SUMMARY

• Expertise and Versatile experience of Confidential to work in various Payers Systems like Trizetto Facets, TOPS, COSMOS, NDB, PEGA Customer Service, WEB Portals.
• Worked for many Commercial, Medicare, Medicaid, Blue cross plans.
• Having very strong domain knowledge of Confidential plans like: HMO, PPO, POS, EPO, Indemnity plans, Dental & Vision HMO, PPO plans, CDHP Plans - FSA, HRA, HSA, Medicare, Medicaid, COB and other functionalities.
• Having a good knowledge of Health insurance claims like 837I, 837P, Ub92, HCFA, Super bills, NCPDP V-D.0 etc.
• Well versed with Membership, Enrollment, Billing, Premiums and Provider data.
• Knowledge of ICD-9 & ICD-10 codes.
• Having a knowledge of Health Insurance Exchange (Public and Private) regards to PPACA act.
• Good functional knowledge of eligibility determination based on State mandated rules for Government sponsored health plans (Including the process of SSAP, Federal Hub, IRS and other sources)
• Knowledge of SDLC & STLC.
• Well familiar with Agile methodologies of Software Development and currently working on the same environment.
• Involved into grooming sessions with developer, scrum meetings, sprints, user stories development.
• Involved in development of Business need, Epic, User Stories and their associated tasks.
• Good interpersonal skills, commitment, result oriented hardworking with a quest and zeal to learn new technologies and undertake challenging tasks.
• Strong problem-solving skills.
• Worked in various roles like Business System Analyst, Business Analyst, Business Configuration in Facets (Products and Pricing both) in other legacy systems like TOPS, COSMOS, FACETS.
• Involved into development of Business Cases for various projects.
• Estimation of different projects - like Top-down, Bottom-up, Analogous.
• Qualitative and Quantitative risk analysis for the different projects.
• Core hands on experience in writing Business requirement documents or functional system design document.
• Involved into requirements gathering, elicitation and JAD sessions to develop the product for healthcare payers or States.
• Involved in writing BRD, DSS, SRD, RACI matrix other artifacts.
• Involved into Root Cause Analysis for different issues of the application.
• Involved into grooming sessions with developers and testers to develop and test the required enhancements.
• Involved into POC - Proof of concept in various functionality of Facets like Medicare supplemental, Medicare Advantage, Exchange implementation.
• Involved into grooming sessions with development team to make them understand the functionality and impact.
• Involved into UAT with customers before proceeding to post production.
• Involved in Providing KT to onshore and offshore development and BA team on Trizetto - Facets Business Segments or HIX-Individual
• Involved into develop writing test plans, business scenarios and helping testing teams to solve their configuration setup of Payer Systems.
• Providing the offshore support to the onsite account management team in the preparation of Business Presentations, Proposals, SOP’s etc.

TECHNICAL SKILLS

Packages: MS Office

Operating Systems: Windows Family, IBM Mainframes - (CICS Screens)

Automation Tools: QA - Hyperstation (Compuware), CTT, UTR

Performance Tool: Sql- profiler

Healthcare products: Trizetto Facets 5.01 and HIX Individual market place

Databases: MS Access, Sybase, SQL Server, DB2

Bug tracking tools: JIRA, Test-Director, HP-Quality Center

PROFESSIONAL EXPERIENCE

Confidential

Responsibilities:

• Involved into WLP Legacy Claims system migration to GBD Facets of Amerigroup.
• Involved into core business products requirements gathering, analysis and documentation of Medicare Advantage Products of Customer and Medicare Supplemental Products.
• Involved in Core Business Product configuration of Medicare Business.
• Solely responsible for project deliverables on time with the help of Dev and QA team to answer the Business Stakeholders.
• Providing support to Development team to help them out to understand the Business Functions.
• Analysis of system requirements and Defect Triaging.
• Analysis the requirement of Configuration and apply in the FA product.
• Involved into Benefits Configuration, Provider Contract Configuration in Facets with Unit Testing Scenarios.
• Involved into implementation of full cycle of Facets Benefits and Provider contract configuration from Analysis, implementation and testing.

Confidential

Product Owner - Implementation

Responsibilities:

• Involved into core business products requirements gathering, analysis and documentation of Medicaid LOB’s and Subsidies sponsored by state.
• Involved in Core Business Product configuration of Medicaid business
• Solely responsible for project deliverables on time with the help of Dev and QA team to answer the Business Stakeholders.
• Providing support to Development team to help them out to understand the Business Functions.
• Analysis of system requirements and Defect Triaging.
• Analysis the requirement of Configuration approach with enrollment process of trizetto facets and Exchange.
• Involved into implementation of full cycle of Products, Eligibility, Plans, and Enrollment with Facets integration from Analysis, implementation and testing.

Confidential

Business System Advisor

Responsibilities:

• Analysis the incidents of production and business functionality.
• Involved in writing Business use cases, BRD, SRS for assigned projects or task orders.
• Involved into Quality Process to track the whole project with CMMI guidelines under VSS.
• Solely responsible for project deliverables on time with the help of Dev and QA team to answer the Business Stakeholders.
• Providing support to Development team to help them out to understand the Business Functions.
• Analysis of system requirements and Defect Triaging.
• Analysis the requirement of Configuration and apply in the FA product.
• Involved into Benefits Configuration, Provider Contract Configuration in Facets with Unit Testing Scenarios.
• Involved into implementation of full cycle of Facets Benefits and Provider contract configuration from Analysis, implementation and testing.