Jamesjordanbaa

James Jordan
SUMMARY
● 13+ years of experience as a Sr. Business Analyst / QNXT Configuration Analyst in the HealthCare domain.
● In depth knowledge and hands on experience working with SDLC methodologies like Waterfall, RUP, RAD and Agile.
● Expertise in preparing Business Requirement Documents, Use Case Specifications and Functional Specifications Document.
● Proficiency in SQL and experienced in applying and executing SQL queries from SQL Server databases for Back-End data
validation.
● Experience implementing Eligibility System, Facets Data model, Configuration Implementation of FACETS module.
● Experience in using Joint Requirement Planning (JRP) and Joint Application Deployment (JAD) sessions for gathering
requirements and brainstorm ideas.
● Knowledge of different modules within Healthcare Claims Adjudication Process (Membership process, billing process and
enrollment & Claims process).
● Efficient in translating Business Requirements into Functional and Non-Functional requirements.
● Expertise in creating and maintaining the requirement documentation like system use cases, supplementary specification
documentation, and business glossary as per the industry standards.
● Expertise in the management of System/User Request Change, and handle User Conflicts.
TECHNICAL SKILLS
Project Methodologies: Agile, Waterfall, JAD UML, RUP, BPMN, JIRA
Business Modeling Tools: MS Visio
Defect Tracking Tools: Rational Clear Quest, Quality Center, Bugzilla
Operating Systems: UNIX, Windows
Change Mgt Tools: Clear Quest, JIRA
Database Tools: MS Access, Teradata, MySQL
EXPERIENCE
Change Healthcare/Emdeon, Nashville, TN
Sr. Business Analyst/ QNXT Configuration Analyst
JAN 2020– Present
Change Healthcare, formerly known as Emdeon Inc., is a leading provider of revenue and payment cycle management and
clinical information exchange solutions, connecting payers, providers, and patients in the U.S. healthcare system. The project
was the Implementation of the QNXT system to include all business and IT areas to support this Emdeon’s existing Medicaid
line of business as well as plans on expanding their territory including: Enrollment/Disenrollment, Finance, Claims, Sales,
Network Providers, and Customer Service.
I worked as a QNXT Configuration Analyst in the system Integration testing team which does the integration of QNXT with its
legacy extensions. And also responsible for testing the functionality of modules such as members and customer support using
rational suit
Responsibilities:
● Working in writing Epics, User Stories and Acceptance Criteria while deciding number of releases and sprints based on
Minimum Viable Product and features.
● Identified internal and external system requirements, design and configuration set-up, also created User Documentation
and conducted training class.
● Processed claims in QNXT and verified 835X12's are generated and sent to Provider.
● Worked on generating ad hoc reports, tables and graphs for presentations and data modeling using SAS Web Report
Studio.
● Involved in all the phases of the System Development Life Cycle (SDLC) to ensure that business objectives were met.
● Followed Agile (Scrum) methodology for test planning and execution. Writing Use cases, Test Cases, Technical
specifications and managing traceability of requirements with deliverables using Team foundation server
● Processed 837P, 837I & 837D transactions, verified those 837 transactions converted correctly to XML file format & XC
keyword file format and verified the claims data loaded to QNXT for further processing.
● Performed data analysis and data validation by writing complex SQL queries.
● Analyzing the reference of data which is extract from source table and transform to the target table by using the SQL
query.
● Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations
● Performed post-production audits of benefit packages and modified configuration findings
● Used Test Director for bug and defect tracking. Coordinated with the developers on defect status on a regular basis.
● Enrolled members through online screens and 834 transactions to QNXT.
● Worked on gathering functional and non-functional requirements for the security login to access application to admin,
high-low level users, multiple departments, providers and end users.
● Conducted User Interviews, Gathered Requirements, analyzed, and documented business requirements (BRD) using agile
methodology.
● Tested the portal application to make sure the claims, members are loading to QNXT
● Proposed pricing configuration changes in accordance to client and state reimbursement methodologies.
● Wrote SQL queries and performed Back-End Testing for data validation to check the data integrity during migration from
back-end to front end.
● Involved in Adding Contracts to the Provider in QNXT and associating Providers in Portal while creating claims.
● Created and maintained test strategies, test plans, test cases, and product release reports for small projects or
components of larger projects in Confluence, and Jira.
Colorado Access, Aurora, CO

Business/Configuration Analyst (QNXT)
Sep 2018 - Dec 2020
Project was initiated to implement QNXT which is a Web application system and handles various health plans. Built on "n-tier"
environment and service-oriented architecture, QNXT offers the flexibility and functionality that payers need in order to
achieve optimal growth and efficiency-with the lowest total cost of ownership. System capabilities also included claim-
reprising and external-billing as well as integrated care management, care planning, predictive modeling, and branching logic.
Responsibilities:
● Worked in accordance with the Agile/Scrum methodology for various phases of the business and created business vision,
business architecture documents and mock reports
● Elicited project requirements by conducting JAD sessions, document analysis, requirements workshops, and interviews
with Subject Matter Experts (SME) and stakeholders.
● Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
● Gathered Business Requirements. Interacted with the Users, Designers and Developers, Project Manager to get a better
understanding of the Business Processes.
● Performed Data Profiling of current state of data in the Data Warehouse by doing Data Analysis using advanced SQL
Queries and Microsoft Excel, finding Gaps in Data and formulating solutions for the same.
● Performing Frontend testing extensively through QNXT.
● Evaluated existing JIRA Implementation and recommended best practices on its future configuration based on meetings
with and feedback from team members.
● Responsible for process reengineering, change management, Business case development, project requirements
management using Agile methodology.
● Worked extensively with the QA team for designing and validating Test plans and Test cases for the User Acceptance
Testing.
● Worked on Member Management, Benefits, Eligibility, Claims, and Billing modules within QNXT.
● Developed and managed the formal Agile Methodology which includes Configuration Management, Requirements
Management, Agile Manifesto, Lean Development
● Extensively used SQL query statements to verify the data integrity and validation between the front-end values with the
backend database values of the application.
● Conducted Oracle database testing by developing SQL Queries.
● Interacted with business heads to finalize the Business Requirements for the application.
● Wrote User stories which included the business logic, expected behavior and user acceptance criteria.
● Tested the changes for the front end screens in QNXT related to following modules, test the QNXT batches (member load,
Billing, Provider, etc. )
● Worked within the full project life-cycle through all phases, from requirements gathering to development and quality
assurance. Utilized full SDLC with Agile methodology.
● Extensive use of Jira for project configuration, add-ons, managing groups, project tracking and bug fixing and project
management functions.
● Utilized Mercator as an EDI mapping tool to map the claims data that passes through the HIPAA EDI gateway to the QNXT
claims processing application
● Elicited requirements from stakeholders using JAD sessions, interviews, document analysis, business process descriptions,
use cases, scenarios, and work-flow analysis.
● Processed claims in QNXT and verified they are generated and sent to Provider.
● Conducted Joint Application Design (JAD) sessions for eliciting data requirements that support the business requirements
and documenting data flows.
BCBS, Baton Rouge, LA

Business Systems Analyst / Configuration
Mar 2017 – Aug 2018
The purpose of this project is to aid needy families through technology services. Was able to deploy a solution that provided
off-the-shelf flexibility and affordability, scalability, a flexible business services model, and critical capabilities to support their
transformation and modernization strategies, I have been working with multiple teams on several projects simultaneously and
coordinating for implementations of Design, build and test Facets configuration in support of business requirements
Responsibilities:
● Reverse engineer FACETS benefit configuration design by researching, analyzing and validating existing benefit
configuration. Create design documents to capture findings.
● Understood the benefit summary and built product configuration according to the benefit matrix
● Created and modified queries (SQL) utilizing FACETS data tables
● Worked on Claims Test Pro (CTP) Facets for project tracking and for reporting progress.
● Tested product build to make sure claims hit the correct benefit rule
● Analyzing the reference of data which is extract from source table and transform to the target table by using the SQL
query.
● Moved configuration flow through team track
● Developed the mapping specifications from the business requirements and the data model.
● Wrote advanced SQL queries to extract, manipulate, and/or calculate information to fulfill data and reporting
requirements including identifying the tables and columns from which data is extracted.
● Troubleshot benefit configuration errors and corrected and tested related issues
● Created Technical Design documentation for the data models, data flow control process, metadata management.
● Worked on EDI transactions: 270, 271, 834, 820, 835, and 837 (P.I.D) to identify key data set elements for designated
record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business
processes.
● Used SQL tools to run SQL queries and validate the data loaded into the target tables.
● Developed and executed SQL queries for verifying backend data.
● Strong ability in developing advanced SQL queries to extract, manipulate, and/or calculate information to fulfill data and
reporting requirements including identifying the tables and columns from which data is extracted.
● Electronically submitted Enrollment (834) data.
Education: Bachelor’s degree in computer science, University of Buea , Cameroon

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James Jordan

Colorado Access, Aurora, CO

BCBS, Baton Rouge, LA

Education: Bachelor’s degree in computer science, University of Buea , Cameroon

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