C C. Email & Phone Number

Bellevue, Washington, United States

Business Analyst with over 6 years of experience in the Healthcare domain. Expertise in various areas like EDI, Medicaid and Medicare Services, Claims Processing, Billing, Insurance and Reimbursement. Having a good experience with different project methodologies including Agile-Scrum Methodology, Waterfall, Modified-Waterfall, Iterative, Incremental and RUP.

Pleasanton, California, United States

Create a Data Mapping document and work with businesses and vendors to write transformation rules.Analyze the business requirement to develop the functional and non-functional specification.Prepare the Business Requirement Document BRD and functional requirement document FRD for the enhancement of the existing services.Conduct JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.Developed Schemas of EDI X12 Claims (837) and Eligibility forms in XML. Involved in creating sample mappings for the conversion of EDI X12 transactions code sets. Work with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.Create workflow diagrams, UML diagrams, activity diagrams, use cases.Conduct Business Requirements walkthrough with the business owners as well as the Technical Stakeholders internal and external requirements from development stage to production, including both Companion Guide creation and Test cases, Test plan. Test the changes in Facets front end screens after the authorization load is completed.Responsible for maintaining the change notification request document and communicating with the developers in each iteration review meetingsPerform research on Member, Provider, Claims and Authorization data from Facets back end and front-end application system for reporting purposes.Successfully tested all the test conditions, documented the defects and discussed with technical analysts the discrepancies between expected and actual results for the test conditions.

Dover, Delaware, United States

Built an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part of the Affordable Care Act (ACA).Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act. Thorough knowledge of ICD-10 codes and CPT codes for both Mental and Medical Health and worked extensively with Inbound and outbound 834 Transactions processing systems.Compile, validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services.Collaborate with federal clients (CMS, NIH, ONC) and standards development organizations such as HL7 to develop Responsible for UAT project planning and Performed Regression, UAT, Integration, User Interface, GUI, and Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes and conducted research on IT requirements and business requirements in UAT areas.Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA). Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance.Lead projects to design a state-customized Financial Management solution for Health Insurance Exchange (HIX).Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.Developed EDI specifications and applications structures for data feeds and mappings for integration between various systems, including XML and performed back-end testing on the Oracle database by writing SQL queries Handle the tasks of helping the organization staff in planning data sets for UAT. Created Test Strategy Planning (TSP) and assisted the testing team to implement test plans during the UAT kickoff.

Springfield, Illinois Metropolitan Area

Facilitated JAD sessions to collect requirements from system users and prepared business requirements that provided appropriate scope of work for the technical team to develop prototype and overall system.Responsible for creating working documents to document provider agreement information, gathering and documenting Participating Specialist, Ancillary & Hospital providers, creating Specialist, Ancillary & Hospital agreements in Facets, resolving failed claim tests, and documenting progress and ensuring all provider agreements were created. Provide analyst support during all phases of the Software Development Life Cycle including development and testing (unit/system) phasesExtensively involved and performed Feasibility Analysis for the proposal of the new system around Agile methodologyDevelop, coordinate and support Information Technology Division on all operational requirements of FACETS claims processing system and production management.Involved in developing database objects using FACETS database in both SQL Server and Sybase environments.Worked closely with stakeholders and SME’s for requirements gathering.Created EDI Export and Import processes and work with EDI Trading Partners, Payers or VendorsDeveloped requirements integrating Use Case diagrams and designed the testing process flows.Writing Complex SQL queries and optimizing SQL QueriesUsed MS-Visio to analyze business requirements and processes through Use Cases, Class, Sequence, and Activity diagrams, and adapted UML standards to define modularized Data Process Models.Ensured Use-Cases were consistent and covered all aspects of the Requirements document.Created test files and analyzed test results using MS-Excel.Coordinated and facilitated the execution of User Acceptance testing.

India

• Experience of managing multiple stakeholders across the organization, and in QA integration of systems. Involved in detailing project mission, data process flow diagrams, and timelines.• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.• Documented business requirements, and communicated the requirements with the development team for design and implementation of business solutions.• Worked with the Business Analysis team to prepare a detailed Business Requirement document (BRD) and System Requirement Document (SRS).• Analyzed Business Requirements to develop functional and detail design specifications.• Conducted Requirement Gathering Sessions with the stakeholders. Incorporated stakeholder feedback throughout the project lifecycle to ensure project quality and customer satisfaction.