Nilesh D'Souza

Phone: 609-***-**** Email: acrv8q@r.postjobfree.com

PROFESSIONAL SUMMARY:

●Over 8+years of experience as a Business Analyst and UAT coordinator with frontline leadership role in System Development Life Cycle (SDLC).

●Demonstrated ability to work efficiently in different phases of Software Development Life Cycle (SDLC) such as Agile methodologies (SCRUM) and Waterfall methodologies in multi tier web based architecture.

●Facilitated and attended Scrum ceremonies (grooming, sprint planning, retrospectives, daily stand-ups).

●Thorough understanding of Agile software development methodologies, values, and procedures.

●Experienced in authoring various documents such as Software Requirement Specifications (SRS), Business Requirement Document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.

●Adept at coordinating with stakeholders, Subject Matter Experts (SMEs) and End Users to understand, analyze, communicate and validate requirements through User interviews, Joint Application Design (JAD), Joint Application Review (JAR) sessions.

●Experienced in conducting different requirement gathering techniques like Brainstorming, JAD sessions, Focus Analysis, Reverse Engineering, Survey, Document Analysis, Interview, Prototyping and Observation.

●Proficient in requirement analysis and creating Use Cases, Sequence Diagrams, Activity Diagrams, Class Diagrams using Object Oriented Analysis and Design (OOAD).

●Excellent knowledge of Medicaid, Medicare (Part A, B, C, D), Procedural and Diagnostic codes and Claims Process.

●Involved in reviewing test procedures, defining test cases, reviewing and maintaining test scripts, analyzing bugs and User Acceptance Testing (UAT).

●Dedicated, results-oriented and motivated team player with excellent communication, analytical, leadership, interpersonal and problem solving skills.

●Experienced in conducting different requirement gathering techniques like Brainstorming, JAD sessions, Focus Analysis, Reverse Engineering, Survey, Document Analysis, Interview, Prototyping and Observation.

●Strong knowledge of HL7 Standards, HIX, EHR - Electronic Health Records, EMR - Electronic Medical Records, CMS regulations, Meaningful Use Compliances, Health Care Reform, EMTALA, PPO, POS and HMO.

●Well versed with clinical workflows and EHR/EMR systems like AllScripts, EClinicalWorks, EPIC Clarity

●Strong experience on working with EPIC Clarity Data Model

●Experienced in Membership, Billing and Claims Payment Processing in relation to HIPAA 4010A/5010 X12, EDI codes 834, 837,835, 270/271, 276/277 and 820, and ICD-9/ICD-10.

●Excellent knowledge of Medicaid Management Information Systems (MMIS)

●Proficient in Trizetto Facets implementation 5.01.

●Proficient in requirement analysis and creating Use Cases, Sequence Diagrams, Activity Diagrams, Class Diagrams using Object Oriented Analysis and Design (OOAD).

●Adept experience working with ETL (Extract, Transform and Load) of data into a data warehouse/data mart and Business Intelligence (BI) tools.

●Extensively used DDL and DML Commands in SQL for back end testing on Oracle and SQl databases.

EDUCATION:

Masters in Healthcare Administration

Bachelors in Science

TECHNICAL EXPERTISE:

Business Modeling Tools

Rational Rose, MS Visio, MS Office Suite, Rational Suite

Methodologies

Agile, RUP, Waterfall, Spiral, Iterative, UML, Six Sigma, CMM

Requirement Management

Tools

Rational Suite ( requisite Pro, Clear case, Clear Quest, Rose), Caliber RM, Optimal Trace 5.1, Rally, HP Quality Center

Applications

MS Office (Word, Excel, PowerPoint, InfoPath, OneNote, Publisher, Outlook) MS Project 2000, PowerBuilder, Intuit QuickBooks, Business objects, Crystal Reports, ACT Sales Database,

Languages

UML 2.0, HTML,XML,

Operating System

Windows NT/98/200/2003, Windows XP, UNIX.

PROFESSIONAL EXPERIENCE:

CLIENT: North Shore LIJ, New York, NY Oct 2013–Till Date

ROLE :Sr. Business Systems Analyst

DESCRIPTION: North Shore Long Island Jewish Health System implemented the "Explorys" cloud based analytics solution to help improve the quality of care delivered, measure clinical performance by metrics and overall analysis of data. North Shore LIJ health system collects data from various applications for their many facilities for Explorys. From the collected data, Explorys solution will provide NSLIJ analytics, access to longitudinally rich aggregated data, and program frameworks that enables NSLIJ to expand its research, population health management, and performance measurement capabilities. This project helped in the development of 25 population based analytics reports.

RESPONSIBILITIES:

Worked on more than 25 Different reports simultaneously under Explorys Project.

Coordinated and Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.

Created Use Cases, Workflows, and Screen Shots for the Application.

Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.

Groomed stories effectively using OneNote as an effective tool and gathered business requirements through discussions and brainstorming sessions and conducted specification reviews and walkthroughs with the designers, developers and stakeholders.

Co-ordinated JAD sessions with Multiple Stakeholders (Customer Marketing, Security, Fraud, Sales and UX), SME’s and the End Users for feasibility studies and to discuss the functionality of the flows.

Experience creating Mock ups based on the discussion with Business and provided the same to UX and Development team.

Responsible for Prioritization of Stories in Version One for every Sprint.

Co-ordinated the Triage Meetings and got the defects fixed based on priority.

Documented the final flow of each features and presented it to End users (Sales and Marketing team) for their usage

Actively participated and initiated Sprint Planning meetings in order to plan the functionalities which were supposed to be implemented for the sprint.

Helped Product Owner in creating and developingProject Charters.

Facilitated meetings, workshops, for in depth of business discussions and to extract business requirements.

Responsible for running SQL reports for ARRA Meaningful Use Stage 1 & 2

Report writing from all Health Information Systems including Allscripts Electronic Medical Records system and Data

Extensively involved in requirement gathering and design meeting with Business/Lead users to understand requirement for configuring / test system workflows.

Conducted sign off meetings with IT teams to lock down the requirements.

Used Microsoft SharePoint Connector and Confluence for accessing and sharing project data.

Facilitated meetings, workshops, for in depth of business discussions and to extract business requirements.

Built Excel formatted tracking sheets for the project and its 25+ applications.

Performed Data Mapping and confirmed validations with the SME's.

Created and executed SQL queries in SQL analyzer to view and update data in tables.

Helped QA team in testing Sprint stories and in completing the testing.

Conducted reviews with QA team for Test Scenarios, Test plans, Test cases and analyzed Test results and involved in Defect management using ALM (Quality Center - QC) and made sure those defects are efficiently closed.

Co-ordinated to get the Automation scripts which are scheduled to run every day to perform Regression Testing for different versions of application.

Involved in each Sprint Regression testing where different functionality was tested after every Sprint elevation.

Hands on experience on Mobile Apps application and involved in testing the mobile message applications to check the message transfer for security features via SMS and Email.

TOOLS & TECHNOLOGIES: HP Quality Center, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), Clarity (Microsoft SharePoint Connector), Confluence

CLIENT: WellPoint, Wallingford, CT Nov 2012 – Sep 2013

ROLE : Sr. Business Systems Analyst

DESCRIPTION:The project involved multiples goals to achieve in order to streamline the data flow between the Clearing House and external vendors. The scope involved automation of Service Verification Letters to the Medicaid members, development of an Authorization Grid primarily to display services requiring an authorization and to provide as a reference tool for Medical Management. The project also involved processing real time transactions with Clearing House to receive a HIPAA 5010 compliant Eligibility Inquiry (270) from providers and produce a HIPAA 5010 compliant Eligibility Response (271) and also to was to add a Claim Status Inquiry (276) and a Claim Status Response (277) to list of services offered to Providers.

RESPONSIBILITIES:

Worked for operating support group involved in multiple projects for the claims and compliance department.

Worked on EDI 270/271,276/277,835 &837 for the claims department and interacted with Affinity’s compliance, special investigation department & PA state DOH(Department of health)

Extensively used SQL queries to fetch data from different claim & membership table(CLCL_CLAIM,CDML_CL_LINE,MEME_MEMBER,SBSB_SUBSC)

Interacted with affinity’s Medical management, Customer service & Intake team (provider authorization)

Designed screen mockup/layout after taking input from customer service, intake team.

Designed the look & feel of the CDRS front end (auth grid search screen)

Validated HCPCS & CPT codes in Facets,worked with configuration analyst for configuring missing CPT & HCPCS codes in Facet

Developed mapping documents based on Clearing House’s specs & CAQH core operating rules

Mapped clearing house provided service codes to Facet by developing crosswalk tables

Worked with plan data model in Facet front end (2X) & backend (CMC_PLDS_PLAN_DESC, CSPI_CS_PLAN, CMC_SETR_TIER)

Documented claims extraction process using Visio and worked with provider relation & membership department

Performed Root Cause Analysis for errors found in facet for membership and claims status

Conducted offshore testing with cognizant team in Chennai India

Facilitated issue resolution and created RFC’s presenting in CAB (change advisory board) meetings

Performed UAT, modified requirement to improve functionality based on user input

Conducted reviews with QA team for Test Scenarios, Test plans, Test cases and analyzed Test results and involved in Defect management using ALM (Quality Center - QC) and made sure those defects are efficiently closed.

TOOLS & TECHNOLOGIES:Agile Scrum, Rally, MS Excel, MS Word, MS Visio, UML, SQL server 2008, Facets 5.01, Outlook, SharepointXML,

CLIENT: Capital One, Richmond, VA Jun 2011 – Oct 2012

ROLE : Business Analyst

DESCRIPTION: The project was to upgrade the existing web-page application product of the bank used by customers in which the scope was to integrate various features in the online banking tab that would give the customers a consolidated view. It was mainly designed to maintain customer accounts and support the multiple business functions, establishing a link between accounts, balance inquiry, balance transfer, electronic payment and account activity look-up. It also allowed automating the bill payment services online and having periodic reminder system trigger based on various events. The transaction history can also be customized, using fillers like date, amount and deposits etc.

RESPONSIBILITIES:

Successfully implemented Password Management Pro Tool within a stringent time frame.

Involved with testing of Password Management Pro Tool and documenting procedures for Administrators

Actively involved in different phases of manual software testing which included understanding project requirements, execution, test result analysis and bug reporting for the application

Acted as a Liaison between various technical, functional teams and stakeholders

Prepared Test Scenarios, Test Conditions, Test cases and Automation Scripts in Quality Center

Generated flow diagrams for various processes and functionalities used in Cash Management Module

Prepared technical specifications for the development of Informatica mappings to load data into various target tables and defining ETL standards

Designed test plan and test cases to test Informatica mappings

Developed and validated the test packages of business process like sales order, credit management, billing and pricing

Created standard guidelines for User Interface Testing

Performed manual testing for the reports.

Involved in testing the new functionalities based on test cases and coordinated with the development team in fixing the identified bugs and defects

TOOLS & TECHNOLOGIES: Environments: MS Visio, MS Project Plan, Microsoft Office, HP Quality Center, Informatica Power Center, Agile, MS Excel, Visio, SQL server 2008, Facets 5.01, outlook, share point

CLIENT: Montefiore Medical Center, New York, NY May 2009 – May 2011

ROLE : Business Analyst

PROJECT 1: ICD -10 Remediation:

DESCRIPTION: The ICD 10 Implementation replaced the ICD-9 code sets, developed nearly 30 years ago. It was an enterprise level project impacting multiple systems such as provider web portal, medical management application and the mainframe systems. I was responsible for requirement gathering and testing coordination for the medical management application and web portal of the ICD-10 Remediation project.

RESPONSIBILITIES:

Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD) using Rational Requisite Pro.

Conducted JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.

Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.

Responsible for the UAT testing of the ICD 9 to ICD 10 Diagnostic and Procedure codes while reviewing the information to ensure accuracy.

Developed (UAT) User Acceptance Testing plan to guide a select group of key end-users in testing the user interface and functionality of the application.

Also developed Requirements Traceability Matrix (RTM) mapping UAT plan and BRD.

Conducted Smoke Testing of the new ICD-10 UAT region and recorded all the testing results in RTM.

Developed UAT Test Cases to cover overall quality assurance testing.

Compared and validated 5010 system test results with 4010 results for the same test scenarios.

Developed Functional Testing Approach for ICD-10 Remediation and included in UAT Plan.

Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.

Checked files in Electronic Data Interchange (EDI) transaction support tool and reporting tool and modified the files based upon the errors and also checked them if they were loaded successfully in CIS.

Performed System testing, Regression testing and UAT for several claim types and test scenarios.

TOOLS & TECHNOLOGIES: HP Quality Center, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), Windows 7, UML, HIPAA, Oracle, SQL

CLIENT: Airtel Telecom, Mumbai, INDIA Jun 2008 – Apr 2009

ROLE : Business Analyst

DESCRIPTION: This was an enhancement project in telecom billing domain which handled billing, invoices and collections for Airtel’s users across India.

RESPONSIBILITIES:

Worked with client, project managers and business users to gather and elicit detailed business requirements

Created use-case models, business process flows and activity diagrams using UML

Produced & maintained Requirements Traceability Matrix

Closely worked with project managers to manage the project scope, identify & engage appropriate resources to support the systems development efforts

Played a significant role in co-coordinating with various teams,demonstrated excellent communication skills

Performed coding/programming tasks in java,oracle and documented technical artifacts

Developed test plans and participated in code testing to ensure workability, completeness and quality

Developed the service layer test cases

TOOLS & TECHNOLOGIES: Java (J2EE, EJB), Eclipse, NetBeans, ANT, JUnit, XML, Kenan API, Servlets, Windows NT/2000, Oracle, TOAD, Unix, VSS, XML,BEA Weblogic, WebSphere Application Server, Spring, IntelliJ IDEA

CLIENT: Ranbaxy Pharmaceuticals, Mumbai, INDIA Feb 2007 – May 2008

ROLE : Business Analyst

DESCRIPTION: The goal of the project was to implement clinical trial management system based on Siebel 8 platform in compliance to FDA 21 CFR Part 11. The project involved documenting and designing the clinical workflow involved in clinical trials.

RESPONSIBILITIES:

Closely interacted with Clinical Research & Development Management and Leadership teams, regarding sensitive handling of confidential information and comprehensive attention to accuracy and quality.

Participated in functional requirement gathering and design review meetings which resulted in the creation of Views based on responsibilities in Siebel 8, as well as creating i-Help applets within the application.

Documented specifications for CTMS business processes, including report design in Siebel Analytics to meet organizational needs, serving also as a CTMS Administrator, super-user and technical support.

Researched, analyzed and presented best practices in a Clinical Trials Study environment to determine the best overall solution to leverage metrics with the support of CTMS-Siebel 8.

Developed, wrote and published training materials, user manuals and process flow maps as well as e-learning systems for the CTMS Siebel 8.0 System.

Tested, executed, and reviewed User Acceptance Test (UAT) scripts.

Responsible for ensuring end users continue to update and maintain the system on a daily basis and identified and implemented new areas to utilize the system to increase efficiencies.

TOOLS & TECHNOLOGIES: Siebel 8.0 Clinical Trial Management System (CTMS), Oracle 11g, Microsoft Project Enterprise Edition 2007, Citrix, Siebel Analytics.

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