SUMMARY

• 6+ years of IT and Management experience in Software Development Life Cycle (SDLC) and Project Life Cycle working as Business/Quality Analyst in Healthcare domain.
• Followed the Agile methodology, Service Oriented Arch. (SOA) methodology, RUP and extreme programming concepts of project development. Analyzed and incorporated User Stories in different release plans for the sprints in Scrum process.
• Business requirements gathering and documentation.
• Developing Use Case Diagrams and creating Use Case Specification Documents (USD).
• Worked with various Rational tools like RequisitePro - Requirement gathering/maintenance, Use Case document maintenance, ClearCase- version control and ClearQuest/TestDirector for bug tracking, Rational Rose for Use case diagrams, Sequence diagrams and activity diagrams.
• Experienced in developing functional specifications through JAD sessions and user interviews.
• Experience with dimensional modeling and analyzing scope of changes in different phases of the datamart development efforts.
• Worked in ETL environment involving Informatica/DataStage and Business Intelligence tools like Cognos, Business Objects.
• Worked with various teams and data-architects to come up with processes in Dev/QA/Prod for extraction, transformation and loading the data into the datamarts. Documented all the involved processes - how they would be started/stopped/upgraded/removed/restarted etc.
• Designed, documented, tested and maintained various web-based project using PHP, MySQL, Javascript, XML, HTML and CSS.
• Actively involved in developing, executing and managing User Acceptance Testing (UAT).
• Experience with best practices and structured QA methodology.
• Command in Mercury Quality Center writing Test plans, executing and tracking the defects.
• Experience executing test cases and doing Ad Hoc Testing, Regression Testing, System Testing, Smoke Testing, logging defects and tracking to resolution.
• Efficient in MS Project/MS Excel for planning/status reporting/writing test scenarios.
• Expertise in managing multiple projects and teams with an excellent track record.
• HIPAA compliance and 21 CFR Part 11 code of federal regulation for electronic records and electronic signatures.
• Claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors.
• EDI automated claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
• Enrollment, Disenrollment, Eligibility verification for members and providers, benefits setup, and backend payment cycle.
• Trizetto QNXT system implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs and proprietary format files and Reports development.
• Configuration of claims adjudication systems, i.e., Amisys, Facets, QNXT.
• BlueCross BlueShield, Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, 837, 997 for interfaces and images to third part vendor applications.

TECHNICAL EXPERIENCE

Process/Modeling Tool: Software Development Life Cycle (SDLC), MS Visio, Rational Rose, Rational RequisitePro, Rational ClearQuest, SSIS, SSRS.

Operating System: Windows 7/Vista/XP/2000/98/NT, Unix, MS DOS

Office Tools: MS Office 2010/2007/2003/2000, Word, Excel, Access and PowerPoint, OneNote

Project Management: MS Project 2007/2003/2000

Databases: MS SQL server, DB2, MS Access, MySql, OracleLanguages HTML, XML, C, C++, Visual Basic, .NET

Testing Tool: Mercury Quality Center, ClearQuest, QTP, TestDirector, TestLog, WinRunner, LoadRunner

Reporting Tool: BOU, SSRS, Crystal Reports, Internal internet-based reporting tools

Others: Computer Networking, Hardware Configuration and troubleshooting ClearCase, MS SharePoint, RequisitePro.

PROFESSIONAL EXPERIENCE

Confidential, Nashville, TN

Sr. Business Analyst

Environment: QNXT 4.71/5.01, SQL Server Management studio 2008, SSRS, Microsoft Outlook 2007/2010, Microsoft Office packages 2007/2010 (Word, Excel, Visio, OneNote, PowerPoint), Microsoft Lync (communicator), TestLog V3.0, SharePoint, InterCall Unified Meeting, Gentran, BMC Service Desk Express (SDE), Snagit 9, Adobe Reader XI, notepad, notepad++

Responsibilities:

• Deal with Business users, SMEs to understand their business needs.
• Facilitate meetings, gather requirements and document it.
• Creation of BRDs, FRDs, Mapping Documents within QNXT and ODS domain, review documents and get signoff from business users.
• Perform impact analysis on various aspect of the project.
• Explained / helped developers, testers understand the requirements.
• Enrollment and Disenrollment of members (Excel, CSV, 834) into QNXT for new programs implemented.
• Implemented / Tracked enrollment process (Record Validation and Categorization, BEQ/BEQR processing, CMS (Accretion, TRR Load) processing, CASS Address Standardization Process) till it successfully gets loaded into QNXT.
• Implemented / Tracked post enrollment process
• Triggering of Plan Action into QNXT to generate ID Cards, Letters, Material requests, Welcome Kits etc.
• Data feed to RR Donnelly (Outbound letter file (OBF), Exhibits) for printing and shipment.
• Creation of Data Flow Diagram, prepared test scenarios for each steps, and tested thoroughly.
• Mockup reports templates and provided to developers to give clear picture of reports and to meet business expectation.
• Brain Storming, Researching, verifying, running and testing various types of SSRS reports:
• Premium Billing Reports - (Group Bills, Split Bills, Individual Bills), LIS/Retro Adjustment reports, CMS reconciliation reports, Manual Adjustment reports, Summary/Detail Reports, Enrollment Reports, Reconciliation Reports etc.)
• Load Reports - (Employer Group Client Service Report, Member Administrative Services (MAS) reports, Default Cancel Candidate reports, Bad Address Reports)
• MMAI/ICP/LTSS - (Reconciliation reports, Lookup report, Case/Appeal Reports, Disability report, OOA Disenrollment report etc.).
• Created / supported feeds to Emdeon for printing and dispatching of Bills to members and clients.
• Configuration of different programs, plans, attributes etc. into QNXT system.
• Wrote SQLs / StoreProc for various reporting purpose.
• Helped / conducted testing (unit, regression, UAT) in various aspect of project.
• Assisted creating SQL object in ODS tables.
• Provided logics for Type-2 slowly changing dimension (SCD) tables in ODS.
• Provided business logics to update existing tables/views in ODS / SXC environment to accommodate new business rules.
• Coordinate with ITOpts team and clients to define protocol for the transfer of the files via FTP process.
• Coordinate to setup Active Batch process to automate execution and triggering of various tasks in sequential order.
• Automate provider (PCP) assignment to member.
• Analyze, facilitate and supported during QNXT version upgrade.
• Measured the success/failure/demand for new or existing features.
• Wrote test plan document and execute test cases to perform system test in Excel and TestLog.
• Help resolving small to larger change requests, enhancements, defects.
• Create tickets/projects into SDE and assign to appropriate team, get necessary approvals, track them till completion.

Confidential, Hartford, CT

Business Analyst

Environment: Control Center (DB2 v9.7), SQL Server Management studio 2008, Microsoft Outlook 2010, Daise, Clear Case, Clear Quest, RequisitePro, Microsoft Office packages 2007/2010, Microsoft Lync (communicator), SAP Business Objects InfoView (BOU) enterprise XI 12.1.0, Decision support internet-based reporting tools (like AHIA, UWID, MCM, e.PSM)

Responsibilities:

• Conduct and facilitate JAD sessions, gather requirements, document requirement in meeting minutes.
• Wrote requirement document in business understandable format.
• Followed the Aetna Project Life Cycle (APLC) methodology for developing Aetna Information Systems (AIS) projects.
• Conduct Work Product Inspection (WPI), Work Product Review (WPR) and get signoff, using clear quest, for the documents from businesspersons, SMEs, technical teams, ETQAs and other stakeholders.
• Upload the approved documents and other supporting documents into clear case, using the APLC CM process, for version control.
• Schedule, run and analyze reports using a decision support and reporting tools (like Universal Web Information Delivery (UWID) for Manage Care Monitor (MCM), Aetna Health Information Advantage (AHIA), e.Plan Sponsor Monitor (ePSM)).
• Perform impact analysis for upstream applications, downstream applications, data mart (DM), reports, reporting systems and existing Enterprise Data Warehouse (EDW).
• Wrote technical specification documents (TSD) in daise and provide logic for creating Global lookups and Lookup tables.
• Wrote technical documents for Adhoc reporting (BOU).
• To explain the business requirements and rules to Developers and Testers.
• Reviewing the test plan, test case and suggest where applicable.
• Perform UAT testing and production support.
• Remediation of EDW ETL logics for different sources like HMO, ACAS, HUDA, APMCAS, Disability, ATV/eTUMS, for different downstream applications like MCM DM, MCM Standard Reports, UWID, AHIA DM, AHIA Gold, HWDM DM, MARS/MARS Workbench, ePSM/ePSM BoB, AHI/AHM, Lab Leakage, Clinical Apps.
• Tagging requirements using RequisitePro for tracing purpose.

Confidential, Chicago, IL

Business Analyst

Environment: Availity, Clarity, Lotus notes, Windows XP, HP Quality Center, Facets 4.51, Oracle 10g, MS Word, MS Excel, MS Visual Studio, MS Visio, Rational Rose

Responsibilities:

• Conduct JAD sessions with business users, stakeholders to analyze the business needs, requirement and resources.
• Created Statement of Customer Needs (SCN), Customer Requirement Document (CRD), Requirement Traceability Matrix (RTM), and gone through peer review with managers, SME and businesspersons.
• Created work flow diagram for better understanding of the system.
• Build and managing of test approaches and plans, that includes dropping claims, running payments, enrollments and mass adjudication.
• Creation and loading mockup data of members and their eligibility information into Facets, via front end and back end, and configuring/attaching plans and benefits to the members for testing purpose.
• Validation of member’s data, adjudicated claims amounts, estimates etc. results against Facets.
• Develop comprehensive test plans according to business, functional, and technical requirements.
• Use proficiency in test plan development skills and quality management software to manipulate systems to perform various testing techniques.
• Provide product testing and enablement expertise across configuration, development and test teams.
• Demonstrate mastery of writing and executing test plans, verifying results and escalating defects appropriately.
• Understand and analyze system impact during design reviews and product integration, and troubleshoot test failures.
• Use effective communication to share product and testing knowledge across configuration, development, and test teams.
• Troubleshoot problems found and validating against business rules.

Confidential, Honolulu, HI

Business System Analyst

Environment: QNXT 3.4, Team Track, Serena ChangeMan version Manager, PlanView Enterprise 2005, SQL Server Management Studio 2005, Microsoft Visual Studio 2005, Microsoft Office Outlook 2003, Office Communicator 2007, Windows XP, TIDAL

Responsibilities:

• Deal with Business users to know their specification and coordinate with project manager in order to implement it.
• Validate codes in QNXT using SQL Server.
• Import data into QNXT from other Data source table and flat files using SSIS package.
• Unzip and Import national standard codes provided by CMS, FDB etc into QNXT DB.
• Wrote, modified Store Procedures.
• Build code to extract data from QNXT Data Base and write into flat files.
• Used SSIS packages to integrate packages like source, destination, command lines etc.
• Responsible for testing the code and packages build.
• Unit tested the code, imported data and output flat files.
• Wrote test plan document and execute test cases to perform system test in Excel.
• Validate the extracted files in test environment to make sure it meets all the requirement, system testing.
• Validation of Taxable and Non-taxable codes to claims.
• Drive through development to production.
• Used Tidal to automate and schedule the import and export process.
• Build separate extracts to Captiva, different system, with their separate flat file specification format they use.
• Implementation of the ANSI X12 involving 837 HIPAA compliance and 835 Remittance Advice.
• Debugging errors at the time of adjudication 837.

Confidential, St Louis, MO

Business System Analyst / Quality Analyst

Environment:MS Office Tools, UML, Ms Visio, MS-SharePoint, Windows XP, Trizetto QNXT 3.4, SQL Server 9.0, Oracle 9i, DbVisualizer 6.0, TIBCO, DataStage, Win SCP, AppworX, CommandReciever, Version 1, Mercury Quality Center 9.2.

Responsibilities:

• Analyzing and understanding the Business Requirements Document (BRD), Technical Specification Document (TSD), Mapping Documents to write test cases.
• Validate the Outbound file based on the TSD and Mapping Documents.
• Tested the loading of member/enrollments/provider/claims data into QNXT 3.4.
• Scheduled meetings with Various Teams
• Verified Log files, Data sets and Reports
• Performed Functional, Integration, Regression, Smoke and Business Scenario testing and Recorded/updated defects in Quality Center.
• Participated in Walk Through and Defect report meetings periodically.
• Discussing and putting forward with possible solution for the issues that arises while testing.
• Troubleshoot problems found and validating against business rules in through QNXT GUI and QNXT Database through SQL.
• Tracking job status after triggering job through AppworX manually and following execution process in TIBCO, till file gets generates.
• Involved in detail Production testing.
• Working closely with User group and Developers.
• Follow-up with QA team and lead them to chase deadlines and troubleshoot the problems, if any, periodically.
• Coordinate with the data conversion team, Trading partners, SME during the development, test, and reconciliation process and post implementation QNXT and legacy systems data to ensure accuracy and consistency.
• QNXT Configuration and Maintenance/QA Activities included: Addition/Removal of AUTHs/CPT/HCPCS/Rev/ICD 9/Procedue codes/Custom fees/Restriction and Service Groups in a Benefit/Contract term. Also, addition and updating of Contract Terms (Change in reimbursement fees like daily rates) with the state specific revised rates of fee schedules.
• Troubleshoot any problems found within QNXT and when testing the SQL data database while validating against the business rules.
• Used the Agile methodology to build the different phases of Software development life cycle.
• Supported the business and the technical team in the product development and delivery process and successfully managed cross- departmental relationships.
• Used sqls to test various reports and ETL load jobs in development, QA and production environment.
• Actively participated in all phases of testing lifecycle (Design, Planning, Development and Results).