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TrainTest

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Sum Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.
Sum Capable to prepare written proposals, requirements specifications, invitations to tender and solution specifications.
Sum Able to identify business & systems process improvements from Big Picture to detail level.
Skill CERTIFICATION AND TECHNICAL SKILLS
Skill Languages:
Skill SQL, PL\SQL, HiveQL, SAS, R, XML, Java, Python, .Net
Skill Tools & Environments:
Skill MS Office, MS Visio, SQL Server SSIS, SSRS, Oracle Developer, Tableau, QlikView, Power BI, SAS EM, ERwin Data Modeler, WebI, SAP Business objects, UDT, Excel, Rational Rose, MS Visio, Visual Paradigm, JIRA, Confluence, MS Visual Studio
QC Certifications:
QC SAS Certified Data Mining and Business Intelligence professional, Google Analytics and AdWords Certified Professional, Certified Microsoft Technology Associate (MTA) in .NET, Advance communicator Silver and Advance Leader Bronze by Toastmasters International
Exp Work Experience:
Exp DST Health Solutions, Birmingham, AL July 2016 -Present
Exp Sr. Business System Analyst
Exp Project Description: The project was on create claim management system which has benefit module for all Medicare part D and Medicaid expansion plans for states. The project was also utilizing analytics for optimization of processes and benefits.
Exp Responsibilities:
Exp Gathered requirement through workshops and JAD sessions.
Exp Developed documents like BRD, FRD, Data specification document, technical specification documents, file transfer document, Data mapping document etc.
Exp Participated in analysis workshops for ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
Exp Developed Use case diagrams, activity diagram and system design diagrams.
Exp Validated CPT, HCPC, ICD 9 code sets from Data Flat files to support configured benefit plan building.
Exp Managed global administration and support of the Documented based Regulatory Electronic Document Information System (EDMS).
Exp Facilitated Electronic Data Interchange (EDI) and storage in the ICD-10.
Exp Worked on HIPAA Transaction Sets 837P and 837I Standards as per the test scenarios.
Exp Created Test Conditions from business requirement document and functional requirement document.
Exp Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims.
Exp Accessed Diagnosis Master File and Crosswalk Mapping file to use ICD Diagnosis and Surgical Procedure Codes.
Exp Performed GAP Analysis to make sure that all requirements were covered by test cases.
Exp Prepared and submitted weekly test status reports to QA Lead.
Exp Developed SQL scripts for mining medical claim cases which helped in making faster decisions for over 400 healthcare-835, EDI cases
Exp Conducted JAD sessions with the stakeholders to solve Amisys Advance claims and presented solutions using structured SDLC approach
Exp Designed data flow and mined data for HIPAA/ICD/EDI claim analysis that helped expedite the process of Medicaid claim processing
Exp Performed GAP and risk analysis on workflow and business rule models to create project specific action plans for HIPAA implementation
Exp Created PL/SQL procedures and performed data stage transformations, benefiting data flow of over 2000 claims and 5 functional areas
Exp Collected data from EDI, HIPAA, 837,835 CRM transactions which helped in smooth functioning of Medicare and Medicaid entities
Exp Worked on EDI 834 to validate new enrollment and dismiss the enrollment.
Exp Accepted and validated messages in EDI 999 form like accepted, rejected, and accepted with error.
Exp Coordinated System and Regression testing schedules and completed the same.
Exp Ensured the functionality meets business requirements as defined in test results logged in RQM.
Exp Developed Test Cases to test the functionality of the system based on the test conditions.
Exp Extensively used Rational Quality Manager to monitor the progress of assignment of testing activities and Reported executed results.
Exp Logged the defects in Clear Quest tool, assigned the right severity level and managed the defects through it.
Exp Analyzed several defects related to Edits & Audits functional area along with the help of a SME.
Exp Conducted KT sessions for Member, Provider and Service Authorization.
Exp Environment: MS Office, MS Visio, Rational ClearQuest, Windows 7, Citrix, PLSQL, JIRA, CRM, Oracle10g
Exp Texas State DHHS, Austin, TX Jan 2013 to June2016
Exp Sr. Business System Analyst/Data Analyst
Exp Project Description: The project was about to implemented new business processes in MMIS and integrates MMIS with Integrated Eligibility System.
Exp Responsibilities:
Exp Conducted user interviews, gathered requirements, analyzed and documented business requirements in BRD
Exp Balanced competing project constraints such as scope, quality, schedule, budget, resources, and risks.
Exp Involved in Release, sprint planning and making work ready for releases and sprints.
Exp Created strategy for risk detection, risk management, Risk Mitigation and dependencies.
Exp Performed user storytelling and grooming using CA Rally.
Exp Worked with contract manager to develop and modify project plans on routine basis and jointly provided weekly high-level briefings on status of individual projects to senior State IT management and to review IV&V outcomes on a periodic basis.
Exp Conducted JAD sessions between multiple cross functional team to resolve problem and requirements pass on.
Exp Created process flow of case management for healthcare Assistance Eligible member in IBM Curam.
Exp Created process flow of case management for TANF Eligible member
Exp Current areas of focus include IV&V initiatives, program support initiatives, and human services cost allocation.
Exp Maintained all professional documents on SharePoint.
Exp Responsible for maintaining share-point directories and document template for my project using share-point.
Exp Worked on Medicaid Managed care programs, encounter claims and Medicaid eligibility program.
Exp Gathered and managed XML elements for portals.
Exp Developed Technical Design Document and helped Architect in developing System architecture document.
Exp Filtered applicant using different business cases to create a separate flow to route them for better case management services.
Exp Developed functional specifications and system design specifications consistent with findings of Independent Validation and Verification (IV&V) audit based on knowledge of existing system specifications.
Exp Created Swim lane diagram, process flow diagram, Activity diagrams, use cases diagram using MS Visio.
Exp Worked on HIPAA EDI 837, EDI 835, CPT and ICD10 codes and state eligibility policies.
Exp Worked on creating project end to end process flow using BPMN 2.0 in JBPM tool and Visio.
Exp Prioritize user stories for each release and sprint as product owner.
Exp Assign task to other BA and estimated their work effort.
Exp As a part of IV&V team, conducted assessment to cooperatively facilitate evaluation of the sub-components and services necessary for a complete solution to meet business.
Exp Trained other Team members so they can perform in expected format.
Exp Research to gather business requirements from valid sources by myself and convert them in Business, functional and non functional requirements.
Exp Supported in architecture, High level UML diagrams and prototype of proposed solution.
Exp Test rules service requests and response using REST and SOAP.
Exp Created HL Design and low level design Medicaid eligibility.
Exp Environment: MS Office, Quality Center, SQL Server, Facets, MS Project, Server, MS Visio, Unix, SQL, HTML, Java, XML, Rational ClearQuest, Windows 7, AWS, MMIS.
Exp American Family Insurance, Madison, WI Jan 2012 to Jan 2013
Exp Sr. Business System Analyst
Exp Project Description: To create a web based application which would automate the claims process and reduce costs. Application was an Electronics Claims Processing (ECP) system designed to accept the electronic claims coming from the various providers (doctors and hospitals) and process them. The project involved HIP...
Exp Responsibilities:
Exp Implemented RUP methodology for iterative and incremental development of the system.
Exp Involved in the creation of the Mockups and Use Cases for MACD quotes and Orders using MS Visio.
Exp Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
Exp Recorded requirements in the Requirement Traceability Matrix (RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
Exp Planned RUP iterations and documented the artifacts throughout the various phases of the development process.
Exp Propose strategies to implement HIPAA 4010 to HIPAA 5010 changes in the System.
Exp Developed an implementation guide for Partners for HIPAA 5010EDI X12 transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claim status response), 820 (enrollment), and 834 (premium payments).
Exp Studied the existing business process and created AS-IS workflow to illustrate the existing system.
Exp Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.
Exp Compiled the Vision Document and composed detailed Specification Documents in Rational RequisitePro.
Exp Created UML class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
Exp Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
Exp Created Technical documentation for the project using tools like Visio, Word, etc.
Exp Used MS Project for managing schedules, resources and collaboration.
Exp Produced complete data mappings and data conversion documents needed for the Claims application.
Exp Performed Functional and GUI Testing to ensure that the user acceptance criteria are met.
Exp Co-coordinated the UAT with the SME’s to make sure that all the Business Requirements are addressed in the application.
Exp Formed detailed UAT and QA test plans, managed system testing and preserving testing documentation.
Exp Environment: MS Office, MS Project, MS Visio, SQL, Oracle, Test Director, Rational Unified Process (RUP), Rational Suite (RequisitePro, ClearQuest),Business Objects, Windows XP.