SUMMARY:

• Over 7 years of Business Analysis experience in Healthcare industry.
• Extensive knowledge of MMIS claims processing for Managed Care Organization (MCO) and Fee For Service (FFS)
• Extensive knowledge of IBM Curam system solution for Eligibility and Enrollment
• Deep knowledge and expertise on the Confidential (Curam Based Application Suite) working with clients and other system integration partners on requirements definition/elaboration, functional design, fit/gap, and testing.
• Experienced in writing Confidential scripts using the IEG2 editor, curam data mapping, work queue provisioning within Curam 6.0 framework.
• Curam Citizen's Account configuration and hands on Life Events within Curam 6.0 framework.
• Worked on Ant scripts for building Curam Application.
• Experiences in using modeling tools Rational Software Modeler (RSM) and IBM Rational Modeler in various Curam projects.
• Experienced with J2EE technologies using Java, Servlets, JSP, JSTL, Tag Libraries and JDBC
• Experienced with XML related technologies such as XML, DTD, SAX and DOM.
• Functional experience in health Care Industry with vast knowledge on Confidential and Medicaid.
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
• Experience in IBM Curam Framework, Document Management,Social Security, Health Care applications and Insurance domain applications.
• Experience with Healthcare claims process, EDI transactions, EMR (Electronic Medical Records), DSM (Direct Source Messaging) HiPAA (Health Insurance Portability Accountability Act), EOB, ANSI 837 UB92, 5010, HIX. Well versed in project management tool (MS Project) for status reporting, planning and resource allocation.
• Work with Curam Software V 6.0 to implement eligibility system.
• Worked on bug tracking reports on daily basis using JIRA.
• Expertise in integrating CA Wily Introscope 8 and APM 9 to WebSphere Application Server
• Experience in IBM Curam Social Program Management v5.2 SP3, v6 and v6.0.5.4

TECHNICAL SKILLS:

Language: Java, C++, C, HTML, JavaScript, AJAX, XML and SQL

J2EE Standards: Web Service and SOAP, Servlet, EJB, JDBC, RMI, JSP, JAXB, OO Analysis & Design (UML).

Open Source Framework: Eclipse, Struts, Spring, Hibernate, Ant.

Products and Tools: Worked extensively with WebSphere Application Server, WebLogic, Curam, SAP BOE 4, Crystal Report 2008, APOS Manager, Rational Application Developer, Rational Software Architect, Eclipse, SVN, CVS, MQ Series, LDAP, DB2, Oracle, AIX, Solaris and Linux.

PROFESSIONAL EXPERIENCE:

Confidential, St Paul, MO

Sr. Curam Business Analyst

Responsibilities:

• Understand the gap between the Confidential functionality and state requirements.
• Involved in the Interface testing for the Federally Facilitated Marketplace Eligibility.
• Testing in and running the Payload received from FFM to Confidential using SOAP UI and verify the payloads data against the Federal Exchange table
• Tested optimum functionality of Eligibility Coverage determination for MO Health Net for insurance coverage plan namely MHF, MPW, UWHS, MHK and CHIP Cases.
• Attended weekly defect report meetings and presented progress reports to senior management.
• Experience in Oracle RDBMS database testing using PL - SQL queries in TOAD.
• Conducted Functionality and Regression testing during the various Sprints of the application using Rational Functional Tester (RFT)
• Logged defects using JIRA, research the origin of errors and recommend bug fixes.
• Validate the MMIS Files and running the batch process using JENKINS and Tridal.
• Testing and running the Payloads received from FFM to Confidential using SoapUI and verify the payloads data against the Federal Exchange table
• Tested web services (Information services) like Verify SSA Composite, Verify Medicaid Coverage Service, and Verify Annual House Hold Income using SoapUI.
• Extensively used SoapUI to validate the services and data flow through the systems and Federal Data Services HUB.

Confidential, Milwaukee, WI

Business Analyst

Responsibilities:

• Gathering, eliciting and analyzing requirements using Use case design documents, flow charts and class diagrams.
• Comprehensive understanding and analyzing of Curam Case Management functionality and associated business processes of a Social Security organization along with working on the SOP.
• Worked with various teams on the Confidential and other system integration partners on requirements definition/elaboration, functional design, fit/gap, Confidential configuration, and testing usually UAT and other testing like smoke, sanity, performance, conversion testing and regression testing.
• Responsible for defining the scope of the Renewal project and implementing business rules for the project involving both Medicaid and Confidential .
• Provided major information on the Cúram data model and explained entities and attributes in the model and the relationships between them following the SDLC life cycle.
• Create test cases using the IBM Curam Application tool for both Confidential and Confidential regions with the help of Confidential
• Worked extensively on both the Case worker and Citizen Portals for creating cases
• Coordinated with the MMIS, Health care Eligibility and Operations ( Confidential ) teams to help process delayed renewals and keep track of defects through a master defect tracking list.
• Created several test cases in Case worker and Citizen portals using various scenarios related to health programs like MA/BHP/PTC/QHP and Confidential part A through D.
• Reported Application tool defect during making of Test cases in Confidential and Confidential regions.
• Helped write JIRAs (defects) and PMOs(change requests) with the Eligibility/Enrollment Team so that the defects could be fixed and thereby enhance the use the IBM application tool.
• Played a great role running batches in Pseudo Prod and report cases that have not gone through with the team so that the issue could be escalated and JIRAs could be written.
• Dedicated IT Support skills when ever needed along with ETL, Oracle, Oracle PL/SQL, Scrum, Agile, Software Design.

Confidential

Business Analyst /IBM Curam

Responsibilities:

• Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance.
• Business knowledge in Group Insurance and Behavioral Health domains, Social Security Child and Youth Service on IBM Curam Application.
• Worked Extensively on CURAM 6.0.5.3 IFIX 6 HCR portals Universal Access As well as case worker Portal.
• Facilitated meetings and interviews with the client and subject matter experts to gather and/ or define requirements.
• Conducted JAD session to gather the requirements.
• Knowledgeable with all components identified and contribute to the documentation of the associated screens, batch jobs, interfaces, correspondence, and business logic and rules.
• Identify Member, Provider, Coverage, Confidential, and Medicaid.
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Developed functional designs associated with the extensions.
• Performed analysis of current operations with IBM Curam Healthcare Reform Case Management.
• Test Mobile application on various Mobile devices like navigation, UI, self provisioning/campaigns.
• Translate business needs into functional requirements to support process, organization and technology change
• Assist in obtaining business & technology sign-off on test scripts and execution plan
• Processed Medical claims and applied edits to the claims for testing purposes. Experience in business process analysis and mapping with in the Curam Application Suite.
• Develop requirements specifications according to standard templates, using natural language
• Collaborate with developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs
• Increased the productivity of our customers by creating an efficient UI for the mobile application
• Liason between the business units, technology teams and support teams
• Understanding of the business mission and technology environment
• Provide assistance to Test Team in condition/Test Script development
• Wrote and execute tests to verify the solution is properly configured and extended to meet requirements
• Helped testing team to test the customizations, Confidential Services, Modified Rules to Accommodate Missouri specifications.
• Participated in Regression testing as well as Automated testing =for running the Confidential scripts.