SUMMARY:

A customer oriented, multitask professional with several years’ of experience working on wide range of projects in Healthcare Claims Management Systems. 10 years of experience on a large MMIS ( Confidential ) Implementation Project in gathering, analyzing and documenting Business Requirements, Developing Requirement documents for Functional Requirement Specifications. Excellent analytical and logical skills in writing, implementing Test scenarios, Test cases, System testing, data capture requirements and maintaining traceability of defects and change request for baseline documents. Skills in providing functional specifications to the development team to bring out technical solutions.

FUNCTIONAL TECHNOLOGY:

• Business & Systems Requirements definition, requirement verification, functional specifications and gap analysis.
• Use cases, scenarios, and workflow requirement functionality of Confidential and requirements testability.
• Documenting business rules and related artifacts using standardized, formal methodologies
• Develop and maintain business rules.
• Logical and physical models reading and interpret.
• X12 Electronic Transaction FIT and SIT, X12 data mapping 837/835/270/271/276/277/278 inbound/outbound
• QA Test Cases/Scripts, Defect objects and CR.
• Collaborative sessions, discovery sessions.
• Auditor of Quality Control.
• Functional areas leader, team member Liaison.
• Development of business process test cases scenarios
• Implementation, Modification projects, QA end to end testing and user acceptance testing.
• Regression capability based testing validation.
• HIPPA rules data error (s) test files compliance.
• XML to PDF Form data capture.

TECHNICAL SKILLS:

Citrix ICA Applications: Rational Requisite Pro/Reqweb, Share Point, Data Model LDM/PDM and Visio.

Databases: Oracle, SQL Server.

Operating systems: Windows (NT/2000/XP)

Testing Tools: Edifecs Transaction Management(TM), Edifecs SpecBuilder , UltraEdit Text Editor, WinSCP SFTP (SSH File Transfer Protocol, MFT Mailbox, Cognos (EOR), CQTM - Clear Quest.

Development Tools: XML, HTML

Microsoft Tools: Project Management. Access/Excel/Words/Visio, MS Project/OCS

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Functional Area Data Analyst SME

Responsibilities:

• Participate in Focus Group collaborative sessions to document "as is" and "to be Medicaid Confidential transactions for Confidential as a team member of Confidential Functional area.
• Created specification crosswalks, manage Change Request for Confidential mapping technical specification documents for delivery of X12 electronic transactions.
• Conduct root cause analysis of Confidential processes and data error (s) test files for compliance of HIPPA rules.
• Determine data capture requirements and define business process specify form data for XML to PDF 835 Payment Remittance automation.
• Test execution of Confidential test cases/scripts to assure requirements testability of defect objects corrections and designs approval.
• Performed SME validation of Regression capability based testing for Confidential technical deliverables by managing construction, training, and other change/defect management work of other analysts for quality - related business outcomes.

Sr. Business Analyst QA Tester

Confidential

Responsibilities:

• Develop Requirements Specification, General System Design, Detailed System Design documents for assigned areas.
• Created roadmaps of business process work flows.
• Participate in requirements analysis for cross functional business area.
• Ensure business area requirements, rules, related artifacts, system lists and HTML are included in the overall requirements documentation.
• Interface documents base on source to targets created.
• Communicate requirements and business processes to technical development team.
• Requirements validation activities participated.
• Managing HIPAA Confidential requirements, technical specifications for delivery of X12 electronic transaction FIT and SIT testing.
• Managing of specialized software used for analyzing, developing and/or testing Confidential Services interfaces. Conduct root cause analysis of Confidential processes and data error (s) of test files for compliance of HIPPA implementation guide.
• Created documentation, test executions and demonstrate the ability to develop and implement solutions for the causes identified.
• Developing business test cases scenarios for justification of functional requirements relating extranet of web application/ Confidential Gateway and Administrative Vendor .
• Defined technical requirements documentation for system/operations workflow process of functional specifications, policies, routing workflow and communication between Focus group members.
• Managing of system test cases/scripts testing to assure requirements testability of defect objects corrections and designs approval.
• Managing Defects and Change Orders relating to Alaska Confidential transaction.
• Facilitated workgroups, requirement verification, review discovery sessions, business processes review sessions for validation of decisions made in cross-functional areas.
• SQL data review.

QA/QC Test Auditor

Confidential

Responsibilities:

• Ensures testing procedures are properly understood, carried out, evaluated and that product modifications are investigated if necessary.
• Provided documentation of quality related items to addressing all objectives and overall expectations of test case/test script development.
• Maintained Internal Control standards, including internal execution test results, concluding on their impact to external audit points and any issues raised by client external audit regulators (TAC).
• Provided quality analysis review on all documentation created by internal test team for review by client external audit regulators (TAC).

Sr. Functional Area Business Analyst

Confidential

Responsibilities:

• Works on multiple Functional areas as a leader and often as a team member.
• Exhibit strong understanding of end-to-end Medicaid health plan business processes and interactions with both internal and external stakeholders.
• Perform detail requirements gathering, Business Process review, Interpretation of design system documentation ( Confidential ) analysis, process, and data flow diagramming for processes of moderate complexity of Medicaid Information Technology Architecture (MITA) .
• Worked with business users to identify and manage changes to the business rules.
• Communicate status, issues, and risks to Functional Manager.
• Participate in and leader collaborative sessions to document "as is" and "to be Medicaid business processes.
• Develop and manage requirements.
• Coordinate activities of cross-functional teams in order to achieve goals of IT projects, including work plans, system design and testing of solutions.
• Read and interpret conceptual, logical and physical models to include context, data flow, process flow, logical diagrams, and data dictionaries.

Confidential

Independent Business System Analyst Project Consultant

Responsibilities:

• Performed analysis of content and Internet design standards for Confidential by working directly with various departments and Care Centers to develop application requirements and ensure application meets business objectives.
• Review of sites with applicable departments.
• Workgroup facilitated session/meetings.
• Analysis of user training and user documentation training conducted.
• Participate in developing test cases.
• Developing business cases scenarios for project justification of functional requirements relating extranet of web application.
• Performed evaluation on requirements routing workflow processes technical design of operation/system to determine functional specifications policies and communication for impact assessment.

Confidential

Independent Business System Analyst Project Consultant

Responsibilities:

• Internal Control Liaison for State users external audit points to ensure requirements technical solution are developed as State specified throughout the business solution development life cycle. Supported the Confidential Confidential Implementation of Confidential as a participating member of quality analysis review on all documentation in establishment of requirements baseline, requirements specification and verifying the fulfillment of all requirements.
• Facilitated workgroups, requirement verification review discovery sessions, business processes review sessions, validation of Confidential .
• Managed processes to ensure the remaining functional business area understands the details of decisions made in cross-functional areas.
• Managing of requirement traceability matrix issues, process owners and deliverables. Identified processes to assist state in analysis of propose new changes out of scope.
• Prepare documentation to ensure system requirements are useful for design/construction by analysis of change orders, panel mock ups, letters, reports and other system objects through change control processes.
• Managing of system test cases/scripts review to assure requirements testability of defect objects corrections and designs approval.
• Execute UAT testing for verification and expected results.

Confidential

Independent Consultant/Business Analysts

Responsibilities:

• Implementation of Confidential Data to Confidential current business processes by defining business unit requirements for mapping files layouts of patient Premium Reconciliation Billing Files.
• Analysis of documentation of revenue data files and system technology for replacement of HPN Texn software, MHS Powerstep to convert Amisys/Facet and PREM REC billing and accounts receivable applications software by converting HPN data to SQL data warehouse.
• Created tables mapping for data elements through MS Access.
• Created various testing documents by developing test scenarios and test cases necessary for testing external vendor’s requirement in Medicaid Confidential transactions.