Naitik Patel

732-***-****

PROFILE SUMMARY

* 7 years of healthcare experience as a Business Analyst/Business

Process Engineer.

* Outstanding communication, writing and presentation skills. Experience

working with internal and external stakeholders including senior

management.

* Solid understanding of all phases of Software Development Life Cycle

(SDLC) methodology (such as requirements gathering, analysis, design,

development, data modeling, business process modeling, implementation

and deployment).

* Conducted user interviews, gathered requirements, and analyzed the

requirements using Rational Requisite pro. Maintained and kept track

of stakeholder's requests for enhancements and changes using Unified

Change Management tool (UCM) such as Rational ClearQuest.

* Knowledge of Rapid Application development and Agile Application

development methods.

* Broad knowledge of Test plans, Test cases and Test scripts from the

Requirements Document.

* In-depth knowledge of Rational Unified Process (RUP), Agile/Scrum;

risk engineering, data modeling and mapping, and design using UML

(Unified Modeling Language), Rational Rose and Visio.

* Good knowledge of Oracle and Microsoft SQL databases.

* Provided direction to Data Warehouse team members in adopting new

technologies and developing new business solutions.

* Proficient in medical terminology and coding outpatient and inpatients

diagnosis and procedures by using ICD-9 codes. Knowledge of ICD 10.

* Excellent knowledge of HIPAA (Health Insurance Portability and

Accountability Act) transaction codes such as EDI 270/271

(inquire/response health care benefits), 276/277 (claim status), 835

(payment/remittance advice), 837 (health care claim) and 834

(beneficiary enrollment).

* Well versed with HIPAA, FACETS in Enrollment verification, Member's

benefit verification, claim processing from point of entry to

finalizing and claim review

* Capable of managing multiple projects simultaneously.

* Exceptional problem solving skill and sound decision making

capabilities.

* Experience in writing queries/scripts for data analysis and QA report

testing.

* Conducted successful projects by collaborating with multiple teams to

achieve deadlines in a timely and efficient manner.

* Experience in User Acceptance Testing (UAT), Smoke Testing, Regression

Testing, Performance Testing and Functional Testing.

* Experience working in Medicare and Medicaid projects.

* Experience in conducting SWOT Analysis, Cost Benefit and ROI Analysis.

* Created Requirements Traceability Matrix to keep the stakeholders

informed of the progress of the project.

* Experience in Health Insurance Claim process including Claims Billing,

Claims re- pricing, Claims Payment Processing, social services,

Medicaid and Disease Management.

* Belief in team work, dedication, and professional ethics within the

working environment.

* Extensive experience in conducting Joint Application Development (JAD)

sessions for project definition involving analyzing requirements,

creating prototypes, user interface, database schema and system

design.

* Extensive experience in gathering Business/Functional user

requirements, creating Use Cases as per user requirements,

developing/designing UML diagrams such as Use Case, Activity, Class

and Sequence diagrams, and in addition to creating Business

Requirements Document (BRD) and FRD.

* Organized, goal-oriented, self-starter, and ability to master new

technologies, manage multiple tasks while following through from

initiation to completion.

* Flexibility in adapting to a wide range of work environments.

* Extensive experience in working in a Customer - oriented environment.

* Ability to inculcate new relevant skills with ease in a time sensitive

frame.

TECHNICAL SKILLS

Methodologies RUP, Agile, SCRUM, UML, Six Sigma, CMM

Testing Tools JIRA, Rational Enterprise Suite, Test

Director, Win Runner, Load Runner, Quick Test

Pro (QTP)

Change Management Tools Rational Clear Quest, Test Director

Business Modeling Tools Rational Rose, Microsoft Visio

Version Control Systems Rational Clear Case

Project Management Microsoft Excel, Microsoft Project, Microsoft

Office, Track Wise, Crystal Reports

Programming Languages SQL, PL\SQL, Visual Basic, Java, JavaScript,

C, C++, HTML

Databases Oracle 8/8i, MS SQL Server 7.x/2000,

MS-Access.

Web Technologies Microsoft FrontPage, Facets, SharePoint

Mathematical Packages Matlab, MathCAD

Multimedia Adobe Photoshop and Fireworks

Platforms Windows NT/2000/XP/Vista/7, MSDOS, Mainframe,

Linux, UNIX

PROFESSIONAL EXPERIENCE

Massachusetts Health Exchange, Boston MA

April 2014- March 2015

Sr. Business Analyst/ UAT Test Lead

Massachusetts Health Exchange is pursuing a "dual track" solution to make

the Health Connector work better for the next open enrollment period. The

project is to work in release management work track on HIX Enrollment

Application to manage releases content and deployment in lower environments

and in Production. In addition, working with MA HIX State partners to

conduct UAT testing and documenting test results for production release. In

addition to this the work also consist of documenting new requirements

and/or gaps in existing system and entering them in defect tracking tool

JIRA for implementation.

Responsibilities:

* Responsible for gathering requirements through interviews and detailed

sessions with business area experts for Massachusetts Health Exchange

enrollment application.

* Responsible for creating, maintaining the timeline of the project

using MS Project.

* Capturing requirements for eligibility determination and aid cats in

informal and formal sessions while maintaining scope and change

control.

* Requirements and Functional Specifications documentation for PD Gates

Up and Gates Down logic based on enrollment time frame.

* Documenting and mapping requirement changes from the enrollment

application to EDI 834.

* Identified and reviewed the Manual Test Cases to be automated.

Performed Load Testing to evaluate the performance of the server using

Load Runner tool. Developed SQL scripts to perform Backend Testing.

Performed Smoke, Functional, Integration, Interface, Regression, Load

and System testing.

* Worked with state partners to document 834 enrollment guide for

Massachusetts Health Exchange which involved all the transection sets

used in 834 and the flow of these components from enrollment

application.

* Tracked the Regression status of the Team members in the Quality

Centre. Involved in creating the configuration files for setting up

the environment with different databases such as Oracle, MS SQL

Server, Sybase and DB2

* Able to bridge the difference between the end user's non-technical

point of view and the developer's technical point of view.

* Analyzing and translating user-level requirements into a logical

design, using UML diagrams, Use Cases and Activity diagrams.

* Prepared Workflow diagrams to analyze AS IS and TO BE scenarios,

designed new process flows and documented the business process and

various business scenarios.

* Created Use Case Document, user interface design document to elaborate

user experience taking into account the business objective.

* Interacting with the developers and QA Team on resolving the reported

bugs and various technical issues.

* Interacting with users and assigning roles to users for user

acceptance testing and taking feedback from them.

* Responsible for adhering to project timelines while anticipating and

resolving issues.

* Working with Infrastructure team for JIRA administration.

* Created new projects in JIRA and defined each different workflow to

support all different work stream of hCentive.

* Responsible for designing screen schema for the new and existing

projects and modifying existing screen schema as per business

requirement.

* Acted as a liaison between stakeholders: system users, clients and

Project Managers.

Environment: JIRA, MS Office Excel, Word, PowerPoint, MS Project, MS Visio,

UI, UML, Rational Unified Process (RUP)

Blue Cross and Blue Shield, Detroit, MI

March 2011- March 2014

Sr. Business Analyst/UAT Test Lead

Blue Cross Blue Shield is one of the leading health care providers in the

United States. The company is undergoing its biggest project of I2I/G2I

Migration and New Healthcare Reform Enrollments (Obama Care) where the

individuals enrolled in 2013 Group/Individual products are migrated to 2014

individual products. The individual are migrated to comply with 2014 New

Healthcare Reform as 2013 products are no longer HIPAA compliant. The

second part of the project is for New Business Enrollment where 2014

products are offered for Single, Family and Child Only applicants. The

project is an integrated application of different set of rules and

processes like HIPAA compliant, EDI 834 and Medicare and Medicaid processes

along with the project Doctor Plus and ICD 9 - ICD 10.

Responsibilities:

* Conducted JAD sessions. Focus groups and individual interviews to

facilitate elicitation with regards to analysis, specifications, and

design of the relevant business processes and systems.

* Prepared UAT Test Plans and UAT Test Cases based on the business

requirement.

* Performed backend testing from FACETS

* Conducted workflow, process diagram and gap analysis to derive

requirements for existing systems enhancements.

* Modeled functional requirements using MS Visio to create Use Case

Diagrams, Activity diagrams, Sequence Diagram and logical Class

Diagram for interaction between the various actors and system and to

supplicate the Workflow Models.

* Researched on the medical disciplines and documented Business

Requirements Document.

* Traced High level into Detailed Requirements in Functional

Requirements Document (FRD).

* Worked extensively on inbound transaction set 834(Benefit Enrollment &

Maintenance).

* Performed Analysis to check if EDI Type trees for transaction sets

834, 837, 835 are HIPAA Complaint.

* Working on the activity diagrams, File Transfer Specification (FTS),

Required Repository Template (RRT) in Coordination of Benefits,

Benefits translations, Utilization Management and Referrals.

* Worked in coordination with business users to perform backend testing

from FACETS

* Verifying the Member's Eligibility and review information about the

member's benefits in FACETS.

* Aided in workflow analysis and process design.

* Involved in the build validation procedures of HIPAA for 834, 835 and

837.

* Responsible for conducting gap analysis as is to be for ICD9 and

ICD10.

* Assisted with user testing of systems (UAT) and ensuring that

appropriate documentation is in place

* Executed UAT test cases with Business users to ensure proper data

mapping and data load into the systems.

* Responsible for architecting integrated HIPAA, Medicare solutions,

FACETS.

* Facilitated and reviewed test plans during system development and

quality assurance testing; participated in User Acceptance Testing

(UAT) and facilitated issue resolution including communicating end

state solutions to business.

* Conducted joint discussion sessions with business users and

stakeholders to understand the requirements in more detail.

* Developed project plans and managed project scope.

* Interacted with Data Warehousing team in Metadata Modeling and

gathering requirements for product catalogue data load specifications

for Data mapping and Data Modeling.

* Gathered requirements and prepared Business Requirements Document

(BRD).

* Created RRTs for the claims migration pricing process.

* Helped in determining the application flow (activity diagram) of

various entry point in enrollment application.

* Helped developers with the following list of HIPAA-EDI Transaction

Code sets: (834, 835, and 837).

* Helped in determining and documenting the marketing strategies to

retain current subscribers and attract new subscriber.

* Determining the correct route to sent various letters for 2013

subscribers at various point in letters and emails campaign.

* Acquiring the business rules related to Group Drop, Enrollment

Reminder and Last Call letters to 2013 Group and Individual

subscribers.

Environment: MS Office Excel, Word, PowerPoint, MS Project, MS Visio, UI,

UML, Rational Unified Process (RUP), Rational Suite Requisite Pro, Rational

Rose, Windows XP, HTML, PHP, XML, UAT

Freedom Health, Tampa, FL

Jan 2009 - Feb 2011

Business Analyst

Freedom health is one of the leading Medicare payers, which is an

incorporated Health Maintenance Organization in Florida. It serves about

thirty countries and has a strong network of healthcare providers. Freedom

Health offers a variety of Medicare Advantage health plans. These plans

offer more benefits than Original Medicare. The project was to customize

the software called IKA. It is a Web-based application for healthcare payer

organizations. IKA Medicare Gateway is the key component of the software

which allows payers to significantly expedite and increase the accuracy of

Medicare application processing, eligibility verification, and enrollment,

membership and payment reconciliation through online functionality and real-

time access to information from CMS (Center for Medicare and Medicaid

services) Marx database.

Responsibilities:

* Used UML diagrams for data capture activities which required working

with SMEs to ensure consistency and accuracy of data during the data

loading process and that the data passes validation and integrity

constraints with corporate database repositories.

* Clear understanding of Medicare (Part A, Part B and Part D) and

Medicaid benefits as well as business processing.

* Involved in process analysis and defined executed data migration plans

for local data for global applications.

* Worked with the management for improving and giving new ideas for

designing future processes of the HIPPA transactions dealing out with

EDI'S 834, 837, 835, in Enrollment verification, Member's benefit

verification, claim processing from point of entry to finalizing and

claim review their source and providing alternative solutions using

best practice model and principles

* Database support that includes activities required to correct, delete

or summarize medical history of members as well as provider

information.

* Experience in CMS and MMA Guidelines.

* Collaborated on the development of user requirements and design

specifications using standard UML techniques such as use case,

activity, sequence, and class diagrams.

* Conducted JAD sessions, Focus groups and individual interviews to

facilitate elicitation with regards to analysis, specifications, and

design of the relevant business processes and systems.

* Thorough understanding of health benefit products, assisted in

consolidating the summary of Benefits.

* Executed Smoke, Functional, Integration, End-to-end and Regressions

Tests in each environment by tracking the test status in Quality

Center (Test Director).

* Applied advanced Excel skills (pivot tables, macros, lookups, charts)

and Access database querying skills in streamlining and automating

accounting processes.

* Documented detailed business, functional, and User Interface system

specifications using standardized company templates for the business,

development, and QA team.

* Build relationships with Information Systems and other relevant

business partners, balancing practicalities with innovative and

efficient business systems solutions.

* Created test cases and performed manual testing of the functionality

of the application by inserting varying data on different test runs.

* Documented Requirement Traceability Matrix in Requisite Pro for

traceability of requirements through test cases.

* Developed Forms using MS Access using Forms and Reports for reporting.

* Produced clear user manuals & training guides for User Acceptance

Testing (UAT) and deployment for end-clients with step-by-step

instructions and created appropriate GUI screenshots.

Environment: SQL Server, UML, Rational Requisite Pro, Test Manager, Clear

Quest, Windows XP, MS Visio, MS Access, MS Project, UAT, JAD, UML

Diagrams, MS Visio, HL7.

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