Neeraja Mallu

Business Systems Analyst Analytics

ac9dxe@r.postjobfree.com

425-***-****

OVERVIEW

Business Systems/Data Analyst professional with cumulative 10+ years of experience working both as a clinician and business analyst. Deep understanding of healthcare process work flow and business operations with an ability to synthesize business needs and help integrate with technology solutions. Skilled at learning new technologies quickly, team builder with excellent communications, time & resource management & continuous client relationship development skills.

CAREER ACHIEVEMENTS / CORE SKILLS

Certified Scrum Master (CSM)

Microsoft Certificate in Data science essentials

Knowledge of all phases of Software Development Life Cycle (SDLC) methodology

Experience gathering requirements, creating use cases and Business requirements documents including data mappings and workflow diagrams

Experience identifying, gathering, synthesizing, mining and analyzing healthcare payer data ensuring project completion on time with the desired results.

Knowledge of building Supervised and Unsupervised Machine Learning experiments using Microsoft Azure utilizing multiple algorithms to perform detailed predictive analytics and building Web Services models

Validating test cases and assisting in User Acceptance Testing (UAT)

Written SQL queries for data validation and data manipulation

Create ad-hoc reports as needed for Finance, Utilization management, Claims, and regulatory compliance.

Expertise with MS Office – including Word, Excel, PowerPoint, Visio.

Experience with Tableau for monitoring trends, providing data insights and creating data visualizations.

Core Competencies

Certified Scrum Master

Certificate Microsoft professional in Data Science Essentials

Licensed Physical Therapist

Business Requirements

Data Mapping

Test case / UAT

Azure Machine Learning

Programming and Tools

Microsoft Excel

Tableau

Talend

Gretl

Azure Machine Learning

Project Lifecycle:

Requirements Analysis

BA Analysis and Monitoring

Requirements Elicitation

Project Scheduling

Operationalization

Databases

MS Access

MS SQL Server

Value-Added Leadership:

Team Building & Mentoring

Client Relations & Presentations

Business & IT Planning

WORK EXPERIENCE

Business Analyst – Pharmacy Benefits Manager – CVS Health April 2018 - Current

Cognizant Technology Solutions

Gathering requirements from the client for Medicare -D and Medicaid plan build in RXClaim system

Liaison between the configuration team and the client providing functional specifications and clarifications as needed

Working with QAs, BAs, Clients and Devs to make sure work is in scope and requirements are delivered in a timely manner

Supporting leadership vision to automate new plans build (RPA) by leading automation activities, providing mapping documents, functionality support, and UAT of developed plans

Involved in troubleshooting parallel processing issues (discrepancies identified in claims output between legacy system and RXClaim system) providing analysis and configuration fixes if any required.

Business Systems Analyst Sep 2016 – Aug 2017

Santa Clara Family Health Plan

As a Business Systems Analyst, acted as a liaison between the business units, software development, and production support teams, under various projects supporting SCFHP objectives and regulatory compliance.

Provider Dispute Resolution (PDR) Letters Automation

Conducted / attended meetings with internal teams and management to understand the overall project objectives and success criteria

Gathered requirements from business users and SMEs and created BRD defining project scope.

Created test cases and performed Unit testing to ensure system functions end to end

Member & Provider Portal Implementation – HealthX

Created source mapping and thorough extraction logic for enrollment & eligibility, claims, authorizations and provider files. Mapping was done to extract files from the new system (QNXT) in anticipation of future implementation of Medi-Cal and Healthy Kids line of business

Developed a detailed test plan and test cases to cover all the requirements.

Conducted extensive testing and validation in legacy, interim and new production environments

QNXT System migration – Authorizations and Claims migration from legacy Xpress system to QNXT system

Conducted meetings with business SMEs and executive leadership team to gather requirements

Documented business requirements defining scope and post go-live process plan

Created extensive source-to-target data mappings to assist in migration of claims, service groups and authorizations from legacy Xpress system to new QNXT system for Authorizations

Created test cases and conducted extensive UAT and validation in dev, test and prod environments

Identified core data errors and fall-outs during conversion and recommended clean-up post Go-Live

Assisted in configuration of custom fee schedules in QNXT

Assisted with identifying configuration defects related to service groups

CMS and DHCS Regulatory reporting - Compliance

Project managed annual CMS Compliance reporting

Created and maintained log of Compliance issues that helped define new remediation projects

Assisted/Generated reports for CMS and DHCS yearly reporting

Reporting

Written SQL queries to generate ad-hoc reports for Claims, Finance, Compliance, Enrollment, Providers and Utilization management reports as requested

Automated reports on report portal as needed for recurring use.

ID Card Implementation - HealthLogix

Conducted meetings with marketing, enrollment, vendor and management teams for project planning and gather business requirements

Created BRD to unify ID card process for Cal MediConnect, Medi-Cal and Healthy Kids lines of business

Created data mapping to extract ID Card files from the new QNXT system

Created test data in test environment for validating test cases

Physical Therapist Mar 2008 – Jun 2016

Worked as a Physical Therapist in various settings – skilled nursing facility, home health and long-term care in NJ, WA, CA and TX.

EDUCATION

BS in Physical Therapy

Certified Scrum Master (CSM) – 1027015

Certified in Microsoft Data Science Essentials

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