SUMMARY

• 9 years of professional experience as a EDI Analyst and an Enterprise Liaison between End Users and Technical Group, especially in Healthcare domain.
• Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software development methodologies.
• Expertise in developing Requests for Proposals (RFP), evaluating responses, and leading IT system selection teams.
• Extensive experience in identifying and documenting opportunities to integrate IT systems and resources to fulfill project requirements.
• Experience onEDIHIPAA 834, 835, 837 (D, P, I), 277/278 and other Health Care Transactions
• HIPAA transaction and code standards and electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.
• Experience with health care systems: QNXT, Medicare Part A, B, C, D, Medicaid systems etc
• Excellent Business writing skills in writing Business requirements document, Use Case specifications, Functional Specifications, Business Requirements Document (BRD), System Requirement Specifications (SRS), Test cases, Test plans, GAP analysis, Traceability Matrix, Workflows and Unified Modelling Language (UML) such as Activity diagrams, Collaboration Diagrams, Class diagrams and Sequence diagrams.
• Experience in coordinating sessions with stakeholders for documenting requirements, pain points, solutions and communicating with developers and business users for implementation, acceptance testing and sign off.
• Experience in facilitating and coordinating Joint Application Development (JAD) and Joint Application Requirement sessions (JAR) with excellent inter - personal and conflict resolving skills.
• Successful experience in communication skills both written and orally. Implementation of strong decision-making skills. Extensively involved in all the phases of SDLC, requirement analysis and Graphical user interface (GUI) business specification, development, enhancement, quality assurance, testing methodologies and implementation.
• Expertise in coordinating JAD Sessions, UAT cycles, specifically for mobile applications to help users understand the differences across various platforms and devices.

TECHNICAL SKILLS

Testing tools: Quick Test Pro (QTP), Quality Center,HP ALM, JIRA, Selenium (Web Driver And RC) Load Runner, SOAP UI, Simulator,TFS

Bug Tracking tools: Quality Center, Jira, Rally, Doors, TFS, Visual 2010, Octopus

Languages: VB, Java (JUnit), ASP.Net, C#., C++, HTML, XML, JASON

Database: PL/SQL, SQL DB, Oracle 10g, SQL Server 2005, TOAD 2005

App/Web Servers: Apache, Tomcat, Web logic, Web Spheres

Operating Systems: MS Windows 98/NT/2000/XP/Vista/7, Windows, Windows Mobile, Linux/Unix

Methodologies: Waterfall, Agile,SAFe

Management Tools: MS Project, MS Visio, MS Office

PROFESSIONAL EXPERIENCE

Confidential, Uniondale, NY

EDI Analyst

Responsibilities:

• Play an active and lead role in gathering, analyzing, and writing business requirements.
• Project is being implemented in phases, enabling system to deliver as many business requirements as early as possible.
• Involved in Requirement Scoping and analysis of high priority requirements for implementation.
• Work on Transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
• Work on HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 820, 278, 999/TA1, and 277 CA.
• Evaluate Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.
• Coordinate, implement and provide on-going support of the Quality Performer as outlined in the Specifications Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS).
• Use HP Quality Center for writing Test plans and Test Cases.
• Implement software development projects using methodologies such as Waterfall, RUP, and Agile Scrum.
• Use HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment.
• Work closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD).
• Develop Software Requirement Specification (SRS) document using Visio and MS Office.
• Work on Agile SDLC during the project phase, performed the role of Product Owner and Team member in Scrum Meetings.
• Participate in agile process - planned iterations, created tasks, assigned tasks to quality assurance team based on the priorities and estimated capabilities of quality assurance team for every iteration.
• Involved in Testing Out-Bound Transactions (835 Health care claims Payment, 277 Claim Status Response).
• Consults with healthcare third-party Administrator Company to develop conversion specifications for member, enrollment, and authorizations.
• Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed.
• Respond to billing inquiries from patients and payers.
• Analyze and study the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/ Advice).

Confidential, Portland

EDI Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed, while constructing new sites.
• Gathered high-level requirement for all the external projects in a release.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked on EDI transactions: X12,835, and 837 (P.I) to identify key data set elements for designated record set.
• Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category.
• Informatics was used for ETL process and Business Objects.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Performed Analysis on Data mapping between different data models.
• Developing a single application to process data from multiple integration points

Confidential, Plano, Texas

EDI Analyst

Responsibilities:

• Analyze client’s business needs and processes through document analysis, interviews and workshops.
• Conducting the tests including functional, regression, customer acceptance, integration and outcome analysis to ensure that the client’s needs are met.
• Communicate client’s business requirements by constructing suitable data and models.
• Provide input into developing and modifying systems to meet client needs and develop business specifications.
• Liaise between business and technical personnel to ensure a mutual understanding of various processes and applications.
• Develop business architecture using requirements such as scope, processes, alternatives, and risks.
• Rebuilt vendor relationships, increased consumer engagement and improved sales team performance.
• Revised purchase ordering algorithm to maximize efficiency and output.
• Review purchase orders
• Interview business clients to analyze their business requirements and design technological improvements to their business processes and various operational procedures.
• Developed process mapping of current and future business processes.
• Prototyped new procedures and trained new users on software enhancements

Confidential, Irvine, California

EDI Business System Analyst

Responsibilities:

• Administer, manage, and develop business system applications and technologies needed to support the Warehouse Operations process area.
• Develop detailed systems specifications based on business requirements. Lead the analysis, design, and testing of new enhancements and solutions, as required. Consult with other analysts and business users to identify current operating procedures and opportunities for improvement, and to clarify the related business requirements.
• Work with processes and practices in the warehouse operations process areas following applications/automation: WMS, TMS, SPS, PTL, Conveyor and other automation equipment.
• Participate in application development and testing enhancement and software defects.
• Ability to quickly understanding markets, technologies, economic structures and business requirements.
• Interaction with Business and IT: Work with business users during definition, design and implementation initiatives. Work and communicate with business and IT personnel in implementation and support activities. Implementation of new designs with in the Business Operating Model. Supply Chain modeling and advice on Planning Systems.
• Documentation: Develop and maintain system support documentation as required. Assist with user documentation for fixes and enhancements, if applicable
• Work directly with appropriate vendors during problem resolution and enhancement cycles.