SUMMARY

• Hands on experience gathering requirements, interviewing senior level company officials to gather requirements for documenting project functional specification.
• Extensive noledge of ANSI X12N 5010 HIPAA formats 837, 277/277CA, 997/999 and working noledge of 835, 270/271, NSF formats, mapping, Implementation Guides, Companion Documents, HIPAA Standards
• Hands - on experience in claimsanalysis and TEMPeffective liaison between healthcareclearinghouses and payers resulting to successfulclaimsprocessing.
• Part of the migration team of HIPAA - EDI X12 4010 series to 5010 series for EDI Transaction code sets:
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Experience in developing XML requests for Web Service Testing and validating response XML
• Involved in Facets Output generation, Interface development and Facets Migration Confidential .
• Experience and understanding of software development process including Software development life cycle (SDLC), RUP’s Iterative System Development Life Cycle process, implementing the Rational Unified Process (RUP) in all four phases of a project Inception, Elaboration, Construction and Transition.
• Experience in capturing data requirements, data analysis & data mapping for Vendor feeds and Databases.
• Expert in agile software development methodology and release management.
• Experience in creating and maintaining the Requirements definition documents dat include Business requirements and Functional requirements.
• Skills in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
• Expertise in all areas of software development including client interaction, requirements gathering, analysis and tele-conferencing with the client during the progress of the project.
• Efficient in MS Project and MS Excel for planning, status reporting and writing test scenarios.
• Experience with TriZetto Facets 4.21/4.31 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Experience with TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Used MS Excel spread sheet, PowerPoint, MS Visio, and MS Confidential .

TECHNICAL SKILLS

Manual and Automated Testing Tools: Quality Center, Quick Test Pro, Rational TestManager

Change Management & Defect tracking tools: Quality Center, ClearQuest

Requirements Gathering tools: Rational Requisite Pro

Operating platforms and Systems: Windows, UNIX

Databases: SAP, Oracle, MySQL 5.3, PeopleSoft, MS SQL Server, Teradata

Applications: PeopleSoft HRMS, Oracle HRMS, EPIC, Cerner & MEDITECH

Project Management Applications: MS Project, Visio, UPK authoring software, RUP, MS Office suite

PROFESSIONAL EXPERIENCE

Confidential

SAP Package Technologies

Responsibilities:

• Serves as an EDI Reporting Specialist for Human Resources and Payroll Shared Services
• Fixes discrepancies on the 1095A forms dat is sent to each tax filer or Subscriber and the database to guard against errors in respect to the data provided by the employee/Subscriber loaded in the System.
• Developed Incident documents and portrayed the As-Is reporting structures versus To-be Reporting needs for data integrity and accuracy for the Affordable Care Act new Health Insurance Exchanges (Exchanges) for new employees to select, and enroll in health plans dat fit their needs at competitive prices.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment on the Affordable Care Act with step-by-step instructions and appropriate GUI screenshots to enable employees understand the program.
• Participated in regular meetings with the Business users and SMEs to prioritize the Business Requirements for the four Affordable Care Act types of health insurance plans available through ObamaCare’s Marketplace: Bronze, Silver, Gold and Platinum health insurance plans.
• Gathers requirements, runs, modifies, and publishes reports out of SAP Business Warehouse, Query Manager and SAP InfoSet Query applications.
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements.
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business work flow of applications.

Environment: MS Office Tools, Windows XP, MS Project, RequisitePro, MS Visio, MS PowerPoint, Mercury Quality Center, MS-SharePoint, MS-Word, MS-Excel, Facets

Confidential

EDI Application Support Analyst

Responsibilities:

• Performed impact analysis on reimbursements turnaround and revenue cycle in accordance with the Affordable Care Act mandate and guidelines.
• Participated and provided Training sessions and walk-throughs on employer mandate fees, how full-time hours are calculated, how to get cost assistance on employee coverage and, what type of coverage will be offered.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets including HIPAA 4010; 820, 837, 834, 835, 270/271, and others per Implementation guidelines.
• Provided healthcare provider problem resolution by using root cause analysis, technical documentation, Reviews, and evaluated business systems for end user needs, including Companion Guides, business process reengineering, including GAP analysis and documenting requirements, documenting processes, workflows.
• Worked on 820, 837 and 834 Confidential, HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Created, logged tickets and Reported Hardware, Security and software issues accordingly to appropriate Technical resource. Resolved other issues “on-the-fly” within Command center guidelines
• Provided Ad Hoc training on workflow as needed

Environment: Cerner, EDl XML files, Microsoft SQL Server, SAP, Gentran, JMS Engine

Confidential, Atans, GA

EDI Support Consultant

Responsibilities:

• Supported patients’ PowerChart data migration in various departments of the Hospital system: Nephrology, Urology, Dialysis, Mother and Baby and Pediatrics to MyChart.
• Designed and tested ADT(Admissions, Discharges, Transfers) workflows as well as the development of EDI integration in support of service provider billing.
• Identified and fixed claim errors to reclaim lost revenue in Cerner Medical Billing workflow
• Scrubbed 820, 834,837,270, 271 and 997 claims for errors before submitting using Claims Editor
• Assisted nurses in navigating through PowerChart for incoming patient admissions codes, documentation and charting, transfers and discharge, acnoledging patient care information, releasing medications and orders and care plan documentations, filling out the doc flow sheet, intake/ output and vitals for meaningful use verification.
• Assisted physicians set up Dragon, manage orders, place orders and order sets, modify orders, medication reconciliations, sign and hold orders, pre/post ops documentation, consults and charges and cosign requests for meaningful use validation.
• Proactively troubleshot workflow issues and reported any technical issues and other issues to the Command center.
• Submitted error-free electronic claims and post insurance explanation of benefits (EOBs)
• Validated the status of claims in respect to Claims Status Inquiry, Billing and Payment using TriZetto Provider Solutions' Claims Status Inquiry (formerly Gateway EDI), to submit electronic claims and payments to payers.

Environment: Cerner, EDl XML files, Gateway EDI, Microsoft SQL Server, SAP, Gentran, JMS Engine

Confidential, Columbia MD

Wellness Program Processor

Responsibilities:

• Processed Flu Program documentation to ensure accuracy and accountability for the National and South East Regions.
• Processed and collected corporate clinics and Insurance Accounts Receivable (A/R).
• Provided healthcare provider problem resolution by using root cause analysis, for Insurance basis, including documenting requirements, processes and workflows.
• Audited and processed flu paperwork daily to ensure error-free documentation.
• Performed Alpha/numeric data entry with accuracy.
• Performed timely billing of corporate clinics and Insurance claims.

Environment: GRITS, Microsoft Office Suite

Confidential, MD

Sr. Business Analyst

Responsibilities:

• Identified the scope, business objective and documented the functional requirements
• Involved in the migration of HIPAA - EDI X12 4010 versions to 5010 versions for EDI transaction code sets specifically 837 me and 270/271
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify the changes in the segments and data elements
• Developed GAP analysis documents and portrayed the As-Is reporting structures versus To-be Reporting needs for data integrity and accuracy
• Directly involved in process improvement plans and implementing business change. Held regular meetings with the business users and SMEs to priorities the business requirements
• Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD)
• Coordinated with the different teams distributed at different geographic locations for various releases
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using MS Visio
• Prepared and performed training to Client and Internal staff as a result of system changes
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots
• Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions
• Created use cases specifications, use case diagrams, and activity diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio
• Conducted and participated in JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions
• Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business workflow of applications

Environment: Oracle, Java J2EE, Visio, Quality Center, XML, MS Office, Visio.

Confidential, Dallas, TX

Business Analyst/Test Analyst

Responsibilities:

• Performed stakeholder analysis to identify key players for project success
• Identified and involved all key stakeholders, contributors, business, operations and technical resources dat must participate in a project and ensured dat contributors are motivated to complete assigned tasks within the parameters of the project plan
• Played an active and lead role in gathering, analyzing, and writing business requirements
• Followed the Agile methodology throughout the SDLC
• Involved in meeting with business process owners, SME (subject matter experts) and marketing team for requirements gathering
• Wrote specifications dat would read an order and generate an enrollment card showing the medical plan and ancillary coverage's such as prescription plans
• Reviewed and validated “Medicare Part A” coverage for inpatient hospital stays, skill nursing facility and beneficiary planning from insurance company.
• Reviewed outpatient services under “Medicare Part B” for physician and nursing service, outpatient hospital procedure and generated GAP analysis for those
• Translated the business needs into functional requirements and communicated with the business users on a non-technical level
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically on EDI Health Care Claim Transaction set (837)
• Established, documented, and maintained EDI procedures. Tasks include identifying errors and taking corrective action, reconciling EDI transactions through coordinating information with internal and external customers, and working closely with internal departments and external vendors to maintain EDI integrity
• Created and maintained the Requirements Traceability Matrix (RTM)
• Worked with development/technical team to ensure dat the enhancements would meet the defined business requirements
• Analyzed Business Requirements to produce System Requirements for the technical team using MS Visio
• Interacted with other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues
• Carried out User Acceptance Testing (UAT). Performed Integration and regression testing along with testers
• Assisted with Test Cases and developed strategies with Quality Assurance group to implement them
• Collaborated with Quality Assurance Analysts to track defects

Environment: Agile, MS Project, Oracle, Quality Center, MS Office Suite, MS Visio, UML, Adobe Acrobat, SQL, Oracle, SDLC, SharePoint

Confidential, Oakland, CA

Business Analyst/Test Analyst

Responsibilities:

• Responsible for gaining a good understanding of user needs and accurately representing them in a well-documented software functional specifications document
• Gathered Business Requirements, interacted with the users, designers and developers, project manager and QA team to get a better understanding of the Business Processes
• Interacted with the “End-Users” by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process
• Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).
• Utilized EDI Health Care Claim Payment/Advice Transaction Set (835) to make payments, send an explanation of benefits (EOB) remittance from a health insurer to a health care provider.
• Authored data flow diagrams, sequence diagrams and business process models dat describe how the EDI Health Care Claim Transaction set (837) is used to submit health care billing information and encounter.
• Followed a structured approach to organize requirements into logical groupings such as requirements for Customer, Client, Group, Member and Reporting dat critical requirements are not missed
• Involved in creating Business Process Documentation. Identified Use Cases from the requirements. Created UML Diagrams including Use Case Diagrams and Activity Diagrams using MS-Visio
• Analyzed and optimized the process, prepared Business Requirement Document and managed requirements using Quality Center
• Facilitated JAD sessions with business and technical units to fine tune, prioritize and detail requirements and use cases
• Managed change of the requirements and associated requirements to other requirements for traceability
• Involved in drawing data flow diagrams and process flow diagrams using MS Visio for the Claim Adjudication module and in generating Test Plans and Test Scenarios as per Business requirements
• Involved in conducting Manual and Automated testing User Acceptance Testing at various phases of the project development
• Participated in the bug review meetings, updated requirement document as per business user feedback and approved changes in the functionality of the application

Environment: MSOffice Suite, Oracle, Java J2EE, Visio, Quality Center, XML, MS Office, Visio.

Confidential

PeopleSoft Consultant

Responsibilities:

• Presented, articulated and communicated team assignments, project updates, issues, problems, actionable events, project milestones, issues, and deadlines on deliverables to team and management.
• Facilitated formal and informal walk-through for Fit - Gap sessions on MSS module to senior stakeholders and middle management and transferred noledge of the HR functionalities to designated resources.
• Created Functional Design, Business Requirements, Configuration documents and Test plans on the MSS module to facilitate testing and transition to production.
• Configured and documented access privileges for MSS transactions on new hires, maintenance of access privileges, access changes for transfers, promotions, leave approvals, reporting changes, giving and removing access rights.
• Researched user autantication techniques and resolved designated MSS users' security access issues, including maintenance of job profile definitions used for systems access during the Testing phase.
• Configured MSS workflow approval levels and notifications. Set workflow defaults to enable email and worklists. Configured direct reports user interface and user profiles to select Roles.
• Created user training documentation using Universal Productivity Kit (UPK) for Train-the-Trainer sessions; tested the module to ensure workflow accuracy with designated users from functional areas within the organization.
• Functional Testing support in the EHRP initiative on the Benefits Administration project for the HHS Employees Annual Enrollment Health Benefits Program.
• Created documentation for the Pay Raise per Daily Interface and Non SF50 Interface processes, change requests and orders, requirements, test traceability matrices, test plans, test conditions, test scripts, test scenarios, test validation and results for resolving production issues on the Benefits Administration project.

Environment: PeopleSoft HRMS 8.9, 9.0, Oracle E-Business Suite, eProfile Manager Desktop (MSS), Benefits Administration, Recruiting, Payroll, UPK, MSOffice Suite

Confidential Internal

Confidential, Reston, VA

Responsibilities:

• Proposal Development: Worked on the PeopleSoft eProfile Manager Self Service implementation Proposal for the Federal Government Department of Health & Human Services dat won a 9-month contract for Confidential . Received formal training on methods and techniques of implementing HRMS Self Service application Confidential .
• Systems Integration Oracle HP Offering: Worked on the Vendor Selection Documentation Library to build out the HCM Catalog library for each HR Business Area. Reviewed operations and identified areas to streamline business processes using industry best-practices for TEMPeffective Knowledge Transfer. Contributed updates to HCM articles and workflow PowerPoint presentations in the Knowledge Database. Maintained current noledge and documentation to answer questions from team members on procedures, policies, directives and processes. Maintained HCM administrative reference materials, project files and relevant background documents.
• Market Analyst & Media Relations Initiative: Worked with the Market Analyst & Media Relations Group to create educational materials for the North America group about Confidential 's strategic initiatives. Participated in the 2007 analyst outreach plans to represent Confidential 's industry practices to the analyst community. Coordinated with senior executives to capture analysts' interactions dat positively conveyed Confidential 's messages. Collaborated with the company's global Media Relations communications teams to distribute thought leadership and news reports gathered, through the company noledge database.
• Oracle Business Intelligence (OBIEE): Participated in the initiative to implement Human Resources Dashboards for Company Executives, HR Managers and users within the HCM workforce. Managed the offshore resources in the creation and publication of various scorecards, dashboards and reports, and gave presentations on specific HCM business processes. Assisted with the analysis of results for continuous improvement opportunities.
• Talent Management Back Porting HCM Approach: Worked as subject matter expert (SME) on the Back Porting Talent Management initiative and presented a demo in Vancouver, Canada at the client event presentation on PS 9.0 Talent Acquisition Manager/Candidate Gateway business processes. Developed and maintained an understanding of the technologies and various third party vendors which enable Talent Acquisition Business Processes.

Environment: Oracle Business Intelligence Enterprise Edition (OBIEE), PS HRMS 8.9, 9.0, PS Recruiting: Talent Acquisition Manager/Candidate Gateway, Oracle HRMS Learning Management Module (LMS), Quick Test Pro, ClearCase, MS Visio, UPK

Confidential

PeopleSoft Consultant

Responsibilities:

• Facilitated requirement gathering sessions with the stakeholders and generated Project Requirements Plan (PRP) and Business Requirements Report (BRR).
• Facilitated JAD and demo sessions and created Use case diagrams to review processes with the BPOs/SMEs.
• Created Training job aids for setup and process for awards. Provided educational information on the administrative capabilities.
• Maintained responsibility for documentation, reporting needs, data integrity and recruitment support for end users of the PS 8.9 eRecruit Enhancement tool.
• Participated in HCM Roadmap sessions, gathered requirements and coordinated information and attendee feedback. Also assisted in stakeholder presentations and facilitation at management meetings and discussions.

Environment: PeopleSoft HRMS, UNIX, QTP, Quality Center, Oracle Applications, Java

Confidential

EDI Analyst II

Responsibilities:

• As an On the Job Trainer, trained team members and Home Owner Association Representatives methods and techniques of utilizing the vECAP system for compensation on sales for specific administrative and technical installation of FiOS.
• Generated business-centric test cases based on mandated regulatory requirements and accomplished all project testing on schedule and under budget with minimal system defects.
• Successfully tested EDI billing financial transactions during regulatory commission testing and certification (tested internally and externally utilizing multiple power service providers - Verizon approved)
• Worked with trading partners, clients, management, technical and non-technical personnel to create use cases and system validation.
• Maintained alternative approaches in the process of advising management concerning major aspects of vECAP system design, such as what system interrelationships must be considered, and what interface, operating mode, system software, and equipment configuration is most appropriate to electronically transmit data for a given project, relationship with the Presidents/Vice Presidents or Company Representatives for the Builder/Developer/Home Owner Association accounts.
• Worked with the Business Analysts & Subject Matter Experts within various departments to develop Verizon Training materials and presentation documents for marketing strategies and exhibitions.
• Attended and facilitated UPK Storyboard review sessions with the State BAs and SMEs; capturing feedbacks & comments on the various PeopleSoft topics/processes in the system.
• Created online simulations to design training and performance support deliverables.
• Created and delivered Course Outline materials, Storyboards, Job Aids, Module Exercise topic transactional scenarios, Presentation Materials and UPK training materials
• Delivered the Train-the-trainer session to the Account Managers within the Sales Department based on needs and the scheduled course outlines. Identified User roles and designated tasks to each Account Manager.

Sales Support Coordinator

Confidential, VA

Responsibilities:

• Processed all dissemination of Analyst Relations reports, collateral and branding documentation and approvals from the Verizon Legal Group and Brand Identity Management.
• Updated and managed the reporting tool used for publishing price sheets and sales order forms nationwide and built community Webpages for Online communication between the company and its vendors nationwide.
• Delivered training and disseminated Verizon educational sales materials and reports to the sales team of seven (7) Representatives and eleven (11) Account Managers, on the impact of analysts on the market and how analysts' opinion in sales situations could be leveraged for the corporate accounts.
• Tracked inaccuracies in sales orders on Quality Reports using Verizon Avenue Sales Tracking (VAST) and provided feedback to managers on inaccuracies as well associates who may require additional training or counseling.
• Monitored customer base and reported significant trends in customer base to management and worked closely with other departments to communicate and improve internet product and offerings.
• Provided EDI operations support to 30+ systems. Developed EDI paper map documentation.
• Interfaced with internal users and worked with remote to develop, test, and support new EDI documents.
• Maintained and validated Oracle Systems against EDI 810, 820, 834, 850, 852, 855 and 997.
• Developed, tested, and implemented communications scripts for AS2 connectivity and EDI data transfer to several VAN (Value Added Network) and to direct AS2 trading partners using the AS2 communication application.
• Developed and implemented the process control schedule to ensure data transfer in a just-in-time environment, and on a predefined communications schedule.
• Coordinated new mapping development with both internal and external trading partners.
• Provided EDI support to all internal Verizon departments, world-wide; and all trading partners
• Provided support, as needed, for the Oracle upgrade and implementation.
• Worked with trading partners on resolving issues and ensure customer accounts are accurate.

Environment: Oracle CRM Applications, UPK, BRIO, OBIEE, CSG, MS Word, Excel, PowerPoint, Access