Manager Project
Resume:
Trisha T
Email: **********@*****.***
SUMMARY
Product Manager/ Business Analyst with about 8 years of experience in IT and software projects in Healthcare. Involved in various projects for Integration, Migration/Conversion, Configuration and Production Support.
Worked extensively on Business Analysis (Enterprise Analysis, Requirements Elicitation, Requirements Analysis & Documentation, Communications, Solution Assessment and Validation).
Delivered high quality functional and non-functional requirements using Business requirements documents, process flows, user stories, Acceptance Criteria, data flow diagrams.
Facilitated strong communication with Vendors, Client and the Business Owners across all the departments. Also facilitated JAD and JAR sessions for requirements generation, Scrum stand-ups, Scrum Retrospective sessions.
Managed projects in healthcare across all lines of businesses (Medicare, HMO, PPO, CHIP, Medicaid) and Pharmacy data (PBM) with prime focus on claims adjudication, provider, Eligibility, Payments, enrollment data.
Proficient in unified modeling language (UML) tools such as MS Visio, Rational Rose and Requirement Management tools such as Rational RequisitePro.
Experience with data mappings including ANSI 4010A1 835, 837I, P,D, 276/277, 820, 834, 270/271
Have experience working with IT Applications EDIFECS Ramp Manager, EDIFECS Spec Builder, EDIFECS Transaction Manager, Ops repository, Team foundation server, Health Rules Manager developed by HealthEdge, Transsend by Axiom
Effectively been involved in conducting Business Analysis, scope identification, requirements gathering and analysis, feasibility analysis, gap analysis, risk analysis – mitigation plan, release management and Training to end users.
Generated clear and concise documentation and communicated effectively to business users and project management team across all phases of the project.
Performed Business Analysis related activities like scope identification, requirements gathering and analysis, feasibility analysis, gap analysis, risk analysis – mitigation plan, release management and Training to end users.
Interfaced with outside vendors: Optum, CMS, First Recovery Group, Crimson, Bswift, Softheon, Vitals, and Axiom.
SKILL SET
Requirement Tracking: Methodologies: Waterfall, Agile/Scrum
Performance Testing Tools: Rational Suite Performance Studio
Operating Systems: MS Windows NT/98/2000/XP, UNIX, iOS
Web/Design Tools: HTML, XML, MS Front Page,
Databases: SQL Server
Office Tools: MS Word, Excel, MS Outlook, Team Foundation Server, MS Visio
Applications: HealthRules - HealthEdge, Transaction Manager - EDIFECS, Transsend - Axiom
EXPERIENCE
FirstCare Health Plans, Austin, TX July 2013 – Present
EDI Product Manager
Project(s): Data migration from Legacy system AMISYS to HealthRules
Compliance to HIX/Exchanges Plans (Pharmacy Data)
Enrollment and ID generation Process
ICD 10 Implementation
Health Rules Upgrade
Have worked on multiple projects apart from the ones mentioned above during my tenure with FirstCare.
Have been involved in projects involving all lines of businesses (Medicaid, Medicare, Commercial, Exchanges)
FirstCare has been using a Legacy system AMISYS and the data is currently in the process of migration to a new application HealthRules developed by HealthEdge Solutions.
Started off working on Waterfall SDLC methodology and are working towards switching to Agile/Scrum Methodology
Responsibilities include interacting with the client for data compliance and gathering requirements
Weekly/Daily Standups and Scrum meetings with Webex/Lync sessions are scheduled to discuss the requirements/concerns/issues
Team Foundation Server developed my Microsoft is used to track the changes and updates in the respective sprints
As a Product Manager, I have had the responsibility of prioritization and allocation of projects, tasks, issues/bugs, enhancements and Production support
Interact with the clients and business to develop user stories and acceptance criteria’s
Conduct scrum meetings with the team on a daily basis to track the progress
Create process and data flows to depict the exchange of data between the two systems using UML tools like MS Visio
Create tasks, bugs and issues to track them and address any outstanding issues
Performed SQL queries to have data base knowledge that helped us in identifying data issues
Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis. This helped immensely in identifying the configuration issues that had occurred during the process.
Work with the development team in generating extracts in a timely manner.
Created documents, incidents, changes and releases in SAMNAGE for moving the processes for tracking, sign offs, approvals and deployment.
Triaging the service now tickets to the respective owner and tracking the progress
Monitored project status to ensure progress toward completion, required procedural steps are completed fully and timely, interested groups and individuals are informed of progress, and project output is appropriate
Responsible for documentation, change management, configuration issues, requirements, process flows, and data flows.
Cigna Healthcare, Chattanooga, TN Dec 2011 – July 2013
EDI Specialist/ Business Analyst/ Command center Lead
Project: EDI Intake Solution Production Support and Assessment
Description: Working with the Cigna Business and EDI Specialist Business Analyst team in the providing Production Support for the migration of data from EDI Gateway (developed by HP) to Cigna’s Infrastructure.
Currently involved in migration of TPG (Trading Partner Gateway) to Sterling Gateway which is scheduled to go live on 7/1/2013.
Involved in the mapping changes w.r.t the migration and defects
Capturing EDI data for 837, 835 and 277 claims.
Electronic Data Interchange (EDI) was the primary aspect of the project which revolved around claims processing and remits.
Worked on the Healthcare Transaction Manager (HTM) supported by EDIFECS.
Transaction Manager, Ramp Manager, Spec Builder, Ops Repository are some the tools that have been used during my tenure in this project.
Worked mainly on the mapping specs for converting X12 and CCF to various output formats, Claim engines and Business rules
Converting the output formats (within Cigna) into readable formats using tool called “Testers”
Performed requests to IBOR (Individual book of records) i.e present within Cigna for Business rules using SOAP UI.
Coordinate with the business from IBOR and CBOR (Claims book of records) present within Cigna on various scenarios
Involved in the triaging and assigning tickets to various technical teams for resolution.
Functional understanding of the client’s entire claims IT landscape along with the surround systems.
Mostly involved in 837 IB/OB and 835 remits payments processing
Involved in working with the technical teams and providing inputs
Co-ordinate meetings and calls across multiple teams along with executive management.
Conducting analysis and documentation of as-is capabilities about business processes, resources and technology in order to develop solutions for potential growth strategies
Acted as liaison between Client team and offshore and delegated tasks
Reviewing BSD (Business Specification Document) and liaising with onsite/client for issues through regular status update meetings and preparation of quarterly release management decks for consumption by senior management.
Coordinate between various technical and business disciplines to gather, analyze, and assist in clarifying requirements needed for completion of the project
Formulating and implementing recommendations, solutions and business process optimizations
Preparation of a knowledge repository for account level business specific documents, collaterals and training material for new resources joining the account
Working knowledge and understanding of code set and crosswalks in ICD9 and ICD10 formats.
Involved in a few instances where I performed testing in SYT region
Coordinates business relationships with defined trading partners.
Develop EDI Maps according to Customer and Vendor Requirements.
Troubleshoots EDI issues in HPSM
Consults with users, management, and IT to implement EDI based tools in support of the business plan.
Escalates critical issues through appropriate channels.
Analyze and evaluate requirements for customer inbound and/or outbound mapping requirements that will facilitate customers EDI interfaces.
Prepare detailed mapping specifications for development activities including reports, interfaces, conversions, enhancements, and forms.
Facilitate knowledge transfer, communication and interaction between various functional organizations and the Information Technology department
Experience building and maintaining in EDI maps
CVS Care Mark, MI March 2010– Sept 2011
Sr. Business Analyst
Project: Compliance with HIPAA 5010 and ICD 10 standards.
Conducted business needs analysis and assisted Project Manager in defining high level scope for the project proposals and created Scope definition documents.
Responsible for owning complete requirements related activities on assigned project and related deliverables.
Facilitated Vision workshops with stakeholders to help define and document business needs and solution vision.
Conducted Scope analysis and gathered high level business requirements through various requirements elicitation techniques and created various scope and requirements models like Use Case Models, Process Models and Activity Diagrams.
Conducted business process analysis and created business Process Models and Business Process Flow Diagrams.
Involved in preparing "BRD" Business requirement documents for 5010.
Prepared "FSD" functional specification document for 5010 from 4010A.
Analyzed source and target data in MS Excel.
Performed the detail comparison between 4010A and 5010 to identify differences across loop structures.
Involved in gathering data and supported application development. Data includes patient's admission status, discharge details and transfers. Also tested claims and diagnosis reports of the patient.
Examined clinical data to evaluate existing and/or potential trends as specified by scope of Health Care Requirement Analysis contracts.
Extensive working experience with HIPAA transactions & code set rule
Worked on EDI 835, 837, 270, 271 as per HIPAA guidelines.
Conducted "JAD" sessions to understand detail requirements and performed "GAP" analysis.
Involved in the data movement between systems and validating the business requirements.
Followed the RUP methodology for the entire "SDLC".
Actively participated in status report meetings and interacted with developers to discuss the technical issues.
Performed "UAT" for 5010 and ICD 10 codes.
Worked in testing the professional, institutional claims processing and adjudication and validate data with facets.
Conducted walkthroughs and defect meetings periodically to assess the status of the testing process and discuss areas of criticality.
Tested data to check HIPAA implementation.
Extensively involved in database testing by writing SQL queries.
Pfizer, New York, NY March 2008– Jan 2010
Business Systems Analyst
Project: Multiple Projects
Gathering and reviewing the business requirements and working with Development and QA team for gaps found during the review.
Analyzed business requirements and functional specifications for testing the application.
Developed test plan to give a detailed approach of the testing that will be performed on the projects.
Understanding the business requirements and developed Test scenarios and test cases as per process flows, business rules.
Reviewed current use cases and process flows for business requirements.
Responsible for the UAT for the entire application for system process functionality, business logic.
Assisted in creating test data files for the HIPAA 837/835 (Claims Processing/Claims Payment), and 276/277 (Claims Request and Claims Response) transaction based on the ANSI X12N HIPAA standards
Worked effectively on HIPAA 837 (Claims processing) EDI standards
Communicated with Senior Business Analyst, Retrieve Requirement and Develop Test Scenarios and Test Cases from the Business Requirement.
Performed Traceability matrix to match test scenarios to the requirements.
Documented and communicated test results and status to the appropriate Analyst.
Utilized project management methodologies to develop project deliverables.
Analyzed and Researching test results based on the defined specifications to ensure all functionality, requirements, and business values are met.
Conducted reviews of test efforts, scenarios, plans, and results to obtain sign off and approval from claims services department.
Triggering pending claims, copying claims from Production to Test Environment and putting them through daily and weekly cycles.
Analyzing Professional and Institutional Claims create claim level, line, and payment level out of Balance Reports under the Submitted Billing Provider Number.
Validated the X12 files according to the 5010 standard.
Used Quality Center powered by HP as a repository for all the test case scenarios, test cases, test results and defects.
Maintained UAT Metrics and providing status updates to stakeholders.
Attended various review meetings coordinated with the developers to resolve the defects, to discuss requirement issues, major defects found during testing, enhancement issues.
Education:
Master of Science, New Jersey Institute of Technology, NJ, USA
Bachelor of Science, Chaitanya Bharathi Institute of Technology, India
Certifications:
HIPAA Privacy and Security Certified
Brain Bench certified in Unified Modelling Language and Requirements gathering.
Contact this candidate