Description
Experienced with EDI files 834,835,270/271, 276/277 file formats * Mapped HIPAA 4010 and 5010 differences * Read and interpreted 997/999 acknowledgments * Facilitated the setup of new trading partners, including planning, project management, testing, documentation, and implementation. * Developed and maintained functional specifications for new / existing applications needed to maintain/enhance EDI processing and address the requirements of new trading partners. * Participate in transaction analysis and mapping needs, system / interface analysis, and work with programmers to implement changes as needed. * Elicited and documented API specifications, SLA (Service Level Agreement) detailed requirements for customers * Helped QAs to write test cases, test plans, run tests, log defects, track defects, and generate test report * Performed Requirements Gathering and Analysis and facilitated JAD sessions with Subject Matter Experts (SMEs), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks * Performed the Gap Analysis to find the existing gap between HIPAA 4010 and HIPAA 5010 EDI transactions and between ICD 9and ICD 10 * Designed and developed Use Cases, Activity Diagrams, and Sequence Diagrams using UML tools * Conducted impact analysis of HIPAA 5010EDI835 and 837 transaction sets on different systems. * Initiated with an impact analysis report of migration from HIPAA 4010 to 5010 * Used General Equivalence Mapping, both forward mapping and backward mapping, to convert from ICD 9 to ICD 10. * Documented, organized and tracked the requirements using Rational Requisite Pro. * Worked on ICD conversion from ICD 9 to ICD 10 with respect to the claims related to Medicare * Derived BPMN for batch loading of Provider and Member data into FACETS. * Tacked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM). * Generated the sequence, state chart, and activity diagrams to enable understanding and representation of the business processes for ease of software system development in Rational Unified Process (RUP) methodologies using Rational Rose. SUMMARY * 6+ years of diverse experience as a Business Systems Analyst in the Healthcare & Pharmaceutical Domain. * Experience in defining business processes, identifying risks, base-lining acceptance criteria, and deliverables. * Expertise in various SDLC methodologies like Agile, Waterfall and RUP. * Experienced in manual as well as automation testing of both web based, and client based applications on Windows and UNIX environments. * In-depth knowledge of Medicaid and Medicare Services. * Excellent knowledge of EDI transaction files such as 270/271, 276/277, 470, 835, 820, 837 and 834. * Extensive experience on working with ICD 9 and ICD 10 and adept understanding of professional, institutional, PX/DX relationships. * Good working knowledge of XML. * Requirements gathering in compliance with HIPAA 4010 and 5010 standards. * Thorough understanding of HIPAA standards, compliance issues, privacy policy, opts in/opt out policy. * Rich experience with various modules of Facets like membership management, premium billing, enrolment, claims processing & adjudication, coordination of benefits administration. * Experience in writing Test Cases and Test Plans. * Experience in testing the HIPAA EDI transactions X 12, 834, 820, 837/835, 276/277, 273, 270/271 according to the requirement test scenarios. * Considerable knowledge in the analysis, design, business processes, data modelling and application development. Applying Unified Modelling Language (UML), and the implementation of performance measures. * Experience working with FACETS 4.71 & 5.0 claims processing. * Adapt at transforming requirements into Business Requirement Document (BRD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) * Experience in designing business models using Business Intelligence, use case models, workflow models, analysis models, activity diagrams, sequence diagrams, and collaboration diagrams. * Acted as liaison between management and development team for requirements. * Experience with Quality Center (QC) * Knowledge of Healthcare Products and Guidelines. Worked in compliance with HIPAA guidelines. Experienced with working on Version 5010-revised HIPAA transaction standards & prerequisite for ICD-9, ICD-10 and EMR/EHR. * Good Knowledge of Web Service Testing using Soap UI * Tested different web services using SOAP UI * Proficient in conducting Functional and user Acceptance Testing. * Excellent analytical skills coupled with interpersonal, communication, presentation, and self-organizing skills, assertive and a committed as a team player. * Involved in Gathering testing requirements from BRD's and specifications. * Performed Defect reporting using reporting tools. * Coordinated and facilitated meetings between test team and applicable development team members to identify and resolve defects identified by the test team. * Participated in walkthroughs and meetings with the development team
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