Project Data
Resume:
Amanpreet S. Kang
********@*****.***
. 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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