Wasim Feroz

732-660-7777
[email protected]

PROFESSIONAL SUMMARY:
 Qualified professional with 9 years of extensive experience as Business Analyst in Healthcare include
understanding of Business Requirement Gathering, Business Analysis, Joint Application Development JAD
sessions with clients and referring to accessible documentation and procedure.
 Experience and understanding of Healthcare and Health Insurance business models and operations including
Enrollment, Membership Management, Claims Processing, and Client Management
 In-depth understanding of provider networks, managed care contracts, Accountable care organizations ACO,
patient benefit plans, and administrative procedures that support new and existing contractual agreements within
hospitals and Centers of Excellence.
 In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component
and deployment views to extract business process flow.
 Extensive knowledge of SDLC with different methodologies, such as SDLC, Waterfall, Agile, Scrum, RUP,
Extreme Programming and Scrum-Waterfall Hybrid.
 Experience in Agile / Scrum methodology in writing user stories/epics and acceptance criteria using JIRA.
 Experienced writing business requirements for agile projects, to include Epics, Features and User Stories in JIRA.
 Extensively used rational tools for UML, tracking and reporting and applied the Rational Unified Process in all
areas of a software development life cycle.
 Having extensive domain knowledge in MMIS, EPIC, EDI X12, HIPAA, System, Medicare and Medicaid, CMS
Compliances/Regulations.
 Experienced in working with executives, subject matter experts and client in all the revenue cycle management
departments and front office departments to ensure a positive patient experience
 Experience in creating Power BI reports and data Visualization dashboards.
 Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS-
Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
 Experience in documenting the methodologies for integrating data from different applications to EDW.
 Expertise in Healthcare Systems ITS, Health insurance plans Indemnity plans, Managed Care plans HMO, PPO
POS, Government Sponsored Programs Medicare, Medigap, MMIS, FEP SHBP Consumer Driven Health plans
CDHP. Medicare Part A, B, C, D and Medicaid systems.
 Involvement in all phases of Software development life cycle including System Analysis, Design, Modeling,
Implementation and Support.
 Experienced in software development life cycle such as Waterfall, Agile/SCRUM and SAFE methodology,
Business Analysis and Modeling.
 Solid experience in using Microsoft BI studio products like SSIS, SSRS, Power BI, Power Pivot, Tableau, SSAS,
Python.
 Experience in writing complex SQL queries involving multiple table’s inner and outer joins, stored procedures.
 Good knowledge of ETL reporting tools Power BI, Tableau, QlikView and Excel to develop dashboards and data
 Extensive experience in using Tableau for analyzing data sources from Excel/MySQL, Oracle, SQL server
 Experience conducting User Acceptance Test (UAT), data quality checks using SQL, gap analysis and
Requirement Traceability.
 Expertise in generating reports using SQL server reporting Services, Crystal Reports, Power Pivot and Power BI.
 Determination of error corrections in those cases where the business units are not able to provide the information
(example, the Claims department does not provide corrections for denied claims so the EPRA analysts will have
to do it). Medical, Medicaid, and Medicare
 Extensive experience in healthcare insurance payer systems, Security, Compliance, Healthcare Reform
implementation, reporting, integration, equivalent consulting experience
 Experience in SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data
warehouse processes.
  Experience in modeling UI wireframes, mockups and documenting the end-user AS-IS workflow and TO-BE
business processes.
 Extensive experience in creating/executing Test Plans, Test Scenarios and Test Cases and assist in User
Acceptance Testing (UAT).
 In depth understanding of the AS-IS and TO-BE business processes and experience in converting these
requirements into technical specifications for preparing test plans.

WORK EXPERIENCE

Celtic Healthcare, - Pittsburgh, PA (Remote)

Celtic Healthcare is involved in development of schemas as well as customization of User interface in Java Language for
HIPAA ANSI x12 transactions 837,835, 270. It also involved migration from Diamond software to Facets including
configurations, claims auto adjudication scope and definitions, financial transactions, Membership, Enrollment. EDI 835,
837I, P, 270, 271.

Responsibilities:
 Worked on Software Development Life Cycle (SDLC) including requirements gathering, analysis, design,
implementation, testing and deployment.
 Elicited business and functional requirements using in interviews, document analysis, business process
descriptions, use cases, business analysis and workflow analysis with the use of Agile methodologies.
 Created EDW source-to-target mapping and report requirements documents.
 Worked on HIPAA EDI transactions such as 835(medical claim payments), 837(medical claims), 276(claim
status), 277(claim status response), 278(Health care service review information), 270(eligibility inquiry), 271
(eligibility response).
 Reviewed the data model and reporting requirements with the Data warehouse/ETL and Reporting team.
 Actively participated in gathering requirements from various SMEs, Financial Analysts, Risk Analysts and
Portfolio Management via JAD/JAR sessions.
 Prepared Business Process Models that include modeling of all the activities of the business from the conceptual
to procedural level.
 Worked on the BRD document and derived the FRS in to system use case diagrams.
 Created Source to target mapping Documents, business rules, and workflows.
 Created different types reports like graphs, pie charts etc. based on user requirement by using SSRS
 Monitored the compliance mapping of transactions to the EDI transactions standards ANSI -X12.
 Gathered requirements and preparing functional documents for Facets.
 Worked with the business/functional unit to assist in the development, documentation, and analysis of functional
and technical requirements within FACETS.
 Involved in Facets Output generation, Interface development and Facets Migration.
 Reviewed Stored Procedures for reports and wrote test queries against the source system SQL Server to match the
results with the actual report against the Data mart Oracle.
 Facilitated Product Incremental meeting in SAFe Framework with Release Train Engineers, other teams and
identified dependencies/ Risk for Project success goals.
 Involved in Microsoft Dynamics 365 data capture, integration, auditing, data mapping, importing data and
Creation of interfaces.
 Kept track of Agile (scrum/ Kanban), Safe metrics tracking variables to gain transparency on product and sprint
backlogs
 Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government
carriers.
 Followed up on rejected/denied Medicare and Medicaid claims via Epremis, FISS, Epic and HP Web-Portal.
 Developed SQL queries and tables which replicated the ETL, and compared the SQL results with the Informatica
tables.
  Worked on Informatica Power Center client tools - Mapping designer, Workflow manager, Workflow monitor,
Repository manager.
 Interfaced with business users to prepare and update Business Process Requirements for the new release
of healthcare tools and prioritized outstanding defects and systems problems, ensuring accuracy and deadlines
were met.
 Created various data quality mappings in Informatica Data Quality (IDQ) tool and imported them into Informatica
Power Center as mappings, mapplets.
 Worked in developing Power BI Reports and Dashboards from multiple data sources using Data Blending, Data
Model and also resolve the data integration and mapping [source to target] issues arising out of data transfer to
and from distributed sources.
 Performed Data mapping, logical data modeling, created class diagrams and used SQL queries to filter data.
 Worked with BI architects and report developers to ensure EDW physical design (Netezza) was compatible with
Micro strategy architectures and met reporting requirements.
 Worked with SQL queries using MS Access for data manipulations and involved in writing scripts for patient
online registrations using the VB Script.
 Identified the elements the needs to be mapped for the business requirements and analyze the data and ensure the
data was mapped correctly.
 Analyzed data contained by the databases using Structured Query Language (SQL and PL/SQL) and Tableau to
confirm data accuracy and integrity of various reports.
 Involved in Implementing metadata standards, data governance and stewardship, master data management, ETL,
ODS, data warehouse, data marts, reporting, dashboard, analytics, segmentation, and predictive modelling.
 Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
 Established interoperable data requirements for tracking IPA, ACO Capitation fee and Managed Care - Bundled
Payments for Care Improvement (BPCI) involving SNF, LTAC operations.
 Used various customer data to create dynamic BI presentations in Tableau & PowerPoint.
 Responsible for configuration/ compatibility and BA testing with the help of Facets, SharePoint and Tidal
scheduler.
 Tested the changes for the front end screens in FACETS related to following modules, test the FACETS batches
membership, Billing, Provider.
 Created and maintained user stories in JIRA for better understanding of the requirements for the development
team also use JIRA for bug tracking.
 Conducted end-to-end source to target validation of a sample of claims, encounters, eligibility, and provider by
year.
 Assisted QA department to write and execute Test plans and Test Cases and work on UAT testing.

State of Virginia (VDH) – Richmond, VA

The project was all about to develop a software that check if the person is eligible or not, processing Medicaid request
forms, Medicaid claims, check if funds available and also help staff into looking each costumers data to check eligibility
of costumer for the Medicaid and help them best as possible.

Responsibilities:
 Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement
to Technical specifications.
 Gathered analyzed and documented business and technical requirements from both formal and informal sessions
and validate the needs of the business stakeholders.
 Elicited, analyzed, documented and communicated requirements for implementation of the trading system in the
Agile Environment.
 Studied established Trading System to understand the processes and challenges in STP, which helped define
project scope.
 Gathered Business Requirements, Interacted with the Users, Designers and Developers, Project Manager to get a
better understanding of the Business Processes.
  Responsible for the full HIPAA compliance lifecycle from Gap Analysis, mapping, implementation and testing
for TennCare processing of Medicaid Claims.
 Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
 Developed gap analysis document, logical and physical design and remediation plan for State.
 Responsible for mapping documents, creation of test plan, test scenarios, test cases for unit, system and system
integration testing.
 Worked with business owners, content staff, IT and other stakeholders in creating a content management solution
for managing the information in the supplier portal using WebSphere Application Server.
 Built and customized SoDA for Word templates and extract information from information sources such as
RequisitePro and Rose, and created a highly automated system for handling approvals, exceptions and priorities.
 Used the Rational Unified Process (RUP) to build the different phases of Software development life cycle
 Created Project management plans for managing on time delivery using MS Project along with writing test cases,
unit and systems integration test plans in Quality Center.
 Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and
sequence diagrams using UML.
 Well versed with HIPAA, 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.
 Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP
Methodology).
 Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process
new products.
 Conducted gap analysis and made As-is-to-be diagrams to understand new business requirements and challenges
in implementing new modules.
 Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
 Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level
Requirements.
 Planned and documented procedures for data processing and prepared data flow diagrams for the application.
 Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
 Worked with System Matter Expert (SME) and Point of Contact (POC) for Chart Of Accounts and GL Balancing
of Claims and Membership for EDW.
 Visually reviewed, systematically tested, and verified all customer enrollment data when putting customer EDI
group data into test or production systems, based on customers' EDI status.
 Worked on Updating EDI Feed data as needed once re-provided by customer for re-initialization. Once
successful, assisted in project management finality tasks to mark group as live.
 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.
 Developed data mapping documents to support the data extracts to be supplied to Functional Design Document.
 Performed data analysis and created data mapping and data analysis document.
 Designed and developed Activity Diagrams, and Sequence Diagrams utilizing MS Visio.
 Documented the server farm requirements and requirements related to security within Share Point.
 Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
 Rewrite, Add and Define, Rewrite existing requirements, breakout into new requirements, and create additional
documentation where appropriate.
 Prepared functional requirements to define the system rules by creating Use cases, interface design and data
dictionaries.
 Worked with a team of 5 quality analyst/testers within Agile Methodology.
 Defined and delivered test strategy, plans, and systems scripts.
 Conducted through testing to make sure the application is developed as per the business requirements.
 Created UAT test plans and test scenarios & cases.
 Actively facilitated complete UAT process - creating UAT schedules, testing guidelines, managing feedback,
follow-up, and resolving open issues.

Assurant Health - Milwaukee, WI

The purpose of this project involves population of the Enterprise Data Warehouse EDW which is used in critical reporting
and analysis. Informatica was used for ETL process and Business Objects XI R2 are used for reporting duties.

Responsibilities:
 Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to
configure and develop process, standards, and procedures and create a Business requirement Document.
 Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
 Worked closely with office of healthcare reform on current issue from CMS on 834 files. Raised tickets with
CMS and triage the issues on basis of severity
 Obtained 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.
 Created frequency distributions of provider type, claims, aid category, by year, and analyze patterns.
 Facilitated discussions on the shortcoming/limitation/extendibility of the system to provide clear understanding of
system capabilities to the clinical business users.
 Documented all data mapping and transformation processes in the Functional Design documents based on the
business requirements.
 Worked in accordance with the Safe Agile/Scrum methodology for various phases of the business and created
business vision, business architecture documents and mock reports.
 Analyzing Business Object report and analyzing data in Source EDW systems.
 Involved in designing and developing programs to transform Claims and Membership of most of the regional and
operations systems into Enterprise Data Warehouse (EDW).
 Assisted UI/UX team in translating client graphical requirements to reality by creating Mockup Screens.
 Involved in defining the source to target data mappings, business rules and data definitions.
 Played the role of Requirement Analyst in critical business functionalities for Shared Saving Program (MSSP)
and Pioneer Program of Confidential ACO project for Confidential.
 Created Business requirement documents and plans for creating dashboards by designing and developing Tableau
visualization solutions.
 Actively participated in Clinical Care Management web application system enhancement by conducting thorough
analysis on the app usability
 Enforce compliance with Health Insurance Portability and Accountability Act (HIPAA) throughout all levels of
the program
 Worked with System Matter Expert (SME) and Point of Contact (POC) for Chart Of Accounts and GL Balancing
of Claims and Membership for EDW
 Visually reviewed, systematically tested, and verified all customer enrollment data when putting customer EDI
group data into test or production systems, based on customers' EDI status.
 Worked on Updating EDI Feed data as needed once re-provided by customer for re-initialization. Once
successful, assisted in project management finality tasks to mark group as live.
 Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the
business rule.
 Served as a liaison between the internal and external business community (Claims, Billing, Membership,
Capitation, Customer service, membership management, provider management, advanced Healthcare
management, provider agreement management) and the project team.
 Worked on automate reporting processes utilizing SSIS, Power BI and SQL Server scheduled Jobs.
 Working with clients to better understand their needs and present solutions using structured SDLC approach.
 Involved in creating databases for various departments for ad-hoc reporting
 Assisted in writing BRD for the Regulatory Reporting Unit under the system streamlining, followed the Agile
Methodology for the entire SDLC.
 Worked with JIRA entering user stories into respective epics, tasks and assist with prioritizing stories for sprints.
 Responsible for integrating with Facets. Designed High level design for new process, integrating with legacy &
Facets.
 Worked on HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
 Involved in mapping data from different EDI files onto database using different routing transformations.
  Translated stakeholder requirements into different tangible deliverables such as functional specifications, user
cases, user stories, workflow/process diagrams, data flow/data model diagrams.
 Extensively involved in designing the SSIS packages to export data from various sources like Oracle, SQL
Server, and MS Access etc. to SQL Server database.
 Performed on Data cleansing and loading application using ETL, Tableau and SQL Server.
 Involved in Developing Functional Specification document for each sprint including Interaction diagrams, and
User stories.
 Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and
Reporting team.
 Maintained key records for purposes of Compliance review, QA/QC, and/or regulatory inquiry. Performed Data
mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
 Participate in conducting review sessions on regular basis with QA and development teams for preparing status,
delivery report and client reporting.
 Involved in Iteration or Sprint Planning meeting (SAFE Agile) with the team members to plan and agree on the
stories and backlog items.
 Created reports to evaluate provider performance relative to patient care and associated HEDIS measures.
 Acted as User Acceptance Testing (UAT) coordinator, monitored business testing, and interred with the
development team regarding defect status and fixes on a daily basis.
 Identified and clearly defined functional issues and support IT development staff throughout the design,
development, unit testing, and implementation phases of the software development life cycle (SDLC)
 Analyzed and translated business requirements into system specifications.

Envision Healthcare - Nashville, TN

Envision Health implemented an internet-based application to improve its Health Insurance claim processing by automating
receiving and processing health benefit claims including Medicare and Medicaid.

Responsibilities:
 Involved in defining the scope and implementing business rules of the project, gathering business requirements
and documentation.
 Consulted with healthcare insurance company to develop conversion specifications for other insurance
Coordination of Benefits (including Medicare).
 Understand the As Is system, develop the To Be system concept, and prepare the System Process Maps.
 Converted SSRS reports into Power BI reports through implementing Power BI Desktop tool.
 Involved in presentations of the Q/A test results with analysis to the stakeholders and users and documented
modifications and requirements.
 Facilitated and conducted JAD sessions with SMEs of all sources and warehouses to help them understand the
EDW requirements, identify the GAPs between warehouses and EDW, and identify the alternatives.
 Involved in Designing and Built the Dimensions, cubes with star schema using SQL Server Analysis Services
(SSAS).
 Involved in all phases of Software Development Life Cycle (SDLC) and implemented multiple product
development initiatives.
 Coordinated with the Scrum masters, Product owners and Project Managers to work in Scaled Agile Framework
(SAFe).
 Used various customer data to create dynamic BI presentations in Tableau & PowerPoint
 Involved in creating Dashboards as needed using Tableau Desktop and Tableau Server
 Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft
Visio and Rational Rose.
 Collected business requirements to govern proper data transfer from data source to data target during the data
mapping process.
 Identify risks and inform Senior QA Specialists and QA Managers and participated in development of Test Data
Strategy.
 Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government
carriers.
  Used JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.
 Created Use cases, activity report, logical components and deployment views to extract business process flows
and workflows involved in the project. Carried out defect tracking using Clear Quest.
 Documented elicited requirements into Business requirement document (BRD), Functional Requirement
Document (FRD) and Software Requirement Specification (SRS)
 Involved in compatibility testing with other software programs, hardware, Operating systems and network
environments.

Baxter Health Care - Deerfield, IL

Responsibilities:
 Extensively involved in maintaining requirements traceability and communicating any changes to these
requirements to different business groups and programmers.
 Created context and workflow models, information and business rule models, Use Case and Object Models during
the analysis using rational tools.
 Gathered requirements and modeled the data warehouse and the underlying transactional database
 Using SQL server reporting services (SSRS) delivering enterprise, Web-enabled reporting so creates reports that
draw content from a variety of data sources.
 Responsible for writing detailed descriptions of user needs, program functions, and steps required for developing
or modifying software programs using Rational Rose (UML).
 Followed Agile methodology, being Business Analyst as Product Owner for better Collaboration among Scrum
Master, Scrum Team and Business Stakeholders
 Involved in writing PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
 Used JIRA for User Story requirements management throughout the Agile Sprints and development life cycle.
 Involved in reviewing and writing BRD, URS and Functional Requirements for MDM Business and Data Quality
Requirements for Health Insurance Exchange (HIX) and Health information exchange (HIE) system.
 Worked on Health Insurance Exchanges (HIX) working on eligibility, enrollment, premium reconciliations,
Medicaid/Medicare provisions of the Affordable Care Act (ACA) direct-to-consumer requirements, etc.
 Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending
issues.
 Actively participated in review sessions on regular basis with QA and development teams for preparing status,
delivery report and client reporting.
 Collaborated with the QA team to ensure adequate testing of software both before and after completion,
maintained quality procedures, and ensured that appropriate documentation is in place.
 Involved Functional Specification Documentation (FSD) and communicated these to the stakeholders.
 Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and
Requisite pro - RUP
 Actively interacted with different business groups to perform Gap analysis to identify the deficiencies in the
system by comparing the actual objectives with the system objectives desired.

Education: Bachelors of Science in Biomedical Engineering, 2010