Project Manager
Resume:
Dhruv Bindra
Sr. Business Systems Analyst
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Professional Summary
Sr. Business Systems Analyst/Data Analyst with 6+ years of experience in all phases of Software
Development Life Cycle: gathering requirements, analysis, coding, testing and implementation of projects. I
am independent, motivated, sincere, committed, fast learner, detail-oriented team player with excellent
communication, analytical, leadership, interpersonal and problem solving skills.
• 6+ years of diverse experience in Business Analysis, Quality Assurance (QA) and Software
Development Lifecycle (SDLC).
• Worked on some major Healthcare IT implementations such as EHR (Electronic Health Records),
HIPAA 4010-5010, PPACA (Health Care Reform) and ICD 10.
• Extensive experience with Rational Requisite Pro, Rational Quality Manager, Clear Quest, HP
Quality Center and DOORS.
• Extensive experience with Clinical and Revenue Applications such as LYNX (OptumInsight) I/C
Point and E Point, Passport, Central Logic, Quantim and Midas.
• Expertise in development of Business Requirements, Technical Specifications, Test cases &
scenarios, Test Execution, Defect & Change Management, User Training and Post Implementation
Support.
• Played a lead role in UAT (User Acceptance Testing), Regression testing, Integration Testing and
Test Execution of Test Scripts in various systems such as EPIC, IBM Mainframe and IFacets.
• Experience in development of documents such as BRD (Business Requirements Document), FSD
(Functional Specification Document), Test Plan Documents and User Manuals.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange ), transaction syntax like
ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Worked with ANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837
I/P/D (claims submission), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility
response), 276 (claim status), 277 (claims status response) and 834 (enrollment).
• Facilitated JAD (Joint Application Development) sessions for requirements gathering and
development.
• Experience in estimation of test effort and coordinate test schedule with overall project schedule.
• Experience in writing System test plans, defining test cases, developing and maintaining test scripts.
Documented all phases of QA process. Experience in developing business based functional test
scenarios.
• Developed and maintained databases in SQL/PL-SQL, Oracle and MS Access.
• Experience in estimation of test effort and coordinate test schedule with overall project schedule.
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Technical Skills
• Revenue Cycle and Clinical Applications: Passport, LYNX I/C Point, E Point, Quantim, Central
Logic, Midas
• Data Formats: X12 (EDI transactions) and HL7
• Major Projects Implementations: HIPAA 5010, Electronic Health Records, PPACA (Heath Care
Reform) and ICD 10
• Platforms: IBM Mainframe, EPIC, IFacets and MS4
• EDI transactions: 837 I/P/D, 835, 270/271, 276/277 and 834
• Methodologies: Waterfall, RUP, Agile
• Requirements Management tools: Rational Req Pro, DOORS
• Change Management Tools: Rational Clear Quest
• Business Process Modeling Tools: MS Visio
• Programming Languages: Java,VB.NET, XSLT, ColdFusion
• Database: Oracle, SQL, MS Access,
• Front End Tools: Visual Basic, VB.NET
• Testing Tools: Rational Quality Manager, Win Runner, Load Runner, Test Director
Work Experience
Sutter Health, Rancho Cordova, CA Aug
2012-Present
Applications Analyst 4
Sutter Health is one of the leading Health care providers in Northern California serving over 100 communities
in Bay Area, Central Valley and Sac-Sierra region. The project involved implementing the EHR (Electronic
Health Records) system as part of the Federal regulation. The project was mostly focused on integrating the
current Revenue Cycle and other Clinical applications to the Epic system.
• Represented Revenue Cycle applications such as LYNX E Point and I/C Point.
• Gained extensive experience with Inter Organizational patient transfer application Central Logic.
Performed extensive testing for integrating new facilities and HL7 message analysis.
• Tested and implemented Insurance Eligibility application Passport.
• Translated and assessed HL7 messages from EPIC to downstream applications (Central Logic,
Quantim, MS4)
• Acute knowledge in performing HL7 validation, unit, integrated testing for multiple downstream
applications.
• Assisted in supporting patient payment system, by performing root cause analysis for issues and
resolving interruptions of service and communicating to customer base.
• Managed cross platform accounts for both MS4 and Epic.
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• Provided on-site support in various Sutter hospital sites of Sutter during implementations.
• Provided support for various Revenue cycle applications (Clinical & Non-Clinical) during regional
cutovers.
• Utilized the BMC Remedy ticket system for service restoration and request management via Remedy
reporting.
• Assisted in the resolution of data mismatch from Epic to Central Logic.
• Resolved time critical tickets for the clinical staff in the ED department using LYNX E point
application.
• Gained expertise in integration testing of LYNX applications with Epic system.
• Worked on high level business reporting module of LYNX applications.
• Highly proficient in testing real time clinical scenarios in LYNX.
ACS-Xerox, CA-MMIS, Sacramento, CA July 2011-July
2012
Sr. Business Analyst/ QA Analyst
ACS, A Xerox Co. is a leading software consulting firm actively developing the Healthcare mandates for the
California Medicaid system. The project involved working on the HIPAA 4010 to 5010 conversion for the
existing system. It included working on the major EDI transactions as per the current CA-MMIS architecture.
• Performed gap analysis for EDI transactions such as 837 I, 837 P, 837 Crossover and 835.
• Developed the Business requirements for all the major claims transactions such as 837I/P and 835.
• Worked closely with the development team regarding the technical and design aspects of the HIPAA
5010 project.
• Worked with SQL for Business Reporting activities such as Monthly Remittance File, Claim
Adjudication file preparation.
• Worked with SQL for Data Extraction during File Compare 4010-5010 activity.
• Worked on the various database systems for Claims and Remittance management.
• Developed Test Cases and Scenarios for the testing team based on the business and technical
requirements.
• Actively participated in the Test Execution phase for various EDI transactions.
• Gained extensive experience with various tools and platforms such as Rational Quality Manager
(RQM), Clear Quest (CQ) and DOORS among others.
• Gained extensive experience with IBM Mainframe and all the major components of the system.
• Worked on various new screens and reports for IBM Mainframe due to 5010 Enhancement.
• Developed and designed various Mainframe CICS Screens as part of the HIPAA 5010 Enhancement.
• Worked actively with the developers and the QAs for the Defect Management during the testing phase.
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• Extensively developed User Manuals for various applications for Claim Submissions.
• Actively participated in Change Management of the requirements and other specifications.
• Worked extensively on Test Script Development on RQM.
• Worked extensively on test data manipulation of X12 format on tools such as EDIFECS and Slick
Edit.
Excellus Blue Cross Blue Shield, Rochester, NY June 2010-July 2011
Requirements Analyst/ Business Systems Analyst
Excellus BCBS is the leading healthcare insurer in upstate New York. The project Health Care Reform
involved making all the changes within the corporation as per the legislation to be in compliance with HCR.
Other responsibilities involved working on projects such as ICD 9 to ICD 10 transition and Medicaid Third
Party Health Insurance Feed projects.
• Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR.
• Interacted with senior business teams and legal firms to gather and analyze requirements.
• Participated in various JAD sessions involving various business and technical teams.
• Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS
Visio pertaining to various provisions of HCR.
• Performed Gap analysis for various existing product lines and operations with respect to HCR.
• Worked extensively on all the mandated first phase of provisions of Health Care Reform.
• Responsible for gathering and documenting Legislative, Business, Functional requirements for all the
provisions and their impact on the existing products and systems.
• Gathered and documented functional requirements pertaining to iFacets and other legacy systems such
as LRSP, TOPPS and MABIL.
• Extensively used Requisite Pro and other Rational tools for Requirements Management and their
traceability.
• Gained extensive experience related to various product lines and impact on the respective products due
to HCR.
• Worked on the modification of Pricing Modeler of the various systems.
• Gained extensive experience with medical codes and the change of benefits regarding various products.
• Gained extensive experience regarding all phases of Requirements Management and Change Control
for various projects.
• Ensured legal compliance of the corporation in regards to the mandates of the Federal and State
regulations.
• Worked with Customer Care department to document the User Guides and Corporate
Communications regarding policies and products.
• Attended training sessions for the latest versions of existing Rational tools such as Rational Requisite
Pro 7.1.1, Rational Quality Manager and Rational ClearQuest 7.1.1.
• Analyzed the structural and operational impact of ICD-10 on the current systems.
• Worked for Provider & Quote to Bill team for requirements gathering and documentation phase.
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• Interacted with various departments and application admin regarding the impact of ICD 10 into the
system.
• Managed all the ICD 10 business and functional requirements and related attributes on the latest
version of Requisite Pro 7.1.
• Worked on the ICD-9 to ICD-10 transformation project including the gap analysis.
• Worked on the requirements Gathering and management of the Medicaid Third Party Health
Insurance Feed project.
Ingenix Connectivity Solutions, United Health Group, CO Dec 2009-
May 2010
Business Systems Analyst
UnitedHealth Group offers a broad spectrum of products and services through seven operating businesses:
United Healthcare, Ovations, AmeriChoice, Uniprise, OptumHealth, Ingenix, and Prescription Solutions.
Through its family of subsidiaries and divisions, UnitedHealth Group serves approximately 70 million
individuals nationwide.
• Performed gap analysis ‘Effect on CMS-1500 by 837P HIPAA 5010’ and recommended the user
interface changes.
• Created test scenarios for various EDI transactions such as 270/271, 276/277 and 278 for future
implementations in HIPAA 5010.
• Performed testing of various EDI transactions related to HIPAA 5011 for future implementation.
• Prepared structural difference report for transactions in regard to the affected elements of the
transactions.
• Worked extensively on the HL7 Messaging system covering many areas such as ADT (Admit
Discharge Transfer) and CDA (Clinical Document Architecture).
• Worked on ODBC compliant databases for HL7 data transfer.
• Created multiple pro
• Developed Process Flows, Data Flow Diagrams and Swim lanes for various clinical areas of the
project.
• Responsible for creating and reviewing business requirements, functional specifications, project
schedules, documentation and test plans.
• Responsible for requirement and design documentation review, test plans, identifying and reporting
software anomalies and test results.
• Developed test scenarios and implemented test plan. Providing key input in working with users in
defining project and system requirements.
• SCRUM principle was used in acute functionalities to design, document and manage requirements
throughout the lifecycle of the project, i.e. definition, design and testing phases.
Assurant Health, Milwaukee, WI June 2008-
Nov 2009
Business Systems Analyst
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Assurant Health provides health insurance coverage for more than 1 million people in the United States. The
assigned project was to build a Web Based system called EASE (Electronic Agent Sales Experience) in
collaboration with Capgemini a consulting company to establish a competitive advantage by making it easier
for independent agents and customers to obtain insurance quotes and submit policy applications. Other major
functionality includes e-mail notifications for agents, detailed quotes and medical underwriting. Other projects
include such as My Web Page which is a health insurance agent’s own personal Web site that can be easily set
up with some technical help by the company.
Responsibilities:
• Created Use Case diagrams using UML and Business Process Models using MS-Visio.
• Responsible for Business Process Management (BPM) for development of various projects.
• Worked on Medicaid and other claims processing division of the company.
• Participated in providing implementation assessment for Rational RequisitePro, Rational Rose and
Rational ClearQuest using Unified Modeling Language (UML) and Rational Unified Process (RUP).
• Developed Use Cases, Sequence Diagrams, Collaboration diagrams, Activity Diagrams and Class
Diagrams.
• Assisting the project manager in creating detailed project plans and scheduling and tracking project
timelines.
• Responsible for preparing the Software Requirement Specifications (SRS) document, Standard
Operating Procedures (SOPs), Functional Specification Document (FSD).
• Worked as the primary liaison between the business user and the developers through out the project
cycle.
• Worked with ANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837
(medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim
status), 277 (claims status response), 820 (enrollment).
• Worked with various Business Intelligence tools for reporting and decision making.
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the
requirements for the change in the proposed system.
• Handled changes at each stage of project development.
• Worked with Object Oriented Programming (OOP) environments such as Java, VB.net and C#.
• Worked in various other technologies such as XSLT, CSS, XML and HTML.
Minnesota Department of Health, MN June 2007-June
2008
Business Systems Analyst
This project at Minnesota Department of Health involved me helping to develop a Comprehensive Information
Management System (CIMS) about workers injuries. The purpose of this project is to support all the forms
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processed against workers compensation claim. This system was developed using client server technology and
PowerBuilder 5 integrated with Visual Info for Claims and Adjudication Forms Management. I also had to work
with SMEs on helping to develop this system. This involved a high level of interaction, which involved having
effective communication skills (verbal and written), excellent interpersonal skills, as well as exceptional
organization skills. I had to have excellent knowledge of the adjudication and claims process so that I could help
make these changes and to help develop this system.
Responsibilities:
• Responsible for creating and reviewing business requirements, functional specifications, project
schedules, documentation and test plans.
• Worked on the MMIS (Medicaid Management Information Systems) for State government.
• Responsible for Business Process Management (BPM) for development of various projects.
• Closely interacted with designers and software developers to understand application functionality,
navigational flow and updated them about end-user sentiments
• Perform EDI activities that comply with government reporting requirements and standard.
• Working with management to establish, document and maintain EDI procedures by identifying errors
and taking corrective action, reconciling EDI transactions through coordination of information with
internal and external customers, Accounting Department, IT Department and external vendors to
maintain EDI integrity.
• Overseeing and maintaining the EDI Inquiry Problem database including the evaluation of problems or
issues through to resolution.
• Conducting regular audits of EDI transactions to determine accuracy and areas for improvement and
maintaining EDI maps and business rules for HIPAA validation software.
• Worked on the various web based projects for the department and responsible for updating the current
system.
• Worked with Object Oriented Programming (OOP) environments such as Java, VB.net and C#.
• Worked in various other technologies such as XSLT, CSS, XML and HTML.
• Generated queries in Oracle and SQL Server.
• Managed Version Control, each version of the application was stored in Clear case and necessary
modifications, updates, analysis was done. Developed ER diagrams for depicting relationships between
entities. Mapped ER Diagrams to relational database.
• Worked extensively with Oracle and SQL Server.
• Worked closely with Developers, User Representatives and participated in the product design process
including specifications and other document reviews.
• Created and maintained the Requirement Traceability Matrix between the requirements and other
products such as design documents and test plans.
Educational Qualifications
• MS Software Engineering
North Dakota State University, ND, USA
(graduation expected by 2014)
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• Post Graduate Diploma in Computer Science
Ansal Institute of Technology, India
• BS Electronics Engineering
University of Pune, India
References
Available upon request
Work Authorization Status
No work visa sponsorship required. Authorized to work across the United
States of America.
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