Requirements Management Strategic Planning

SAMEENA SULTANA

ad0cr3@r.postjobfree.com

Tel: 689-***-****

Over 9 years of diverse experience in the field of Information Systems with emphasis on Business Analysis, Healthcare Processes, Strategic Planning and Healthcare projects focused on Healthcare Medicare, Medicaid and Pharmaceutical based industries.

Good understanding of gap analysis, requirements management, risk analysis and project plans. Proven expertise in creating UML diagrams, flowcharts, screen mockups, systems requirements specifications, and test plans.

Expertise in using requirements tracking and business modeling tools like, Rational Rose, Rational Enterprise Suite, MS Visio, Rational requisite pro.

In depth knowledge of Software Development Life Cycle (SDLC) with Waterfall and Agile methodologies thorough understanding of various phases like Requirements Analysis, Design, Development and Testing.

Practical knowledge of Rational Unified Process (RUP) as iterative SDLC with implementation of all four phases: Inception, Elaboration, Construction and Transition.

Strong project management skills including planning, scheduling, monitoring and budgeting with experience in gap analysis, risk analysis, effort estimation etc.

Experienced on Batch Processing & EDI interfaces in healthcare domain.

Working knowledge of requirement gathering by conducting personal interviews, developing questionnaire, brainstorming, conducting JAD (Joint Application Development) sessions, or role playing to get a better understanding of client business processes and creating requirements traceability matrix for tracking the requirements.

Experienced on Health insurance exchange programs during the project and worked with many insurance clients and companies for the billing and claiming issues.

Deep knowledge of Medicare- Medicaid rules, HIPAA, CMS Guidelines mandated by the Federal Government, ICD9/ICD10 codes, CPT,EDI transactions (274, 275, 837 and 835)

Deep knowledge in conversions from HIPAA 4010 TO 5010.

Highly experienced in agile/scrum methodology.

Experienced in data mapping document and functional design document and worked with stakeholders and helped during the project.

Had excellent communication skills, leadership and presentation skills, time and group management skills.

Conducting user acceptance testing (UAT) with business users and Postproduction maintenance support once the product is in the use.

TECHNICAL QUALIFICATIONS

Methodologies

RUP, Agile, Waterfall, UML, Business Process Modeling and Data Modeling

Office Tools

MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, M Outlook

Process/Modeling tools

MS Visio, Rational Rose, Rational Requisite Pro

Database

MS Access, SQL Server 2008, Oracle 9i & 10g, Informatica

Testing tools / QA

Test Director, Quality Center, MS – Excel, HPALM

Quality Management

HIPAA, CMMI, CMM

Languages

C/C++, SQL, PL/SQL, HTML, XML

PROFESSIONAL EXPERIENCE:

COMMONWEALTH CARE ALLIANCE (CCA), Boston MA Jan 2022- present

Sr Business Systems Analyst

Roles & Responsibilities:

Captured requirements for the base FHIR core solution.

Worked with Architect lead to create Solution Intent and Solution design documents.

Created RTMs for the end-to-end traceability.

Worked on Rally to create Ideas, Features and Stories for all the development worked.

Presented several demos for the POC work, Mapping, SD and SSP portal.

Created Mapping for all 8 Provider resources.

Implemented DaVinic PDEX Plan Net 4.0.1

Extensive knowledge on Identifiers and reference ID’s in FHIR

Created Custom extensions and Custom search parameters upon client requests.

Mapped from JSON to FHIR for all 8 profiles.

Validated the FHIR APIs using Postman tool.

Started to work on converting EDI 274 to FHIR

Handson Experience in creating stories for ADF and Azure Healthcare service.

Created crosswalks, reference docs and reference integrity documents.

Written requirements for Error Log and handling process.

Facilitated data loads like incremental & bundling upon requests.

Participated in Security reference meetings and guided on how to add Security on the API requests/responses.

Worked with Security team to define the roles-based access to FHIR Server

Anthem Inc. Norfolk, VA Jan 2018 – Feb 2022

Sr. Systems Analyst

Anthem Inc. is a health insurance company which deals with the insurance claims for Medicare and Medicaid and Government business divisions. Anthem is one of the fastest growing companies in insurance claims among the U.S

Roles & Responsibilities:

Worked on Sentinel Axway B2BI tool for mapping services.

Validation of the EDI claim in Sentinel Axway.

Experienced in Scrum methodology during the project.

Document review sessions with the stakeholders which includes SME (Subject matter experts), business, stake holders, Sponsor for the project and project manager, Developers and QA.

Working on New Jersey HL7 file load processing into ODW database.

Expertise in Standard Operating Procedure for designated operations and situations to find the better solution.

Expertise in documenting Business requirements document (BRD) and Functional requirements document in compliance with the company system.

Worked on Provider data information which includes provider credentialing data and active provider information

Implemented EDI- 274 Medicaid project for CA state (State level mandatory HIPAA guidelines for the implementation)

Worked on EDI-274 transaction i.e. Healthcare provider directory for California state Medicaid line of business.

Hands on experience with multiple data mapping sheets from multiple source system.

Worked on SQL and Informatica databases for the flat file generation of the required elements from the source systems.

Worked on requirements gathering sessions with multiple stake holders from the business.

Experienced in EDI – X12 file validation for the required and situational segments in the EDI-274 file.

Hands on experience in leading the team of 16 members for coordination and multiple deliverables of the end product in sprints.

Worked closely with EDI team which deals with Axway tool where the Axway tool generates the EDI file

Highly experienced in JIRA and Confluence and Service now (SNOW) for creating tickets (or) production deployment.

Worked on Test plan document, test case creation and test case execution for all provider types in the flat file and EDI file format.

Worked on Level of Effort for additional work involved in the project.

Worked closely with the developer for the final deliverables to the customer/business.

Worked on waterfall methodology for the final product deliverables of the EDI – x12 file.

McKesson Specialty Health, Scottsdale AZ Feb 2015 –Dec 2017

Business system analyst (BSA)

McKesson is the multi-specialty health care company which serves the patients with mail order pharmacy benefit programs, Patient assistance program. McKesson is usually deals with the patients who don’t have an insurance coverage for the medications. It mainly deals with the Medicare part B and Medicare part D coverage patients.

Roles & Responsibilities:

Worked on patient assistance program.

Worked on pharmacy benefit management (PBM).

Worked on prescription drugs, Medicare part B & Medicare part D program.

Worked on Gsk (Glaxo Smith Kline) program, mail order pharmacy program.

Worked on SQL queries, Oracle toad application.

Worked on SQL queries regarding the patient, insurance and Advocate tables in different servers and Database.

Worked on BTA (Bridges to Access) and CTA (Commitment to Access) program for the patients who don’t have insurance coverage for the Medications.

Worked on ProPbm set up.

Worked on pharmaceutical drugs, sun setting (end dating) of brand drugs.

Document preparations which includes business requirements and as well as system requirements.

Worked on scrum methodology and worked on project plans and created project chart and worked efficiently with the stake holders.

Document review sessions with the stakeholders which includes SME (Subject matter experts), business, stake holders, Sponsor for the project and project manager, Developers and QA.

Used to prepare test cases, test case reviews sessions.

Worked on test plans and test cases and UAT (User Acceptance Testing) testing for the deployment process.

Equinox IT Solutions, Hyderabad India Feb 2014 – Feb 2015

Intern Business analyst

Roles and Responsibilities:

Played a key role in the planning, testing, and implementing system enhancements and conversions.

Provided key project inputs by working with users in defining the project and system requirements.

Reviewed business process and functional requirements.

Worked on Pharmaceutical data processing for improving database for storing user files.

Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.

Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.

Worked on Pharmacy benefit management tool for entry and sunset of the drugs.

Analyzed Requirements and created business requirement document (BRD), current business process flow, future business process flow, use case diagrams, and activity diagrams using Microsoft Visio.

Experienced of managing multiple stakeholders across the organization and in QA integration of systems.

Assisted in building a business analysis process model using Requisite Req Pro and MS Visio.

Environment: Requisite Pro, MS Visio, MS Project, MS Access, MS Office.

EDUCATIONAL QUALIFICATIONS:

Bachelors in dental surgery from Rajiv Gandhi Health University, Bangalore India

Master of Dental Surgery from SRM University, Chennai India

P.G. Diploma in Business Management from Indian Institute of Skill Development Training

P.G Diploma in Clinical Research and Pharmacovigilance from Institute of Clinical Research India

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