work on Claims Processing with different claim types like Encounter, FFS (Fee for Service), Medicare A & Medicare B and Crossover.
• Worked on the KEES (Kansas Eligibility Enforcement System) to create beneficiaries with the required benefit plan eligibility.
• Executed efficiently in using defect/bug reporting and tracking tool like HP ALM (HP application life management) and Service Now to track down the issues of the application.
• Worked on NPPR and PRN Provider files.
• Document requirements specifications using high-maturity methods, processes and tools.
• Support requirements management and change management processes.
• Develop Use Case Scenarios and based on it develop the document.
• Good knowledge and hands on experience to work on the HP ALM.
• Having a very good knowledge on the Provider Module. Also experienced in creating and designing the testing scenarios for regression and progression testing.
• Experience in creating and using the PIVOT table for financial team.
• Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA X12 EDI transaction codes such as inquire/response health care benefits, Claim status, Benefit enrollment, Payment/remittance advice, Health care claim.
• Experience and good Knowledge on Provider, Clams, PIUR, CRM, Drug Rebate, SAS and Finance Module.
• Reviewed the data model and reporting requirements for PIUR Reports with the Data warehouse/ETL and Reporting team
• Supported ETL mapping activities as per established business requirements.
• Specialized experience in healthcare insurance domain including Medicare and Medicaid. Profound understanding of insurance policies like HMO and PPO. Proven experience with HIPPA X12 EDI transaction codes such as inquire/response health care benefits, Claim status, Benefit enrollment, Payment/remittance advice, Health care claim.
• Conducting triage call and resolving the issue for the high priority/severity defects.
• Perform User Acceptance Testing (UAT) for the module.
• Perform Regression Testing and Unit Testing for the Business requirement.
• Writing Test Matrices and Test cases for the Business requirement.
• Experience in creating and tracking the Service Now tickets and over all in-depth knowledge as well.

Environment: MySQL database, JAD, HP Quality center (ALM), MS Visio, MS Excel, MS Outlook, SharePoint, C and C++, Dot Net, XML, UML, Waterfall Methodology, Agile Methodology, PIUR, ICD-9/10 and HIPPA.

IT Business Analyst / QA

Responsibilities:

• Researched and analyzed complex healthcare data from variety of sources to evaluate, define, design, develop, test and implement technical solutions to produce accurate data extracts/reports in the required file layout based on the Federal requirements.
• Tested a Web portal which includes real time access for X12 transactions.
• Created and reviewed source to target data mapping documents from crosswalk analysis to MMIS healthcare systems.
• Experience on Member Eligibility Functionalities and Beneficiary Web Portal.
• Manage/update requirements documents as needed throughout the development process.
• Ensured that project requirements meet all applicable regulations by CMS and the state.
• Conducted and supported testing activities, as appropriate.
• Managing test preparation and execution.
• Reviewing test specifications with the business representatives and the Test Manager.
• Ensuring requirements and design documents are reviewed and issues are raised and managed in HP ALM.
• Tracing test specifications back to the business requirements.
• Presenting the actual results of the test runs by capturing and storing documentation (test script results, reports, file dumps) or by demonstration (captured screens, panel displays), or both
• Identifying and tracking defects to resolution.

Environment: XML, HP ALM, Microsoft Word, Excel, PowerPoint, SQL developer, MS Visio, Power builder tool, .Net, C & Unix, SharePoint, Content Manager, SSRS, SAS Visual Analytics, Tableau, RDBMS, SQL Server, SQL Developer.