Business Analyst / Quality Analyst

Manoj Kumar Bukka

+1-856-***-**** **********@*****.***

SUMMARY

Experienced Business Analyst and Quality Analyst having 12+ years with deep domain expertise across Healthcare, Insurance, Clinical, Medical, and CRM environments, including customer service, claims processing, medical transcription, and practice management.

Proven SDLC expertise with hands-on delivery across Agile (Scrum), Waterfall, and RUP methodologies, consistently supporting enterprise-scale healthcare and insurance initiatives.

Expert in requirements management including elicitation, stakeholder interviews, JAD/JRP/RAD sessions, GAP analysis, SWOT assessments, ROI calculations, and business case development.

Strong Product Owner experience owning and grooming product backlogs, writing epics and user stories with acceptance criteria, prioritizing features based on business value, and partnering with Scrum Masters and development teams.

Authored comprehensive functional and technical documentation such as BRDs, FRDs, SRS, FSDs, use cases, RTMs, as-is/to-be process flows, UML diagrams, DFDs, and activity models using Visio, Rational Rose, and Confluence.

Strong QA and UAT leadership, supporting test strategy, test scenario design, test data preparation, UAT execution, defect triage, and traceability using HP Quality Center (ALM).

Certified Salesforce Business Analyst/Admin with end-to-end CRM implementations, data migration, governance, transformation, UAT leadership, and legacy-to-Salesforce system modernization.

ServiceNow ITSM process analysis experience, covering Incident, Change, Request, CMDB, procurement workflows, and cross-functional operational improvements.

Strong healthcare data and claims expertise, including HIPAA EDI transactions (837, 835, 820, 276, 277, 278), Medicaid systems, ICD-9 to ICD-10/PCS conversions, and compliance-driven clinical data initiatives.

Extensive data analysis and validation experience, performing end-to-end data reconciliation across source, staging, and target systems using complex SQL queries, ETL validation, data mining, and data warehouse (OLAP/OLTP) concepts.

Validated cloud and legacy data integrations, including API testing using Postman and SoapUI, ETL pipeline verification, and collaboration with BI teams on Cognos reporting accuracy and Medicaid compliance.

Advanced technical and analytical skills, including SQL for backend validation and reporting, Excel (Pivot Tables, VLOOKUPs, charts), and tools such as JIRA, HP ALM, SharePoint, Clear Case, Requisite Pro, and ClearQuest.

Recognized change leader and communicator, known for bridging business and technical teams, driving organizational change management, stakeholder adoption, and delivering high-quality solutions on time.

TECHNICAL SKILLS

Business & Systems Analysis: BRD, FRD, SRS, FSD, RTM, Use Cases, User Stories, Process Flows, Gap Analysis, SWOT, Impact Analysis, As-Is/To-Be Models, JAD/JRP sessions, BPMN, UML Diagrams (Use Case, Sequence, Activity)

Healthcare & Compliance Standards: HIPAA 4010/5010, ICD-9/10, HL7 v2.5.1, FHIR, CPT, DRG, Medicaid/Medicare, CMS Guidelines, Claims Adjudication, EDI Transactions: 270/271, 276/277, 278, 820, 834, 835, 837

Testing & Quality Assurance: UAT, Regression, Smoke, Functional, Sanity Testing, Test Plan and Test Case Design, HP ALM/Quality Centre, Selenium, Postman, SOAP UI, JUnit, Cucumber, Jira, Confluence

Product Owner: Product Ownership, Backlog Management, User Stories & Acceptance Criteria, Sprint Planning, Feature Prioritization, Stakeholder Collaboration, UAT Sign-off

CRM & ITSM Platforms: Salesforce (Administration, Reports, Dashboards, Validation Rules, Workflow Automation, Data Migration), ServiceNow (Incident, Change, Problem, CMDB, Service Catalog, Discovery, SLA Management), Microsoft Dynamics CRM

Programming & Scripting: SQL, PL/SQL, XML, HTML, Java, Python, Batch Scripting

ETL & Data Tools: Informatica, Oracle Data Integrator, DataStage, SSIS, EIM, ETL Testing, Data Mapping, Data Warehousing, OLAP, OLTP, DB2, Oracle, MS SQL Server

Modelling & Reporting Tools: MS Visio, MS Excel (Pivot Tables, VLOOKUP), Tableau (Basic), Axure RP (Wireframes), PowerPoint, SharePoint

Methodologies & Project Tools: Agile (Scrum, Sprint Planning, Backlog Grooming), Waterfall, RUP, CAB Meetings, Jira, Confluence, MS Project, Version Control (Git, ClearCase)

PROFESSIONAL EXPERIENCE

State of California - Child Welfare Digital Services (CWDS) Sep 2024 -Present

Senior Business Analyst / Quality Analyst

Responsibilities:

•Partnered with county stakeholders, social workers, policy teams, and IT to understand child welfare workflows and translate real operational needs into clear system requirements.

•Reviewed epics, user stories, and acceptance criteria to ensure completeness, clarity, and testability; provided QA feedback during backlog grooming and sprint planning sessions.

•Designed and executed comprehensive functional, integration, regression, and UAT test cases for Salesforce-based CWDS applications, ensuring system stability across releases.

•Facilitated workshops and JAD sessions to gather requirements for core CWDS functionality including case management, intake, eligibility, and service tracking.

•Converted complex policies and processes into clear documentation—process flows, BRDs, functional specs, and gap analyses—so development teams could execute with confidence.

•Worked closely with developers and Scrum Masters during sprint planning, grooming, reviews, and releases to keep delivery aligned with user and policy needs.

•Managed defects using JIRA and Azure DevOps, performing root-cause analysis, prioritization, retesting, and closure validation to ensure production readiness.

•Supported end-to-end UAT coordination, including scenario validation, test execution support, results analysis, and business sign-off readiness.

•Supported data migration and system integration efforts between legacy CWS/CMS systems and the Salesforce-based CWDS platform.

•Interpreted state and federal child welfare policies and communicated their system impact clearly to technical teams, ensuring compliance without disrupting workflows.

•Continuously incorporated stakeholder feedback to improve usability, simplify processes, and drive iterative product improvements.

State of California - Department of Health Care Services (DHCS) Nov 2019-Aug 2024

Senior Business Analyst / UAT Lead

Responsibilities:

Gathered, analyzed, and documented business, system, and functional requirements through stakeholder interviews, JAD/JRP sessions, workshops, walkthroughs, and UAT cycles, ensuring alignment with CMS, HIPAA, and federal and state Medicaid regulations.

Led business analysis for Medicaid eligibility, enrollment, billing, claims processing, and Justice Initiative initiatives, integrating new requirements into platforms including ACES, MHIMS, CAPMAN, and Salesforce.

Collaborated closely with business stakeholders, policy teams, and technical leads to clarify requirements, assess impacts, and support prioritization based on compliance, business value, and delivery timelines.

Owned the requirements lifecycle from discovery through validation, including BRDs, functional specifications, user stories, acceptance criteria, and requirement traceability matrices.

Played a key role in QA and UAT activities by defining test scenarios, reviewing test cases, validating outcomes, and supporting user acceptance sign-off.

Executed and supported functional, integration, regression, smoke, and UAT testing cycles; partnered with QA teams to track defects, perform root-cause analysis, and ensure timely resolution.

Performed backend data validation and reconciliation using SQL to verify accuracy of claims, payments, provider, encounter, and enrollment data across legacy and cloud environments.

Supported statewide healthcare modernization efforts under CAA 2023 Section 5121 and the 1115 Re-Entry Waiver by contributing to system planning, governance, and cross-agency coordination.

Worked extensively with Salesforce to support configuration, reporting, integrations, and legacy-to-cloud data migration, including validation of migrated data during QA and UAT phases.

Conducted gap analysis and business process improvements between legacy Medicaid systems and CAPMAN to support waiver-driven functionality and operational efficiency.

Supported interoperability and cloud initiatives by validating APIs and data exchanges involving FHIR, HL7, and HIPAA EDI transactions in collaboration with integration teams.

Prepared clear and detailed business and QA documentation, including BRDs, functional specs, data mapping documents, test scenarios, and implementation guides to support development, testing, and deployment teams.

Centene Corporation, Missouri Aug 2018-Nov 2019

Senior Business Analyst / Quality Analyst – Healthcare Integration & ITSM

Responsibilities:

Led end-to-end analysis and processing of complex Medicaid claims in EDI X12 formats (837, 835, 834, 270/271), ensuring compliance, improving adjudication accuracy, and streamlining claim filing processes.

Conducted As-Is and To-Be GAP analysis to assess current and future state business processes across Medicaid and healthcare operations, driving system improvements and regulatory readiness.

Led multiple modules from inception to delivery, including full project lifecycle management, business analysis, stakeholder engagement, and iterative delivery aligned with Medicaid initiatives.

Led multiple Medicaid initiatives from inception to delivery, supporting full lifecycle analysis, stakeholder engagement, and iterative implementation.

Acted as Product Owner for assigned modules, translating business and regulatory requirements into prioritized user stories and managing the product backlog.

Collaborated with stakeholders to prioritize features and enhancements based on business value, compliance needs, and delivery timelines.

Played a key role in ServiceNow Agile development, building workflows, Service Catalog items, and SLAs while applying ITIL practices to ensure ticket and service compliance.

Partnered with development and QA teams during sprint planning, reviews, and UAT to support sprint acceptance and release readiness.

Administered and enhanced Salesforce CRM, creating dashboards and analytical reports focused on Medicaid enrollment, eligibility trends, and claims performance.

Led and supported integration and interoperability initiatives using FHIR APIs, HL7 interfaces, REST APIs, and HIPAA EDI transactions in collaboration with architects.

Supported cloud migration of Medicaid data pipelines, validating data transformations and ensuring HIPAA and CMS compliance across on-prem and cloud environments.

Served as SME and super-user for CTMS, LIMS-R&D, PMS-RIMS, and SharePoint platforms, ensuring data readiness for regulatory and research needs.

Created executive dashboards and metrics enabling leadership to track Medicaid program performance, trends, and continuous improvement KPIs.

Client: Hughes Communications - Germantown, Maryland Oct 2016-July 2018

Role: ServiceNow Business Analyst

Responsibilities

Led end-to-end implementation and enhancement of ServiceNow ITSM modules including Procurement, Incident, Change, Problem, CMDB, and Service Catalog, aligning workflows with ITIL standards to improve operational efficiency and SLA compliance.

Analyzed procurement and compliance processes for purchase requests, approvals, audit controls, and GL coding; gathered and documented requirements and BPMN models to support ServiceNow Procurement implementation.

Collaborated closely with ServiceNow architects and platform teams to redesign and optimize the Service Catalog, improving usability, request routing, and service fulfillment turnaround times.

Facilitated Change Advisory Board (CAB) meetings with IT managers, SMEs, and service owners, supporting risk assessment, back-out planning, and timely approvals for enterprise system changes.

Integrated ServiceNow Discovery to automatically identify and reconcile Configuration Items (CIs) within the CMDB, improving data accuracy and reducing manual maintenance.

Executed legacy-to-cloud migrations for enterprise applications including Microsoft Dynamics CRM, supporting data validation, transformation, and post-migration verification.

Translated complex business and operational needs into epics and Agile user stories with clear acceptance criteria using Jira, maintaining collaborative documentation in Confluence.

Designed, optimized, and validated SQL and PL/SQL scripts to support data integrations, reporting, and ETL workflows across enterprise systems.

Led change management and stakeholder adoption efforts across ITSM and enterprise platforms, ensuring smooth rollouts, user readiness, and sustained operational adoption.

Philips HealthCare – Atlanta, GA Jan 2016-Sep 2016

Senior Business Analyst – Healthcare Integration & Interoperability

Responsibilities

Gathered and analysed user, business, and system requirements from stakeholders and SMEs, translating them into URDs, FSDs, URS/FRS, use cases, workflows, UML models, and RTMs to support system modernization and regulatory compliance.

Administered Salesforce CRM across Sales, Marketing, and Support teams, configuring custom objects, page layouts, dashboards, and reports to improve productivity and visibility.

Led cross-functional collaboration and JAD sessions to assess impacts of HIPAA 5010, ICD-10 transitions, and EDI X12 regulations, performing gap analysis, risk assessment, and regulatory mapping.

Analysed, designed, and validated healthcare interoperability solutions using HL7 v2.x/v2.5.1, CDA, FHIR, and HIPAA EDI transactions (837, 835, 270/271, 277, 834).

Supported HL7 interface development and testing between hospital systems (HIS), EPIC, and ancillary applications, performing message validation and integration testing.

Designed and implemented SOA-based integration solutions, enabling secure data exchange across multiple client systems and platforms.

Utilized Edifecs for EDI guideline gap analysis, data mapping, migration, and validation, streamlining Medicaid claims processing and reducing manual rework.

Supported claims adjudication and QA/UAT activities, authoring and executing functional, integration, regression, and UAT test scripts, managing traceability in HP ALM/Quality Centre, tracking defects in JIRA, and contributing to Agile ceremonies.

Client: GE Capital, Norwalk, CT June 2015-Dec 2015

Role: Business Analyst

Responsibilities:

Developed “As-Is” and “To-Be” process models, data flows, entity relationship diagrams (ERDs), and workflow charts using MS Visio to document and improve core business processes.

Validated key HIPAA-compliant EDI transactions, including 837 (Claims), 835 (Remittance), 270/271 (Eligibility Inquiry/Response), 277 (Claim Status), and 834 (Enrollment/Disenrollment).

Partnered with ServiceNow team to standardize undocumented change management workflows, enabling CMDB accuracy, SOX-compliant audit trails, and improved stakeholder communication.

Administered ServiceNow modules (Incident, Change, Problem, Configuration Management), customizing UI actions, client scripts, business rules, and data policies to meet ITIL standards.

Supported core ServiceNow system setup: LDAP configuration, default system settings, UI personalization, and branding updates to enhance platform usability and security.

Assisted in gathering ITSM requirements from Solution Architects and transformed them into actionable technical specifications; supported ITSM 7.6 installation and configuration.

Analyzed, manipulated, and updated SQL databases to support reporting, data validation, and business rule enforcement across multiple healthcare modules.

CERTIFICATIONS: Salesforce Certified Business Analyst

Salesforce Certified Administrator

ISTQB Advanced Level (Level 4) Certified

EDUCATION: Bachelors in electrical and Electronics Engineering, JNTUH.

Master’s in Computer Engineering, California State University.

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