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Exp Wrote stored procedures in Oracle PL/SQL for data entry and retrieval.
Exp Extracted and modified data from VSAM files for PDF reports.
Exp Automate nightly batch processing and job alerts using REXX.
Exp Responsible for migrating WebSphere server from v6.1 to v8.0 and migrating IBM CICS Transaction.
Exp J2EE to communicate legacy COBOL based mainframe implementations.
Exp Designed and developed Message Flows and Message Sets and other service component to expose Mainframe applications to enterprise J2EE applications.
Exp Use FileAid datasets to validate backend results of test events.
Exp Configuring and analyzing JCL to execute mainframe batch.
Exp Actively involved in contributing to RFP and POC activities in IMS.
Exp Used standard data access technologies like JDBC and ORM tool like Hibernate
Exp Designed, implemented new website features and provided support, maintenance
Exp Environment : Core Java, JSP, JUnit, Mercurial, Eclipse, .Net, JIRA, JDBC, Struts 2, Hibernate, Visual Source Safe, Weblogic, Oracle , OGNL, C, C++, Linux, MS SQL Server, COBOL, FileAid, REXX, ISPF, Mainframe, CICS, IMS, VSAM, JCL.
PI Dhanalaxmi Sangole
PI Ph No: 916-282-9259
PI Email ID: sam@vishconsultingservices.com
PI Senior Business Analyst
Sum Professional Summary:
Sum Experienced as a Sr. Business Analyst for 7+ years with proficiency in Business Process Engineering and Software Development Life Cycle including analysis, design, testing and implementation of software applications.
Sum Highly motivated, self-starter, able to work independently and collaboratively within a diverse technical team.
Sum Excellent team player work in conjunction with testing, development and other teams in validation and testing complex scenarios and projects and in the maintenance of Quality Standards in Projects.
Sum Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Document (BRD), General system Design (GSD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
Sum In-Depth Knowledge in facilitating Joint Application Development (JAD), Rapid Application Development (RAD) and Joint Requirement Planning (JRP) sessions, interviews, workshops and requirement elicitation sessions with end-users, clients, stakeholders and development team.
Sum Strong Knowledge with Iterative approach for Software Development as per Rational Unified Process (RUP) and Agile approach. Involved in inception, elaboration, construction & transition phases using rational tools like Requisite Pro, ClearCase and ClearQuest during various phases of RUP.
Sum Experienced in Business Analysis, SWOT Analysis, Gap Analysis, Risk Analysis, Disaster Recovery Planning, Testing and Project Planning.
Sum Extensive knowledge of Medicaid (MMIS), Medicare, Procedural and Diagnostic codes and Claims Process.
Sum Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response, EDI 834-Enrollment and 820-Payment order an...
Sum Experience in Conversion of HIPAA X12 4010 codes to X12 5010 codes and ICD 9 codes to ICD 10 codes.
Sum Gathered requirements for ICD 10 Codes pertaining to Other Payer Liability (OPL), Federal Employee Program (FEP), Enterprise Code Management system (ECM), Claims Processing System (Diamond), Maintenance Process.
Sum Proficient in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using Rational tools and Microsoft Visio.
Sum Experienced in handling Change Management.
Sum Experienced in analyzing and documenting business requirements and system functional specifications including Use Cases.
Sum Experienced in writing Test Plans and executing Test Cases.
Sum Experience with healthcare reform (HCR) and healthcare payer systems.
Sum Proficient in Developing and executing Test Plans, Test Scripts, performing functional, usability testing and ensuring that the software meets the system Requirement.
Exp Professional Experiences:
Exp Wisconsin Medicaid (HHS), Madison, WI
Exp Apr 2014 – Present
Exp Role: Sr. Business Analyst
Exp Description: This project was to implement IV&V on MMIS and Medicaid Eligibility System.
Exp Responsibilities:
Exp Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases
Exp Develop the supporting plans such as scope, cost, risk, schedule, quality, resource, security deliverables, procurement and change management plans.
Exp Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in synchronous with the business requirement processes.
Exp Created Requirement validation and Verification Plan.
Exp Mapped all functional requirement with Business Requirement and all user stories with Functional requirement so it gets easy to do IV & V.
Exp Involved in HIPAA 5010 gap analysis of ANSI X12 4010.
Exp Developed plan for data feed and data mapping for integration between various systems including XML, to follow ICD 10 code set and ANSI X12 5010 formats.
Exp Develop Project charter and got Approval.
Exp Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
Exp Prepared UAT Materials, UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements.
Exp Extensively gathered business requirements for ICD -10 Groupings/classes pertaining to the maintenance process, ICD -10 Business rules remediation process, Other Payer Liability (OPL), Claims Processing system (Diamond).
Exp Gathered High Level Deliverables for ICD -10 Remediation of Configuration Rules to comply with ICD mandate , to regroup with sequential ICD- 10 Codes
Exp Gathered detailed requirements OPL tables to convert, capture and/or map the current ICD 9 diagnosis and procedure codes to the new ICD -10 diagnosis and procedure codes.
Exp Define project goals, objectives and success criteria.
Exp Identified and document Project constraints and assumption.
Exp Used MS Visio to create Use Cases and Sequence Diagrams.
Exp Accomplished experience through whole SDLC from requirement analysis till deployment.
Exp Assisted development team to translate requirements into technical specifications.
Exp Created and Maintained the Requirement Traceability Matrix (RTM).
Exp Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
Exp Conducted User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.
Exp Environment: HP Quality Center 10.0, Caliber RM, SAP, MS Office, Windows XP, Windows Vista, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML, SpecBuilder, MMIS, Mainframe.
Exp Blue Cross and Blue Shield, Jacksonville, FL
Exp Feb 2013-Mar 2014
Exp Role: Sr. Regulatory Analyst
Exp Description: The project involved TriZetto heading the IT solution for Blue plans. Project was involved working on the design and configuration changes as per the PPACA (Patient protection and Affordable Care Act) in the current healthcare plans. As a Business Analyst I partnered closely with SME's and legal teams ...
Exp Responsibilities:
Exp Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
Exp Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
Exp Tested and validated claims processed by Facets.
Exp Participated in the CORE (Committee on Operating Rules for Information Exchange) compliance process for the company.
Exp Actively involved through the successful Implementation phase of HIPAA 5010 Project.
Exp Involved in HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278.
Exp Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010 and ICD 9-CM (Clinical modification) to ICD-10-CM/PCS (Clinical modification/procedure coding system) simultaneously
Exp Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
Exp Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
Exp Worked on the PPACA for various mandates such as Grandfather Rule, Rescissions, D-26, Pre Ex-19, Preventive Care, Operating Rules, and Early Retirees Fund etc.
Exp Wrote test cases and test scripts for the User Acceptance Testing.
Exp Performed Requirement Analysis and developed Use Cases and Activity Diagrams.
Exp Traced High Level Requirements (HLR) to Detailed Level Requirements (DLR) using MKS Integrity.
Exp Conducted meetings with SME's to understand current business process and performed Gap Analysis to meet future business needs.
Exp Created and managed project templates, use case project templates, requirement types and traceability relationships in MKS Integrity.
Exp Developed Systems Specifications document to define the impact of the new requirements on the existing system.
Exp Developed and managed creation of product documentation to communicate features, benefits, positioning and impacts to different audiences and ensured that documentation deliverables from various groups are produced as needed.
Exp Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
Exp Environment: MS Office, Rational Quality Manager, SQL Server, MS Project, MS Visio, Unix, j2ee, Java, XML, Mainframe and Rational ClearQuest, ClearCase, Windows XP.
Exp Health Integration, Tampa, FL Apr 2011 – Jan 2013
Exp Role: Sr. Business Analyst
Exp Description: This project mainly deals with the large web based applications used in the clinical settings.
Exp Responsibilities:
Exp Developed Functional Requirement Scenarios and Use Cases based on business needs.
Exp Involved in gathering Data Mapping Requirements from Technical Team.
Exp Worked with Business user to define Functional Requirements and Business Process Flows.
Exp Developed Business Requirement Document (BRD) and Use Case Document (UCD) using Microsoft Office.
Exp Worked with data migration and file mapping for various EDI transactions.
Exp Enhanced the Provider/Patient verification criteria using additional parameters based on the information retrieved from the EDI 837 I/P transaction files.
Exp Translated the EDI X12 data into XML format for initial transformation/migration.
Exp Reloaded multiple business rules from the Legacy System into the new system.
Exp Worked on various Business and technical documents including the Requirements and Specifications.
Exp Worked on Child Support Obligations and benefits and prepared process flows and data flow diagrams.