Name: Karishma Patel

Skills: BA HEALTHCARE

Phone No: 602-***-****

Email: ac553k@r.postjobfree.com

•Having 5+ years of experience in Business Analyst an understanding of the regulations, bargaining agreements, and or business processes that relate to a business domain

Demonstrated use of standard techniques JAD, (Joint Application Development) interviewing, use case modeling, gap-fit analysis, process definition, requirements management for gathering requirements

•Experience developing standard software documents including Discovery, SOW, Business Requirements, Functional Specifications, Configuration Documents, Use Cases

•Strong knowledge of: Internet application development in a Java environment, data modeling, databases and quality assurance processes

•Experience working and completing the entire SDLC (Software Development Life Cycle)

•Familiar with EDI (Electronic Data Interchange), Gateway processing and ActiveX interfaces

•Experience with ICD codes used in healthcare claims processing and banking.

•Healthcare business analysis, bridging clients and software development team.

•Translated business requirements into functional requirements and approaches for

developers.

•Experience of clinical trial procedure and data validation.

•Knowledge of the drug development process in all four phases of clinical trial data.

•Strong scientific research background with problem solving skills.

•Having hands on experience on scientific research.

•Great problem solving skills with broad knowledge of science and technology.

•Accustomed to working in challenging environments under deadlines and competitions.

•Involvement in full Healthcare System Development Life Cycle with understanding

of a variety of technologies and platforms such as web, client/server, relational

database concepts and object-oriented programming.

•Represented the organization in client meetings, document meeting outcomes, and

coordinated all internal and external follow-ups to close issues in support of the

project requirements.

•Workflow documentation and comprehensive training to the healthcare clients.

•Analyzed corporate healthcare business processes to develop customized solutions.

•Assisted EMR vendor in customizing templates to increase efficacy and efficiency of work-flow for users

•Continued to train staff on EMR documentation and system use

•Maintained, supported and updated current EMR and dragon voice recognition services

•Sustained premium patient care at all times and earned highest possible rating of "exemplary" during performance review

•Healthcare client interaction to gather requirements, objectives, input and output

requirements.

•Assisted in setting up user stations with hardware including laptops, desktops and hand-held devices

•Continued to assist end users with EMR application issues by opening incident tickets

•Assisted users in trouble-shooting network issues that arise during patient treatment time

•Played an integral role in interdisciplinary team proceedings

•Have transferred complex Health IT solutions into user friendly softwares.

•Excellent skills in Business Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case development using UML methodology.

Technical Skills :

Operating Systems

Windows XP, Windows XP Pro, Windows 2000, MS DOS, LINUX.

Languages

Visual Basic 5.0/6.0, XML, PL/SQL.

Middleware/ Interfaces

. EMR, HER, HIPPA

Web

Web Services,

Database

SQL Server, My SQL, MS Access.

Methodologies and IDE/ Tools

MS Visio 2003/2010/2016, UML,

Client: Kaiser Permanente Santa Rosa, CA June 2017 – April 2018

Role: BUSINESS ANALYST

Project – Member Service Address intervention: The project involved validating the member address against the address listed for home delivery.

Roles and responsibilities:

•Analyzed corporate healthcare business processes to develop customized solutions users with HIPPA, SOX and PII compliance as a major requirement throughout the application as well as part of the end user trainings.

•Having good knowledge with primarily health system to one where virtually everyone has a digital footprint of their care because of the dramatic uptake of electronic health records (EHRs).

•Having good knowledge with EHRs had mixed positive effect on quality, safety, and efficiency of care. cardiovascular, surgery, and pneumonia patients and that switching EHRs did not result in adverse safety events.

•Having good knowledge with the Health Insurance Portability and Accountability Act (HIPAA) to make providers and individuals aware of patients’ rights to access and transmit their data;

•Having good knowledge and requiring publishing application programming interfaces (APIs) to enhance the connectivity between EHRs and provider and consumer applications.

•Healthcare client interaction to gather requirements, objectives, input and output

requirements.

•Worked on designing & documenting the current process flow and the futuristic MS operating process flow.

•Actively involved in gathering high level system requirements needed to implement the new operating platform for claims processing

•Involved in regular meetings with the support team, business users and the MS team to identify the gaps in pharmacy order processing

•Conducted a detailed research on how the pharmacy orders migrate on the system through each step in the process flow.

•Worked closely with the team to make sure that the system defects are rectified and the orders are processing correctly.

•Analyzed MS logs to complete GAP Analysis on Pharmacy order completion process flow.

•Perform server side validation while checking integrity of applications using SQL queries.

•Set up JAD sessions with project manager and stake holders for a detailed analysis and better understanding of the impact in project.

•Involved in working with internal and external parties to organize the various components needed to initiate, run and conclude major product testing and UAT Tester from business team.

Client: Athena Health, Watertown, MA Jan 2015 – May 2017

Role: BUSINESS ANALYST

Project – Aetna Medical Analytical Reporting: The project involved extraction of data from both external and internal sources of Medicare data for Aetna and loading of data warehouse for Aetna. The process is driven by comparing HICN numbers received from CMS with HICN in Aetna data stores.

Roles and responsibilities:

• Translated business requirements to functional requirements with help of Use cases and UML diagrams for developers

•Represented the organization in client meetings, document meeting outcomes, and coordinated all internal and external follow-ups to close issues in support of the project requirements

•Analyzed corporate healthcare business processes to develop customized solutions.

•Worked as a functional and technical analyst to support healthcare client’s system.

•Assisted in representing as the point of contact in the HICN core team for responding to any questions/ queries related to business.

•Worked on claims which involve specific logic for Medicare and Medicaid Claims.

•Provided specifications for the development team for data loads as well as the reporting layer.

•Collected and documented nonfunctional requirements related to data security, performance and data availability for the data loads as well as the reporting layer.

•Suggested solutions to the development team for the issues reported by business user group.

•Actively involved in making sure that the Business needs are met based on requirements from each system to process claims in a cost-efficient manner.

•Reviewed the project deadlines, schedule changes along with keeping tab on effort spent on the entire team and simultaneously communicated the same to the business community

•Conducted JAD sessions with Subject Matter Experts (SME's).

•Incorporated Rational Unified Process (RUP) and analyzed User Business Requirement Document (BRD), Technical Requirement Specification and Functional Requirement Specification (FRS) using MS Visio.

•Did Presentations making Stakeholders understand how the changes would affect different modules with respect to Medicare and Medicaid.

•Conducted User Acceptance Testing (UAT) prior to and after implementation phase.

•Worked on ICD conversion from 9 to 10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D)

•Worked with Source System Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.

•Played a key role in planning UAT and implementation of system enhancements and data migration and conversions.

•Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.

•Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for ICD 10.

•Assisted in writing test case scenarios for unit testing, integration testing and compliance testing.

•Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS

•Coordinates closely with the Quality Assurance team.

•Supports management in the resolution of production issues.

Environment: MS Visio, MS Office Suite, Agile, MS Project, Outlook, SQL

Client: United Health Care, Trumbull, CT Oct 2012 – May2015

Role: Business Analyst

United HealthCare is one of the world’s largest health care insurance providers. Their mission is to help clients with their health security and well-being, which they accomplish by providing a multitude of product and service options, through a plethora of resources and a very expansive network of physicians and providers.

Responsibilities:

Studied existing business application and processes, collected end user requirements and suggested the improvised business process model as per Agile Methodology

Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.

Defined and documented the vision and scope of the project.

Conducted one on one interviews with high level management team and participated in the JAD session with the SME’s.

Worked as a liaison between the business and technical side to convey the business needs to the system architects. Worked in association with RUP mentors to ensure fidelity to the standard RUP practices of the institution.

Participated in weekly status meetings to present status and incorporate any digressions from the original scope. Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.

Created and managed project templates, Use Case project templates, requirement types and trace-ability relationships in Requisite Pro.

Carried out a thorough target organization assessment and risk analysis.

Involved in cross-functional teams, developing new ways to boost efficiency and delivering results in a fast changing environment to achieve company goals.

Provided the management with test metrics, reports, and schedules as necessary using MS Project and participated in the design walkthroughs and meetings.

Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.

Education:

Masters in Business Analyst 2010, University of Phoenix AZ.

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