Data Project
Resume:
Business System Analyst
Nikhil Nukalapati
adbm74@r.postjobfree.com
PROFESSIONAL SUMMARY:
Over 7+ years of experience as a Business/System Analyst in IT Industry.
Well experienced in gathering requirements from the stakeholders, clients, and products owners. Eliciting the requirements and prepared Business Requirement Document (BRD) and Functional Requirement Documents (FRD).
Experienced in SDLC methodologies like Agile-Scrum and Waterfall.
Experience in developing use cases, use case models, and other supporting materials or requirements.
Efficient in writing Use Case Specifications, Functional Specifications and Business Process Flow diagrams.
Experienced in using different types of Project Management tools during the project such as HP ALM, JIRA, SharePoint, and MS Project.
Worked in MMIS project for dental claims.
Hands on experience on different domains like healthcare, management, and insurance etc.
As a business analyst managed many project with group and alone also.
Used different tools for claims adjudication and claims process.
Great skill on conducting interviews with business clients, stakeholders, and Subject Matter Experts (SMEs) and to elicit business requirements based on the expectations of the clients or stakeholders.
Experienced conducting all the meetings in the Agile-Scrum methodology such as Daily Stand-up meeting, Sprint Planning, Sprint review meeting, and Retrospective meeting throughout the project.
Conducted GAP analysis using AS-IS and TO-BE business process, Impact analysis, SWOT analysis and ROI analysis.
Strong experience in explaining the business requirements with team and converting them into functional and non-functional requirements with UML diagrams.
Good at using prototyping application user interfaces, user experience, and user interaction.
Good understanding of risk analysis, risk management, and business process flow.
Experienced in working with the Requirement Traceability Matrix (RTM) during all the phases of the project.
Good experience in performing (JAD) joint application development sessions, (JRS) joint requirement planning sessions, (RAD) Rapid Application Development, and communication interviews.
Experience in working with Test Management and defect tracking tools like HP ALM/Quality Center, IBM Clear Quest and JIRA.
Knowledgeable data warehouse house concepts with ETL process Extract, Transform and Load of data.
Solid knowledge on data ware house concepts, modeling, ETL tools, and (EDW) enterprise data warehouse concepts.
Used SQL queries for testing and report/data validation.
Experienced in writing database queries by using Microsoft SQL Server for data retrieval and storage
Performed Test Plans, Test Case, FRD, Test Scenarios, performing functional, usability testing and make sure that the software meets the system Requirement.
Good knowledge in Project Life Cycle (PLC) and Project Management skills.
Conducted manual and automation test cases for products and services as well.
Bug tracking reports on daily basis using JIRA.
Capable to work with the team project and able to handle the project single. Coping with Developers and QAs to associate with other departments to make things to be done easily and comfortably.
Experienced in risk analysis, diagnose the problem, forecasting and providing budgeting solutions.
Strong communication skills in engaging with business stakeholders, and Users in gathering the intricate flows of the business processes.
Worked on data warehouse concepts like data mining, migration, modeling, analysis, study, and others etc.
Creating process flow diagrams, and prototypes.
Good at problem solving, risk analysis, critical thinking, and understanding the whole process.
PROFESSIONAL SKILLS:
Operating Systems
Windows, Unix, Linux
Databases
MS SQL Server, Oracle
Methodologies/Frameworks
RUP, UML, E/R Diagram
Software Tools
Rational Rose, Rational Requisite Pro
Office Tools
MS Access, Excel, Power Point, Word, MS Outlook Express, Outlook Exchange
Project Management
MS Project (PERT, GANTT Charts), MS Navision
Testing Tools
Jira, HP ALM/Quality Center, TFS, QTP
Data Modeling Tools
Erwin, MS Visio
PROFESSIONAL EXPERIENCE:
Accenture MMIS, Austin, TX July. 2018 – Till date
Sr. Business Analyst
Scope of the project was to develop new features in the Medicaid Claims Processing module that includes the prioritization of claims, creating Medicaid reports and checking the status of claims. Worked as Business System Analyst with plexus system specifically for the Benefits and claims. The scope of the project is to specify or to enhance EDI mapping service to send error messages or response to DMAS and save the transaction, in case of encountering technical exception in X12 validations.
Responsibilities:
Coordinated with market BAs and business owners to gather requirements.
Collected requirements from stakeholders and acted as bridge between stakeholders, mangers, and developers.
Conducted JAM, JAD, grooming, daily stand up, brain storming, and meetings etc.
Worked on EDI X12 validation and used data mapping techniques.
Validated industry codes with project codes and created error specification codes.
Developed process flow diagrams, flow charts, and project specific diagrams with help of Microsoft Visio etc.
Worked on tool like TFS (team foundation server), Jira, Share point, and QTP.
Responsible for identifying and maintaining a clear and measurable software development process that is deployable throughout the enterprise using SDLC.
Worked on Agile Scrum methodology of SDLC. Involved in release, eliciting user stories and supported the design, development and testing team on daily basis.
Conducted JAD sessions for requirements gathering, analysis and design of the system.
Responsible for creating and mapping EDI claims and with Plexis claims management system.
Worked on different tools like TFS, JIRA, and HP ALM.
Worked on Agile and Waterfall methodologies.
Expertise in payer domain System Integration with Health plans eligibility and claim information.
Worked on Claims Processing/adjudication, Members, providers, payers and other insurance entities etc.
Documented the requirements in BRD, FRD, BFD, and SRS etc.
Communicated well with stakeholders and translated the requirements in the requirements documentation.
Communicated well with stakeholders and developers.
Meetings with stakeholders, managers, and products to discuss about the requirements.
Carrying all the requirements to developers in the form of documents and in some instances prototypes etc.
Managed the project using the Agile Method of project development.
Conducted user interviews and documented business and functional requirements.
Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
Defined, developed specs for federal reporting specific to Medicare Advantage.
Used data mapping methods to co-relate with industry codes and international codes. And performing gap analysis on the systems.
Used XML for building and parsing of Application Configuration file on Plexis (Quantum).
Analyzed the claim scenarios and claim adjuration process.
Completed the documentation of Claims Scenario's for the source system.
Created BRD for EDI X12 validation and developed new feature that user friendly for members and payers.
Worked with developers in upgrading the existing system that is compatible for feature generation by adding new buttons, columns, and tabs.
Developed prototypes and business process flows with the help of Microsoft visio.
Co-ordinated with tester in configure the new feature with existing system. Created test cases in manual testing and used automation as well.
Created workflows in enrollment system with what client expects.
Monitor data quality and integrity of internal systems and applications and CMS Centers for Medicare Medicaid Services extracts.
Worked on EDI (X12) 820,835, 837, 834, 820, 835,999, 276, 277 Transactions. Worked on X12 validations and validated the EDI transaction.
Worked on HIPAA compliance lifecycle from GAP analysis, mapping, implementation and testing for Medicaid claims.
Data mapping methods and techniques are implemented as part of project.
Developed workflows and process flow diagrams with Microsoft Visio.
Conducted daily stand up meeting, JAM, JAD, and one to many and one to one sessions also.
Tufts Health Plan, Watertown, MA Apr 2017 – June 2018
Business systems Analyst
Scope of the project was to develop new features in the Medicaid Claims Processing module that includes the prioritization of claims, creating Medicaid reports and checking the status of claims. Worked as Business System Analyst with Health Edge Payor system organization specifically for the Benefits and claims.
Responsibilities:
Worked on dental claims in MMIS project.
Responsible for identifying and maintaining a clear and measurable software development process that is deployable throughout the enterprise using SDLC.
Worked on Agile Scrum methodology of SDLC. Involved in release, eliciting user stories and supported the design, development and testing team on daily basis.
Conducted JAD sessions for requirements gathering, analysis and design of the system.
Configured provider contracts for Tufts as business is moved to the Health Edge software platform.
Attended the business configuration and technical training programs at Health Edge.
Tested HIPAA regulations in Health Edge HIPAA privacy module
Attended the business configuration and technical training programs at Health Edge.
Involve in Health Edge Implementation, involved end-to-end testing of Health Edge Billing, Enrollment Claim Processing and Subscriber/Member module.
Responsible for creating and mapping EDI claims and with Plexis claims management system.
Expertise in payer domain System Integration with Health plans eligibility and claim information.
Strong understanding and Claims Processing/adjudication, Memberships and other standards.
Involved in preparing “BRD” Business requirement Documents for 5010.
Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
Managed the project using the Agile Method of project development.
Conducted user interviews and documented business and functional requirements.
Defined, developed specs for federal reporting specific to Medicare Advantage.
Participated in writing data mapping documents and performing gap analysis on the systems.
Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
Completed the documentation of Claims Scenario's for the source system.
Configured Medicare data for the Enrollment, Billing and Reconciliation modules in Market Prominence.
Created workflows in enrollment system with what client expects.
Monitor data quality and integrity of internal systems and applications and CMS Centers for Medicare Medicaid Services extracts.
Analyzed the existing claims process on Plexis claim management and specific business rule logic will be applied in the ACP model. Prepared and modified Requirement Specification Documents for different markets for EDI (X12) 837, 834, 820, 835,999, 276, 277 Transactions.
Worked on HIPAA compliance lifecycle from GAP analysis, mapping, implementation and testing for Medicaid claims.
Strong Experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
Recommended changes for system design, policies and workflow affecting Medicare/ Medicaid Claims processing system in compliance with current government process like HIPAA and EDI.
Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution.
Identified the bugs and kept track of the defect report using ALM/Quality Center, and also analyzed the root cause for defects.
Created Test scripts in UFT/QTP and integrated those into ALM/Quality Center to run from QC Test Lab.
Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Smoke testing Load testing, User Acceptance testing and Pilot testing.
Developed test cases and performed UAT testing for all the files and reports also performed regression testing.
Investigated software bugs and reporting to the developers using ALM/Quality Center Defect Module.
N.C Department of Health and Human Services, Raleigh, NC Mar 2016 – Feb 2017
Business System Analyst
North Carolina Child Support and Welfare Enforcement is part of the North Carolina Department of Health and Human Services. The North Carolina Department of Health and Human Services also supervises a number of complementary programs and services administered by county departments of social services. The team was responsible for the enhancement of the Department's child welfare collection and disbursement function, and provided oversight of the maintenance of the child welfare trust fund. Child welfare encompasses programs and policies oriented toward the protection, care, and healthy development of children. Work involved planning and coordinating program activities to ensure compliance with state and federal regulations and identifying the potential impact of program changes on the quality control system.
Responsibilities:
Identified the business functions and processes, and prepared system scope and objectives based on user needs and industry regulations.
Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD).
Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.
Addressed requirements as a liaison among stakeholders in order to elicit, analyze, communicate, and validate the requirements and business processes.
Participated in all Iteration, Scrum, Daily stand-ups and Iteration review meetings working in an agile development methodology.
Analyzed the functional details of various modules in mainframe and did the GAP analysis with the new system.
Documented the complete process flow to describe program development, logic, testing, and implementation, application integration, coding.
Involved in defining the source to target data mappings, business rules and data definitions.
Designed and executed Test Plans and Test Cases and generated Test Scripts and Test scenarios.
Utilized Agile methodologies to analyze and document any proposed requirement.
Worked with Department of Human Services and performed comprehensive business analysis of Eligibility and Enrollment Processes for Potential Medicaid Members and Newborns for a Quality Improvement Process initiative and State Children’s Health Insurance Plan (SCHIP) programs.
Custom report generation (SQL, Access, and Excel), dashboards and analytics for operations / process management, quality assurance, and executive analysis.
Used Quality Center to plan tests, managed test assets, created and run manual and external scripts to check GUI and functional features of the AUT.
Involved in developing and maintaining Test Matrix and Traceability Matrix, and performing Gap Analysis.
Created ad hoc reports inquired by the client and/or internal staff.
Communicated the business requirements and data mapping in technical terms to the ETL developers using Informatica.
Developed Informatica mappings, enabling the ETL process for large volumes of data into target tables.
Used data analysis techniques to validate business rules and identify low quality missing data in the existing data warehouse (EDW).
Used ETL tool for Extraction, Transformation and Loading the data into target database.
Developed thorough Use Case Diagram, Activity diagrams based on UML, methodology and business process flow diagrams, Data flow diagrams, state chart diagram using Microsoft Visio.
Performed UAT by formally documenting the results of each test and provided error reports and correction requests to the developers
Responsible for designing and performing User Acceptance Test evaluations that ensure adherence to the company’s quality assurance standards. Assured compliance with company and/or external requirements and specifications for user acceptance testing.
Involved testing of the application Internal and External Environment in using QTP.
Maintained and executed QTP Script from Quality Center/ALM.
Performed day to day Back-end testing procedures using SQL statements for various online customer interactions.
Involved in testing of reports taken from Back-end application as Business Object of SIT, UAT and Production.
Wrote SQL Queries for data analysis and manipulation.
Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
Extracted data from different sources like flat file excel data sheet, access database and SQL & Oracle relational databases.
Mercy Health System, Chicago, IL JAN 2015 – Feb 2016
Business Analyst/System Analyst
I worked on HIPAA EDI transactions and on Claims processing module of the Group Approval Process (GAP). The project was to implement a web based claim processing application and give the users the clear vision of claim life cycle from submission through payer adjunction. It helped the organization increase its claim processing capacity and scalability. It connected the organization to the largest all-payer network of commercial and government health plans nationwide to provide a wealth of real-time patient benefit information.
Responsibilities:
Wrote down the requirements in the form of user stories and helped the product owner prioritize them in the product backlog.
Gathered, created and reviewed business rules, business requirement documents, functional documents and Interface requirement documents for multiple business processes.
Interacted with business users and collected the requirements. Analyzed business requirements designed and recommended solutions over agile methodology.
Facilitated JAD sessions with business and technical units to fine tune prioritize and detail requirements
Responsible for identifying and documenting business rules and creating detailed Use Cases.
Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
Worked in Facets with deferent modules like Subscriber/Member, Open Enrollment, Claims Processing, Billing and Providers Applications.
Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc).
Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/ Medicaid claims processing.
Involved in Scrum ceremonies such as Daily standup meeting, sprint review, sprint planning and sprint retrospective.
Involved in resolving impediments that affected the performance of the Scrum Development team.
Helped in creating of Data-Mapping best practices document including visual processes and trained team members on Data Mapping process and tools.
Responsible for the core activities of test team including creating and executing test cases, analyzing and documenting results and drawing a traceability matrix to match the requirements with final test scenarios.
Developed test cases, test plans, and acceptance criteria.
Created Requirements Traceability Matrix and support in creation of enterprise solution architecture to integrate business rules across domains.
Assisted in the development of quality assurance activities including Quality Assurance Plan, Technical solution Summary, Technical Design Document, Test Plan, and Test Cases.
Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
Participated in SCRUM meetings and worked closely with the Subject Matter Expert.
Organized and conducted extensive JAD sessions with users to identify and understand requirements.
Responsible for doing the gap analysis for the interfacing system.
Written Complex SQL queries and optimizing SQL Queries.
Wrote Use Cases, prepared use case diagrams (using MS Visio, Azure RP) and followed agile methodology at every stage of the process.
Involved in bug tracking and defect prevention activity, configuration management, and UAT.
Created UAT test cases in HP ALM/Quality Center tool and worked with the business users to validate the functionality in UAT.
Performed Functional, Regression, System and UAT testing using QTP.
Provided reports and other documentation on projects to client and internal staffs, as needed.
Worked with team leaders and supervisors to ensure project and organizational deadlines are met.
Sandune Software Solutions Pvt. Ltd., India May 2012 – Sep 2014
Business Analyst/ Systems Analyst
Responsibilities
●Assisted in the development process of the Software development and IT team’s procedures, policies in order to make the process more efficient.
●Worked closely with the Software development team to get the projects developed and implemented.
●Managed ticket tracking to assist the IT help desk to make sure that Key Performance Metrics are maintained.
●Assisted with system design, implementation, administration and network management.
●Advised and recommended areas of program planning, budgeting, execution and business management.
●Formed and maintained business requirements and functional requirement documentation (FRD).
●Key team deliverables included business and functional requirements, use cases, usability metrics, test plans, test scripts and end-user training.
●Worked with stakeholders to further elicit requirements using interviews, document analysis, requirement workshops, surveys, site visits, business process descriptions, use cases, and workflow analysis on various web and application projects.
●Served as the conduit between the end users and software development team by participating in system testing, data validation, collection and documentation of software bug reports.
●Created an organizational chart of key decision makers and with background knowledge set conference calls, web-demos, face to face meetings and proof of concepts.
●Created use cases, flow charts, OO model, UML diagrams, process flows, task analysis, database diagrams, wireframes and screen mock-ups.
●Worked closely with the Software development team and aided in the development of an application.
●Led various Scrum meetings with development team to review Functional specification & design the system.
●Worked on building an e-Commerce website for a client launching an online apparel store.
●Directed biweekly forms update meeting, created reports, provided follow-up on outstanding requests.
●Prepared Training documentation for end users to update customized information regarding employee status. Assisted in the post implementation activities.
●Achieved collaboration across different groups by using MS SharePoint and keeping track of the progress by efficient management.
Envirorment: RUP, JAD Sessions, MS Office Suite, MS Access, BPMN, MS Visio, VMware, Rational Requisite Pro, XML, HTML/HTML5, CSS, Teradata, HP Application Life Cycle Management, Rational Suite
Education: MS IT information technology Wilmington university DE
MS MBA Wilmington university Delaware
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