SAURABH NALAVADE ac36g7@r.postjobfree.com

662-***-****

EXPERIENCE SUMMARY

Highly motivated, focused, and detail-oriented Business Systems Analyst with professional experience in Healthcare domain. Experience in testing HIPAA compliance conditions and strong knowledge of EDI X 12 transaction code set version 4010 to 5010. Well versed with ICD9, ICD-10, CPT, HIPAA, claim adjustments, claim pricing, claim adjudication. In-depth knowledge of Testing concepts, Software Development Life Cycle (SDLC). Thorough knowledge of various phases of SDLC like Requirement Gathering, Analysis/Design, Development and Testing, Deployment and Maintenance of software applications. Proficient in writing Test Plans, Test Strategies, Test Scenarios and Test Cases. Ability to succeed and excel in diverse environment and projects with strong determination and dedication. Highly self-motivated individual capable of functioning in a team environment with excellent analytical, presentational, inter-personal and verbal/written communication skills.

SYSTEMS ANALYST EXPERTISE

Extensive experience in all phases of SDLC and STLC processes

Strong knowledge of Software Development Life Cycle(SDLC) Methodologies such as RUP, Waterfall and Agile Scrum

Experience in Healthcare/Claims adjudication working with various modules which include claim processing using EDI transactions which fall under the HIPAA compliance

Experience in verifying EDI raw data of 834 transactions as per HIPAA 4010 and 5010 formats

Excellent skills in identifying test data including the input data, pre-conditions and expected results for both positive and negative test scenarios

Ability to review and analyze Business Requirement Document (BRD), Functional Requirement Document (FRD/FRS) and develop appropriate Test Cases

Proficiency in creating Test Plans, Test Strategies, Test Scenarios and Test Cases

Involved in Test Planning, Test Cases, Issue Resolution, and Report Generation

Performed manual testing of the applications to verify the requirements and business functionality

Proficient in writing SQL queries to retrieve data from databases for Back-End Testing to check and analyze data integrity and validation

Strong experience of working and interacting with clients to transform their business problems into technology solutions and ensuring that business goals are met throughout the product lifecycle

Experience in Joint Application Development (JAD) sessions with cross-functional project teams

Good Management, Execution and Documentation skills

TECHNICAL SKILLS

SDLC Methodologies:

Waterfall, Agile Scrum, RUP

Operating Systems:

Windows 9x/XP/NT/2000, Unix, Mac, Linux

Markup Languages:

HTML, XML

Databases:

SQL SERVER, MS Access

Defect Tracking Tools:

JIRA, Quality Center, MS Excel

Modeling Tools:

MS Office, MS Visio

PROFESSIONAL EXPERIENCE

Sharp Healthcare - San Diego, CA

Data Quality Specialist / Tester - EDI Management

October 2016 - Present

Project Overview -

Sharp is not for profit, but for people, which means all their resources are dedicated to delivering the highest quality patient-centered care, the latest medical technology and superior service. At Sharp HealthCare, mission is to improve the health of everyone. Moreover, as San Diego's leading health care provider, Sharp is proud to touch the lives of more individuals in community than any other health care system.

The scope of the project is to migrate to a new system (HealthEdge). HealthEdge will provide better enrollment and claims processing efficiency, and is a more flexible system that will enable to implement enrollment and eligibility changes quickly and easily. The project also focuses on accommodating feeds and services such as: claims processing, paper vs automated enrollment, Coordination of Benefits (COB), Account Receivable (AR), ID Cards, and Provider/Customer/Member services.

Responsibilities:

Enrolling members in IDX system from different employer groups

Analyzing and reviewing the Sharp Health Insurance plans, PCPs for employer groups

Assigning health plan contracts, PCPs, and terminating contracts in IDX system as per inbound EDI 834 files

Working on the discrepancy reports with employer groups on inbound EDI 834 enrollment files

Analyzing the IDX system with all EDI 834 transactions

Managing member data in IDX system from CureIS

Testing the EDI 834 specifications to meet HIPAA requirements set forth by the Federal government

Modifying the inbound EDI 834 file, and checking if the eligibility enrollment is properly loaded in IDX system

Working with other Analysts regarding EDI 834 transactions as per guidelines of 5010 implementation guide

Coordinating with the QA team to manage and perform project planning, system requirements, auditing and certification of documentation to ensure compliance according to QA

Involving in review and walkthrough meetings with Testing and Development team

Demonstrating health plan operations, health plan software configuration, enrollment, and data processing environments

Prioritizing and reporting defects by using the generated documents and reports for further analysis

Collaborating with the Project Manager and Business Users to gather, analyze and document the functional requirements for the project

Performing mapping of the requirements to ANSI X12 for 834 Benefits Enrollment Process

Performing parallel testing for enrollment of members in IDX and HealthEdge system

Developing test cases for HIPAA EDI 834 from CSRs (Change System Requests)

Working on EDI 834 (Benefit Enrolment and Maintenance) claim transaction in IDX system

Working on HIPAA EDI 834 use cases and collaboration templates according to business requirements in Claims Process

Involved in validation of EDI 834 for claims used for dental billings by writing test cases, test plans

Executing test cases manually to check GUI and Functional features, compared and analyzed actual results with expected results and reported all deviations

Performing manual testing for enrollment of members in HealthEdge system

Environment: EDI 834, IDX System, HealthEdge System, SQL Server, Microsoft Office Suite, Windows

INTERNSHIP EXPERIENCE

Parker Hannifin - Madison, MS

Engineering Intern (EI)

Co-op Engineer

January 2014 – June 2014

Responsibilities:

Created layout, part detail and assembly drawings to design specifications

Performed engineering calculations for use in design work

Created model index charts, and reported performance, event records of Assembly Cell Units

Setting up and monitoring laboratory tests on different assembly parts

Assisted with product failure analysis

Assisted in shipping out the final product from the plant

RELATED SKILLS

CAD:

SolidWorks, Autodesk Inventor

Computational:

Mathcad, Mathematica

Programming:

Visual Basic Programming

HONORS & ACTIVITIES

Honored with Commercial Pilot License, Aviatour Flight School, Philippines (July 2009)

Basic survival awareness program for the Pilots

Outstanding Achievement award by The Green Glory Club for advertising and campaigning of events

Awarded the Entering Freshman Access Grant Scholarship by Mississippi State University (2010)

Dean’s Scholar: Spring 2011

President: Mississippi State University Cricket Club, Starkville, MS

EDUCATION

Bachelors of Science in Mathematics Mississippi State University, USA

Contact this candidate