SUMMARY

• Business Analyst Consultant with 6 plus years of diverse experience in Business Requirements Analysis, Business Modeling, Document Processing, and Requirements Traceability Matrix (RTM).
• Expert in analyzing EDI transactions, Facets upgrades, forward mapping, HIPAA Regulatory changes and Application Integration in healthcare domain.
• Solid Knowledge of analyzing, reviewing software and business requirement documents, and also document management.
• Has substantial working experience in gathering business requirements, JAD Sessions, Gap Analysis, UML diagrams, Process Flows, Business Documentation, Claims Processing & Testing, Claims Adjudication for Medicare and Medicaid, Data Mapping/Modeling, Trizetto Facets 4.x, and Medical Billing.
• Specialized in ANSI 4010/ 5010 and ICD - 9, ICD -10 implementation.
• Worked in the various types of software development methodologies as including Agile & scrum, Waterfall, and RUP.
• Over 6 years of working experience as EDI analyst including but not limited to 834, 820, 270, and 271.
• Experienced in Healthcare, Risk and Compliance and Document Management.
• Worked with the implementation and ongoing support of the Health Insurance Exchange (HIX) and compliance with Affordable Care Act (ACA) mandate and Health Care Reform Act.
• Excellent knowledge of Medicaid Management information System (MMIS).
• Experience with TriZetto FACETS and HIPAA Gateway - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Experienced in verifying and documenting HIPAA regulator changes found when moving from .
• Full Transaction Mapping knowledge of .
• Experienced in GAP analysis of HIPAA with particular attention to qualifier, length and required field, and situational rules.
• Resuscitating requirement elicitation techniques, coordinating user interviews and JAD sessions.
• Management of requirements using Rational Requisite Pro and Use Case Modeling with all phases of SDLC.
• Conducted Risk analysis, Risk mitigation, and Impact Analysis.
• Synthesized 4010 and 5010 HIPAA implementation guides related to Claim Testing and Medical Billing.
• Perceived ITIL Framework and the various areas of IT service delivery and support including Customer Relationship Management.
• Substantiated Object Oriented Analysis and Design
• Experience with Facets upgrade .
• In representation techniques in UML using Rational Rose, Dataflow Process Modeling and Analysis & Design with Interaction and Class diagrams.
• Executed advanced level SQL queries to verify data integrity of the databases.
• Excellent knowledge and hands on experience with SSRS reporting systems.
• Experience with Trizetto’s Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, and Utilization Management.
• Scheduled meetings and reinforced business analysis with developers, system analysts and testers to collaborate rescore allocation and project completion using MS Project.
• Have worked with SAS (Statistical Analysis System) Integrated system, particularly in the modules with Data Analysis, Performance and Risk Management.

TECHNICAL SKILLS

Operating Systems: Windows NT, Windows 95/98/00, UNIX and DOS.

Bug Reporting Tools: Test Director, Rational ClearQuest

RDBMS: Oracle 7.0/8.0, SQL Server 2000 and MS-Access.

Web Languages: ASP, HTML, CSS and JavaScript.

Web Server Concepts: IIS 5.0, Apache and Jakarta Tomcat

PROFESSIONAL EXPERIENCE

Confidential, Baltimore, MD

Configuration Analyst

Responsibilities:

• Conducted one on one interviews with high level management team and participated in the JAD session with the SME’s.
• Worked on Facets Claims Software System, to convert data from their legacy system (LRSP) and add custom applications to satisfy in-house requirements.
• Responsible for updating and maintaining provider information, provider contracts, fee schedules and contract configuration.
• Involved concurrently in enhancement of HIPAA X124010transaction to HIPAA X125010andICD 9-CM (Clinical modification)toICD-10-CM/PCS(Clinical modification/procedure coding system).
• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.
• Defined and documented the vision and scope of the project.
• Followed the RUP methodology for the entire SDLC
• Analyze data to determine appropriate configuration changes & requested Configuration Change Request (CCR) for the new contracts accordingly.
• Worked on various health programs with specified configured contracts for each market.
• Accurately interprets specific Contracts as well as additional business requirements and converting these terms to configuration parameters.
• Used General Equivalence Mapping to convert ICD 9 to ICD 10. Involved in both forward mapping and backward mapping.
• Performed impact analysis for conversion ofICD-10.
• Used GEM for forward and backward mapping to convert ICD 9 codes to ICD 10 codes and vice versa.
• Worked as a liaison between the business and technical side to convey the business needs to the system architects.
• Used SQL Queries in Oracle to pull out data from the databases for the data validation and routine report generation.
• The process included importing claims into Facets that had been adjudicated and setting them in a “PAY” status so that a payment cycle could be run to create checks on Facets.
• Worked in association with RUP mentors to ensure fidelity to the standard RUP practices of the institution.
• Involved in writing and implementation of the test plan, and various test cases.
• Studied existing business application and processes, collected end user requirements and suggested the improvised business process model.
• Initiated, proposed and implemented critical analytical and technical turnkey solutions extensively increasing the quantitative and qualitative value of the application
• Involved in project planning, coordination and implemented QA methodology.
• Developed the matrix, prioritized and determined QRT impact of all applications.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions
• Utilized technical flow charts, Network Diagrams and Gantt Charts to effectively map and manage critical paths and bottlenecks in conjunction with Project Tracking Reports and Project Data Sheets for Senior Management.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
• Defect Tracking and Bug Reporting was performed using Quality Center.
• Participated in weekly status meetings to present status and in corporate any digressions from the original scope.
• Created and managed project templates, Use Case project templates, requirement types and trace-ability relationships in Requisite Pro.
• Carried out a thorough target organization assessment and risk analysis.
• Involved in cross-functional teams, developing new ways to boost efficiency and delivering results in a fast changing environment to achieve company goals.
• Provided the management with test metrics, reports, and schedules as necessary using MS Project and participated in the design walkthroughs and meetings.
• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.

Environment: J2EE, Java, UNIX, SQL, Siebel 7.7, Windows XP, MS Project, RUP, Rational ROSE, Req Pro, Rational Clear Case, UML, MS Visio.

Confidential, Nashville, TN

Business System Analyst

Responsibilities:

• Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Analyzed the existing Claims Direct Data Entry (DDE) application
• Worked withFACETSTeam for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
• Involved inclaim adjudication processof facets application
• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)
• Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.
• Assisted the EDI team in the development and documentation of the test strategies for the EDI transactions which included all standard transactions, auditing and error correction processes, and the creation of the transactions.
• Tuned SQL queries and performed refinement of the database design leading to significant improvement in system response time and efficiency.
• Worked onHIPAA Transactionsand Code Sets Standards according to the test scenarios such as270/271, 276/277,837/835transactions.
• Coordinated with the EDI team in developing and documenting the detailed testing work plans and created the various testing documents for the assigned EDI transactions.
• Involved in writing and implementation of the test plan, and various test cases for UAT.
• Involved in project planning, coordination and implemented QA methodology.
• Worked with FACETS,eBillingandEDI HIPAA Claims (837/835/834)processing.
• Prepared theBusinessWorkflow using MS-Visio with input, output,Preand Post conditions.
• Enhanced test cases and scripts by adding the required functionality as per the newbusinessrequirements.
• Defect Tracking and Bug Reporting was performed using Quality Center.
• Tested theHIPPA EDI, 834, 270/271, 276/277, 837/835transactions according to test scenariosandverify the data with Facets on different modules.

Environment: Oracle, MS Access, Test Manager, Java, Clear Quest,Rational Suite, Clear case, SQL, MS Visio, Facets, MS Office

Confidential, Trumbull, CT

Business System Analyst

Responsibilities:

• Wrote numerous test cases based on test strategies
• Analyzed, revised and created test plans according to business requirements.
• Analyzed team performance with the QA manager and implemented the changes if any with respect to raising the efficiency of the entire team.
• Evaluated and implemented QA process improvements for ongoing testing.
• Wrote Use cases and Activity Diagrams.
• Assisted the customer in defining the high-level Functional Requirements and needs.
• Gathered the requirements, developed process models and detailed Business Policies, and modified the business requirement document.
• Used SQL Queries in Oracle to pull out data from the databases for the data validation and routine report generation.
• Involved in the Data Movement between Systems, validated the Business Requirements.
• Participated in the team for User Acceptance Testing (UAT).
• Involved in Functionality and Regression testing during the various phases of the development.
• Utilized RUP to create use cases, activity, class diagrams and workflow process diagrams.
• Responsible for coordinating and performing functional and date-related testing.
• Prepared the Business Workflow using MS-Visio with input, output, pre/ post conditions.
• Used Rational Clear Quest to report defects and test results.
• Conducted the Customer Acceptance Testing, System Acceptance and End-to-End testing.
• Detected defects communicated to the developers using bug-reporting tools and tracked the defects.
• Conducted Back End Testing on the Oracle database using SQL.
• Defined transactions to measure server performance and creating rendezvous points to simulate heavy load on the server.
• Involved in maintaining the Test Matrix.
• Actively participated in enhancement meetings.
• Helped Test Engineers troubleshoot and problem solve any issues that would arise.

Environment: Windows NT Server,SQL, Oracle, Web Logic, IIS, Java, WinRunner, LoadRunner and TestDirector.

Confidential, Virginia Beach, VA

Business System Analyst

Responsibilities:

• Worked on all kinds of correspondence materials such as Welcome Kits, ID cards, Coverage documents, etc.
• Worked closely with Subject Matter Experts regarding the changes that were made.
• Worked with both technical and non-technical users throughout the project.
• Gathered requirement onFACETS EDI 834 Benefit Enrollment and Maintenance subsystems.
• Workedas a part ofClaims AdjudicationTeam on FACETS.
• Gathered business requirements (functional and non-functional) and documented then in the BRD.
• Created swim lane diagrams for “As-Is” and “To-Be” Business Process Flow using MS Visio.
• Worked closely with the project team to identify use case dependencies and planned the use case development.
• Extensively used Cognos for report generation.
• Worked on data modeling and produced data mapping and data definition documentation
• Performed numerous data extraction requests involving SQL scripts
• Involved in creating SAS codes to export and import data in and out of SAS and Teradata.
• Responsible for creating and maintaining requirements traceability matrix (RTM) using Quality Center.
• Worked with the QA team in writing Test Plan and conducting the testing process.
• Wrote SQL queries for database related works such as creating test data, identifying data sources and verifying data integrity.
• Worked on the FACETS front end and backend for testing and for documenting the Business requirement documents.
• Performed in depth analysis of data & prepared periodic reports using MS Excel and SQL.
• Used HP QTP to execute the test cases and carry out the testing process.
• Logged issues and kept track of them until they were resolved.
• Conducted walkthroughs and trainings after the application was deployed to make sure the end users knew to navigate the new changes in the application.

Environment: MS Project, MS Office, Quality Center, Teradata, Cognos, UML, SQL, JAD