An accomplished IT Professional with good experience as a Business System Analyst / Project Coordinator in all phases of Software Development Life Cycle with solid understanding of Business Requirement Gathering, Business Process Workflow and Business Process Modelling.

• Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
• Expert in analyzing, elicitation and management of requirements. Highly experienced in creating Business Requirement Document (BRD) and Functional Requirement Specifications (FRS) document.
• Involved in maintaining performing GAP analysis, Requirement Analysis, Document Analysis.
• Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
• Experienced in methodologies like Agile, Waterfall Model and Data Modelling Creating Process mapping, Use Cases, Sequence diagrams, Activity diagrams
• Solid understanding of Membership, Claims Processing, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions.
• Experienced in Healthcare/Claims adjudication with knowledge of industry compliance standards like HIPAA and EDI X 12 transactions (834, 837, 835, 270/271, 276/277). Thorough knowledge about QNXT and Facets.
• Good understanding of health care industry, Claims Management process, Medicaid and Medicare Services PBM incorporate complete Member Enrollment and Eligibility check, Drugs Prescription, Plan design, Claim adjudication and Verification, Call chain, Rx enquiry, Clinical requests handling etc.
• Experienced working on HIPAA implementation guides relate to Claim Testing and Medical Billing
• Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
• Experience in writing and reviewing Test Cases and Test Plans and performing User Acceptance Testing
• Proven ability to analyze complex problems, identify risks and develop effective solutions to improve productivity, reduce cost and track progress through all phases of SDLC
• Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
• Effective Communicator with good Interpersonal and Customer Relational skills.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment. TECHNICAL COMPETENCIES: