PROFESSIONAL SUMMARY:

• 6+ years of experience working as a Business System Analyst /EDI Analyst/ Quality Analyst with a track record of managing complex IT projects in the Healthcare.
• Well versed with SDLC methodologies, including Waterfall, Agile and RUP.
• Proficiency in orchestrating Joint Application Development (JAD) sessions that brings all elements of the project together in an effort to maximize efficiency and outline vision.
• Highly adept in requirement gathering, data collection, analysis and evaluation in information systems issues, analytical problem solving and decision making, communication and inter - personal skills with ability to interact with individuals at all levels.
• Expert in working with the technical team in translating application functionality into application architecture and the production of a System Functionality document.
• Created, updated and maintained the Test Matrix and Requirements Traceability Matrix to ensure that the test plans written covered the Requirements.
• Good understanding in Defect Life Cycle for tracking the defects.
• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams - i.e. Use Case, Sequence, Activity, and Context diagrams using the tool MS Visio.
• Expertise in conducting workflow analysis, GAP analysis, system design, business process re-engineering, and user interface (UI) design.
• Created numerous Project Management documents and mentored Business Analysts with As-Is processes.
• Proficiency in MS Visio in creating, analyzing and implementing business workflow diagrams including use case diagrams, activity diagrams, state diagrams, sequence diagrams, collaboration diagrams and deployment diagrams
• Clear understanding of ICD 9 and 10 protocols in concert with ANSI, X12, HIPAA, and HL7 standards.
• Highly knowledgeable in deploying healthcare integration systems such as FACETS, HIPAA Gateway, SUR and MAR in accordance with compliance standards dictated by HIPAA 5010 ASC X12.
• Experienced in gathering requirements for HIPPA (Health Insurance Portability and Accountability Act) EDI (Electronic Data Interchange) Transactions 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277, 278, 997 and 999 in various phases of implementation.
• Proficient in writing SQL queries, and Database (MS SQL Server, My SQL, Oracle) technologies.
• Expertise in designing Ad hoc, Drill-Down, Drill-Through, Matrix, Pivot and Tabular reports to match the needs of the end users.
• Experience in Functional and Regression testing utilizing manual and automated testing skills.
• Expertise in performing Back End Testing by writing SQL queries for the purpose of database integrity in MS SQL Server.
• Experience in Bug reporting and Defects Management using Quality Center.
• Experience in the different modules of Quality Center (ALM) such as the Requirements, Test Plan, and Test Lab, Defects modules.
• Knowledge in analyzing the Defect Severity and priority.
• Proficient in Client Interaction, Team Management and Testing/Quality Assurance and testing experience in Mainframes.
• Well versed in the stipulations introduced in the Affordable Care Ac and how to efficiently integrate them into an evolving healthcare system.
• Strong knowledge of Project management skills such as time estimation, task identification, and scope management.
• Strong team player with excellent interpersonal and communication skills. Technically competent and goal oriented with problem solving skills.
• Excellent team management and leadership skills. Additionally, great presentation skills in regards to communication with both business and technical teams.

TECHNICAL SKILLS:

Project Methodologies: UML, RUP, Agile, RAD and Waterfall

Business Modeling Tools: MS Visio, MS Project, Rational Rose

Rational Requisite: Pro, Rational Rose, Clear Quest, Clear Quest, Clear Case

Database: DB2, MS SQL Server, Oracle

Languages: XML, SQL, Visual Basic

Operating System: Microsoft Windows XP / Vista / 7, Unix, Linux

Other Tools: MS Office Suite, SharePoint

PROFESSIONAL EXPERIENCE:

Confidential, Dallas, TX

Sr. EDI Analyst

Responsibilities:

• Prepared the Business Requirement Document (BRD) and Functional Requirement Document (FRD) for the enhancement of the existing services.
• Project Management and Controlling to ensure on time delivery using MS Project.
• Responsible for participating in the design sessions, reporting on project progress and identifying potential risks and issues.
• Conducted JAD sessions for communicating with Stakeholders and Project directors.
• Formulated Test plans from Business Requirements/Function Specifications documents and created several Test Cases.
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Involved in HIPAA EDI transactions such as 270, 271,837 (P, D, I), 276, 277, 834, 820, 278,999/TA1.
• Worked extensively on 837I, 837P, 837D, 835, NCPDP and NCPDP response files.
• Gathered requirements, developed Process Model and detailed Business Policies.
• Worked with the project manager to estimate best/worst case scenarios, track progress with weekly estimates of remaining work to do, conducting informal meetings ad hoc and as needed.
• Involved in writing and implementation of the test plan, and various test cases for UAT.
• Tested HIPAA EDI Transactions such as 837(I/P/D), 835, 834, 270, 271, 276, and 277 in various claims validation processes.
• Analyzed and included 276/277 (Claim Status Request/Response), 270/271 (Eligibility Inquiry/Response) and 820 (Premium Payments).
• Analyzed EDI transactions in XML and X12 responses.
• Created ETL documentation such as EDI X12 837(P,I), 834 and 835 Data Mapping, Transformation logic for Main Frame Layout, Updating Meta data documents for new Platform.
• Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
• Participated in all phases of testing and working through document issues.
• Maintained a traceability matrix of the requirements and created test cases, as well as testing matrix of the test cases and any corresponding defects.
• Involved in developing the test strategy and assisted in developing test plans, test case objectives and test cases.
• Helped in developing QA Test plans for Functional, Integration and System Testing.
• Played a key role in planning the UAT, and implementation of system enhancements and data migration and conversions.
• Maintained meeting minutes, meeting agenda and communicated them with the SMEs and the stakeholders on timely manner using MS Word, MS PowerPoint and created reports using MS Excel.
• Implemented Business Intelligence (BI) to help users make better business decisions. Conducted workflow, process diagram and GAP analyses to derive requirements for existing systems enhancements.
• Used HP Quality Center/ALM for tracking Defects and tracing requirement functionality performances.
• Incorporated Agile to create Business Requirement Document Specifications using MS Visio and MSWord.
• Responsible to meet the information demands of business users by delivering timely, accurate, meaningful and standardized data and generating ad hoc reports as requested.
• Prepared separate FRD for Data Warehouse piece. Highly involved in both ‘Data Integration’ and ‘Business Intelligence’ (Reporting) section.
• Formed advanced SQL Queries and used Microsoft Excel to investigate data issues in the Data Warehouse and worked with the Users and Technology Team to formulate a solution to resolve the issue
• Performed SQL queries for retrieving, organizing the database with general commands like select, create, update, and joins.
• Conducted Data analysis using SQL on the backend databases for producing mapping documentation and transformation rules for developers
• Applied triage, research, collaboration and technical knowledge to resolve transaction and processing issues with the use of supporting technology such as work flow management systems and case management software.

Confidential - Washington, DC

EDI Analyst /Business System Analyst

Responsibilities:

• Maintained a daily meeting with the Business and various stakeholders on task order approval, increased and decrease frequency of the meetings as per the progress of the task.
• Facilitated functional requirement gathering from system users and prepared business requirement documents (BRD).
• Designed and developed project document templates based on agile (scrum) SDLC methodology.
• Coordinated and worked with Project Manager to prepare Project Plan in MS Project for Process Claim Domain.
• Performed GAP Analysis to analyze the current system and worked with internal users to help define system requirements.
• Provided business functional, systems, and technical requirements and engineering management for the implementation of new complex functionality and maintenance of existing FEP national Plan systems.
• Elicited, analyzed, validated, specified, and verified the business requirements of project stakeholders, that is, both internal and external customers and end users.
• Participated in team functions with other FEPOC and CareFirst departments.
• Worked extensively on EDI transactions 837 and 835 Involved in writing test cases for different LOB’s (ITS, FEP And Regular) for SIT, Parallel and UAT.
• Created the logic for flat files and 837I, 837D, 837P according to business requirements and documented in FRD.
• Involved in 835/837(P/I/D)/834 (ANSI X12) transaction with implementation guides.
• Involved in claims submission and payment (remittance) retrievals by using ASCX12N 820 for the In- bound premium payments; ASC x12N 834 for the Inbound Enrollment and Maintenance; ASCX12 276/277 for the claims status enquiry and response; and ASC X12 835 for the Health care Claim Payments.
• Worked on HIPAA Standard/Gstandard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. I.
• Involved in testing HIPAA Transactions & Code Sets Standards like (834- Enrollment /Dis-enrollment to a health plan, 835 and 837).
• Assisted in industry standard requirements elicitation such as Joint Application Development (JAD), interviews, prototyping, and user observation.
• Developed complete, unambiguous description of the solution using use cases, requirements, and business rules that are both verifiable and traceable.
• Communicated with the Development and the QA team.
• Developed test plan, test cases using requirements, use cases, wireframes and design documents.
• Participated in UAT and worked with HP ALM/Quality Center for bug and defect tracking.
• Involved actively in determining the quality and quantity of data to be provided for UAT.
• Analyzed Data using Microsoft BI tools to create reports that helped the management make effective and informed financial decisions.
• Documented requirements traceability matrix tracing across the software development lifecycle to ensure that requirements are met at each step of the lifecycle.
• Assisted in the creation of requirements repositories to store historical requirements information using SharePoint.
• Extracted data from existing data stores, Developing and executing departmental reports for performance and response purposes by using oracle SQL, SAS, procedures, packages, functions, database triggers
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• Used SQL, Data Warehousing and Data Cleansing for the arrangement of customer data. Used Data mapping for collecting the data.
• Wrote complex SQL queries to extract and validate the data from the Facets database.
• Conducted Statistical Modeling of data on how providers submit outpatient authorizations using Pivot Tables in Excel.
• Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
• Documented the outcomes of all the testing in MS Word and MS PowerPoint.
• Involved in creation and updates of several SQL Index, Views, Complex Stored Procedures, triggers and appropriate.
• Documented requirements using Use Case (UC) analysis and User Experience (UX) GUI design.

Confidential, Dayton, OH

Business Analyst /Quality Analyst

Responsibilities:

• Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
• Responsible for the requirement-gathering phase and project plan.
• Used Microsoft Office suit to develop the documents such as Visio for creating wireframes, Word, Excel and PowerPoint for creation of Business Requirement documents.
• Supported PMO by mentoring specific projects in application of the new SDLC based on the Agile, especially from the project management, requirements and architecture perspectives.
• Wrote various Test Cases and was involved in developing test scripts to perform automated testing using Quality Center.
• Prepared Test plans, Functional Test cases and executed the test cases in Quality Center.
• Involved in functionality, database and error testing of the application.
• Involved in the black-box testing of the Healthcare application and identified the different test cases for regression testing.
• Tested the aspect of adding additional features to the customer's account based on the account specifications.
• Identified and documented all the possible defects in application functionality using Quality Center.
• Acted as a liaison between the end users and the software development team.
• Participated in cross functional teams to developer a comprehensive functional and systems level solution test including cross functional review for such plans.
• Establishing, and managing test environments and test data
• Excellent written and oral communication skills required for business partner relationship management and customer facing.
• Involved in Regression testing of each build during the various phases of the application using QTP.
• Tested and delivered Inbound/Outbound Facets interfaces.
• Used to execute test cases for several transactions such as 837, 835, 820, 834, 277, 278, 270/271.
• Created Logical and Physical Test case for Step-Up and Step-Down EDI Transactions for 4010 and 5010.
• Created software testing strategies, estimating testing work efforts, tracking software defects, and prioritization of fixes.
• Created EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors.
• Reported defects and maintained Test Cases in HP Quality Center.
• Reviewed high level and detail SOW and Requirements to provide accurate estimation from QA stands point.
• Used HIPAA 5010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDIs 837, 835, and and ICD-10 code sets.
• Recommend on implementation of HIPAA 5010 (EDI X12 837,834, 820, 278,270,999) in the new System.
• Performed GAP analysis for EDI transactions such as 837, 834 to support state specified X12 5010 file formats.
• Gathered requirement on FACETS EDI 834 Benefit Enrollment and Maintenance subsystems.
• Worked With HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Executed Test cases manually by composing 270, 276, 837 EDI files and dropped inbound and check response 271, 277, 835 using interleaves and outbound.
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Ensured that relevant UML diagrams and tools were used in all requirement documents and prepared Use Case Models, Flow Diagrams, Sequential Diagrams in MS Visio.
• Developed testing strategy and test plan, outlined various capabilities of the testing process. Describe the tasks of each testing capability, outlined roles and responsibilities related to the testing process.
• Generated reports using document generator of Quality Center.
• Tracked post-deployment progress identified improvements and proposed resolutions to existing issues. Coordinated UAT with business partners, helped identify relevant test data and reporting metrics.
• Created Requirement Traceability Matrix (RTM) to trace requirements and manage.
• Conducted Requirements & Impact analysis for doing ad-hoc mass changes to reference data as requested by business.
• Developed several detail and summary reports including line and pie charts, trend analysis reports and sub-reports according to business requirements using SQL Server Reporting Services (SSRS).
• Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
• Extensive backend testing using SQL queries, generating the reports to ensure the data integrity and validate the business rules.

Confidential, Indianapolis, IN

Business System Analyst

Responsibilities:

• Prepared BRD and Derived Functional Requirement Specifications (FRS) based on User Requirement specifications and delivered to the project team. Understand and articulate business requirements from user interviews and then convert requirements in to technical specifications.
• Participated in requirement walkthroughs and creation of test plan.
• Analyzed Business Requirements and segregated them in to high level and low level Use Cases, Activity and Sequence using MS Visio according to UML Methodology.
• Extensively used Agile Methodology in the process of the project management based on SDLC.
• Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications.
• Used Business Rules, Business Use-Case Model and Business Object Model participated in Requirement Analysis of the application and performed GAP analysis.
• Involved in analysis of HIPAA compliance and EDI Transactions sets and took part in discussions for designing the EDI transactions
• Developed technical design documents and mapping documents for implementing Health Care HIPAA transactions like 834, 837I, 837P, 837D, 820, 997,270, 271, 276, 277.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD (Object oriented Design) using UML.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Used and created test cases/plans based on system requirements and design specifications, executed test cases and reported test results, identified potential software issues and provided relevant data points to assist debugging.
• Facilitated User Acceptance Testing (UAT) with stakeholders and the business users.
• Prepared the 837 I&P Claims and validated these in Facets System.
• Worked on X12 transactions 835/837/834/820/271 of medical claims/underwriting for support and point of reference for the vendor in business issues.
• Frequently updated the requirements and defect status as per the current status of the Testing project in the Clear Quest.
• Documented the Use Cases and prepared the Use Case and Activity Views using MS Visio and Rational Rose for a clear understanding of the requirements by the development team.
• Maintained Traceability Matrix in Excel.
• Responsible for development of Test Cases and executing the Test Cases using Quality Center
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Developed timelines for project delivery, and managed projects and resources to successful completion.
• Performed Data Analysis on the extracted data, data cleansing and scrubbing.
• Worked closely with lead Data Warehouse developers to evaluate impact on current implementation, redesign of all ETL logic.
• Validated the database by applying business rules using SQL queries.
• Created use-case scenarios and storyboards in MS Word and MS PowerPoint for better visualization of the application.
• Project tracking and documentation using MS Project, Excel, Access and Word.