Suraj M

Sam@lavsun.com
214-699-6298

Professional Summary
● Experienced Business Analyst with around 10 years of proven skills in requirement gathering, interacting with
developers, documenting various business processes, executing test plans, coordinating various projects contributing
in Medicare in region of Healthcare IT Sectors.
● Experience in Healthcare Application Facets in different modules like Claims. Membership. Provider and Billing.
● Extensive knowledge of EDPS errors which includes 254, 19, 255, and 465 etc... Also include RAPS Errors 450.
451,455, 400, 500 etc.
● Excellent knowledge in Health Insurance, Health Insurance Exchange (HIX), Asset Management, PBM, Data
Warehousing and Human Health Services (HHS) environment.
● Development of 820. 834, 837 Claim billing, 276 Status. 834 Enrollments. 835 Claim Payments. 829 and many other
healthcare maps.
● Understanding of EDI business practice and the ability to understand the client's needs.
● Strong Experience in Claims Processing and Claims Scrubbing in HMO, PPO. Medicaid and Medicare.
● Created data visualizations and reports using Tableau to communicate complex information effectively to
stakeholders and facilitate data-driven decision-making.
● Worked closely with business stakeholders to identify key performance indicators (KPIs) and metrics to measure
business success and monitor progress toward strategic objectives.
● Proficiency in requirements elicitation practices including interviews, questionnaires, user empathy, workshops, JAD
sessions, user stories, and prototyping.
● Acting as a liaison between the Business owners and IT Teams for gathering and validating the requirements.
● Analyze and document the functional behavior of systems and their interactions in UML or other standard modeling
tools, Translate business requirements into functional specifications.
● Skilled in writing user stories, and cases, Identifying Personas, writing use case diagrams, workflow diagrams, and
sequence diagrams by using MS Visio and Pencil tools for writing UML diagrams.
● Excellent knowledge of healthcare systems like FACETS (QNXT), Provider systems, Member systems, claims
processing and settlement, and Healthcare files.
● Excellent knowledge of HIPPA transaction codes such as 270/271(Inquire/Response Health Care Benefits), 276/277
(Claim Status), 835, 837 (HealthCare Claim), and 834 (Benefit Enrollment)
● Very good knowledge of Electronic Data Interchange (EDI) files and application integration.
● Creating Screen Mockups, Wireframes and conducting GAP, Impact analysis.
● Involved in Test Planning, Test Preparation, Test Execution, and Issue Resolution and Report.
● Expertise in Scrum, Lean, and KANBAN methodologies.
● Working experience in Health insurance Exchange (HIX). Health information Exchange (HIE) and Encounter Data
Processing System (EDPS/RAPS).
● Experienced with Federal contracts. X12 transactions, health care act EDI transactions 270 271 834, 835,
837.Responsible for assuring all required design inputs are captured and incorporated into product labeling
development and design changes.
● Used the JIRA tool extensively to write user stories analyzed the Burn Down charts and reviewed defects.
● Expertise in using Agile Scrum methodologies, Expert in Cost-benefit Analysis/Effort calculation, and ROI calculation in
project/product features.
● Developed Requirement Traceability Matrix (RTM) in HP ALM and QTEST applications respectively.
● Proficient in writing SQL /PL SQL Queries and in data verification and debugging the business code.
● Extensively worked with the On-site and Off-shore Quality Assurance Groups by assisting the QA team in developing
Test Plans, Test Cases, Test Scripts, etc., and conducted User Acceptance Testing (UAT).
● Experience working in a complex integration system, data transmission through XML and JASON using REST and SOAP
API’s.
● Hands-on experience in Microsoft Azure cloud, contributed to migrating on-premise applications to Cloud
infrastructure.

Technical Skills

Project
JIRA Agile, Rally, Confluence, SharePoint, MS Project, Azure DevOps
Management
Project Design MS Visio, Balsamiq, Invision, Pencil.
Documentation MS Office Suite
Test Tracking Tools HP ALM, QTest, Bugzilla, JIRA
Databases Oracle 12c, MS SQL Server
Automation Tools Selenium, Blue prism
Deployment Tools Maven, GitHub, Jenkins, VSTS
Cloud
Microsoft Azure, PCF cloud, Amazon web services (AWS EC2)
Infrastructure
Integration Tools Talend Integrator, BizTalk, Webservices (REST and SOAP)
Operating Systems Windows7, Windows 8 & 10, Mac OS x, Linux

Professional History

Humana, Louisville, Kentucky Mar 2022 - Till date

Sr. Business Analyst
Project Objective: This project is about the implementation of Electronic New Rx requests in ePost that aims to empower
pharmacists with the capabilities to generate electronic Rx requests for the members including renewal request and
creating follow up orders for the patients. The Prescriber has an ability to approve, deny, or change New Rx request
based on patient health. This also involves integration of RTM application with ePost application to process the RTM
requests to electronic requests in ePost application.

Responsibilities:
● Gathering business requirements and documenting functional requirements through JAD sessions, workshops, and
user interviews with the business stakeholders, business process owners, and subject matter experts (SMEs).
● Participated in Discovery sessions, studying existing process documentation and system, and Conducting JAD
sessions.
● Experience on all phases of Software Development Life Cycle (SDLC) from project initiation to deployment. Experience
in Agile and Scrum methodology.
● Participated in requirement elicitation activities and transformed them into System requirements.
● Worked as a liaison between the Business and Technical team, collaborating with PO for solution design & writing
user stories.
● Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.
● ICD 9-ICD 10 Conversion Project worked in the analysis of the ICD 9-10 codes conversion Project.
● Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system).
● Developing UI design (Wireframes & UI Mockup) and solution design documents.
● Contribute to the design of Tableau Dashboards for visualizing the claims numbers, frauds, and processing times.
● Helped the team in Backlog refinement and Story pointing in BLR meetings and Sprint planning sessions.
● Validated the system enhancements by performing Functional testing through data staging, Test design, and Test
execution. Also participated in regression testing activities.
● Assisted team in Functional testing and UAT by reviewing and approving the test scripts written by testers.
● Validated the system enhancements by performing Functional testing through data staging, Test design, and Test
execution. Also participated in regression testing activities
● Developed a Data flow diagram and Data mapping document for the Architects helping in data modeling.
● Analyzed requirements and created use cases Process flow diagrams & Design documents.
● Identified & documented Features & user stories in JIRA.
● Conducted GAP analysis and requirement reviews.
● Helped the team implement CI/CD for automation testing and deployment in the Azure cloud.
● Contributed to Developing Vision document along with Product owner and Business Process managers/SMEs.
● Extensive Experience in Functional, Integration, Regression, and User Acceptance (UAT).
● Writing complex SQL queries for data analysis/Validation and verification.
● Experience working as a Scrum Master and performing velocity, burn-down, story point estimating, sprint planning,
product backlogs, and retrospectives in a very fast-paced development environment and rapidly changing
requirements.
● Facilitating all the Scrum events like iteration planning, Daily stand up, Retros, and Demo events for the team.
Environment: MS Project, MS Visio, AI models, Tableau, Windows 10, CI/CD Tools (Jenkins), MS Office Suite, Oracle 12c,
Angular 6.0, Enterprise JIRA, Confluence, SharePoint, Azure cloud.

Molina Healthcare, CA Jan 2020 - Feb 2022

Sr. Business Analyst
Project Objective: Enhancement of Claims management system (CMS) is a FACETS used to streamline the medical claims
process, which eases the relationship between provider and insurance company and efficiently speeds up the patient’s
payment lifecycle. This application leverage automation features so hospitals and clinics can easily manage claims
processing and billing workflow. The module also facilitates detailed EOB and coverage.

Responsibilities:
● Created and maintained requirement documents for Facets for the different modules like Billing. Member enrollment
and Claim adjudication.
● Facilitated Scrum meeting with technical/non-technical team, Accounts updating, data analysis and sharing with XML
patterns. SME's to clarify business rules & solve impediments, rectifying the regulatory issues with SME's and
translated Functional requirements into User stories using JIRA.
● Prepared test data from user stories, write and execute test cases in JIRA.
● Thorough knowledge of ICD-9, ICD-10 codes and CPT codes for both Mental and Medical Health.
● Track Performance Indicators/Metrics and addressing any issues as they arise. These metrics include Velocity, Burn
down charts, Release progress, etc.
● Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and
Sequence Diagrams.
● Created new report types, new reports and dashboards to monitor and issue regular key productivity indicator
reports and charts.
● Worked closely with Sales force Developers in clarifying the requirements per client needs.
● Worked in enhancement of system with CMS interoperability, RPA for star rating and drug calculator
● Conducted the role of Senior Business Analyst and Senior Quality Analyst for the Confidential Health Insurance
Marketplace Eligibility & Enrolment project.
● Worked on a high-performing Software Development/Testing Team through all phases of application development.
● Responsible for creating and documenting Business Requirements, Functional and Non-Functional requirements,
System Specifications, etc.
● Ensuring that information systems, products, and services met or exceeded organization/industry quality standards
and end-user requirements.
● Eliciting & consolidating business requirements from business owners, through Joint Application Developments (JAD)
& Walkthroughs, Interviews, Workshops, and Rapid Application Development (RAD).
● Critically evaluating information gathered from multiple sources, breaking down high-level information
into detailed features or stories.
● Preparing Software Requirement Specifications (SRS), Business Requirements Documents (BRD), Use Cases,
Functional Specifications (FSD), and Requirement Traceability Matrix (RTM).
● Monitoring testing activities to ensure the quality and functionality of assigned systems.
● Collaborating with application administrators and infra team for deployments ensuring 100% Automation.
● Helping users to perform UAT and GO-Live activities, complete support to users post Go-Live activities.
● Performing implementation of the automated test suites for the web service application in different environments.
● Performed Automation testing using the Selenium framework to validate the system functionality.
Environment: Azure, Agile Scrum, Balsamiq, MS Office, MS Visio, MS Project, JIRA, SharePoint, BizTalk

American Express, Phoenix, AZ Sep 2018 – Dec 2019

Healthcare Business Analyst
Project Objective: American Express is a leading credit card company with a vast presence throughout the world. The
objective of the project was to onboard restaurants, Motels, ATMs, and hotels globally, provide offers and promotions to
Amex card users. This project also intended to analyze the purchase/spend matrix in these partner entities.
Responsibilities:
● Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems in SOA
are impacted by the
● EDI X12 Transactions, XML, XSLT. Code set and Identifier aspects of HIPAA.
● Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
● Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
● Integrated Sail Point IIQ with their existing provisioning system in order to cater existing requirements.
● Involved in the User Acceptance testing UAT to check the reliability for end users.
● Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
● Strong HIPAA EDI 4010 and 5010 and ICD-9 and ICD-10 processes for member, payers, providers including
Coordination of benefits, Copays, benefits and etc. Gathered requirements by analyzing the current process/ system
and also interviewing the business users.
● Involved in converting the user requirements into business requirements, logical specifications, and technical
requirements and creating business process models from the requirement specs
● Participated in daily scrum meetings, sprint planning, and sprint review sessions as a team member.
● Developed “As-Is” and “To-Be" processes after requirement analysis and identified existing gaps in the business
processes and participated in business processes review.
● Worked with architects documenting UML methodologies to create use case diagrams, data flow diagrams, and ER
diagrams
● Assisted the development teams by reviewing their test cases and approving them to ensure their complete
coverage.
● Involved in conducting UAT sessions to gain the confidence and approval of the end users.
● Coordinated with developers, testers, business managers, and clients to implement the requirements and
incorporated the changes as per client needs for regulatory purposes.
● Documented the use cases and activity diagram to work on COTS integration
● Created and maintained workflow plans and business process flows using MS Visio 2013.
Environment: Windows XP, MS Office 2013, MS Visio 2013, MS SharePoint 2013, Agile, Enterprise Architect, .Net Core
Platform, MS SQL Server, Agile, Rally

LabCorp, Houston, TX June 2017 – Aug 2018

Business System Analyst
Project Objective: LIMS is a cloud-based service for electronic health records (EHR) integrated with a suite of applications
like revenue cycle management and medical billing, patient engagement, care coordination, and population health
management; the billing module can be used in tandem with the EHR on its own and features a patented and
continuously updated rules engine. Medical practice management tools include visibility into daily responsibilities,
custom benchmarking, proactive trends analysis, and more.
The application is hosted in the AWS EC2 instance.

Responsibilities:
● Ensured that ICD-9-CM procedure codes used for services and CPT codes were not outdated.
● Managed the technical efforts associated with implementing complex EDI trading partners regarding 8371 and 837P
transaction sets.
● Analyzed TA1, 999 and 277CA responses pertaining to claims within the 8371 and 837P files.
● Worked with FACETS, e-billing and EDI HIPAA Claims (837/835/834) processing.
● Also verified the test scripts before manual execution if they cover all the aspects of rate and quote details according
to State Medicaid and Medicare
● Performed the requirement analysis for the gathered requirements, conducted impact analysis, and documented the
functional specification document.
● Develop and document use cases, functional requirement documents, test and training plans, and other design
artifacts as needed.
● Documented business and IT system processes and workflows. Models AS-IS and TO-BE processes.
● Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for
processing of Medicaid Claims.
● Hands-on experience in Manual and Automated testing tools including planning, design, and implementation of tests
and test cases, integration, system and regression testing, and test efforts documentation management.
● Evaluated and documented business requirements and technical specifications for Epic apps.
● Maintained documentation of existing data flows for system interfaces
● Involved to understand and implement Processing ICD-9 ICD-10 Diagnosis codes.
● Participated in Scrum ceremonies including sprint-planning sessions, backlog-grooming sessions, daily scrums product
demos, sprint reviews, and sprint retrospectives.
Environment: SQL, MS Office, MS Excel, AWS, Cognos, Oracle 12C MS Visio, Jira, Balsamiq, SharePoint, Confluence pages.

Vertical Techsoft, India June 2013 - April 2016

Business Analyst
Project Objective: Involved developing features for consumer lending technology as part of this project we were
developing enhancements in Finacle for lending to the consumers. The enhancements were related to the processing of
loans, accounts remediation, and foreclosures.

Responsibilities:
● Gathered, Analyzed, Validated, and Managed, and documented the stated Requirements. Interacted with users for
verifying requirements, manage the change control process, and update existing documentation.
● Involved in converting the user requirements into business requirements, logical specifications, and technical
requirements and creating business process models from the requirement specs
● Performed Gap Analysis of the “As-Is” and “To-Be" processes within the organization to analyze and fill the existing
gaps in the business processes and participated in business processes.
● Worked with the design team to implement UML methodologies to create use case diagrams and data flow diagrams.
● Involved in conducting UAT sessions to gain the confidence and approval of the end users.
● Co-ordinate with developers, testers, business managers, and clients to implement the requirements and
incorporated the changes as per client needs for regulatory purposes.
Environment: Windows 2008 Server, MS Office 2013, MS Visio 2013, MS SharePoint 2013, Agile, Finacle, MS SQL Server.

Education
● Bachelor of Technology, India, May 2013

Professional certification
Certified Scrum Master (CSM)