Amanpreet S. Kang

acg1zy@r.postjobfree.com

559-***-****

. 8 years of experience as Business Analyst/Data Analyst with hands on

experience in Insurance/Healthcare government welfare Sectors.

. Strong knowledge of the Software Development Life Cycle methodologies

(phases and gates) like Agile and Waterfall models.

. Extensive experience in Business Requirements gathering and writing

skills with expertise in developing and documenting Business Requirement

document (BRD), Functional Requirement Document (FRD), Software

Requirement Specification (SRS) across the deliverables of a project.

. Experience with Base SAS procedures such as Proc Contents, Format,

Import, Print, Report, Tabulate, and SQL.

. Have considerable expertise in Metadata Management, Data Analysis, Data

Profiling & Quality, Data Governance and Master Data management (MDM).

. Effectively used Rational Requisite Pro to organize, track and change

requirements of the system.

. Expertise of UML in visualizing and documenting the artifacts using Use

Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow

Diagrams, Business Flow Diagrams, Sequence Diagrams using MS Visio.

. Experience in facilitating Joint Application Development (JAD) sessions,

conducting user interviews and acting as a liaison between the customers,

development team and testing team.

. Experience in working with QA team to develop the test plans, test

scenarios, test procedures, and test cases to ensure adequate testing of

software both before and after completion.

. Facilitated User Acceptance Testing (UAT) with the stakeholders and the

business users as well as trained users to use the system configured.

. Analytical, methodical and resourceful approach to problem solving,

identifying root causes and corrective actions to meet short and long-

term business, financial and system requirements.

. Excellent verbal/written communication skills and strong analytical

abilities and can perform well both independently and as a team player.

. Excellent understanding of the working of SharePoint application.

. Extensive experience in Functional testing,, Integration testing,

Regression testing, GUI testing, Back-end testing, Browser Compatibility

testing, System Testing, Build Verification Testing, User Acceptance

Testing.

. Good Knowledge of PMBOK and BABOK.

. Conducted JAD sessions, created Use Cases, work flows, screen shots and

Power Point presentations for the Web Applications.

. Worked on Mercury Quality Center, Jama Requirements Management tool.

. Experience in conducting Feasibility Studies, Data Analysis, System

Analysis, Gap Analysis, Risks Analysis and Root Cause Analysis (RCA).

. Gathered and documented functional and non-functional requirements.

. Experience in preparation of Deliverables, Business Requirement Documents

(BRD), detailed Functional Specifications and Non-Functional

Specifications, developing Use Cases and Test Cases.

. Experience with mainframe applications such as TSO, and CICS, and

familiar with SQL Query Management tools like Toad for Oracle and the

Query Analyzer in Microsoft SQL Server.

. Familiar with HIPAA EDI transactions such as 835, 837, EFT/ERA 270/271,

276/277 etc.

. In depth knowledge of SDLC in all four phases of a project: Inception,

Elaboration, Construction and Transition.

. Performed UAT and exposure to Operational Readiness Testing (ORT)/SIT.

. Expertise in Procurement and Management Services.

Software/Hardware:

C#.Net, VB.Net, SQL, IDMS, QTP, MS Windows NT 4.0/2000, Windows 95/98,

Windows XP, MS Visual Studio, .Net, Rational Rose, UML 2.0, RUP, MS Visio

and Visual Studio.Net, Sybase SQl Anywhere 5/6, Adaptive Server Anywhere,

MSSQL 7, Oracle 6 / 7.x / 8i / 9i, Informatica, Business Object, ETL,

Cognos, Visual Source Safe 6.0, Cobol, MS-Office. MS Power Point, MS Visio,

IBM Rational Clear quest, SharePoint etc.

PROFESSIONAL EXPERIENCE:

Xerox State Healthcare LLC, CA-MMIS, West Sacramento, CA

July '13 to October '14

Business Analyst/Data Analyst

Description: Xerox State Healthcare LLC has a contractual partnership with

the state of California Department of Healthcare Services to process the

welfare medi-cal claims and financial regularities. FI Systems Group

department is responsible for the timely and efficient implementation of

System Development Notice (SDN) as issued by the California Department of

Healthcare Services by utilizing the waterfall SDLC approach. A System

Development Notice (SDN) differs in approach based on policies for

Affordable Care Act, ICD-10 Implementation, replacing old CMS (08/05) claim

form with new CMS 1500 (02/12) claim form, capturing ICD Indicator,

updating procedure codes and modifiers, SLR project, validating Rendering

Provider Numbers for Group providers, HIPAA Code conversions etc.

. As a BA, extensively involved in SDN 13001 (Modify Paper Claim Forms)

starting from the beginning of the SDLC phases: Inception,

Elaboration, Construction and Transition.

. Hands on experience with the processing of a CMC and paper claims,

including RTD process, claims denial process.

. Extensively involved with mailroom, claims prep team, KDE/OCR team to

identify the impacts of replacing the old CMS 1500 (08/05) claim form

with the new CMS 1500 (02/12) claim form.

. Complete understanding of how a claim is processed on paper claim form

30-1, 30-4, 25-1, Appeals, CMS 1500 (02/12), as well as a CMC

(Computer Media Claim).

. Modified rejection letter 88-J-28 to add new post ICD-10 project

implementation information.

. Conducted daily, weekly and monthly meetings to capture and document

requirements.

. Conducted JAD sessions with the client to identify and document

requirements.

. Understood problem solving and conflict management, including the

ability to manage conflict and find mutually acceptable resolutions.

. Co-ordinated the team effort with the ICD-10 project team to identify

and root out gaps between ICD-10 project and SDN 13001 (Modify Paper

Claim Forms).

. Attended regular defect control meetings.

. Extensively involved in identifying the issues, defects and problem

statements with the SDN team and ICD-10 project team.

. Hands on experience with Facets UI, overview administration platform

and navigational user guides.

. Extensively involved with publications department in writing and

publishing over 40 provider bulletins, news flashes, and making

updates to over 30 provider manual sections using DCN process.

. Worked with project team and DHCS to solve project related issues and

defects.

. Experience with PROD support and co-ordinate effort to solve PROD

issues.

. Working on to update the Companion Guide using the Council for

Affordable Quality Healthcare (CAQH) Committee on Operating Rules for

Information Exchange (CORE) v5010 Master Companion Guide Template per

the CAQH CORE Phase III Operating Rule 350.

. Gathered requirements to implement Uniform Use of Claim Adjustment

Reason Codes and Remittance Advice Remark Codes (835) per the CAQH

CORE Phase III Operating Rule 360.

. Establish written Late/Missing EFT and ERA Transactions Resolution

Procedures defining the process a healthcare provider must use when

researching and resolving a late or missing healthcare EFT Standards

payment and/or the corresponding late or missing ASC X12N 835 per the

CAQH CORE Phase III Operating Rule 370.

. Wrote and documented requirements for the implementation of the

Eligibility and Benefits Batch Response Time per the CAQH CORE Phase I

Operating Rule 155.

. Wrote and documented requirements Implementation of the Eligibility

and Benefits System Availability per the CAQH CORE Phase I Operating

Rule 157.

. Identified and defined the additional data elements within the ASC

X12N 270 Batch Processing Detail Report.

. Experience in working on a mapping document defining CARC/RARC/CAGC

combinations for claims based on CORE-Required Code Combinations for

CORE-defined Business Scenarios, version 3.0.4, published February 01,

2014.

. Gathered and documented requirements to communicate the procedures to

resolve late/missing EFT (Electronic Fund Transfer) and ERA

(Electronic Remittance Advice) transactions according to the CAQH CORE

rule requirements.

. Gathered and documented requirements for Batch ASC X12N 277 Response

Transactions for the corresponding ASC X12N 276 requests.

. Experienced in working with TSC and Cash control unit training program

and SOP manual updates.

. Experienced in working with TSC and O&E Training department.

. Experience with SYSIN table creation and updates verification.

. Complete understanding of CA-MMIS tables in TSO and Layouts.

. Experience with mainframe production and system test application/

modules, including provider sub - system, PcMF inquiry screen,

diagnosis code inquiry screen, and the corresponding sub-system

applications.

. Complete understanding of CA-MMIS eligibility screens, diagnosis icd-

10 to 9 crosswalks.

. Experience in working with mid-range applications like SURS,

TAR/SURGE, LSMS, OLCC application.

. Complete understanding of POS device processing of a claim.

. Experience in working with a project related to deactivation of legacy

IDs.

. Experienced and understanding of San Mateo HCP 703 CCS only Aid Code

9D.

. Experience in working on projects related to managed care plan and fee-

for-service claims.

. Complete understanding of claim type 01, 02, 03, 04, 05, 06, 09,

appeals, CIF, and crossovers.

. Experienced in updating the 16 POS user and technical manuals.

. In process of coordinating the training effort for the stakeholders

and users for the new VX 520 POS device.

. Complete understanding of implementation of Affordable Care Act aid

codes.

. Implemented more than 40 ACA aid codes to the medi-cal reports MR-O-

145, MR-O-151, MR-O-351, TP-O-412, and TP-O-740 for federal funding

participation distribution based on emergency, pregnancy, ambulatory,

LTC services.

. Complete understanding of full scope and restricted ACA aid codes.

. Complete understanding of mapping the ACA aid Codes to CMS 64 system.

. Created 4 new special reporting categories for ACA aid codes.

. Did extensive research to find impacts and constraints to map the ACA

aid codes 4 existing fund codes in the CMS 64 system; and successfully

mapped.

. Extensive experience in working with CHDP reporting and funding.

. Experienced in creating excel tools for the accurate documentation of

interaction of team members during the all the 4 phases of waterfall

SDLC.

Texas Medicaid and Healthcare Partnership, Austin, TX

June '11 - April '13

Business Analyst/DW Analyst

Description: Texas Medicaid and Healthcare Partnership is a state owned

contractor for Texas Medicaid which includes CHIP, Dental, Star and Star

Plus modules. The main purpose of the project is the MCO expansion to

transfer database from Sun to Oracle and to redesign the PPS (Premium

Payment System) to perform several functions like incremental load versus

full load every month, modify outputs to utilize new PPS incremental

records with increased disk space to provide additional storage capacities

for the V21 Data Warehouse.

Responsibilities:

. Conducted meetings with the team members to organize and finalize the

working hours and resources.

. Prepared a detailed BUR (Business User Requirement) document to

explain working of the project to the stakeholders.

. Define business and user requirements.

. Defined in scope and out scope requirements.

. Verified assumptions and constraints with the team members.

. Extensively used data mapping from source to target and target to

source for Sun to Oracle migration of database.

. Wrote use cases for the system.

. Hands on experience in writing test cases from business requirements

and use cases.

. Defined system requirements in the detailed design process.

. Extensively involved in regression, integration, and UAT testing.

. Worked on java code with the developers to verify table and column

names from the database to be transferred.

Environment: Requisite Pro, Rational Rose, Agile, JAVA, HL7 Interfaces,

PL/SQL, HTML, Web Logic,MS Office, MS Visio, EDI, Rational Clear Quest,

Rational Clear Case, UML,RUP, Microsoft Excel, Microsoft Word, Microsoft

Power Point, Visio.

Presbyterian Health Care System, Washington DC

Jan' 11 - May 11

Business/Systems Analyst

Description: Presbyterian healthcare System, a Fortune 500 company and a

leading player in the Health Insurance and services market specializes in

Network based care co-ordination health care welfare services for small

groups, government and specialized groups and commercial employers. The

system streamlined patient registration, patient scheduling, and medical

insurance checking, claims processing, and reporting. The purpose of this

project involves population of the Enterprise Data Warehouse (EDW) which is

used in critical reporting and analysis. Informatica was used for ETL

process and Business Objects are used for reporting duties.

Responsibilities:

. Conducted weekly meetings for deciding the policies and procedures to be

followed while constructing new sites.

. Conduct complex documentation and user needs analysis. Interface with

team and staff to develop HL7 integration.

. Played a key role in the planning, testing, and implementation of system

enhancements and conversions.

. Design, development, implementation and roll-out of Business Intelligence

applications.

. Worked on data modeling and produced data mapping and data definition

documentation.

. Analyzed business area system functionality requirements. Wrote

requirements documentation including Business Requirements Documented and

Statement of Work.

. Provided support to the completion of the MMIS Data Dictionary. Evaluated

and identified all system problem

. Analyzed, designed, and coded several online subsystems for the Medicaid

System.

. Extracted data from Oracle database with MS Access, and performed SQL

query, data analysis and verification.

. Experienced in automating standardized reporting by integrating corporate

data export tools and Microsoft Office tools (e.g. MS Visual Basic, MS

Access, and MS Excel).

. Facilitated Joint Application Development sessions and facilitated

stakeholder meetings to identify business process and requirements;

exhaustive management of project requirements using Caliber RM.

. Gathered requirements by conducting meetings and brainstorming sessions

with end users and Subject Matter Experts (SME).

. Created flow charts in Microsoft Visio for system documentation.

. Provide business intelligence analysis to decision-makers using an

interactive interface in excel.

. Led the development of a training program to train users on a custom web

application and a Cognos ad-hoc reporting environment.

. Created graphical representation of reports as per the End user

requirements using Business Objects and Crystal reports.

. Identified/documented data sources and transformation rules required to

populate and maintain data warehouse content.

. Assisted to develop the Test Plan, Test Cases and Test Scenarios to be

used in testing based on Business Requirements, technical specifications

and/or product knowledge.

. Conducted Joint Application Development (JAD) sessions with IT groups.

Identified the key changes, and participated in Stakeholder Management to

communicate effectively with them

. Reviewed the Joint Requirement Documents (JRD) with the cross functional

team to analyze the High Level Requirements.

Environment: Windows 2000/XP, HL7, MS Office SharePoint 2007, SAS, Agile,

Rational Requisite Pro, MS Office, SQL Server 2005, Cobol, DB2, JAVA, J2EE,

Crystal Report, MS Project, MS FrontPage 2003, MS Access, EDI

Michigan Community Health Deptt, Lansing, MI

June'08 - Dec'10

Business Analyst

Description: The Michigan Department of community Health is currently in

the process of replacing its Bull Mainframe Medicaid Management Information

System (MMIS) with a web based Community Health Automated Medicaid Payment

System (CHAMPS).Currently, eleven (11) DCH applications interface and share

information with the Medicaid System. These interfaces are replaced by

implementing web services to accomplish the interactions as the most

efficient way possible.

Responsibilities:

. Designed and developed the Business Objects Universes which suit the

standard, analytical and ad-hoc reporting requirements of the Business

Objects users.

. Participated in requirements meetings, writing requirements in HP Quality

Center.

. Involved in development & documentation of Software Requirements

Specification (SRS) using Borland Caliber RM.

. Followed Agile (XP) Methodology for the release.

. Worked with Data Warehouse in the development and execution of data

conversion, data cleaning and standardization strategies and plans as

several small tables are combined into one single data repository system

MDM (Master Data Management).

. Set up JAD sessions with project manager and stakeholders for a detailed

analyses and better understanding of the impact in projects.

. Responsible to import the parts of the existing reports using to develop

the required reports in Microsoft Excel and Word.

. Worked closely with the Enterprise Data Warehouse team and Business

Intelligence Architecture team to understand repository objects that

support the business requirement and process.

. Data mapping, logical data modeling, created class diagrams, as-is to-be

process flow and ER diagrams.

. Hands on experience with Logical & Physical Data Modeling and stored

Procedures in Sybase Database Servers.

. Lead multiple project teams of technical professionals through all phases

of the SDLC using technologies including Oracle, Erwin, Data Stage, Data

Warehousing, Websphere and Cognos.

. Prepared Business Requirement Documents (BRD's) after the collection of

Functional Requirements from System Users that provided appropriate scope

of work for technical team to develop prototype and overall system.

. Experience in creating reports from modules using Business Objects based

upon business requirements.

. Implemented Data Modeling standards, including element-naming

conventions.

. Used SDLC methodologies like the RUP and the waterfall.

. Involved in decision making of converting manual test cases into

automated test scripts and analyzing their life time and time required to

update the scripts.

. Prepared and executed test cases for Navigational test, Functionality

testing and GUI testing.

Environment: Rational Rose and Requisite Pro, MS Visio, MS Office, MS

Project, SAS, Agile, UML, XML, Windows XP, NT/2000, HTML, Cobol, DB2, SQL

Server 2000, Crystal Report, JAVA, J2EE, Oracle 8i/9i/10g

North Carolina Deptt of Health & Human Services, NC

March'07 - May'08

Business Analyst/Data Analyst

Description: As a Business Analyst, I have worked on the up-gradation of

the database that has all the record of all the patients and customers.

Including merging of several different data marts and building a new

database so that managers can see all the information all together and then

managed the database, including managing their claims processing system

plus managing the government funding part to support Medicare and Medicaid

through the internal software system within the company. I was also

responsible for the successful implementation Medicaid Management

Information System (MMIS).

Responsibilities:

. Met with client groups to determine requirements and goals to configure

and develop process, standards, and procedures and create a Business

requirement Document.

. Involved in the analysis of the existing processing, mapping phase

according to functionality and data conversion procedure.

. Was also responsible for the successful implementation Medicaid

Management Information System (MMIS)

. Responsible for creation of the Physical Data Model for Program

Management Module of Medicaid Management Information System (MMIS).

. Interacted with business partners to perform the Initial Project

Analysis, define new and document retail sales reporting requirements and

Change Requests (CRs).

. Create and maintain data model/architecture standards, including master

data management (MDM).

. Worked on following applications Business Objects, Enterprise Architect,

Toad, Microsoft Suite (Word, Excel, PowerPoint, Visio, and Access).

. Worked on Requirement Change Management System in Rational Requisite Pro.

. Conducted internal requirement gathering sessions with the SMEs (Subject

Matter Expert) to understand as is process and to-be process for new

system on the external platform.

. Engaged in analyzing requirements, identifying various individual logical

components, expressing the system design through UML diagrams.

. Prepared Business Requirement Documents (BRD's) after the collection of

Functional Requirements from System Users that provided appropriate scope

of work for technical team to develop prototype and overall system.

. Owned the entire reporting process. Interacted with the ETL team,

developer(s), management, and account holders to get the requirements,

document them, design templates, and write specifications

. Documented Best practices, lessons learned for future conversions.

. Documented Data Mappings/Transformations, and Informatica sessions as per

the business requirement.

. Worked closely with the Enterprise Data Warehouse team and Business

Intelligence Architecture team to understand repository objects that

support the business requirement and process.

. Performed extensive data modelling on Data Warehouse data models.

. Interacted with various cross-functional teams on building business use

cases, and understanding expenses and revenue stream.

. Performed extensive Requirement analysis and developed use cases and

workflows.

. Designed and developed Use Cases, Activity Diagrams, and Sequence

Diagrams.

. Worked with Quality Control Teams to develop Test Plan and Test Cases.

. Analysis of new Business Requirements and preparation of the Functional

Design Specifications

Environment: Servlets 2.2, JMS, Java, SAS, DB2, XML, XSL, XSLT, Rational

Rose, PL/SQL, Oracle, HTML, CSS, JavaScript, Cognos, HL7, Crystal Report,

MS Word, Excel, Access, and MS Visio.

Education: Bachelors of Technology in Information Technology, PTU INDIA

(2002-2006).

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