Certifications

Chandra Babu
Green Card
chandrababu.nookala@gmail.com
8008411112

Summary
 Over 7+ years of experience working as Business Facet Configuration Analyst, Billing, pricing in Healthcare domain.
 Specific expertise in Business Analysis, GAP Analysis, Data Analysis, and creating business process documents.
 Detailed knowledge of the Software Development Life Cycle (SDLC) phases.
 In depth knowledge and hands on experience working with SDLC methodologies like Waterfall, Scrum and Agile.
 Expertise in preparing Business Requirement Documents, Use Case Specifications and Functional Specifications.
 Hands on experience of UML diagrams such as Use Case Diagrams, Activity Diagrams and Sequence Diagrams.
 Experience in using Joint Requirement Planning (JRP) and Joint Application Deployment (JAD) sessions for gathering requirements
and brainstorm ideas.
 Experience with TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider,
Subscriber/Member, Utilization Management.
 Hands on experience of operating MMIS centric medical and dental software.
 Experience working in a FACETS environment and extensive knowledge about various modules of a FACETS system such as claims,
membership and enrollment.
 Well experienced with the complex tasks of ICD 9 to ICD 10 conversion and mapping.
 Strong understanding of EDI Claims, Member Enrollment, Eligibility, and HIPAA 5010 (X12) standards
 Knowledge of different modules within Healthcare Claims Adjudication Process (Membership process, billing process and enrollment
& Claims process).
 Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies and reimbursement forms.
 Expertise in FACETS application and familiar with Paid Claim ODS, Claims, Eligibility, Providers, Billing, Product, Customer Service.
 Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
 Excellent experience various EDI files such as 837 Claims processing, 834 Benefit Enrollment, 820 Payments.
 Involved in EDI 834 (Enrollment and Maintenance), 837 (claim processing and clam adjudication including COB), 835 (Claim Payment
and Remittance) and 820 (Payment Order and Remittance).
 Extensive experience in full HIPAA compliance lifecycle from GAP analysis and migration of HIPAA ANSI X12 4010 to ANSI X12 5010
and translation of ICD-9 codes into ICD-10 codes.
 Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997(X12 Standards)
processes of Medical Claims Industry from the Provider/Payer side.
 Experience with HIPAA compliance in the Healthcare systems.
 Experience providing analysis for business processes running on EDI (Electronic Data Interchange) standard.
 Knowledge and experience working with FACETS 4.71 & 5.0 claims processing, dental claims, & dental claim pricing.
 Proficient in SQL query and testing RDBMS such as, Oracle, SQL Server, Teradata for data validation.
 Experience in developing manual and automated Test scripts and test cases based on the client requirements provided in BRD, FRD
and Analyzing Test Results.
 Extensive experience using HPALM/Quality Centre (QC) for requirements, traceability, test execution, defect management and
reporting.
 Experienced in conducting review sessions on regular basis with QA and development teams for preparing status, delivery report and
client reporting.
 Implemented user acceptance tests for web application using Cucumber based on Behavior Driven Development (BDD) framework
 Ability to supervise and make sure testing is done with regards to requirements of the project.
 Hands on experience in writing SQL queries for data gathering.
 Automate infrastructure in Azure with Azure DevOps
 Good knowledgeon DevOps on continuous integration/continuous deployment using Jenkins.
 Excellent project management skills and hands on experience working with software like Microsoft Project.

Professional Experience

Western Health Advantage, Sacramento, CA, Jan 2019 - Present

Senior Business Analyst
As a Business Analyst Worked on the up-gradation of their database that has all the record of all the patients and customers. Including
merging of several different data marts and building a new database so that managers can see all the information all together and then
managed the database. Including managing their claims processing system plus managing the government funding part to support Medicare
and Medicaid through the internal software system within the company was also responsible for the successful implementation Medicaid
Management Information System (MMIS).
The project is to delivery support and maintenance for HIPAA ANSI X12 standard transactions 835 (payment or remittance advice), 837
(health care claim). And the system maintenance support for EDI transactions.
 Developed and prepared EDI documentation for 834 (Benefit & Enrollment Maintenance) for client processing the 834 transaction.
 Experience in developing Use case diagrams, Business flow diagrams, Activity and Sequence diagrams using tools like MS Visio.
 Designed EDI Dashboard for encounter data to identify and report errors in terms of graphical representation for accepted and
rejected claims.
 Gathered requirements from the clients and developed crosswalks for 277/288, 834, 820, 835, 837 P/I claim
 Performed system testing on all EDI transactions both inbound and outbound.
 Performed Analysis, Design, Development and Implementation of X12 EDI maps by using Ramp Manager Application (an EDIFECS
Program).
 Certifications

 Wrote complex SQL queries to extract and validate the data from the Facets database.
 Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing
out with EDI’S 271, 276 and 270, 470, 834, 820, 835, 837, 834, HIPAA 4010, 5010, claim adjustments, claim processing from point of
entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best
practice model and principles and also well versed with ICD10 and Facets.
 Responsible for integrating with Facets, Designing test scripts for testing of Claims in Development, Integration and production
environment.
 Modified and created vendor specific maps for the 850, 820, 834, 855 and 856 transactions (EDI to XML, XML to EDI and delimited to
XML)
 Developed and maintained EDI maps such as 810, 811, 820, 850, 856, 860, in accordance with the related guidelines, which are in
ANSI X12 standards.
 Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the
EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
 Involved in creating requirements that comply with HIPAA, HL7, and ANSI X12 format regulations to protect the privacy of the
employee insured under any policy.
 Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI)
 Reviewing and Implementing VSTS/Azure DevOps project standards, including administration, security, and CI/CD governance, best
practices, principles, and processes.
 Working collaboratively with cross-functional teams to understand business & functional requirements to develop automations and
deliverables.
 Providing guidance, coaching, training on Azure DevOps (VSTS) best practices.
 Ensuring Azure DevOps organization/project are leveraging security configuration correctly.
 Monitors the efficiency, performance and effectiveness of Azure DevOps standards across the teams and makes recommendations
for improvement. Produce regular reports and performance metrics.

Universal Healthcare – St. Petersburg, FL , Jan2018 - Jan 2019

Business Systems Analyst
The project implemented HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system. Appointment scheduling
and recalls, Accounts receivable management and collections, Reporting, and Filing claims through EDI X12 format transaction sets in
compliance with HIPAA standards.
 Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
 Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
 Diagrammed cross-functional business processes in accordance with MITA regulations and system functionality.
 Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
 Hands on experience in MITA, Medicaid, Medicare, Claims, HIPAA compliance, ICD and CPT standards
 Created Use Case, Sequence and Activity Diagrams using MS Visio.
 Participated in creating the User Interface Mockups for the monitoring system using MS Visio
 Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements
Document for the three functional areas
 Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
 Gathered requirements and prepared Use Cases (General System Design documents and Detailed System Design document) by
interviewing tax agents, users and clients.
 Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
 Analyzed, designed, and coded several online subsystems for the Medicaid System.
 Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
 Managed the complete Requirement Gathering process, which involved eliciting, analyzing, and translating user requests into
documented requirements.
 Working knowledge of Medicare, Medicaid and Commercial Insurance benefits eligibility (834s), contracts set up, billing, claim (837s)
processing includes remits (835s) and denials.
 Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High-Level Requirements.
 Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and
experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough
understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
 Assisted in requirements gathering by interviewing store managers and supervisors
 Used MS Visio for Process modeling and Business Process flow diagrams.
 Modeled AS IS and TO BE processes using MS Visio
 Worked in an AGILE delivery model involving multiple scrum teams and daily stand-up meetings
 Implemented and tested the application with Agile Methodology for overall software test strategy and approach, project schedules,
issue management, estimations and risk assessment.
 Analyzed trading partner specifications and created EDI mapping guidelines
 Designed and developed project document templates based on SDLC methodology

Amplity Health | Yardley, PA- January 2017- December 2017

Business Analyst/Scrum Master
Project: Healthcare Insurance Claim,Enhancement and automation of large portions of the claims processes, reduce processing time and
costs, improve customer experience throughout the entire claims processing.

 Articulated project goals and scope, translated business needs into technical terms, prepared detailed work breakdown structures
(WBS) and instilled shared accountability for achieving project milestones usingMS Project
 Certifications

 Participated in the identification, understanding, and documentation of business requirements, including the applications capable of
supporting those requirements.
 Documented and delivered Functional Specification Document to the project team
 Performed Gap analysis, Impact analysis, Cost Benefit analysis, Risk analysis, ROI analysis on the requirements
 Applied the best use of JIRA and Confluence for team and deliverables management by tracking the metrics and artifacts like Velocity,
Capacity, Scrum Board, User Stories, Tasks, Sprint Burndown and Release Burnup Charts.
 Implemented insurance compliances such as EDI 835, EDI 837,EDI 834, EDI 270, EDI 271,transactions, and HL7 messaging.
 Performed test functionality between claim generation system, and EHR.
 Resolved HL7 error logs from the EHR and ensured integrity of the data.
 Coordinated with product owner to bring all process to a level of prosecution to mitigate any impact to current revenue flow under
HIPPA 5010 compliance requirements.
 Assisted product owner in converting high-level requirements (EPICS and Features) into technical User Stories that adheres the
INVEST criteria, and in prioritizing product backlog items using MoSCoW technique
 Assisted the product owner in writing Client-Side validations for the UI webpages
 Actively worked with the PO and team on Definition of Ready (DOR) and with Definition of done (DOD), which expedite the work of
team concerning user stories
 Extensive working experience in Claims Processing and Claims Pricing.
 Assisted the developers in identifying and resolving the impediments and blockers
 Developed Use Cases, UML diagrams, sequence and activity flow diagrams using MS Visio.
 Effectively utilized prototypes to demonstrate and verify the behavior of the system
 Implemented TDDapproach to enhance agility and assisted in identifying web services with the help of UDDI and WSDL documents
 Used Tableau to create dashboards, produce graphs and charts viz. pie charts, bar charts, geographical charts
 Assisted in defining business rules for business logic and implementation of web orchestration process. Used POSTMAN to test the
Web services
 Provided technical assistance in identifying, evaluating, and developing systems and procedures that are cost effective and satisfied
the business requirements.
 Assisted the QA team with manual, functional, system and regression testing in HP Quality Centre

Affinity Health Plan, Bronx, NY ,Feb 2015 – Dec 2016

Business Analyst/ Product Owner
As an Analyst I was involved in the implementation of Facets administrative system, a new core system built by with updated technology to
allow for more efficient claims processing, membership enrollment and provider data maintenance & getting access to customer records. X12
EDI and HIPAA standards were followed thorough the project.
 Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the
business Processes.
 Conducted Risk Analysis and Impact analysis whenever there is any change in the business requirement and proposed solutions
while continually updating the business requirement document.
 Conducted JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team
members.
 Created and updated data mapping document(s) with reference to the source for 270/271 (Eligibility & Benefit Inquiry & Response),
276/277 (Claim Status Inquiry & Response) and 837 (Health Care Claim).
 Conducted Gap Analysis to analyze the client’s applications programs to determine the impact of HIPAA final on EDI transaction set
and defined the changes to bring the affected systems into HIPAA compliance.
 Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
 Utilize Rational Unified Process (RUP) and build different phases of software developmental cycle.
 Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA
compliance and EDI transaction.
 Knowledge of the software system and the programs.
 Developed and executed UAT test cases, UAT test Scenarios using HP ALM/Quality Center and followed-up defects using JIRA.
 Created architectural styles such as application architecture, enterprise architecture, and service-oriented architecture with the help of
Service -Oriented modeling (SOA).
 Performed Requirement Tractability Matrix (RTM) to track and maintain stakeholders requested requirements and changes.

Cardinal Health, Inc, Dublin, OH, Dec 2013 – Jan 2015

Jr. Business Analyst
The project was concerned with providing the ability to enroll new members through the Health Insurance Exchange (HIX) to comply with the
Health Care Reform and obtaining business requirements from business users and stakeholders using interview sessions, brain storming
sessions, and personal interviews to get better understanding of the enrollment requirement changes from the Health Insurance Exchange
(HIX). It also dealt with Design, Development and Documentation of the ETL (Extract, Transformation & Load) strategy to populate the Data
Warehouse from various source systems. Analyzed the client's applications programs to determine the impact of the HIPAA final rule one EDI
Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance. Analyzed
legacy system documentation, file and record formats, system flow charts and other information to develop a comprehensive depiction of the
existing environment as it relates to HIPAA rulings. Involved in claim processing and developed the Business Crosswalks for 837 (P, I, D), 835
and 276/277 according to HIPAA implementation rules.
 Implemented the SDLC for the developing life cycle and followed the standards process in the application.
 Interacted with healthcare clients to gather requirements, objectives, and input and output requirements.
 Developed test cases and scripts for front end testing.
 Performed execution of test cases manually to verify expected results.
 Developed Use case, Functional, Object diagrams using Rational Rose.
 Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
 Implementation of Healthcare EDI transactions using HIPAA CORE Standards.
 Healthcare EDI File knowledge, ANSI X12 (270,271,837,835, 834 & 999).
 Certifications

 Use Electronic Data Interchange (EDI) codes for verifying patient eligibility and receiving the insurance benefits, patient information,
health care claim request, and healthcare claim through the new EHR System.
 Developed Flowchart and process diagram using Microsoft Visio.
 Generated Business Requirement documents (BRD), Functional Specification design documents (FSD) and Functional Requirement
Documents (FRD).
 Worked closely with manager to analyze & understand Business requirements; gathered User, Functional and Non-Functional
requirements & translated the requirements into User Stories for Scrum process using Rally.
 Maintains system protocols by writing and updating procedures.
 Monitors project progress by tracking activity; resolving problems; publishing progress reports; recommending actions.
 Conducted and facilitated technical requirements meeting with the developers on the team to gear up for Iteration 2.

Education: Batchleors/ Master from University and year