SUMMARY

• Actively participated and involved in Product support for Solution Central rolled out in Midland, GA, and Denver, CO
• Worked as Principal Business Architect/Principal Business Process Developer on Pega Business Process Model (BPM) for Healthcare applications for Pegasystems.
• 9+ years of IT experience as a Business Analyst/ SME for BCBS - Healthcare Insurance, PBM- Pharmacy Benefits Management, HL7 (ADT, LAB, Radiology & Pharmacy) Messages and Medicare-D projects on Mainframes and Java environment.
• Pega Certified Business Architect (CBA) and Certified System Architect(CSA)
• Trained on Pega 7.1 and contributing efforts towards on Pega 7.1, in terms of upgrading current Healthcare frameworks applications from Pega 6.3 to Pega 7.1
• Certified professional in US Healthcare EDI Transactions of Healthcare Management
• On site experience with IHealth Technologies and BCBS North Carolina. Having good hands on experience in US- Health Insurance, Healthcare Providers and Clearing houses includes current regulatory issues like HIPAA compliance, NCPDP D.0, 5010 and ICD 10.
• Currently working on Payment Policy Systems for Payers

  Worked as Subject Matter expert for end to end Solution Implementation of US Healthcare Regulatory Systems for HIPAA 5010 for US Healthcare Payers

• Specialized in Cardiology, Internal Medicine, Durable Medical Equipment, Radiology, Neuro Surgery & Spine, Orthotics & Prosthetics.
• Strong on domain knowledge- Healthcare Insurance & Life sciences, Claims processing system, Pharmacy Benefits Management (PBM) and ITS applications.
• Strong in Pharmacy Benefits Management (PBM), Prescription Drug programs, Pharmacy/ Rx claims processing, Formulary contracts, Rebates with drug manufacturers, National Council for Prescription Drug Programs (NCPDP), PBM EDI/ HIPAA/ X12 Transactions, Medicare, Medicare Supplemental & Subrogation, Predetermination of benefits and Claims Adjudication systems.
• Good experience in Professional and Institutional claims Process and adjudicate Medicare Part-A, B, C & D Claims and Commercial Claims
• Strong in SDLC, Software testing methodologies, test process, testing life cycle, test coverage, test scenarios, defect reporting and different QA/ testing approaches.
• Participated in Business walkthroughs and Inspection with Customer and able to do reviews on System Test Plan, System Test Cases, Test scenarios and System Test Results.
• Strong in requirements gathering, Analysis, Use cases, preparation of Business/ System requirements.
• Interacting with the client for requirements gathering and analysis and Responsible for creating Business flow diagrams, High Level Diagrams using MS Visio 2007.
• Responsible for planning and scheduling certain aspects of the project and preparation of the project plan using MS Project.
• Prepared POC (Proof of Concepts) for the modules in Axure (Prototype Software) at the time of finalization.
• Preparing requirements and functional/Technical specification documents preparing documents like Test cases, Test plan for unit and system integration testing, product brochures, deployment manual, etc.
• Expertise in Software Requirement Specification (SRS), User Acceptance Testing (UAT), and Data Flow Diagram (DFD)

TECHNICAL SKILLS

Tools: Axure, iRise, MS Visio

BPM: Pega 6.3, Pega 7.1, Enterprise Architect

Languages: UML

Database: MS Access, SQL Server 2005

Technologies: Web Services

Project Management Tools: Jira v7.13.1, confluence, Pega Project Management Framework(PMF), MS Office suite( MS Word, MS Excel, MS Power Point, MS Visio MS Project), Enterprise Management

Bug Tracking Tools: Pega Quality Director(PQD)Bugzilla, Elementool

Operating Systems: Win NT 4.0, Win 2000, Windows 2003, Windows XP, Vista SP1 &7

PROFESSIONAL EXPERIENCE

Pega Lead Business Architect & Pega UI Expert

Confidential

Responsibilities:

• Involved throughout the product lifecycle to ensure the delivered product meets the functional requirements specified by the business requirements
• Ideas Generation: Participate in Idea Conception / Brainstorming session with Product
• Owners and other respective stakeholders to enhance Solution Central Customer Service
• Application to address business challenges and empower CSR community to best address Member inquires.
• Coordination with PO (Product Owner): Work closely with Product Owners in defining and prioritizing the requirements (User Stories).
• Planning / Sizing / Execution: Participate in Project Planning, Sizing and executing the
• Collaboration: Planning and execution of Daily standup meetings, Defect Status meetings, Project Status meetings and Release Retrospective meetings.
• Functional and Regression Testing: Preparation and/or Review of test cases to ensure complete test coverage of all the modules. Perform functional testing and making sure all the bugs are resolved.
• Backlog Grooming: Participate in Backlog grooming activities and pick up the Bugs/Stories priority-wise and resolve/develop the bugs/stories respectively as per the release plan.
• Healthcare SME (Subject Matter Expert) - Domain Trainings: Provide detailed KT on requirements to Dev and Test teams and resolve any queries raised by Dev/Test teams in terms of functional understanding.
• Status Reporting: Prepare regular status reports and help senior leadership in assessing the project execution status.
• User guides: Prepare user guides for the modules owned.

Confidential

Principal Business Architect & Pega Developer

Responsibilities:

• Involved throughout the product lifecycle to ensure the delivered product meets the functional requirements specified by the business requirements
• Interacted with product requirements to architects, engineers, development managers, product managers, developers and testers
• Worked with Development Managers, Program Managers, and Architects in scoping and sizing of projects.
• Provided oversight and direction during the Framework Development
• Active participation in PRPC development to make the frameworks more intuitive and user friendly. Healthcare Frameworks
• Participating in grooming session with product owners by sharing our thoughts, industry best practices to identify and freeze User Stories
• Collaborating with Sales and frameworks teams from the perspective of Domain Inputs, Client Interactions, Client Requirements Understanding and mapping them back to our respective frameworks
• Conducted periodic domain session to share domain knowledge and understanding
• Ongoing activity to identify PRPC gaps and enhancements in terms of Business User experience

Confidential

Business Analyst

Responsibilities:

• 3 Month onsite for due diligence on Legacy systems, EDI Gateways, Claim Adjudication Systems and Interactions with multiple stake holders from EDI Quality Assurance and UAT departments
• Preparing Project Initiation document(PID) and presenting to stake holder for approval to kick start the projects
• Performing gap analysis, impact analysis and requirement gathering from key stake holders
• Preparing requirements and functional/Technical specification documents preparing documents like Business Requirement Document, Functional Requirement document,
• Preparing Contextual Diagram, sequence diagrams, flow diagrams using Business Process Modeling Notations(BPMN)
• Hands on experience in using Microsoft SharePoint Confluence for all the project related artifacts
• Documented Test Plans that contained test scripts, test cases, test data and expected results for the User Acceptance testing.