Project Data
Resume:
Naitik Patel
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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