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kamal.singhlead12@gmail.com
Over 7 years of professional experience as Business/System Analyst with expertise in Software Development Life Cycle
(SDLC) in Health Care Sector with prime focus on EMR, HL7, claims adjudication, provider, eligibility and prior
authorization for Medicaid and Medicare programs.
Extensive experience in training corporate and independent clients on subjects like Business Analysis, Business
Process Modelling and other core areas of Business Analysis like, Enterprise Analysis, Effective Requirement
Gathering, Skills to survive as a BA(for clients on job) and SOA(Service Oriented Architecture). Also worked on legacy
modernization methodology including the tasks, models and techniques.
Experience with health care Systems: FACETS
Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication)
Experience working with Health Care Client Server Product TRIZETTO/ERISCO FACETS.
Having excellent knowledge and worked as a SME on Medicare, Medicaid, Medicare Advantage, MediGap, HIPAA
Standards (HL7), EDI Transactions (4010), ICD-9 and ICD-10 Codes, and FACETS Healthcare Platform. Also, used Clarity
PPM (Project Portfolio Management) to provide industry best practices for utilizing the Clarity product.
Highly analytical in developing the methods and measures to meet requirements and solve any issues that arise
during the project.
Proficient in the use of tools like Telelogic DOORS, Rational Rose, Requisite Pro, Rational ClearCase, Telelogic System
Architect and MS Visio.
Well experienced in CMMi, SDLC, and Agile development methodologies. Healthcare domain and experience in areas
of Healthcare EDI transaction sets (834,835,837i/p, 820, 997/999), HIPPA, ACA and Health Insurance Exchange.
solution to the customers for Facets Production Issues.
Supported new business requirements by extending the functionality of the core Facets system using the Facets
extensibility architecture feature.
Good knowledge and extensively used RDBMS, Oracle, SQL, and PL/SQL along with MS SQL administration, SQL
Enterprise Manager, Data analysis and reporting.
Working experience in a cross-functional team environment/different geographical locations teams.
Experience with data analysis, data mapping and dimensional modeling experience in decision support systems (data
marts) using Star Schema.
Experience in requirements gathering for development of the customer MDM data models.
Good knowledge on different modules within healthcare (Membership, billing, enrollment, claims, capitation,
providers).
Experience with HIPAA compliance (4010 & 5010) and Healthcare systems
Experience with Medicare, Medicaid, Medigap/Medsupp & commercial insurances in HIPAA ANSI X12 4010, 5010
formats including 270,271, 276, 277, 835, 837, 997, NPI, ICD 9,ICD 10, NDC, DRG, CPT, NCPDP codes & NSF formats
for interfaces & images to clearinghouses/ trading partners applications.
Experience with health care Systems: FACETS, Medicare Part A, B, C, D, Medicaid systems.
Experience in developing and imparting pre and post implementation training, conducting GAP Analysis, User
Acceptance Testing (UAT), SWOT Analysis, Cost Benefit Analysis and ROI analysis.
Driven by creative ideas and backed by strong Analytical and methodical problem solving skills, identifying causes,
corrective actions and providing innovative solutions, building strategic partnerships with senior business leaders
and getting commitments to actions from individuals at all levels.
Extensive experience on Excel, Word, PowerPoint, MS Project, MS Visio, Rational Suite and SQL.
Highly motivated self-starter with excellent communication, presentation and interpersonal skills, can perform well
both independently and with a team, always willing to work in challenging and cross-platform environments.
TECHNICAL SKILLS:
Business Tools Retalix, Proxis Store Manager Classic, TeleTracker Business Suite, PRAPP
Microsoft Tools MS Project, MS Visio, MS Office, MS Outlook, MS FrontPage
Databases & Languages Oracle, MS Access, .NET, MySQL, SQL, HTML, MS Visio, Rational Suite (Rose, RequisitePro,
RequisiteWeb,ClearCase, ClearQuest) Java, Doors, XML
Testing Tools HP Quality Center, Mercury Test Director, WinRunner, Load Runner, Rational Robot,
Quick Test Professional
Methodologies & Standards RUP, Six Sigma, SDLC Agile, QA, HIPAA, Medicare Software, ezclaim, Medicaid, SOA,
CMM, CMMI, PMBOK
Operating System Windows 95/98/NT/2000/XP, UNIX, Linux
Tools Adobe Acrobat, Business Explorer, Toad, Data Warehousing, Lotus Notes
Skills Rational Rose, Rational Requisite Pro, Rational Clear Quest, Snagit, Rational Unified
Process, UML, SOA, Business Process Modeling, MS Visio, MS Word, MS Excel,
PowerPoint, MS Project, MS Access, MS Outlook, ERWin 4.5, SharePoint, Cognos, Crystal
Reports Visual Basic 6.0, Java, Object Oriented Programming, C++ .Net, UNIX, Windows
NT/ 2000/ XP, MS SQL Server, BlueChip, FEP Express, VDR Data System, BlueSource,
Coordinator Mouse.
Professional Experience:
Affinity Health Plan is an independent, non-profit managed care plan that serves the needs of over 210,000 underserved
residents of the New York Metropolitan Area (New York City, Long Island, Westchester, Rockland and Orange Counties.)
Affinity provides healthcare coverage through its Child Health Plus, Family Health Plus and Medicaid programs. Affinity
Health Plan implemented Facets Extended Enterprise(TM) administrative system, a new core system, with updated
technology to allow for more efficient claims processing, membership enrollment and provider data maintenance. Facets
was highly efficient, automated, customizable, and flexible, to help affinity tackle new business opportunities and
compete successfully in a dynamic healthcare industry. Moreover, TriZetto provided ongoing support and training.
Environment: MS Project, MS Excel, MS Word, Rational Rose, Agile, MS PowerPoint, Facets, Tableau, UAT, Oracle 9i,
QlikView , Citrix (server), Epic
Horizon BlueCross BlueShield of New Jersey (Horizon BCBSNJ) is the state's largest health insurer providing individuals
and employers in New Jersey with quality health care. The project required an in depth process review to support the
migration of the Mainframe based system to a browser based platform.
Environment: HTML, XML, MS-Project, load runner ,Agile method ,Sharepoint, Contact center, Facets, MS-Office Suite,
Rational Suite, Doors, RequisitePro, RequisiteWeb, UML, IBM WebSphere, Microsoft Visio, SQL/PLSQL,SQL Server 2005,
Rational tools
Celtic Healthcare, Inc. Pennsylvania, PA .its health plans with consumers across the US. A leading health insurer, it offers
a variety of plans and services to group and individual customers nationwide. Requirements are gathered as per the client
need and configured in FACETS The configuration task includes adding new markets for Community & State Platform. I
am currently working on analysis and Configuration part in Medical Agreement Configurator, Fee Schedule, and NetworX
Qualifier Group.
Environment: Rational Suite (Rose, RequisitePro, RequisiteWeb), Rational Unified Process (RUP), Informatica, facets,
Windows XP/2000, Doors, Oracle, IBM WebSphere, SQL, System Architect, MS-Project, MS-Office Suite, MS Visio, MS
Word, MS Excel
Worked on developing ecommerce Integrated Marketing Platform (IMP) portal intended to increase the marketing return
on investment (MROI) and increase conversion rates. The system was integrated with healthcare and pharmaceutical
systems to track the marketing efforts. The application interconnected with EMR (Electronic Medical Record), Patient
Billing, EHR (Electronic Health Records) Business Intelligence and Integration Solutions to streamline business processes
and improve responsiveness in critical business areas.
Environment: .NET, Oracle 10g, Facets , MS Office Tools, IBM WebSphere, MS Visio, Lotus Note, Outlook, Share Point,
Citrix, TOAD.