SUMMARY

• Product Manager/ Business Analyst with about 8 years of experience in IT and software projects in Healthcare. Involved in various projects for Integration, Migration/Conversion, Configuration and Production Support.
• Worked extensively on Business Analysis (Enterprise Analysis, Requirements Elicitation, Requirements Analysis & Documentation, Communications, Solution Assessment and Validation).
• Delivered high quality functional and non - functional requirements using Business requirements documents, process flows, user stories, Acceptance Criteria, data flow diagrams.
• Facilitated strong communication with Vendors, Client and the Business Owners across all the departments. Also facilitated JAD and JAR sessions for requirements generation, Scrum stand-ups, Scrum Retrospective sessions.
• Managed projects in healthcare across all lines of businesses (Medicare, HMO, PPO, CHIP, Medicaid) and Pharmacy data (PBM) with prime focus on claims adjudication, provider, Eligibility, Payments, enrollment data.
• Proficient in unified modeling language (UML) tools such as MS Visio, Rational Rose and Requirement Management tools such as Rational RequisitePro.
• Experience with data mappings including ANSI 4010A1 835, 837I, P,D, 276/277, 820, 834, 270/271
• Have experience working with IT Applications EDIFECS Ramp Manager, EDIFECS Spec Builder, EDIFECS Transaction Manager, Ops repository, Team foundation server, Health Rules Manager developed by HealthEdge, Transsend by Axiom
• Effectively been involved in conducting Business Analysis, scope identification, requirements gathering and analysis, feasibility analysis, gap analysis, risk analysis - mitigation plan, release management and Training to end users.
• Generated clear and concise documentation and communicated effectively to business users and project management team across all phases of the project.
• Performed Business Analysis related activities like scope identification, requirements gathering and analysis, feasibility analysis, gap analysis, risk analysis - mitigation plan, release management and Training to end users.
• Interfaced with outside vendors: Optum, CMS, First Recovery Group, Crimson, Bswift, Softheon, Vitals, and Axiom.

TECHNICAL SKILLS

Requirement Tracking: Methodologies Waterfall, Agile/Scrum

Performance Testing Tools: Rational Suite Performance Studio

Operating Systems: MS Windows NT/98/2000/XP, UNIX, iOS

Web/Design Tools: HTML, XML, MS Front PageDatabases SQL Server

Office Tools: MS Word, Excel, MS Outlook, Team Foundation Server, MS Visio

Applications: HealthRules - HealthEdge, Transaction Manager - EDIFECS, Transsend - Axiom

PROFESSIONAL EXPERIENCE

Confidential, Austin, TX

EDI Product Manager

Responsibilities:

• Have worked on multiple projects apart from the ones mentioned above during my tenure with FirstCare.
• Have been involved in projects involving all lines of businesses (Medicaid, Medicare, Commercial, Exchanges)
• FirstCare has been using a Legacy system AMISYS and the data is currently in the process of migration to a new application HealthRules developed by HealthEdge Solutions.
• Started off working on Waterfall SDLC methodology and are working towards switching to Agile/Scrum Methodology
• Responsibilities include interacting with the client for data compliance and gathering requirements
• Weekly/Daily Standups and Scrum meetings with Webex/Lync sessions are scheduled to discuss the requirements/concerns/issues
• Team Foundation Server developed my Microsoft is used to track the changes and updates in the respective sprints
• As a Product Manager, I have had the responsibility of prioritization and allocation of projects, tasks, issues/bugs, enhancements and Production support
• Interact with the clients and business to develop user stories and acceptance criteria’s
• Conduct scrum meetings with the team on a daily basis to track the progress
• Create process and data flows to depict the exchange of data between the two systems using UML tools like MS Visio
• Create tasks, bugs and issues to track them and address any outstanding issues
• Performed SQL queries to have data base knowledge that helped us in identifying data issues
• Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis. This helped immensely in identifying the configuration issues that had occurred during the process.
• Work with the development team in generating extracts in a timely manner.
• Created documents, incidents, changes and releases in SAMNAGE for moving the processes for tracking, sign offs, approvals and deployment.
• Triaging the service now tickets to the respective owner and tracking the progress
• Monitored project status to ensure progress toward completion, required procedural steps are completed fully and timely, interested groups and individuals are informed of progress, and project output is appropriate
• Responsible for documentation, change management, configuration issues, requirements, process flows, and data flows.

Confidential, Chattanooga, TN

EDI Specialist/ Business Analyst/ Command center Lead

Responsibilities:

• Currently involved in migration of TPG (Trading Partner Gateway) to Sterling Gateway which is scheduled to go live on 7/1/2013.
• Involved in the mapping changes w.r.t the migration and defects
• Capturing EDI data for 837, 835 and 277 claims.
• Electronic Data Interchange (EDI) was the primary aspect of the project which revolved around claims processing and remits.
• Worked on the Healthcare Transaction Manager (HTM) supported by EDIFECS.
• Transaction Manager, Ramp Manager, Spec Builder, Ops Repository are some the tools that have been used during my tenure in this project.
• Worked mainly on the mapping specs for converting X12 and CCF to various output formats, Claim engines and Business rules
• Converting the output formats (within Confidential ) into readable formats using tool called “Testers”
• Performed requests to IBOR (Individual book of records) i.e present within Confidential for Business rules using SOAP UI.
• Coordinate with the business from IBOR and CBOR (Claims book of records) present within Confidential on various scenarios
• Involved in the triaging and assigning tickets to various technical teams for resolution.
• Functional understanding of the client’s entire claims IT landscape along with the surround systems.
• Mostly involved in 837 IB/OB and 835 remits payments processing
• Involved in working with the technical teams and providing inputs
• Co-ordinate meetings and calls across multiple teams along with executive management.
• Conducting analysis and documentation of as-is capabilities about business processes, resources and technology in order to develop solutions for potential growth strategies
• Acted as liaison between Client team and offshore and delegated tasks
• Reviewing BSD (Business Specification Document) and liaising with onsite/client for issues through regular status update meetings and preparation of quarterly release management decks for consumption by senior management.
• Coordinate between various technical and business disciplines to gather, analyze, and assist in clarifying requirements needed for completion of the project
• Formulating and implementing recommendations, solutions and business process optimizations
• Preparation of a knowledge repository for account level business specific documents, collaterals and training material for new resources joining the account
• Working knowledge and understanding of code set and crosswalks in ICD9 and ICD10 formats.
• Involved in a few instances where I performed testing in SYT region
• Coordinates business relationships with defined trading partners.
• Develop EDI Maps according to Customer and Vendor Requirements.
• Troubleshoots EDI issues in HPSM
• Consults with users, management, and IT to implement EDI based tools in support of the business plan.
• Escalates critical issues through appropriate channels.
• Analyze and evaluate requirements for customer inbound and/or outbound mapping requirements that will facilitate customers EDI interfaces.
• Prepare detailed mapping specifications for development activities including reports, interfaces, conversions, enhancements, and forms.
• Facilitate knowledge transfer, communication and interaction between various functional organizations and the Information Technology department
• Experience building and maintaining in EDI maps

Confidential, MI

Sr. Business Analyst

Responsibilities:

• Conducted business needs analysis and assisted Project Manager in defining high level scope for the project proposals and created Scope definition documents.
• Responsible for owning complete requirements related activities on assigned project and related deliverables.
• Facilitated Vision workshops with stakeholders to help define and document business needs and solution vision.
• Conducted Scope analysis and gathered high level business requirements through various requirements elicitation techniques and created various scope and requirements models like Use Case Models, Process Models and Activity Diagrams.
• Conducted business process analysis and created business Process Models and Business Process Flow Diagrams.
• Involved in preparing"BRD"Business requirement documents for 5010.
• Prepared"FSD"functional specification document for 5010 from 4010A.
• Analyzed source and target data in MS Excel.
• Performed the detail comparison between 4010A and 5010 to identify differences across loop structures.
• Involved in gathering data and supported application development. Data includes patient's admission status, discharge details and transfers. Also tested claims and diagnosis reports of the patient.
• Examined clinical data to evaluate existing and/or potential trends as specified by scope of Health Care Requirement Analysis contracts.
• Extensive working experience with HIPAA transactions & code set rule
• Worked on EDI 835, 837, 270, 271 as per HIPAA guidelines.
• Conducted"JAD"sessions to understand detail requirements and performed"GAP"analysis.
• Involved in the data movement between systems and validating the business requirements.
• Followed the RUP methodologyfor the entire"SDLC".
• Actively participated in status report meetings and interacted with developers to discuss the technical issues.
• Performed"UAT"for 5010 and ICD 10 codes.
• Worked in testing the professional, institutional claims processing and adjudication and validate data withfacets.
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process and discuss areas of criticality.
• Tested data to check HIPAA implementation.
• Extensively involved in database testing by writing SQLqueries.

Confidential, New York, NY

Business Systems Analyst

Responsibilities:

• Gathering and reviewing the business requirements and working with Development and QA team for gaps found during the review.
• Analyzed business requirements and functional specifications for testing the application.
• Developed test plan to give a detailed approach of the testing that will be performed on the projects.
• Understanding the business requirements and developed Test scenarios and test cases as per process flows, business rules.
• Reviewed current use cases and process flows for business requirements.
• Responsible for the UAT for the entire application for system process functionality, business logic.
• Assisted in creating test data files for the HIPAA 837/835 (Claims Processing/Claims Payment), and 276/277 (Claims Request and Claims Response) transaction based on the ANSI X12N HIPAA standards
• Worked effectively on HIPAA 837 (Claims processing) EDI standards
• Communicated with Senior Business Analyst, Retrieve Requirement and Develop Test Scenarios and Test Cases from the Business Requirement.
• Performed Traceability matrix to match test scenarios to the requirements.
• Documented and communicated test results and status to the appropriate Analyst.
• Utilized project management methodologies to develop project deliverables.
• Analyzed and Researching test results based on the defined specifications to ensure all functionality, requirements, and business values are met.
• Conducted reviews of test efforts, scenarios, plans, and results to obtain sign off and approval from claims services department.
• Triggering pending claims, copying claims from Production to Test Environment and putting them through daily and weekly cycles.
• Analyzing Professional and Institutional Claims create claim level, line, and payment level out of Balance Reports under the Submitted Billing Provider Number.
• Validated the X12 files according to the 5010 standard.
• Used Quality Center powered by HP as a repository for all the test case scenarios, test cases, test results and defects.
• Maintained UAT Metrics and providing status updates to stakeholders.
• Attended various review meetings coordinated with the developers to resolve the defects, to discuss requirement issues, major defects found during testing, enhancement issues.