SUMMARY

• Over 7 years of extensive experience as a Business Systems Analyst / Test Lead with a solid understanding of Business Requirements Gathering, Business Process Flow and Business Process Modeling in diverse modules in Healthcare (Provider/Payer) domain
• Demonstrated skills in conducting the GAP Analysis throughout the projects by evaluating/ analyzing the existing standards and policies to determine needed improvements
• Managed multiple cross - functional project teams composed of SMEs, business and I/T technical analysts
• Provided leadership to develop high-level & detailed business, functional and technical requirements
• Adept at creating, editing and coordinating extensive communication networks (facilitation of joint application design (JAD)) sessions and interviews, implementation requirements, project status reports, project impact analysis, request for estimates, oral presentations and email to keep executive staff and team members apprised of goals, project status, resolving issues and conflicts
• Strong knowledge of Business Intelligence with expertise in grasping transaction flows and processes
• Extensive knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), ICD-9, ICD-10, Portals (Broker, Member, Provider, Employer) and HIPAA EDI transactions (837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claim status response), 820 (enrollment), 834 (premium payments), 997 (Acknowledgement) ) and HL7
• Knowledge of Test Scripts to implement and execute the Test Procedures using Test Director and Automated Tests using WinRunner, Quick Test Pro
• Experience working with both Commercial and Government managed Medicare and Medicaid business models (MMIS)
• In-depth knowledge of HIPAA Transactions mapping and HIPAA framework. Strong experience transacting with Healthcare EDI standards - ANSI X12 v, 835/837, 270/271, 276/277 formats
• Proficient in authoring Business Requirement Document, User Interface Requirement Document, System Requirement Document, Narrative Use Cases, Standard Operating Procedures (SOPs), Sequence Diagrams, Activity Diagrams, other UML based diagrams, Required Traceability Matrix (RTM)
• Excellent Knowledge in Electronic Medical Record (EMR) / Electronic Health Records (EHR) modules and process flow
• Expertise in Healthcare Data warehousing, MS BI tools (SQL server Reporting/Analytical tools)
• Expertise in client site coordination that involves understanding business requirements, day to day client interaction, offshore knowledge transfer (KT) activities, onsite status call coordination, achieving project deadline and worked as a team with business partners and data customers
• Expertise in reviewing Test Procedures, creating Test plans, defining System & Integration Test Cases, executing Test Cases, Test Data reviewing, maintaining and executing detailed Test scripts for User Acceptance Testing (UAT), analyzing bugs, interacting with team members in fixing defects
• Experience with Healthcare systems, HIPAA compliance applications and electronic exchange guidelines
• Experience with Eligibility, Benefits, Claims, ID Cards, COB, EOB, Deductible/OOP modules of Healthcare
• Experience with claims process and adjudication in the Medicare (Part A, B, C and D), Medicaid & Private Insurance Sectors
• Experience in providing US Health Insurance domain and system training, mentoring other internal Business Analysts and Entry level freshers

TECHNICAL SKILLS

Languages: C, C++, Java Script, SQL, HTML, XML,PL/SQL and COBOL

Databases: Oracle, MS SQL server, MS Access, DB2

Tools: MS Office (Word, Excel, Project etc.), iRise, Caliber, Visio, Adobe Acrobat Suite

Quality Management: Test Director, WinRunner, LoadRunner, Rational Rose, Quality Center, RequisitePro, Clear case, Quick Test Professional, Clear quest

Platforms: Windows, Unix, Mainframe

Reporting Tools: Business Objects, MS Excel, Oracle BI Discoverer, OBIEE, Crystal reports

Data Modeling/Mapping tools: EDIFECS, BizTalk, GENTRAN, MERCATOR, CLAREDI & EXTOL

Other Tools: Community Manager (Oracle AS Portal), EMC Documentum eRoom

PROFESSIONAL EXPERIENCE

Confidential, Buffalo, NY

Business Systems Analyst

Responsibilities:

• Involved in analysis and risk assessment of EDI transaction sets based on a 834 companion guide
• Analyzed, documented and managed all EDI requirements and changes to requirements throughout the software development lifecycle
• Completed HIPAA X12N EDI QA testing of 834 Enrollment transactions for Employer Health Plans. Utilized CLAREDI testing/certification software
• Developed a System Test Plan for the 834 Enrollment transaction - Inbound / Outbound (included test scenarios, test cases and test scripts). Utilized Extol EDI mapping translator
• Developed detailed understanding of Health plan Enrollment and Maintenance (ANSI X12 834) file specifications under HIPAA framework
• Used Facets to receive 834 inbound files and processing of the files across different modules in the application
• Conducted user interviews, attended JAD (Joint Application Development) sessions, created agendas and documented analysis in requirement gathering
• Reviewed errors and EDI transaction reports and analyzed information for trends
• Updated and maintained all reports for different errors and EDI transactions related to the inbound 834 files
• Verified and validated data model with changes to business rules related with ANSI file feed
• Worked on different EDI scenarios for batch processing
• Analyzed and reviewed existing practices, methods, and formats to create Source-to-Target mapping documentation and documented several Source-to-Target data flows
• Participated in data modeling; planning, designing, implementation of the data warehouse (ETL) and conducted testing
• Created and managed project templates, use case templates, requirement types and traceability relationships
• Performed Gap analysis on EDI - X12 data elements captured by the existing against the new system
• Conducted Business Process Services and Workflow Analysis in the eRoom EMC Documentum (Content Management System)
• Assigned Service desk tickets, issues, problems and defects to appropriate software development team for fixes

Environment: Business Objects, SQL Server, XML, MS Access, MS Office, Lotus Notes, Eclipse, OBIEEDocumentum eRoom, CLAREDI, Extol, Facets, HP Quality Center, Quick Test Professional

Confidential, Atlanta, Georgia

Business Analyst

Responsibilities:

• Incorporated Rational Unified Process (RUP) to create Software Requirement Specification using MS Visio and MS Word and Business Process Modeling Language (BPML) to create business process, Swim lane diagrams and Business Process Workflows
• Conducted JAD sessions with management, SME, vendors and other stakeholders for open, pending and critical issues
• Responsible for allocating resources and maintaining Work Breakdown Structure (WBS) using Clarity
• Provided resolutions relative to EDI implementation, transmission protocols and Value-Added-Networks (VAN) communication problems
• Gap analysis and structured walkthrough of workflow with Automated Enrollment team to identify and fill the gaps
• Helped redefine existing practices, methods, and formats used in creating source to target mapping
• Ensure day-to-day EDI transmission, Reject tracking and Reconciliation
• Maintained the Issues Log used for UAT in Rational Suite (Content Management System)
• Researched in determining the reporting tool, and the allocation of direct access to backend tables for real-time Adhoc Reporting and analysis
• Made the necessary systems changes to in corporate X12 834 changes into the business processes
• Identified data element gaps and documented workflow of X12 transaction sets
• Prepared Software Project Design Document (SPDD), Test Plan, Test cases, Project plan, Lessons Learned Document and various other documents related with the SDLC
• Performed testing and quality control checks on the mapping specifications and EDI requirements
• Planned and defined system requirements to Use Case, Use Case Scenario and Use Narrative using the Business Process Modeling Notation (BPMN)
• Received and Sent transactions/data to the Application and verified the output with Input using the Data Requirements, Data map and EDI Standards
• Played a major role in Unit testing, System testing both functionally and manually by writing test cases and validating them

Environment: Crystal reports, SQL Server, XML, MS Access, MS Visio, MS Office, MS Excel, OutlookClarity, EDIFECS, Rational Rose, Requisite Pro, ClearCase, ClearQuest

Confidential, Buffalo, NY

Business Analyst /Test Analyst

Responsibilities:

• Lead the Portal team in delivering solutions and delegated responsibilities and designed time schedules at a Project Level
• Worked on consolidating all the benefits, service types and categories to be displayed on the Portal through EDI 270/271 transactions
• Analyzed extensively on the detail level information of benefits coding to determine the rules to display the data on Portals
• Determined the impact of program changes on the business case and reforecast value creation and document in monthly program performance review
• Provided technical leadership to the enterprise for the analysis of data and mapping web services to the source system
• Documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders
• Created Web Portal 270/271 Business requirement document, Technical specifications, User Interface document, and Test cases (HTML inquiry & XML response) using Quality Center
• Developed (55) test case scenarios for Web Portal 270/271 (HTML inquiry & XML response).
• Played a major role in Unit testing, System testing, Regression testing functionally and manually by writing test cases and validating them
• Analyze current and future business flows by creating mockups using iRise
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle
• Developed a System Test Plan to receive, authenticate and process a 270 Eligibility Inquiry Request to verify an individual’s eligibility for covered health care benefits and to respond to the provider with a 271 Eligibility Response
• Incorporated Rational Unified Process (RUP) to create Software Requirement Specification and Standard Operating Procedures using MS Visio and MS Word and Business Process Modeling Language (BPML) to create Business Process Workflows
• Completed a HIPAA assessment & remediation plan for HIPAA EDI X12N Transaction Sets and Code Sets and the HIPAA Final Security Rule
• Conducted JAD and Joint Requirements Planning (JRP) sessions with management, SME, vendors and other stakeholders for open, pending and critical issues

Environment: Facets, MS word, MS excel, MS Visio, SnagIt, SharePoint, Informatica, MS ProjectIRise, File aid, Certify, Mercury- Test Director, Quality Center, PL/SQL

Confidential, Louisville, KY

Business Analyst

Responsibilities:

• Lead the team in delivering solutions and delegated responsibilities at a Project Level
• Partnered with Business to understand current process and help defining scope
• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders
• Worked on integration of Portals (Broker, Member, Provider, CPW, UCSW) with CPL by gathering requirements, implementing single sign-on functionality, creating mockup screens and navigation flows
• Created Business requirement document, Technical specifications, Test Plan and Test cases using Mercury- Test Director, QTP
• Played a major role in Unit testing, System testing both functionally and manually by writing test cases and validating them
• Analyzed current and future business flows by conducting data mapping and data analysis using TOAD
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle
• Incorporated Rational Unified Process (RUP) to create Software Requirement Specification using MS Visio and MS Word and Business Process Modeling Language (BPML) to create Business Process Workflows
• Conducted JAD and Joint Requirements Planning (JRP) sessions with management, SME, vendors and other stakeholders for open, pending and critical issues
• Conducted Gap analysis and structured walkthrough of workflow with Actuaries and Underwriters to identify and fill the gap

Environment: Mainframe, MS word, MS excel, MS Visio, TOAD, Facets, Clarity, InformaticaMS Project, COBOL, Mercury- Test Director, QTP, Siebel