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Exp Apollo Hospital, Delhi, India Jan 2009 to Dec 2011
Exp Business Analyst
Exp Project Description: To develop Customer Billing and Management System
Exp Responsibilities:
Exp Writing requirement specifications and functional specifications participation in requirement session with clients and communicate to stakeholders assisted with Sr. Manager
Exp Perform User Acceptance Testing of developed software of Revenue Cycle Management.
Exp Identify source of requirements and develop priority matrix.
Exp Gather requirements, Elicitation & write functional design specification with minimal supervision.
Exp Work with both internal and external stakeholders across locations.
Exp Interviews, surveys and analysis of historical data. Organize brainstorming, facts-finding and structured walk through sessions.
Exp Modeled data into RDMS structure that helped in reporting and maintaining over 200 vendor and client data using Oracle
Exp Enhanced security of consumer data by re-engineering the data warehouse model to include customer specific parameters
Exp Managed billing systems and collaborated with customer service teams which led to 6% increase in positive customer feedback
Exp Research problems and share results and understanding with the test team with domain and functional knowledge
Exp Test the application and Interact and liaise with the technology team to resolve functional & technical queries as a good skilled problem solver
Exp Serve as a conduit for effective communication between team members in India and team members in North America, Works well with all levels of staff with strong presentation skills
Exp Review user documentation of projects and participate in test plan development with exceptional organizational skills
Exp Environment: Agile,MS Visio, SQL Server, MS Office Suite, HP Quality Center
PI Hyma Gumpu
PI danny@stackitprofessionals.com
PI Contact No: 970-294-9622
Sum Profile Summary
Sum An astute, detail-oriented Business Analyst with 7 years of consulting experience including Healthcare (Medicare, Medicaid and Medical), Insurance and Loan Processing. Experienced in testing implemented systems and system changes, including liaising with QA teams to develop test cases, test plans, test scenarios, g...
Sum Proficient in creating User Acceptance Test (UAT) Plans and implementing and coordinating UAT. Experienced running scripts to check web user interface and Portals for Broken Links, Frame Properties, Table Properties, URL links, Images, Text and has prepared Test Metrics to test execution status and results.
Sum Demonstrated expertise with Medicare and Medicaid, including Claims, Adjudication and Billing. Extensive experience with HIPAA regulations, and EDI standards (X12 and HL7). I have got experience developing process maps, and AS-IS and TO-BE process conceptualization and improvements. Proficient in Writing complex SQ...
Sum As a Scrum Master worked with the Product Owner on Backlog refinement for inclusion of user stories (to the Sprint backlog) for future sprints.
Sum Reviewed Policy Centre user story requirements with development & QA and provide on-going support.
Sum Conducted demos and user-stories acceptance meetings with business for sign-off/acceptance.
Sum Trained and advised scrum team members on Agile SCRUM practices to collaborate, as early as requirements to enable parallel development & QA planning
Sum Knowledge on Facets. Facets was highly efficient, automated, customizable, and flexible, to help tackle new business opportunities and compete successfully in a dynamic healthcare industry.
Sum Experience capturing requirements for Explanations of Benefits (EOB). Translating requirements to the development team.
Sum Ran Daily scrum meetings to track team progress using the Kanban board, Burn-down chart in JIRA to maintain work visibility, track team velocity and report progress to program level on a continual basis.
Sum Worked to identify &facilitate resolution of blockers/impediments escalated during Daily scrum
Sum Extensively involved in the modeling and implementation of Reporting Data Warehousing System
Sum Experience in designing and developing project document templates based on SDLC methodologies including RUP, RAD, Waterfall, Scrum and Agile
Sum Strong experience in conducting UAT and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
Sum Excellent business writing skills in writing Preliminary Investigation Report, System Requirements document, Systems Design Specification and System Requirement Change Request.
Sum Good Knowledge of ICD-9 codes and CPT codes for both Mental and Medical Health.
Sum Excellent knowledge of HIPAA transaction codes such as 270/271 (inquire/response healthcare benefits), 470 (benefit codes), 276/277 (claim status), 834 (benefit enrolment), 835 (payment or remittance advice) and 837 (health care claim).
Sum Developed data transformation & data translation rules as part of mapping task from (PC to ESB integration).
Sum Implemented approved enhancement requests from Sprint backlog.
Sum Worked with system architects to validate future state data system design to support business requirements.
Sum Authored Policy Center user stories for new functionality & update existing ones based on approved changes.
Sum Performed GAP analysis, identify use cases and create UI mockups on required Policy Center functionality.
Sum Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process
Sum FACETS experience, knowledge of ICD-10- CM, ICD-10- PCS, HIPAA 4010/5010 initiatives and regulatory compliance framework.
Sum Worked on Master Data Management (MDM) for maintaining the customer information and for the ETL rules to be applied. Worked on SQL tables and objects.
Sum Worked on Wireframe, Visio Tools to present the requirements in a pictorial representation of the requirements to client as well as the development team.
Sum Knowledge in the ETL (Extract, Transform and Load) of data into a data warehouse/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
Sum Extensive risk management experience conducting fraud and risk investigations for financial institutions and payment processing organizations
Sum Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process
Sum Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, problem solving, negotiation, judgment and decision-making skills.
Skill Technical and Business Skills
Sum Professional Experience
Exp Company: Assurant Health, New York, NY
Exp Position: Sr. Business Analyst/Scrum Master Jan 2016 –Present
Exp Objective of the project was to develop Medicaid Management Information System following HIPAA standards. The web-based Health Care Management System is developed using HIPAA guidelines and regulations which keeps track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims S...
Exp Responsibilities
Exp Performed as an active liaison between stake holders; system users, clients and project management.
Exp Ability to interact with customers, sales team, top management, developers and product analysts, testing team regarding project status, testing status and defect tracking.
Exp Responsible to perform detailed analysis within time constraints to transform business needs to high end business requirement and functional specification documentations and strict adherence to template while documentation was required.
Exp Managed onshore and offshore Architects and Scrum teams as Delivery Lead for solution deliverables.
Exp Link the different technical and non-technical perspectives of users from varying domains such as the business users and developer’s environment.
Exp Diagrammatic representations after intense analyzing and deciphering of user-level requirements using; UML, CASE and ACTIVITY were created.
Exp Led projects to develop and enhance claims adjudication, eligibility, formulary, prior authorization and reporting applications internal user experience as well as expanding client product offerings
Exp Developed a comprehensive object-oriented data model for healthcare eligibility, claim and accounts for the entire product suite.
Exp Represented team to attend daily scrum meeting and complete meeting reports to report to scrum master.
Exp Verifying Healthcare Eligibility, Claim, Benefit and Service using ANSI ASI X12 Standards.
Exp Liable to prepare TSD’s and workflow diagrams for AS-IS & TO-BE scenarios. Designed new process flows, documented business processes for varying set-up.
Exp Accountable for use case documentation, user interface design document considering from a business standard.
Exp Required to interact with developers, QA to determine and report bugs and technical concerns.
Exp Defined Rendezvous point to create intense load on the server and thereby measure the server performance under load.
Exp Interact with Business Users & Application Developers during Integration testing
Exp Extensive experience in preparing test plans test metrics, test cases, test scripts and test data based on business and functional requirements.
Exp Wide Exposure to automation tools such as Quick Test Professional, Test Director and Win runner.
Exp Designed Load scripts using Load Runner to load test high traffic end user processes for performance and reliability. Reported results to development teams to resolve critical bottlenecks
Exp Environment: Quality Center, QTP, Load Runner, Java, JSP, JNLP, Web sphere, JDK, Unix, Oracle 9i, SMTP, Unix, Web Client, EJB
Exp Company: Walgreens, IL
Exp Position: Sr. Business Analyst/QA Analyst Nov 2013- July 2015
Exp Walgreens provides medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery, pharmaceutical manufacturing technologies and performance solutions services. The main objective of the project is to build web-based application which handles claim submissions, enrollm...
Exp Responsibilities:
Exp Acted as a liaison between clients and development departments and distinguished requests from needs.
Exp Transferred information from management into needed data.
Exp Found out defects which existed in the system, analyzed how the defects were originated, and cooperated with another department to fix them.
Exp Set up meetings with other departments, SMEs, or clients to solve problems and gathered requirements from meeting.
Exp Translated business requirements into technical details.
Exp Used SAP Business Objects to complete report generation based on corresponding issues of defects.
Exp Worked closely with project lead, technical team and business analysts to investigate data and logic within the database and reporting application.
Exp Worked in Healthcare HIPAA 4010 to 5010 migration and EDI transaction sets such as 835, 837, and 999.
Exp Wrote and executed SQL queries to verify that data has been moved from transactional system to DSS, Data warehouse, data mart reporting system in accordance with requirements
Exp Designs and develops the logical and physical data models to support the Data Marts and the Data Warehouse.
Exp Used Quality Center to track defects’ status and update status as well.
Exp Worked closely with Informatica ETL team with the ability to understand mappings and ETL processes.
Exp Prepared BRD’s and test cases for each defect before defects moved to testing.
Exp Tracked progress and compared it with planned progress.
Exp Coordinated with project manager on regular status updates and assists the overall project management initiative.
Exp Worked extensively with MS office suite for preparing status reports
Exp Environment: Windows, Unix, MS Office Suite, MS Visio, UML, SQL, MS SharePoint, JIRA, Agile/Scrum, Informatica, Cognos, Toad, J2EE, WebSphere.
Exp Company: Amvik Solutions, Los Angeles, CA
Exp Position: Business Analyst Sept 2011 – Sept 2013