Health Care Project

Rashmeet Vig

*** ******** ****, *** **

Highwood, IL

Ph: 1-973-***-****; ********.***@*****.***

Summary

. Certified Scrum Master with extensive experience in gathering Business

and Functional Requirements, developing Project Plan, Business

Requirement document, Functional specification document, communication

plan, Test Plans, conducting Gap Analysis and Impact Analysis, SWOT

Analysis, Cost Benefit Analysis, Return on Investment (ROI) Analysis and

preparing training manuals and knowledge transfer manuals.

. Experience in the field of Business Analysis, Data Analysis, Requirement

Analysis, Business Process Design, Streamlining, System Analysis and

Design, and Quality Assurance.

. Knowledge of industry standard methodologies like Software Development

Life Cycle (SDLC), Joint Application Development (JAD) and Iterative

Software Development Life Cycle Process as per Rational Unified Process

(RUP), CMM (Capability Maturity Models) and Rational Tools used during

various phases of RUP.

. Excellent understanding of ANSI X12 4010 and X12 5010 versions of HIPAA

transaction standards and ICD-CM and CPT code sets.

. Expertise in defining scope of projects based on gathered Business

Requirements including Documentation of constraints, Assumptions,

Business impacts, Project risks & Scope exclusions.

. Used Unified Modeling Language (UML) tools like MS-Visio and Rational

Rose to create use case diagram, flowcharts, activity diagrams, sequence

diagram, state chart diagram, process flow, wireframes, and ER diagram.

. Created Requirements Traceability Matrix (RTM) to keep the stakeholders

informed of the progress of the project.

. Experience with various EDI healthcare transactions such as 837 for

submitting claims, 835 for payments, 834 for benefit enrollment, 820 for

premium payments to insurance products, 270, 271 for health care benefits

and eligibility, 276, 277 for claims status and 278 for transmitting

health care service information.

. Strong HIPAA EDI 4010 and 5010 with ICD-10, analysis & compliance

experience.

. In depth knowledge of Medicare/Medicaid Claims processes.

. Experience in working with Microsoft Office Suite (Word, Excel, Power

Point, Access, Visio, and Project) for documentation, analysis and

presentation.

Technical Expertise

Business Modeling UML, Rational Rose, MS Visio, MS Project

Processes JAD, RUP, SDLC, Agile, SCRUM Methodology

Programming Language HTML, XML, Java, SQL, MS Access, Clear

Quest,.net, ASP, XML, ICES, DRG Grouper

Operating Systems Windows (2000, NT, XP, VISTA)

Project Management MS Office Suite, MS Project, Concept Draw,

SharePoint, JIVE, Rally, Lotus Notes, JIRA, HP

Quality Center

Other Tools SPSS, Adobe Photoshop, Dreamweaver4.0.,

HyperSnap, SnagIt

EXPERIENCE

AIM Specialty Health April 2013-Present

Sr. Business Systems Analyst (Consultant)

. Worked on specialty benefits management Portal and Imasis for radiology,

cardiology, oncology, sleep management, and specialty drugs. These are

web based application used to manage outpatient diagnostic imaging pre-

certification process.

. Identified, validated, and documented the Business Requirements for the

Electronic Provider Access (EPA), Out of Area Provider Selection,

Redesign AIM's Provider Portal, Updates to Servicing Provider Initiated

Cases Business Process and Radiology Clinical Data Clean Up using AIM's

in-house developed methodology 'Business Process Scenario'.

. Worked on State Mandates such as Missouri Turn Around Time for Pre

Certifications and CA SB866 for Specialty Drug Certifications.

. Worked on yearly updates for HCPCS code so that AIM applications are CMS

Compliant.

. Worked on ICD 10 upgrades for AIM applications.

. Assisted in planning and estimation of tasks, activities, dependencies,

and resources using Gantt Charts for the successful implementation of the

Projects.

. Helped design policies and procedures to protect the privacy of

Electronic Protected Health Information (ePHI) to ensure data integrity

as per HIPAA guidelines.

. Created Client Implementation Guide for implementation of EPA Project.

. Worked on SAML Provider Attributes and documented Single Sign On (SSO)

process for different clients.

. Helped create project plan and vision document for database migration

projects.

. Was in regular contact with Business partners on the status of issues,

action plans and timeframe for resolution throughout the development

cycle.

. Conducted Scrum Meetings as necessary.

. Worked on Daptiv for storing documents and sharing them.

. Used JIRA to document the bugs on the above mentioned projects.

. Helped in User Acceptance Testing with different health plans for the EPA

Project.

. Documented Special Imasis and Provider Portal Scenarios and Requirements

for different users using AIM's Website.

. Document business process allowing Servicing Provider Initiated Cases

using AIM's call center.

. Created Automation Processes for Cost Data Load for RBM and Surgical

Shopper.

Harvard Pilgrim HealthCare December 2013-March 2014

Sr. Business Analyst (Consultant)

. Identified, validated, and documented the Business Processes for EDI

transactions such as 834 for benefit enrollment, 820 for premium payments

to insurance products, 270, 271 for health care benefits and eligibility.

. Created data flow diagrams for EDI transaction 834 for benefit

enrollment.

. Worked on Medicaid Management Information Systems (MMIS) tables and

helped create an automated process for updated member information in

these tables.

Harvard Pilgrim HealthCare October 2010-December 2013

Sr. Business Analyst (Consultant)

. Identified, validated, and documented the Business Requirements for the

Oracle Pricer Implementation Design, HPHConnect User Interface, Network

Health Connect, 5010 Implementation, Medicaid Supplement and Medicare

Enhance Projects using Rally Software.

. Created wireframes design documents to document User Interface Design

Requirements.

. Created Use Case preparations as part of Software Development

. Involved in database design and created ER diagrams.

. Solicited User Stories to build a new claims pricing

engine with Oracle Health Plans Inc.

. Created Data Flow Diagrams for Amysis Pricing Engine to

find out which data is need by DRG Groupers and ICES

Software to correctly price the claim.

. Solicited requirements for DRG Grouper and ICES Software.

. Documented EDI Logic to identify claims.

. Created Pricing Modeling Diagrams for Web User Interface.

. Documented Requirements for Webstrat to Winstrat Software

Migration.

. Analyzed current business process flow for various EDI

healthcare transactions such as 837 for submitting claims,

835 for payments, 834 for benefit enrollment, 820 for

premium payments to insurance products, 270, 271 for

health care benefits and eligibility, 276, 277 for claims

status and 278 for transmitting health care service

information by understanding preset business rules and

conditions.

. Created Companion Implementation Guides for 270, 271 for

health care benefits and eligibility, 276, 277 for claims

status for transmitting health care service information

. Interacted with stakeholders and gathered requirements as

per the business needs.

. Worked on Share Point for storing documents and sharing them.

. Used HP Quality Center to document the bugs on the Network Health Connect

User Interface.

. Performed data manipulation and performance testing on MySQL and MS

Access using SQL scripts.

. Documented the requirements for Customer Relations Team on how to enrol a

provider in the EDI system both telephonically and electronically.

. Documented a high-level technical design using UML diagrams that

illustrates the architectural context of the selected Oracle Pricer, and

identifies the constituent systems impacted by the Pricer.

. Identified AS-IS processes of claims transactions of 4010/4010A standard

and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of

5010 standard using the gap analysis.

. Developed Flowchart and process diagram using Microsoft Visio.

. Created Mapping documents for documenting the flow of Electronic Data

Information for Pricer and for Medicare and Medicaid Project.

. Helped create 5010 claims format Companion Guides so that Providers can

be complaint with HPHC 5010 HIPAA compliant initiative.

. Worked with e-business suite team on various EDI healthcare transactions

such as 837 for submitting claims, 835 for payments, 834 for benefit

enrollment, 820 for premium payments to insurance products, 270, 271 for

health care benefits and eligibility, 276, 277 for claims status and 278

for transmitting health care service information.

. Worked on the MMIS Database and ran SQL queries to reconcile the member

ship data sent by the Medicare and data in the Network Health Database

. Adhered to existing change management procedures. Recommended

improvements to existing procedures and in alignment with the Service-

Oriented Architecture (SOA).

. Reviewed the Product Backlog and developed and assisted maintenance the

Sprint Backlog to deliver results consistent with the Task Order.

. Assisted in planning and estimation of tasks, activities, dependencies,

and resources required for the Sprint Backlog identified above.

. Was in regular contact with Business partners on the status of issues,

action plans and timeframe for resolution throughout the development

cycle.

. Conducted Scrum Meetings as necessary.

. Documented the requirements for Third Party Vendors such as PHX and PHCS.

. Documented Special Pricing Scenarios and Requirements for pricing Harvard

Plans, Inc (HPI) claims.

. Ensured the accuracy and consistency of the data during the data loading

process.

. While working with various members at the management level to understand

the business process and decision models, was also involved in compiling

the Vision Document.

Suffolk University, Sept 2008 -

May 2010

Center for Innovation and Change Leadership, Boston, MA

Web Manager

. Manage content on Center for Innovation and Change Leadership Website

. Conduct research on Co-Creation, International Trade and Change

Leadership

. Organized and marketed Global Leadership in Innovation and Collaboration

panel discussion and award

. Create databases and systematized administrative work.

Satnam Woolens Private Limited, Ludhiana, India June 2007-

July2008

Sales and Marketing Manager

. Conducted extensive research on products for import from South Korea and

China in terms of market potential

. Found a new market for an existing product, resulting in 25% increase in

sales in a six month period

. Prepared corporate financial documents.

EDUCATION

Suffolk University, Sawyer Business School

Boston, MA

MBA

May 2010

Awarded Graduate Fellowship

Institute of Chartered Financial Analysts of India

Tripura, India

Post Graduate Diploma in Marketing 2008

SGTB Khalsa College, Delhi University, India

New Delhi, India

Bachelor of Commerce 2007

Delhi Institute of Computer Sciences

New Delhi, India

Diploma in Web Design 2006

Certified Scrum Master Indianapolis,

IN

ScrumAlliance March 2014

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