CAREER SUMMARY

● Business Analyst with almost 8 years of hands-on experience in analyzing, gathering and documenting
functional requirements.
● Experienced with working in both Waterfall and Agile Methodology

● In-depth knowledge of the healthcare industry - commercial and government payers (Medicaid and
Medicare) including claims adjudication, enrollment, eligibility and provider.
● Experienced in creating and modifying complex SQL queries to analyze and validate test databases for data
integrity.
● Strong understanding of functional, integration, system, and regression testing.

● Experienced in various healthcare areas like enrollment, benefits, claims, Medicare, and implementation of
HIPAA key EDI (ANSI X12) transactions.
● Well versed experience in all EDI transactions like 834, 837 P, I (FFS and Encounter), COB claims.

● Experienced in creating ad-hoc reports in support of reporting needs.

● Actively involved in all phases of testing activities, from planning, User Acceptance Testing (UAT) to
production validation.
● Experience in testing Client/Server and Web-Based Applications

● Strong Knowledge of all stages of Software Development Life Cycle (SDLC)

● Performed Sanity Testing, Smoke Testing, Positive Testing, Negative Testing, Black Box Testing, Unit Testing,
Integrated Testing, System Integration Testing (SIT) , Security Testing and Regression Testing.
● Excellent experienced in data Extraction, Transformation and Loading ETL using various tools such as SQL
Server Integration Services SSIS.
● Experienced in generating and documenting Metadata while designing OLTP and OLAP systems environment

● Experience in ER Modeling, Dimensional Modeling (Star Schema and Snowflake Schema) Data Warehousing,
and OLAP tools.
● Extensive experience with Business Process Management (BPM) using workflow and its components – Input,
Transformation and Output.
● Good knowledge of HIX (health insurance exchange), health care reform and patient protection and
affordable care act (PPACA).
● Experience working in a FACETS environment and I have gained extensive knowledge about various modules
of a FACETS system such as claims, membership and pre-pricing etc.
● Expertise in business analysis skills and experience in working in SDLC for Various methodologies included
RUP, Agile, Scrum/XP, Waterfall, and other internal methodologies.
● Involved with Software Development Life Cycle in stages of Requirement gathering, Analysis, Design,
Validation and Quality Assurance, RSA Methodology.
● Created various reports Using BI tools such as Tableau, Power BI and Micro Strategy

● Experience in claim processing, Adjudication and Payment.

● Possess both Healthcare business and Technical knowledge with various systems such as clearing house, Data
warehouse, Facets, Trading Partners and Payment Engine.
● Experience testing Web-services using SOAP UI.

● Excellent communication skills both verbal and written

TECHNICAL SKILLS
Business Modeling Tools: Visio
Data Analysis: SQL, Excel
Reporting: Tableau, Excel
Testing tools: HP ALM, JIRA
Relational Database: Oracle, MS SQL Server, MS Access,
Documentation Tools: HP ALM, JIRA, SharePoint

PROFESSIONAL EXPERIENCE
Sr. Business System Analyst July 2018 – June 2022
Visiting Nurse Services, New York/Minneapolis MN
VNS Population Health Department utilizes the vendor system Guiding Care to perform care
management for members via multiple lines of business. My tasks are to assist transitions from the
legacy system to the vendor-based Homecare Home Base (HCHB) system that feeds Guiding Care.
Additionally, system enhancements required for Guiding Care are identified, analyzed, and developed.
Project – Migration project – Legacy to HCHB system
Responsibilities:
● Perform the gap analysis between the legacy Mainframe system and the future HCHB system.
● Work with HCHB and Guiding Care Technical Team to understand and document the data mapping and
data flow process.
● Based on the identified gaps and issues, suggest necessary system changes to suit the business needs.
● Gather business requirements made to the Guiding Care per business decision.
● Design the business rules of new home health programs under different scenarios.
● Write and maintain functional specifications for new enhancements.
● Perform data analysis to identify production issues and assist the Business in making a business decision.
● Worked in testing the Professional, Institutional Claims processing and adjudication and validate data with
FACETS.
● Tested EDI transactions 270/271, 837, 835, 834(X12) according to the test scenarios.
● Actively participated in smoke, functional and ad-hoc testing during SIT phase.
● Worked on Claims Processing and Claims Accumulation and Adjudication in FACETS.
● Worked on the Workflow application for the Facets e2 core application to reduce claim turnaround
timings
● Directly worked on the Facets e2 core Workflow rules engine and configuration according to rules
established by the plan's business staff.
● Make system configuration for member letters, Health Plans, Programs, Plans, User roles and Scripts.
● Assist Guiding Care business users in resolving daily system issues and provide workaround.
● Manage and keep track of the project progress across the development team.
● Lead the testing activities to ensure all major business needs have been covered.
● Created EDI documentation processes and procedures for high level users
● Exported test cases from HP ALM into Quality Center.
● Executed Web Services functional testing and created test suites for validating SOAP and REST based
services using SOAP UI PRO.
● Analyzed modules and designed test scenarios and test scripts in UNIX environment.
● Executed the test cases in HP ALM.
● Coordinate between VNSNY and Guiding Care offshore team to resolve production issues.
● Report and communicate the project issues and project progress to the Business in the monthly Project
Review Meeting.
Business System Analyst/UAT Tester September 2015 – June 2018
HP (Hewlett Packard Enterprise), Harrisburg, PA
HP supports the Medicaid claim processing for DHS (Pennsylvania Department of Human Services )
using their applications integrated with various functional areas .I am primarily working on various
projects in the area of TMSIS (Transformed Medicaid Statistical Information System) , ACA Provider
Enrollment , Member Enrollment and multiple Claim Processing projects.
Project - Claim Accuracy and claim reimbursement (Facets)
Project - Auto Deferral claims (facets)
Project - EDI 837 quarterly upgrades
Responsibilities:
● Assist in developing and updating data mapping documents to gather and define the required data from
various sources in accordance with CMS guidance for TMSIS system.
● Perform gap analysis to determine the changes and impacts to systems.
● Construct complex SQL queries to perform back-end analysis and validation.
● Interact with internal customers to clarify business requirements and document functional specifications
for FFS claims, encounters, reference updates, creation of new service programs and updated claim
processing logic.
● Create and define the designs for data extracts and reports for provider enrollment reports.
● Peer Review the business requirement document (BRD) and system requirement document (SRD).
● Create test cases for multiple claim work, including new service programs, NPI crosswalk logic changes,
DRG updates in testing and UAT environment.
● Familiar with loops and segments in 837 and 834 transactions and manually manipulated 834and 837EDI
files to suit the different scenarios of test cases.
● Wrote FUDs for the defects and enhancements and got approval from business for the developers.
● Zephyr test management for Continuous testing to test at continuously as well as operate within the
CI/CD pipeline and manage test process.
● Creating custom dashboards, detailed reports or in depth analytics data Zephyr in an agile environment
on a local to AWS cloud data migration project
● Involved in Data Integration by identifying the information needs within and across functional areas of an
enterprise database upgrade and Migration with SQL server Export Utility.
● Used DTS/SSIS and T-SQL stored procedures to transfer data from OLTP databases to staging area and
finally transfer into data marts and performed action in XML.
● Deploy SSIS Package into Production and used Package configuration to export various package properties
to make package environment independent.
● Implemented SSIS (ETL) to extract and transform data from RDBMS and Flat files/CSV, SQL Server 2014
instances and to load into staging and then to Data Warehouse for further Data Analysis and Reporting by
using multiple transformations provided by SSIS
● Creating Dashboard Reports and Tabular Reports using SSRS MSBI Tool.
● Performed data integrity and validation testing by executing SQL statements to make sure the data is
correctly integrated and functional on Relational Database.
● API testing using Soap UI for claim request and response file for data verification and validation.
● Experience working on Full claim adjudication cycle: PRE and POST adjudication claims, claims
reimbursement, claims accuracy and reimbursement project
● For Claim Accuracy worked on claim adjudication scenarios (Facets) for Co-ordination of benefits, late
payment interest, Multiple Surgeries , Accumulators , Provider contracts And Pre Authorization project
updates
● Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing).
● The downstream systems have batch jobs run on CA Workload, with Informatica for ETL transformations
executed on the SQL Database, creating flat files and XMLs for downstream applications.
● Worked with the developer to validate Unit testing results GitHub and Get Next testing tools
● Responsible for Business Process Management (BPM) for development of various projects.
● Coordinate meetings with technical team and the client to resolve outstanding issues.
 ● Perform research and analysis necessary to resolve production issues.
● Proficient in conducting testing for applications portals, database and batch processes and experienced in
preparing test data, test plan and execution of test cases.
● Conduct business design and test results walk-through in small and large group settings.
● Create training materials and release notes for end-users.
● Assist in researching open tickets and testing a variety of production defects.

Business System Analyst July 2014 - July 2015

Blue Cross Blue Shield of Michigan, Detroit, MI
BCBSM was required to submit their various kinds of 2014 commercial data to EDGE Server for CMS new
premium stabilization programs (Risk Adjustment and Reinsurance) from 2014. The ERA team working
with different vendors via multiple tools to ensure that the quality data was submitted, meeting CMS
code changes. I was involved in documentation of business processes, data analysis, testing and
coordination of testing activities.
Project - Medicare/Medicaid claims
Project - Remittance advice updated/ EDI 835
Project - Pre-Authorizations and Accumulators (Facets)
Project - Facets Upgrades
Responsibilities:
● Involved in planning and implementing both high-level and detailed test plans and test cases.
● Responsible for analysis of the “As Is” business process and defining the “To Be” business process
regarding the changes to the data submission process and CMS business rules.
● Documented the existing process and future changes.
● Assisted in ETL process using transactions and loading data from different sources like Flat Files and
Relational Database.
● Analyzed and confirmed the source and target data in the database using Oracle SQL.
● Involved in data discrepancy reporting process by conducting data analysis
● Informed the data quality team of the latest changes from CMS calls and keeping track of file submissions
with different vendors.
● Adhere to existing configuration procedures established by department seniors and/or management
● Communicate with vendor regarding data submission issues and provide a solution to their existing
system
● Attended CMS weekly call regarding the changes made to the monthly file submission process.
● Generated analytical reports to chase DOS mismatch members for chart review process using Advanced
Excel.
● Participate in all Agile Scrum meetings and kept track of defects and issues using JIRA.
● Wrote test cases/scripts and report quality traceability matrix, influencing software design, product
development, and release cycles; ensure software is of high quality and Business Owner’s requirements
are met prioritizing in JIRA Software.
● Tested testing and production data in Edge Server testing regions based on code changes each cycle.
● Performed SIT/UAT testing by running ETL jobs, validating data loads, troubleshooting job execution
errors, and executing test scripts for scenarios for Accumulators, pre- authorizations, Coordination of
Benefits, Late payment interest and Multiple Surgeries.
● Extensive use of SQL for Backend Testing and Data validations for EDI files.
● Complex SQL queries to test the accuracy of the down streaming of data into the Facets interfaces against
the Db2 database.
● Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing).
● Involved in version migration of workflows from Informatica 8.6 to Informatica 9.1
● Understanding and hands-on working experience with standards for medical transactions like Enrollment
834, Claims 837, Eligibility inquiry 270, Eligibility response 271, Claim status 276, and Claim status
response277.
● Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor
Management Business Areas.
 ● Attended daily testing status calls to update the team’s testing progress and address any testing concerns.

Business System Analyst February 2013 – June 2014

Celtic Health Insurance, Chicago, IL
I was involved in the enhancement of the Celtic’s member web enrollment site and billing system when
the company decided to migrate to the new version of Facets.
Project - Claim Intake and Workflow (PEGA Application)
Project - Coordination of benefits/Multiple surgeries
Project - Pre/post claim adjudication edits
Project- Facets Implementation- Medi-Cal, OneCare, PACE.
Responsibilities:
● Responsible for preparing BRD and then translating into functional specifications.
● Used agile scrum/Kanban methodology to manage and coordinate the efforts of the team to ensure
efficient and timely delivery of the documentation, also updated User Stories and Burndown charts.
● Facilitated Scrum ceremonies (Sprint Planning, Sprint Review, Sprint Retrospective, and Backlog
Grooming).
● Assisted in entering and updating Issues (Epics, Stories, and Tasks) onto JIRA Agile application.
● Facilitated and coordinated Release communication and responsible for handoff to the downstream
pillars.
● Perform system requirements gathering and analysis; interview the subject matter experts, stakeholders
and executive sponsors.
● Interact with the business analysts & business users for design & requirement clarification for external
projects & change requests.
● Created Storyboards, Wireframes, Mockups, Prototypes, User journey, Style guides, Color palettes, Icon
libraries
● Gather requirements and prepare business requirement documents (BRD), System Requirement
Documents. Responsible for translating BRD into functional specifications and test plans. Closely
coordinate with both business users and developers for arriving at a mutually acceptable solution.
● Conduct JAD sessions to define the project and to reduce the time frame required to complete
deliverables.
● Constantly interact with the Product Director for enhancements and discussion on the changes.
● Work on EDI X12 transactions, HIPAA standard transaction codes including 837, 834, 835, 270, 271, 276,
277 and perform analysis of such transactions.
● Performed data analysis and data profiling using complex SQL on various sources systems
● Documented the User Acceptance Testing (UAT) Plan for the project and worked with the UAT Team to
ensure every acceptance criteria for the requirements had been included in the UAT task plan for Pega
Applications.
● Responsible for Database testing using SQL queries
● Written complex SQL queries for validating the data against different reports generated by Business
Objects
● Test GET and POST requests and response web services using the tools like SOAP UI, POSTMAN depending
on the type service.
● Extensive API Testing using SOAP UI, Request and response Data validation and verification from the EDI
files against the DB2 database
● Wrote use cases for the Escalation & Reconciliation Management System (ERMS) Pega Application to
include adding Billing Errors Application to the Applied Suspends and Dual Enrollment Applications SDS.
Have knowledge of Capitation, Medicare, Vendors, Billing & Enrollment, ID Cards, Claims processing and
Automated Renewals process.
● Participate in analyzing business requirements, Data Model Design, Data flow from various Sources to
Target.
● Develop Business Process diagram to understand the whole workflow.
● Use TOAD to execute all SQL queries.
● Analyze system requirements and develop detailed Test Plan for System Testing.
● Tested Web services using SOAP UI and SOA Reported Defects to developer and generated Reports.
 ● Involved in testing HIPAA Transactions & Code Sets Standards like (834- Enrollment /enrollment
cancelation to a health plan, 835, 837 ...etc.).
● Understanding and hands-on working experience with standards for medical transactions like Enrollment
834, Claims 837, Eligibility inquiry 270, Eligibility response 271, Claim status 276, and Claim status
response277.
● Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor
Management Business Areas.
● Extensively involved in Database testing by writing SQL queries.

EDUCATION