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Click here or scroll down to respond to this candidateCandidate's Name
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Employer:- Niyaz
EMAIL AVAILABLE
PHONE NUMBER AVAILABLE
Summary
 6+ years of extensive experience as a business analyst and QA, with strong experience in Healthcare especially in insurance claim with a solid understanding of Business Process Flows, Case Tools, and Business Analysis.
 Experience working with HIPAA ANSI X12 4010A 270/271, 276/277, 834, 835, 837 for institutional, professional and commercial claims, and up-gradation of ANSI 4010 to ANSI 5010.
 Excellent understanding of ICD 9, ICD 10, HCPCS, and CPT.
 Commanding knowledge of various development methodologies like Waterfall, SDLC, Rational Unified Process, Agile and Scrum.
 Experience in working with QA testing teams, while interacting with business users and gathering user s requirements to develop necessary Test plans, Test Cases and Test script.
 Extensive experience in gathering Business and Functional Requirements, developing Use Cases, conducting Gap Analysis and preparing Training manuals.
 Experience in developing UML use case diagrams, Work Flow Diagrams using tools like Rational Rose and MS Visio.
 Excellent Business writing skills in creating Business requirement Document (BRD), Use Case Specifications, Functional Specifications, and System Requirements Specifications (SRS).
 Expertise in Rational Unified Process (RUP) methodology, Use Cases, Software Development Life cycle (SDLC) Processes and rational tools used during all four phases of RUP: Inception, Elaboration, Construction and Transition.
 Proficient in Developing and executing Test Plans, performing functional, usability testing and ensuring that the software meets the system Requirement.
 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.
 Knowledgeable about preparing RTM documents.
 Proficient in soliciting client Requirements through interviews, workshops, existing system documentation and organizing JAD sessions..
 Knowledge in documentation project related information like test execution procedures, backup plans, new tester training documents, maintaining test logs, release notes etc.
 Writing and Reading data objects i.e. stored procedures, tables, and views, etc. in SQL server.
 Strong Communication and writing skill.
Skill Sets:
Modeling Tools: MS Visio, Rational Rose, Enterprise Architect, OminiGraffle.
Methodology: RUP, Agile, Waterfall.
Testing: Quality Center, Test Director, win runner.
Programming Languages: C++, SQL, XML, HTML, and VB.
Platforms: Windows, NT/95/98/2000/XP/Vista/Window 7.
Industry standard: HIPAA, ISO, HL7.
Applications: MS word, MS Excel, MS Access, MS Power point, MS Outlook, Adobe Photoshop.
Other Software: SAS, SPSS.
Emdeon, Nashville, TN April 11 March 12
Business Analyst
This Project is about to implement the Automated Adjudication System, which deals with different phases of claim process such as Intake Phase, Adjudication Phase and Reporting Phase. Implementation of ACAS (Automated Claim Adjudication System) must have to comply with HIPAA Rules and Regulation of privacy and security. Implementation of ACAS to generate automated Claim Submission, Processing and creating a report.
Roles & Responsibilities
Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
Gathered Requirements and documented the proposed additional extension to the existing HIPAA application.
Facilitated Joint Application Development (JAD) sessions with the Management, Mainframe and HIPAA team to make sure everyone are in sync with the business requirement processes.
Worked on HIPAA Transactions 270, 271, 276, 277,834, 835 and 997.
Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.
Used MS Visio to create Use Cases and Sequence Diagrams.
Worked on FACET claim processing system.
Accomplished experience through whole SDLC from requirement analysis till deployment, using highly efficient RUP process of Software development.
Assisted development team to translate requirements into technical specifications.
Liaised and Coordinated in resolving EDI mapping issues arising from data transfer process from EWM to ACAS and third party systems.
Analyzed mandatory and the situational fields and compared with the users manuals for EDI.
Worked closely with the host (Main frames support person) and helped him understanding the process and in the creation of the match, input and the delete files.
Created and Maintained the Requirement Traceability Matrix (RTM).
Initiated Test Plans, developed and executed test cases and scenarios, worked with users to develop specific acceptance criteria and prepare test exhibits.
Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
Conducted User Acceptance Testing (UAT) sessions with business users and prepared document for enhancements and bug fixes.
Used Test Director and Mercury Quality Center to report any bugs found and communicate to the developers and product support team.
Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test condition the performance of the application from various dimensions.
Helped create the Business Glossary to facilitate efficient understanding of the Business process amongst the other teams
Environment: MS Visio, MS Project, Windows XP, HIPAA, Microsoft Office Suite, Quality center, Rational Unified Process (RUP), UML.
State of Michigan, Lansing, MI Business Analyst. June 09 January 11
The project was about implementing the HIPAA standards initiative of processing Professional and Institutional Claims using NDC over to HCPCS (Healthcare Common Procedure Coding System) which is the current processing standard and to assist with the Community Health Automated Medicaid processing system.
Roles and Responsibilities
Involved in requirements gathering sessions with SME s (Subject Matter Experts), Business Analysts and Architects to understand requirements in terms of business.
Played a major role in collecting, documenting, blueprinting and managing business requirements.
Actively worked on Business requirement analysis and Data analysis.
Worked at different stages of Software Development Life Cycle (SDLC) with business users, developers, and stakeholders.
Worked on business process from taking a requirement from a systems record to a centralized database.
Gathered requirements from the clients and developed crosswalks for 277/288, 834, 835, 837 P/I claims.
Developed test cases based on the crosswalks and compliance guidelines for 277/288, 834, 835, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
Generated test data using X12 generator for transactions 277/288, 834, 835, 837P/I/D. Conducted Gap Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
Ensured that ICD-9-CM procedure codes used for inpatient services and CPT codes for outpatient and physician services were not outdated
Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Visio.
Participated in Forward Mapping and Backward Mapping analysis of ICD 9 ICD 10.
Participated in the JAD sessions along with the technical team members and clients to elicit requirements for HIPPA 4010 to 5010 migration process.
Actively worked with quality control teams to develop test plans and test cases.
Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
Established Inner Join, Outer Join and created Indexes whenever necessary.
Writing Standard SQL queries and optimizing SQL Queries
Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
Developed test scenarios and implemented test plans for system test and user acceptance test (UAT).
Health Group, New York, NY October 08 May 09
Business Analyst
Health Group is an innovative leader in the health and well-being industry serving approximately 65 million Americans. The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information. Implementation of the Automated Clearing House Origination software to generate NACHA compliant files that adhere to all NACHA standard entry class codes at a multi payer level to further penetrate the provider market with electronic payments and statements.
Roles & Responsibilities:
Gathered Business Requirements, interacted with the Users, Designers, Developers, Project Manager, and SMEs to get a better understanding of the business processes, and analyzed and optimized the process.
Actively involved in the entire Software Development Life Cycle (SDLC) Process.
Created reports containing all the information regarding the publishers, distributors and retailers using crystal reports.
Facilitated demonstration of a major ACH software systems and performed evaluations with a group of experts to select a package that best suits the need of the business.
Extensively worked with HIPAA transactions such as 835-claim payment/advice.
Developed Traceability Matrix for maintaining/updating current and new system requirement using MS Excel.
Researched/Analyzed the various steps in claim processing lifecycle and then wrote the Business Requirement Document and Functional Requirement Document in such a way that developers could construct the system to identify and monitor the riskier claims.
Worked with electronic claim clearing house like Web MD and automated clearing house (ACH) for electronic payment, remittance data processing and services.
Created the User Requirement Specifications and helped convert them to Functional Requirements, and assisted the developers with System Requirement Specifications.
Responsible for ensuring data integrity and coordinating effort with testing and implementation responsible for the development and execution of test plans.
Environment: MS Office tools, MS Project, MS Visio, UML, RUP, Windows, National Requisite Pro, and SQL Server.
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