SALAM KHAN

*** ******** **, **. *******, IL *****

Cell: 630-***-**** E: ac9c8k@r.postjobfree.com

SUMMARY

Over 10+ years of experience in Requirements Analysis, Requirements Management, Use Case modeling using UML, Business Process Modeling, Data Analysis, Asset Management, Change Management, Project Management with focus on Health Insurance.

Strong experience with Scrum methodology and well versed in writing user stories.

Proficient in using Agile Scrum methodologies, performed roles of an Interim Scrum Master following sprint/standup sessions and wrote user stories, analyzed the Iteration Burn Down charts and reviewed defects

Strong Knowledge of Software Development Life Cycle (SDLC), with thorough understanding of various phases such as Requirements, Analysis/Design, Development, Testing and Implementation.

Experienced in conducting Joint Application Development (JAD) sessions with SMEs, Business Analysts, Software Developers and Quality Assurance teams for New Corporate Accounts or Clients.

Knowledge of health information and health care services regulatoryenvironment including HIPAA, Medicaid/Medicare, CHIP &EDI

Have experience in healthcare industry in working with various modules which include claims processing using EDI X12 transactions like 837, 834, 835, 270/271, and 276 as per the HIPAA compliance.

Experienced working with the centers for Medicare and Medicaidservices (CMS), the Healthcare Common Procedure Coding System (HCPCS), Electronic Data Interchange (EDI), Medicare Part D Services, and StatePharmaceutical Assistance Program (SPAP) services

In-Depth knowledgeHL7 Standards, HIPAA, PPACA (Patient Protection and Affordable Care Act), and Compliance issues, LOINC and SNOMED Mapping, HL7 Message Validation (EHR & EMR), ICD 9, Electronic Health Records (EHR), Electronic Medical Records(EMR).

PROFESSIONAL EXPERIENCE

Priority Health (Spectrum Health), Grand Rapids, MI SEP-2017- Present

Business Analyst/Project Co-Ordinator

Project Description: Priority Advantage is a Medicare service offering company across United States. The scope of the project was to design and implement a robust infrastructure cloud solution to support infrastructure needs for Priority Advantage employees, clients, vendors, agent, providers and members. As a business analyst I was tasked to work closely with architects and SME’s to create a project definition document, understand and document the system requirements, create request for proposal (RFP) document for different vendors, document service level agreements from various vendors.

Responsibilities

Responsible for gathering the functional requirements for the health benefit claims receiving and processing system

Participated in brainstorming sessions and walkthroughs with subject matter experts (SME).

Developing Use Case Models, Activity Diagrams, State Diagrams and Data Flow Diagrams (DFD) using MS vison &Gliffy Prepared reports and presentation of key components and milestones to Top Management.

Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and to meet deadlines.

Used confluence software for document storage along with Share Point.

Worked on all modules of SDLC life cycle from Initiation, plan, design, develop, test, deploy & maintenance and created artifacts to support all phases and help the Dev Team and test Team with questions/concerns around BR/FR requirements.

Maintained the Business Impact Analysis Template (BIAT) to analyze and document the effect of proposed changes on the project schedule.

Worked on different EDI modules using EDI X12 transactions like 837, 834, 835, 270/271, and 276

Environment:Waterfall, MS Visio, MS Office, Agile, HP-ALM, Qvidian (RFP tool), SharePoint, AWS-IAM, Confluence 4.3, Gliffy 3.7,Gatherspace

Regence BlueCross BlueShield of Oregon, Portland, OR Feb 2015- JULY 2017

Business System Analyst

Project Description:The project was to replace an existing benefit storage system that generated summary of benefit changes (SBC), EOB’s& other welcome kits for members with a commercial of the shelf (COTS) application which was purchased from a third-party vendor. As a Business Analyst, I was tasked to understand and document the existing system to ensure all the capabilities were available in the new system along with the new functionality.

Responsibilities

Involved throughout the Software Development Life Cycle, (SCRUM) including sprint planning meetings, review meetings and backlog refinement meetings.

Prepared business requirements documents by conducting client group interviews, JAD sessions and with other internal departments.

Managed roles offshore and served as a liaison between development team and business team.

Prepared detailed requirements as per USER STORIES to provide details of each business and functional requirement, development and implementation plan of these requirements, timelines, owners, etc.

Worked on Claims adjudication, benefits as well as member and provider data.

Prepared change request form to provide details of the changes requests and obtained approvals from the appropriate stakeholders.

Implemented HEDIS reporting tool to measure the performance on critical dimensions of healthcare data, to file products with CMS

Provided training to the users and involved in facilitating UAT sessions to gain user confidence and approval.

Supported BRD by creating various UML diagrams such as; Flow chart, Network diagrams, Floor plans, Site maps, Business process modelling software and Venn diagrams.

Environment:Agile-SCRUM, MS Office, MS Access, MS Visio, iRise, MS SQL Server, Informatica Power Center, Rally, MS Project, SharePoint, TFS, Versionone, Abacus

Independence Blue Cross (BCBS), Philadelphia PA May 2012- Dec- 2014

Business Analyst

Project Description:The deliverable of the project was to build a robust system to record enrollment eligibility feed for Medicare and Medicaid plans which would consolidate different means of data transfer within the organization. Due to several limitations on eligibility parameters and certifications for waivers including provider transactions to the claims processing department, sending and receiving eligibility files from various federal and state government agencies, and receiving claims information from claims department for data warehousing, this information is extracted from the enrollment files and maintained which dictated multiple downstream impacts.

Responsibilities

Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.

Responsible for the fullHIPAAcompliance lifecycle from GAP analysis, mapping, implementation and testing for Medicaid Claims.

Responsible for GAP analysisin changing old MMIS and Involved in testing with MMIS System.

Responsible forMedicaid ClaimsResolution/Reimbursement for peach state health plans.

Assisting the project manager in creating the business case and project plan.

Work with business representatives to understand data marts requirements and priorities and ensure that IT works is appropriately aligned.

Responsible for creating business work flows and processes and creating management reports based on the analysis.

Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.

Environment:Waterfall, UML, Windows, SQL, Microsoft Office, Clarity CA PPM, MS Visio, SharePoint, MS Suite (Word, Excel, Power Point, MS Project)

Arch Design Concept DMCC/JLT -ADC Dubai, UAE JAN 2010 – JAN 2012

Project Specialist

Responsibilities

Identify the new business opportunities and develop new businesses.

Attend customer’s enquiries and requirements and to prepare solution’s demo and submit proposals.

Demonstration of products and services to the customers jointly with the pre-sales in charge.

Review the contract in order to ensure that the requirements of the customers are adequately defined and specified in the offer for quotations, any requirements which have been communicated subsequently by the customers have been understood properly and addressed, and the resources are adequate to meet the contractual requirements.

Build and maintain good business relations with the existing clients and to identify the possibilities of securing new business from them.

Prepared business requirements document by conducting client group interviews, JAD sessions and with other internal departments.

Ownership of the pre-sales cycle including demos, presentations, proposals, communication all through the order securing.

AL Gosaibi information Systems " Columbus IT " Dubai UAE MAY 2008 DEC 2009

Data Analyst/Project Coordinator

Responsibilities

Attend customer’s enquiries and requirements and to prepare solution’s demo and submit proposals.

Prepared business requirements document by conducting client group interviews, JAD sessions and with other internal departments.

Demonstration of products and services to the customers jointly with the pre-sales in charge.

Review the contract in order to ensure that the requirements of the customers are adequately defined and specified in the offer for quotations, any requirements which have been communicated subsequently by the customers have been understood properly and addressed, and the resources are adequate to meet the contractual requirements.

Build and maintain good business relations with the existing clients and to identify the possibilities of securing new business from them.

Education/Certification

B.Com. (Bachelor of Commerce) in Accounting & Computers, Osmania University Hyderabad INDIA (2000)

Advanced Diploma in Software Engineering (ADSE) From APTECH COMPUTERS

Software Development and Database Administration

Microsoft Certified Professional (MCP) Certification Microsoft

Microsoft Certified Technology Specialist Core Setup & NAV 2009

Microsoft Certified Technology Specialist Core Financials AX 2012

Microsoft Specialist Dynamics AX 2012 Logistics

Microsoft Certified Technology Specialist (MCTS)

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