Business Analyst Software Development
Resume:
DIMPLE PATEL
******.**********@*****.***
9+ years of experience as a Business Analyst in IT primarily in Pharma and healthcare industries. Coordinated with business and IT across all phases of software development life cycle. Experienced in gathering, analyzing, and documenting business requirements and developing Business Requirement Documents and Functional Requirement Specifications.
EXPERIENCE
JAN 2020 – CUR
EDI BUSINESS ANALYST, PHARMSCRIPT (SOMERSET, NJ)
Gathered information from the accounts department and stakeholders to determine the
current and future needs and requirements that can be accommodated.
Coordinated with the IT team and other clients to discuss the flow of needed data.
Worked with the development team using Agile methodology to develop process,
standard, and procedures.
Managing the claims submitted by the providers through the clearing house from there
SFTP site to client specific folder paths validating these files and load them to the
adjudication system.
Troubleshoot various file transmission issues and perform reconciliation.
Compare the claims that pass validation and claims that were loaded to the adjudication system.
Defined business requirements and acceptance criteria/test cases that support EDI.
Interfaces related to healthcare business platform including but not limited to
835,837, and 834 transaction data and x12 integration NCPDP,HL7 have transformed data from all sources.
Identifying production bugs.
Performed SQL queries to test the location of data and if there are any changes needed.
Provided Micro strategy powered solutions to create workflows and deliver high level of
patient care and outcomes.
Strong verbal and writing communication skills - both technical and non-technical.
Knowledge of Contracting project management, Ad Hoc reporting, and analytics,
Credentialing enrollment, Medicaid pricing and premium business processes in a
commercial and Pharmaceutical managed market.
FEB 2017 – DEC 2019
BUSINESS ANALYST, REGION CARE NURSING AGENCY (QUEENS, NY)
Gathered internal and external enhancement requests from a diverse group of stakeholders including Customers and Doctors.
Proficiently documented Business Requirements Document, User story Specifications, Functional Specifications, and workflows.
Communicated with the different vendors and clearing house to figure out their requirements.
Created file specification and requirement specification document after the detailed analysis of gathered requirement.
Understood the business problems and opportunities in the context of the requirements and help recommend solutions that enable the organization to achieve its goals.
Worked with development and QA to review all requirements documentation, receive feedback, and ensure all issues related to the requirements are resolved in a timely manner.
Utilized Agile methodology to configure and develop process, standard, and procedures.
Participated in daily scrum meeting to discuss the daily task and any functionality issues.
Performed UAT, modified requirement to improve functionality based on user input.
JAN 2014 – JAN 2017
MEDICAL BILLING CLERK, HEALTHIMAX (EDISON, NJ)
Enter and track all daily census and face sheets from Beneficiary Facilities for correct Billing to Medicare, Medicaid, and Private Insurances
Generate patient invoices at end of the month
Contacting the facility on the status of Medicaid pending residents
Preparing and verifying the Prebill and Sales details.
Answer phone calls from the Patients POA and answer there billing related queries
Submitting the OTC for out of state patients
Checking the eligibility for Medicaid for the patients
EDUCATION
NHA MEDICAL BILLING & CODING CERTIFICATION, Param Institute
MASTER’S IN BUSINESS ADMINISTRATION (FINANCE), Gujrat University, 2006
BACHELOR’S IN COMPUTER APPLICATIONS, Bhopal University, 2003
SKILLS
Microsoft Access and SQL
SDLC, Waterfall, Agile/Scrum, Use Cases, Storyboards, Scenarios, UML, Joint Application Development (JAD).
MS-Visio, JIRA.
Linux
SharePoint
SAP
Epic, Practice Fusion, Athena
HL7
Frameworks
Docu Track
Microsoft teams
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