Medical Billing Data

LUBNA VENKAT

Phone :407-***-**** E-mail: *************@*****.***

Senior Business Analyst with around 8 years of experience in collaborating with peers in both business and technical areas, to deliver optimal business process solutions, in line with corporate priorities.In-depth knowledge of data warehousing concepts and in the field of Functional Business Analysis with expertisein End to End SDLC in Waterfall, Agile methodologies (Scrum) based projects in Health care, Property and casualty Insurance domains.

PROFESSIONAL SUMMARY:

Solid understanding of Business Requirements and Business Process flow.

Assisted in developing effective working relations with client teams to understand and support Requirements, scope & prioritization of projects, to effectively manage client expectations.

Proficient in Functional analysis, Business analysis,Requirement Elicitation, Requirement Analysis, Requirement Management and Communication, Impact analysis, As Is- To Be study, Gap analysis and JAD sessions.

Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.

Scrum Events: Backlog Grooming, Story- Point Estimation.

Agile Scrum Ceremonies: Daily Scrum Call, Sprint Planning, Sprint Review, Sprint Retrospective Meeting.

Scrum Artifacts: Product Backlog, Sprint Backlog, Product Increment and Burn-down Chart.

Skilled in creating and maintaining Functional Specification Documents (FSD), Use Cases, Data field mapping, Process Flow mapping, Requirement Traceability Matrix.

Expertise in Requirement Elicitation techniques. Highly proficient in coordinating

with the team and in working with users, stakeholders to elicit the requirements using

Focus groups, Interviews and Brainstorming sessions.

Assisted business in preparing BRD (Business Requirement Document) and FRD (Functional Requirement Document).

Experience in diversified business domains (Insurance, Property&Casualty, Health care, Banking) with heterogeneous relational databases such as Oracle, MySQL and PostgreSQL.

Expertise in creating Use case diagrams, Use case specifications, Dataflow diagrams.

Knowledge in writing SQL queries.

Strong knowledge in software testing lifecycleand coordinate Sanity andUser Acceptance Test

(UAT) activities.

Experience in Medical billing and coding, Managed care networks system.

Expertise in reviewing the Test Scenarios, Test Cases, Test Scripts, Test execution Strategies

Extensively automated regression and functional test suites by developing over 200 test cases, 5 test suites using Selenium WebDriver, JAVA, and TestNG.

Expertise in Grouping of Test Cases, Test Methods and Test Suites for regression and functional testing using the TestNG annotations like Groups, Parameter, Data Provider.

Expertise in Firebug, FirePath add-on tools to identify the web elements using various locators such as id, Name, Xpath, partial link text, and CSS locator in the application.

Experience in Selenium synchronizations with conditional (Implicit, Explicit, and Fluent) and unconditional wait statements.

TECHNICAL SKILLS:

Software Methodologies

Agile (Scrum),Agile(Kanban) Waterfall, Hybrid

Domain Expertise

Health care, Property and casualty Insurance

Business Intelligence Reporting tools

ETL, Informatica, Tableau

Languages

Java, SQL, Python, HTML, CSS, XML

Operating Systems

Windows and Unix

Business Modelling Tools

MS-Visio, Rational Rose

Bug Tracking Tools

JIRA,

Content Management

SharePoint, Documentum

Document Creation/Management

MS Office Suite- Word, Excel, Outlook, PowerPoint, MS Project.

Database

Oracle, MySQL and PostgreSQL.

Wire Framing Tools

Balsamiq, Pencil

Testing tools

Selenium Web Driver.

PROFESSIONAL EXPERIENCE:

Description:

Commerce Insurance Group is an American company that provides personal insurance, commercial property insurance, and casualty insurance in Massachusetts and New Hampshire. Their core product lines include personal automobile, homeowners, and commercial automobile insurance. The project was aimed at developing the UI for insurance claims and also ETL processes to load the target databases to populate the insurance claim's transactions like automobile coverage and personal losses. Further, Business Intelligence reports were also generated.

Responsibilities:

Conducted SWOT Analysis for better market understanding and project implementation.

Documented user stories and modeled Use Case diagrams by utilizing MS Visio.

Performed Gap Analysis to check the compatibility of the existing system with the new business requirements.

Participated and facilitated meetings with business and Subject Matter Experts (SMEs) to capture the highlevel function points and business practices.

Interacted with Claims team for analysis and documentation.

Created a product roadmap for the various stages and releases throughout the project lifecycle.

Provided analytical support in the Design, Development and Implementation of Project.

Created Use Case diagrams, Activity diagrams, and Sequence diagrams by using MS Visio.

Documented Requirement Traceability Matrix (RTM) to check the completion of current project requirements.

Created wireframes for the user interface and provided the same to GUI design team.

Verified the Business Scenarios on new builds to allow testing by the QA team.

Reviewed and approved Test Scenarios and Test Cases based on user stories.

Actively conducted and participated in weekly meetings to analyze the progress and to maintain status reports.

Performed Back End Testing using SQL queries, generating reports to ensure data integrity and to validate the inserted and updated data.

Prepared UAT Test Plan for various Test Scenarios and assisted in User Acceptance Testing.

Environment: SQL Server, HTML, Balsamiq, JIRA, MS Visio, MS Office, SharePoint.

Description:

Sonic Healthcare is a leading national healthcare solutions provider. It supports physicians, patients, and employers through the enhancement of pain management practices and promotion of better health through cutting edge clinical laboratory and genetics testing using state-of-the-art technologies. The project involved user interface development and Claims & Reimbursement processing.Processed patient data for a requirement using ETL tool.

Responsibilities:

Conducted JointApplication Development (JAD) sessions with stakeholders to elicit requirements.

Documented and created Business Requirement document (BRD) and Functional Requirement document (FRD).

Organized and facilitated Agile and Scrum meetings, which included Sprint planning, Daily Scrums or standups, Sprint Review and Sprint Retrospective.

Created and maintained Product Increment, Product Backlog and Sprint Backlog defining new systems operations for the project.

Facilitated User story grooming sessions. Helped the team in breaking down the Epics into User Stories and tasks.

Coached team members on how to effectively use Kanban and Scaled Agile Framework values as a guide.

Designed and developed various UML diagrams like Use cases, Activity diagram and Sequence diagram using VersionOne.

Created swim lanes, wireframes, screen mock-ups usingBalsamiq to present the visual view of the feature within the website.

Played integral part in creating test plan, test scenarios and test cases.

Overviewed end to end defect management. bug fixes, retesting, break fixes, impact analysis and production assurance.

In-depth knowledge in managed care system(HMO, PPO plans).

Worked with multiple teams to improve the overall claim and reimbursement processes.

Expertise in Medical billing and coding in the immensely important reimbursement cycle.

Worked on EDI transactions which are used for submitting and tracking claims and discussed the same with developers and testers.

Worked in the full HIPPA compliance life cycle from gap analysis, data mapping and testing for processing claims.

Knowledge in workers compensation billing and vendor management.

Create weekly reports to inform management about the status of the project. Used JIRA as the project management tool.

Worked with multiple teams, both on site and offshore.

Made sure data is secure and HIPAA compliant.

Worked closely with testers to create test cases and participated in UAT (User Acceptance Testing).

Experience in Managing Custom Dashboards and designing of SDFC custom objects, custom fields, pick list, role-based page layouts, Workflow Alerts and Actions, and Approval Workflow, Validation Rules, Approval Processes, custom Tabs, custom reports, report folders, report extractions to various formats, design of Visual Force Pages, Snapshots, Dashboards, and Email generation according to application requirements.

Environment:SQL Server, MS Visio,MS Project, MS Office Suite, Data Analysis, Medical billing, Claims processing, JIRA, Rally, Version 1.

Description: The Hartford Financial Services Group, Inc., usually known as The Hartford, is a United States-based investment and insurance company that is part of the Fortune 500 list, head quartered in Hartford, Connecticut. The

company’s earnings are divided between Property and Casualty Operations, Group Benefits and Mutual Funds.These projects work on Project Portfolio Management (PPM) which involves maintenance of existing Data warehousing applications for claims data, ETL Informatica jobs and creation of Business Intelligence Solutions.

Responsibilities:

Gathered and understood business requirements and transformed them into data warehousing solutions for Group Health Insurance Customer data.

Involved in meetings with stake holders and Product Owners to understand the Business Requirements.

Wrote and maintained Business Requirements Documents (BRD) and Functional Requirements Documents (FRD) defining new systems operations for the project using Rational Requisite Pro.

Documented all data mapping and transformation processes in the Functional Design documents based on the business requirements.

Created Technical specifications documents based on the functional design document for the ETL coding to build the Data Mart.

Referred Metadata tables, Data dictionary, Data Glossary and used them for elicitation and analysis purpose.

Performed Data Analysis and Data Validation by writing complex SQL queries using Toad for Oracle.

Worked on daily basis with lead Data Warehouse developers to evaluate impact on current implementation, redesign of all ETL logic.

Facilitated walk through to the Development team for Data Extraction, Transformation and Loading (ETL process) from Source to target systems using Informatica Power Center.

Conducted many informal sessions to develop an architectural solution that the application meets the business requirements, resolved open issues, and change requests.

Linked business processes to organizational objectives and perform critical path analysis.

Organized the Quality Analyst (QA) walk through to explain proposed changes.

Assisted Test team in drafting test strategies and test plans to verify accurately any functionality issues and successful system integration.

Worked closely with Reporting team to generate Business Reports using Cognos and visualized these reports using Tableau.

Participated in the analysis and definition of efficient, cost effective solutions, Gap Analysis, Business Impact Analysis.

Worked with Technical Experts to Improve Report Performance and performed System testing.

Recorded project changes on a weekly basis using change data to update the project plan and provide up-to-date information for project status reporting using MS Visual Source Safe.

Performed User Acceptance Testing (UAT).

Environment: Oracle 11g, Windows XP, Microsoft Project 2000, Informatica Power Center 9.5,HTML, Tableau, Erwin, MS Excel, PowerPoint, MS Visio and MS Outlook.

Client: The Commerce Insurance Company, Webster, MA Date: March 2019 – Till Date

Role: Business Analyst

Domain: Property & Casualty Insurance

Client: Sonic Healthcare, Austin, TX Date: November 2015-March 2019

Role: Sr Business Analyst

Domain: Healthcare

Client: The Hartford, Chennai, India Duration: June 2012 – November 2015

Role: Business Analyst/ Data Analyst

Domain: Property & Casualty Insurance

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