SUMMARY

• Hands on experience gathering requirements, interviewing senior level company officials to gather requirements for documenting project functional specification.
• Extensive knowledge of ANSI X12N 5010 HIPAA formats 837, 277/277CA, 997/999 and working knowledge 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 teh 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 Projects.
• Experience and understanding of software development process including Software development life cycle (SDLC), RUP’s Iterative System Development Life Cycle process, implementing teh 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 teh Requirements definition documents that 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 wif teh client during teh progress of teh project.
• Efficient in MS Project and MS Excel for planning, status reporting and writing test scenarios.
• Experience wif TriZetto Facets 4.21/4.31 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending teh functionality of teh core Facets system using teh Facets extensibility architecture feature.
• Experience wif 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 Projects.

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 teh 1095A forms that is sent to each tax filer or Subscriber and teh database to guard against errors in respect to teh data provided by teh employee/Subscriber loaded in teh System.
• Developed Incident documents and portrayed teh As-Is reporting structures versus To-be Reporting needs for data integrity and accuracy for teh Affordable Care Act new Health Insurance Exchanges (Exchanges) for new employees to select, and enroll in health plans that fit their needs at competitive prices.
• Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment on teh Affordable Care Act wif step-by-step instructions and appropriate GUI screenshots to enable employees understand teh program.
• Participated in regular meetings wif teh Business users and SMEs to prioritize teh Business Requirements for teh 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 teh changes in teh segments and data elements.
• Conducted walkthroughs and code reviews wif 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, Wichita, KS

EDI Application Support Analyst

Responsibilities:

• Performed impact analysis on reimbursements turnaround and revenue cycle in accordance wif teh 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, wat type of coverage will be offered.
• Worked wif 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 projects, 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-teh-fly” wifin Command center guidelines
• Provided Ad Hoc training on workflow as needed

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

Confidential, Athens, GA

EDI Support Consultant - Cerner

Responsibilities:

• Supported patients’ PowerChart data migration in various departments of teh Hospital system: Nephrology, Urology, Dialysis, Mother and Baby and Pediatrics to MyChart.
• Designed and tested ADT(Admissions, Discharges, Transfers) workflows as well as teh 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, acknowledging patient care information, releasing medications and orders and care plan documentations, filling out teh 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 teh Command center.
• Submitted error-free electronic claims and post insurance explanation of benefits (EOBs)
• Validated teh 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 teh 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 wif accuracy.
• Performed timely billing of corporate clinics and Insurance claims.

Environment: GRITS, Microsoft Office Suite

Confidential, Owings Mills, MD

Sr. Business Analyst

Responsibilities:

• Identified teh scope, business objective and documented teh functional requirements
• Involved in teh migration of HIPAA - EDI X12 4010 versions to 5010 versions for EDI transaction code sets specifically 837 I and 270/271
• Performed GAP analysis of 4010 and 5010 EDI transaction using implementation guide to identify teh changes in teh segments and data elements
• Developed GAP analysis documents and portrayed teh 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 wif teh business users and SMEs to priorities teh business requirements
• Documented teh Business Requirements Document (BRD) and teh Functional Specification Document (FSD)
• Coordinated wif teh 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 wif step-by-step instructions and appropriate GUI screenshots
• Interacted wif teh development team on regular basis to ensure and balance practicalities wif innovative and efficient business systems solutions
• Created use cases specifications, use case diagrams, and activity diagrams to define teh 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 teh project. Acted as a facilitator on different occasions
• Conducted walkthroughs and code reviews wif 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 that must participate in a project and ensured that contributors are motivated to complete assigned tasks wifin teh parameters of teh project plan
• Played an active and lead role in gathering, analyzing, and writing business requirements
• Followed teh Agile methodology throughout teh SDLC
• Involved in meeting wif business process owners, SME (subject matter experts) and marketing team for requirements gathering
• Wrote specifications that would read an order and generate an enrollment card showing teh 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 teh business needs into functional requirements and communicated wif teh business users on a non-technical level
• Analyzed and worked wif 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 wif internal and external customers, and working closely wif internal departments and external vendors to maintain EDI integrity
• Created and maintained teh Requirements Traceability Matrix (RTM)
• Worked wif development/technical team to ensure that teh enhancements would meet teh defined business requirements
• Analyzed Business Requirements to produce System Requirements for teh technical team using MS Visio
• Interacted wif other teams through walkthroughs, teleconferences, meetings, etc. to resolve various issues
• Carried out User Acceptance Testing (UAT). Performed Integration and regression testing along wif testers
• Assisted wif Test Cases and developed strategies wif Quality Assurance group to implement them
• Collaborated wif 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 wif teh users, designers and developers, project manager and QA team to get a better understanding of teh Business Processes
• Interacted wif teh “End-Users” by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and teh business process
• Determined eligibility benefits for customers wif 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 that describe how teh 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 that critical requirements are not missed
• Involved in creating Business Process Documentation. Identified Use Cases from teh requirements. Created UML Diagrams including Use Case Diagrams and Activity Diagrams using MS-Visio
• Analyzed and optimized teh process, prepared Business Requirement Document and managed requirements using Quality Center
• Facilitated JAD sessions wif business and technical units to fine tune, prioritize and detail requirements and use cases
• Managed change of teh requirements and associated requirements to other requirements for traceability
• Involved in drawing data flow diagrams and process flow diagrams using MS Visio for teh 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 teh project development
• Participated in teh bug review meetings, updated requirement document as per business user feedback and approved changes in teh functionality of teh 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 knowledge of teh HR functionalities to designated resources.
• Created Functional Design, Business Requirements, Configuration documents and Test plans on teh 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 authentication techniques and resolved designated MSS users' security access issues, including maintenance of job profile definitions used for systems access during teh 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-teh-Trainer sessions; tested teh module to ensure workflow accuracy wif designated users from functional areas wifin teh organization.
• Functional Testing support in teh EHRP initiative on teh Benefits Administration project for teh HHS Employees Annual Enrollment Health Benefits Program.
• Created documentation for teh 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 teh 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, Reston, VA

Responsibilities:

• Proposal Development: Worked on teh PeopleSoft eProfile Manager Self Service implementation Proposal for teh Federal Government Department of Health & Human Services that won a 9-month contract for Accenture. Received formal training on methods and techniques of implementing HRMS Self Service application projects.
• Systems Integration Oracle HP Offering: Worked on teh Vendor Selection Documentation Library to build out teh 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 teh Knowledge Database. Maintained current knowledge 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 wif teh Market Analyst & Media Relations Group to create educational materials for teh North America group about Accenture's strategic initiatives. Participated in teh 2007 analyst outreach plans to represent Accenture's industry practices to teh analyst community. Coordinated wif senior executives to capture analysts' interactions that positively conveyed Accenture's messages. Collaborated wif teh company's global Media Relations communications teams to distribute thought leadership and news reports gathered, through teh company knowledge database.
• Oracle Business Intelligence (OBIEE): Participated in teh initiative to implement Human Resources Dashboards for Company Executives, HR Managers and users wifin teh HCM workforce. Managed teh offshore resources in teh creation and publication of various scorecards, dashboards and reports, and gave presentations on specific HCM business processes. Assisted wif teh analysis of results for continuous improvement opportunities.
• Talent Management Back Porting HCM Approach: Worked as subject matter expert (SME) on teh Back Porting Talent Management initiative and presented a demo in Vancouver, Canada at teh client event presentation on PS 9.0 Talent Acquisition Manager/Candidate Gateway business processes. Developed and maintained an understanding of teh technologies and various third party vendors which enable Talent Acquisition Business Processes.
• Facilitated requirement gathering sessions wif teh 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 wif teh BPOs/SMEs.
• Created Training job aids for setup and process for awards. Provided educational information on teh administrative capabilities.
• Maintained responsibility for documentation, reporting needs, data integrity and recruitment support for end users of teh 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 teh Job Trainer, trained team members and Home Owner Association Representatives methods and techniques of utilizing teh 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 wif 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 wif trading partners, clients, management, technical and non-technical personnel to create use cases and system validation.
• Maintained alternative approaches in teh process of advising management concerning major aspects of vECAP system design, such as wat system interrelationships must be considered, and wat interface, operating mode, system software, and equipment configuration is most appropriate to electronically transmit data for a given project, relationship wif teh Presidents/Vice Presidents or Company Representatives for teh Builder/Developer/Home Owner Association accounts.
• Worked wif teh Business Analysts & Subject Matter Experts wifin various departments to develop Verizon Training materials and presentation documents for marketing strategies and exhibitions.
• Attended and facilitated UPK Storyboard review sessions wif teh State BAs and SMEs; capturing feedbacks & comments on teh various PeopleSoft topics/processes in teh 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 teh Train-teh-trainer session to teh Account Managers wifin teh Sales Department based on needs and teh 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 teh Verizon Legal Group and Brand Identity Management.
• Updated and managed teh reporting tool used for publishing price sheets and sales order forms nationwide and built community Webpages for Online communication between teh company and its vendors nationwide.
• Delivered training and disseminated Verizon educational sales materials and reports to teh sales team of seven (7) Representatives and eleven (11) Account Managers, on teh impact of analysts on teh market and how analysts' opinion in sales situations could be leveraged for teh 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 wif other departments to communicate and improve internet product and offerings.
• Provided EDI operations support to 30+ systems. Developed EDI paper map documentation.
• Interfaced wif internal users and worked wif 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 teh AS2 communication application.
• Developed and implemented teh process control schedule to ensure data transfer in a just-in-time environment, and on a predefined communications schedule.
• Coordinated new mapping development wif 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 teh Oracle upgrade and implementation.
• Worked wif trading partners on resolving issues and ensure customer accounts are accurate.

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