PROFESSIONAL SUMMARY:

• Over 8 years of strong experience in IT Business Applications Development
• More than 3 years of experience as a HIPAA Business System Analyst
• Strong experience in NASCO NPS System(Benefits Enrollment & Claims)
• Strong experience in Data Mapping for HIPAA EDI 834, 835 and 837
• Strong experience in testing of Healthcare Claims(837) and 834 Benefits Enrollment
• Strong exposure to HIPAA Healthcare Standards and HIPAA Implementation Guide(IG)
• Experience of the full Software Development Life Cycle (SDLC) and Methodologies & Validations to ensure the Quality Assurance Control.
• Extensive experience in Business Analysis, Business Process Modeling and Improvement, Systems Analysis, Requirements Gathering, Requirements Management, Document Processing, Process Re-Engineering,
• Design and Development in Healthcare, Logistics, Financial and Banking industries. Strong Knowledge of using the Iterative Software Development Lifecycle (SDLC) principles of Rational Unified Process (RUP).
• Excellent analytical, communication, leadership and management skills. Effective team player, innovative and able to thrive in a fast paced, growth-oriented and time-critical environment.
• Strong Knowledge of SDLC, RUP methodology, project life cycle and ability to work as the primary interface between Business Users and Developers / System Analysts.
• Efficient in translating Business Requirements into Functional and Non-Functional Requirements.
  Experienced with Object Oriented Analysis and Design using Unified Modeling Language (UML), Rational Rose, Requisite Pro, Rational Clear Case and MS Visio.
• Knowledge of various process-based SDLC models like RUP, Waterfall, Spiral, Sequential, Rapid Application Development.
• Extensive experience in developing System Requirements Specification (SRS), Functional Requirements Specification (FRS) documents and Use Cases using DOORS, Requisite Pro, MS -Office, MS project, Visio and Rational Suite.
• Proficient in creating Use Case Diagrams, Sequence Diagrams, and Collaboration diagrams, Activity Diagrams, Class Diagrams etc.
  Conducted Joint Application Developments (JAD) sessions, walkthrough, Interviews, Workshops during different phases of the project.
• Proficient in developing and documenting User Acceptance Test (UAT) cases and developed User Manuals for the end users.
• Strong experience in Change Control Management for Healthcare Applications in IBM Mainframe Environment.
• Strong experience with TSO/ISPF, JCL, COBOL, CICS, DB2, VSAM & ENDEVOR
• Excellent experience with Oracle database, SQL server database and Data Warehousing
• Experience in manual testing as well as automated testing by using test management tool like Quality center and several automated tools like Win Runner, Quick Test Professional.
• Experience in Establishing QA Procedures to meet QA Standards, proficient in writing Test Plans, Documenting the Testing Procedures and writing in-depth Test Cases to meet the Testing Cycle, In-depth knowledge in the analysis of application’s higher-risk aspects, and determining scope and limitations of tests.
• Strong analytical experience in developing user interface, functional specifications, and application rules based on specific: Client/Server Testing, Web based Application Testing, GUI Testing, Functional Testing, Integration Testing, Regression Testing, Load testing, Stress testing Interface Testing and Database Testing
• Ability to interact with developers and Business Analysts regarding Testing Status and Defect & Change Tracking using TestDirector (Quality Center)
• Working with product management team to understand product qualities, functionalities and performance to ensure the quality of the product meets required quality goals.
• Have excellent communication, analytical, interpersonal and presentation skills.

SKILL SUMMARY

Windows NT/95/98/2000/XP, UNIX, DOS.

IBM Mainframe

TSO, COBOL. CICS, DB2, JCL, VSAM, IBM OS/390, ENDEVOR

QA / Testing

Black box, White box, Integration, Functional, System, End to End, Regression, Acceptance, Load, Compatibility, User Acceptance, Alpha, Beta Testing and Agile Testing Methodology

Testing tools

QTP 9.2, Quality Center(MQC) 9.2/9.0/8.0, Win Runner 8.0, Load Runner 8.2, Test Director 7.0

Microsoft Technologies

Dot Net Framework 2.0, ASP.Net 2.0, ADO.Net, VB.NET

Languages

HTML, DHTML, XML, C, C++, Java, VB.Net, SQL, PL/SQL

Healthcare Tools

NASCO, Trizetto Facets 4.51, Claredi, Amisys, QNXT

Scripting Languages

VB Script, JavaScript, JSP, HTML, DHTML, IIS

RDBMS

SQL Server 2005/2000, Oracle 9i & DB2 UDB

Documentation Tools

MS Office 2000/2003/2010, MS Sharepoint

EDUCATION:
Bachelors in Computer Science & Engineering

WORK EXPERIENCE:
Confidential,MD Jan’ 07 to Sep’2010
Role: NASCO System Analyst
Responsibilities:

CareFirst Blue Cross Blue Shield of Maryland is one of the largest health insurers with more than 80% of the region’s health care providers participating in its various medical care networks. The scope of the project is to: migrate large account (Large Group Migration – LGM) 200 plus - risk/non-risk) with PPO, indemnity, MPOS, BlueChoice and CDH from a legacy platform Flexx, EAB/CARE to NASCO or to FACETS (TriZetto\'s Product) and then from NASCO to MembersEdge (MetaVance). The project also focuses on to accommodate feeds and services such as: paper vs. automated enrollment, COB, account receivable (AR), claims processing, ID Cards, and provider/customer/member services.

• Gathered and documented business requirements from Trading Partners, user groups and Agents via workshops, interviews and surveys.
• Create the accumulation Rules in NASCO Processing System. The Blue Exchange Provider Tool - Enhanced Eligibility Iteration 4 (EEI4) mandate requires BCBSM to respond to the provider request for eligibility information (HIPAA 270/271) with accumulation amount.
• Performed analysis in Benefit File Automation System Tool (BFAST) and setup Accumulation Rules based on the analysis of coding in existing claim process.
• Setup Master Cross Reference Matrix to tie Accumulation Rules back to Blue Exchange (BX) database.
• Conducted JAD sessions with NASCO project team and came up with the best solution to setup Accumulation Rules in the system.
• Created benefit file Customer Service Request (CSR) to ensure the input of Accumulation Rules in NPS.
  Performed traceability and change management of the Accumulation Rules and update the changes in Project Data Management (PDM).
• Tested Accumulation Rules in Model Office of NASCO Processing System (NPS)
• Worked in close collaboration with the Project Manager and business users to gather, analyze and document the functional requirements for the project.
• Worked with NASCO NPS System and analyzed the business requirements for NASCO Benefits Automation Process for Group Level as well as Member Level
• Worked on new change system requests(CSRs) for NASCO Benefits Automation Process
• Worked on Group Automation Process and generated Benefit books and NAEGS Forms
• Worked with Bluebase NASCO Membership System and BlueCard(ITS)
• Worked with Coverage Levels to process Benefit Payment Information
• Worked with Benefit Coding Tools like Superparticular tables, subparticulars, Qualifier tables and accumulation rules.
• Worked with Benefit file components using Benefit file Inquiry and Maintenance application
• Uploaded Benefits data into NASCO Claims System
• Received Provider files(Provider Data Formats) from providers and sent to ITS for processing
• Worked with provider databases and transferred Data files to Mainframe
• Responsible for migrating the test cases from excel spreadsheets to Rational Test Manager
• Created test cases, executed and recorded results of test cases using Rational Test Manager
• Developed Functional Specifications for 834 Employer Specific Benefits Enrollment Process
• Developed Test Cases for HIPAA 834 from CSRs(Change System Requests)
• Performed mapping of the requirements to ANSI X12 for 834 Benefits Enrollment Process
• Developed NAEGS Forms, Benefit Grids and Benefits Books for Benefits Enrollement
• Developed NPS Mnemonics and performed Benefits Coding for NPS System
• Tested Benefit file codes and uploaded to NASCO System
• Tested TA1 and 997 for acknowledgements and confirmations
• Worked with COBOL Mainframe for Employer Specific Benefits Enrollment Application
• Worked with TSO/CICS/COBOL/JCL/DB2/VSAM for Healthcare Claims Processing
• Worked with ENDEVOR to move the source code from DEV to QA and QA to PROD
• Provide technical and procedural support for User Acceptance Testing (UAT)
• Worked on Project Documentation using MS Office and MS Project

Environment: NASCO NPS, IBM Mainframe, JCL, COBOL, CICS, VSAM, ENDEVOR, Gentran Server, Manual Testing, TSO/ISPF, SQL Server 2005, Oracle 9i, DB2, MS Office, MS project, Unix, Windows 2000/XP

Confidential,VA Jan’ 06 to Dec’06
Role: Healthcare Business System Analyst
Responsibilities:

• Developed Mapping Specifications from Business requirements for 834 Benefits Enrollment
• Developed EDI Maps for 834 Benefits Enrollment
• Developed EDI maps using Gentran Mapping Server for inbound 837 and outbound 835.
• Worked with TSO/ISPF, JCL, COBOL, DB2 and ENDEVOR
• Developed several COBOL DB2 stored procedures for claims pre-adjudication process
• Developed Gentran EDI ANSI X12 Data Maps for Trading Partners Profile Setup
• Developed Test Cases and Test Plans from Business Requirements Document
• Used MS Visio for creating use cases, workflows and sequence diagrams according to UML methodology.
• Developed Test Grid using Microsoft Excel and executed test plans
• Worked on 834 Benefits Enrollment and 837 Claims Testing
• Provide expertise to include planning, process modeling, subject matter expertise, and analysis in support for the Centers for Medicaid and Medicare Services (CMS). Requires experience of business modeling techniques (macro and micro level), impact analysis to help the Agency\'s components
• Understand and manage their enterprise architecture, analyze their business processes, and propose alternative business solutions for consideration. Defines enterprise architectures in accordance with OMB specifications using modeling tools
• Conducted Brain-Storming sessions with project focus groups and JAD sessions
• Conducted interviews with Dental SMEs to identify the current processes
• Identified and documented all Business Requirements from Dental users, stakeholders and business process owners
• Created Membership, Group Benefits, Claims, HDC-Capitation, EDI Transaction, Security, Portals and Provider BRDs
• identified all the feeds from legacy system Latron to different claim engines to accommodate these feeds from QNXT in future like OCR-able claim feed to EDI Gateway, Dentemax Provider feed, Provider feed for online/hardcopy directories, FEP and National Group feed to NASCO Processing System (NPS)
• Created Use Case diagrams, Sequence Diagrams, and Activity diagrams in the BRD

Environment: Gentran EDI Server 6.0, IBM Mainframe, COBOL, CICS, JCL, DB2, Oracle 9i, MS Office, MS Visio, MS Project, Test Director, TOAD, Microsoft EXCEL, Sun Solaris and Windows 2000

Responsibilities:

• Involved in developing test plans, test cases, test schedules and test harnesses based on high-level and detailed designs.
• Created and executed the test cases for various scenarios, and participated actively in system, integration, performance and regression testing for every new build released.
• Worked with Maximo Asset Management Application and SAP EDI Interfaces
• Extensively performed manual testing, requirements verification testing, recovery, functional and user acceptance testing (UAT) on the web-based application.
• Communicated inconsistencies between in the RTMs, system specifications, requirements and test results to the development, analyst system using Agile Process
• Participated in creation of web based test automation management tool designed to store test data, run automated tests and report results using the QTP automation object model.
• Managed the overall testing effort, including coordination of testing personnel and test lab resources.
• Managed the onsite and onshore testing and testing resources.
• Verified the data stored in the database with the help of SQL queries.
• Interacted with various members of the team to discuss and resolve defects, bugs and their priorities.
• Participated in daily status meetings to report any bugs, issues and risks.

Environment: SAP R/3 4.7, Maximo 5.1, Quality Center 8.0, QTP 8.0, Java, J2EE, Oracle 9i, Agile Process, Oracle 9i, Unix, Rational Clearcase, Windows XP/2003

Responsibilities:

• Conducted discussions with Business Analysts (BAs) and Configuration Subject Matter Experts (SMEs) to create Test Cases/Scenarios, Test Steps, Expected Results and Test Data in Test Director
• Test Cases for each of the available data forms were regression tested as new functionality was added; loading WinRunner scripts in Test Director for batch testing
• Used Test Director for defect tracking coordinated the defect resolution process and generated management reports.
• Recorded, parameterized and enhanced Vuser scripts to simulate the critical business transactions.
• Maintained different versions of the build in PVCS for every release
• Analyzed the response times of the business transactions under load of 300 concurrent users.
• Responsible for creating the System Performance Graph from the results of the incremental (user load) stress tests. The management used this System Performance Graph to determine the scalability of the Oracle Lodestar system, response time at the desired throughput and the system break point.

Environment: Java, J2EE, DB2 UDB, VB 6.0, SQL Server 2000, Oracle 8, Lodestar, Test Director 7.0, Win Runner, Load Runner, PVCS, Unix and Windows 2000/NT 4.0