ALI ASKARI

ad23ho@r.postjobfree.com 469-***-****

PROFESSIONAL SUMMARY

Approximately 7 years of hands-on professional experience in Business Requirement Gathering, Business Process Flow, Business Process Modeling and Business Analysis.

Extensive knowledge of Software Development Life Cycle SDLC including Enterprise Analysis, Requirements Planning, Elicitation, Analysis, Communication, Solution Assessment and Validation of Projects.

Worked with Agile software development methodology using SCRUM.

Hands-On experience with all stages of SDLC's ranging from traditional (e.g., Waterfall) to Agile PLM (Product Lifecycle Management) and Rational Unified process (RUP).

Strong knowledge and experience of EDI transactions, HIPAA, ASC X12 Transaction sets 834 (Benefit Enrolment and Maintenance), 835 (Claim Payment/Advice, 837 (Claims and Encounters), 820 (Payroll Deducted and Other Group Premium Payment for Insurance Products) 270/271 (Explanation of Benefits (EOB) /Response to EOB), 276/277 (Claim Status/Claim Status Response).

Comprehensive documentation skills in creating artifacts such as Business requirements document (BRD), Use-Case Specifications, and Systems Requirements Specification (SRS).

Strong understanding of Medicaid and Medicare rules.

Good knowledge of Health Insurance Plans Medicare Part A, B, C and D, managed care concepts Medicaid and Medicare and experienced in determining the membership eligibility, billing experience within life and disability in health plans.

Experience in full SDLC from association with end-users for requirements determination, defining the system scope, system analysis, testing, maintenance and documentation.

Experience in creating User Stories (Functional Stories, Logic User Stories, Service User Stories) from Product Backlog and facilitated Sprint Planning meetings and prepared Sprint Backlog.

Participate in Sprint Ceremonies to suggest improvements in the scrum process.

Skilled in team building, conflict resolution & escalation awareness.

Worked extensively on Business Requirements Elicitation, Gap analysis, Risk Analysis, and SWOT analysis.

Expert in creating Use Case Diagrams, Activity Diagrams, Data Flow Diagrams (DFD), Sequence Diagrams, State Diagrams based on UML Methodology and process flow diagrams using MS Visio and Rational Rose.

Review Test Scenarios, Test Cases, Test Scripts, Test execution strategies

Collect Test Data for UAT which is done in the perspective of the users.

Use Microsoft Team Foundation Server (TFS) for executing test cases, task assignments, project backlog plan, and version control.

Experience with MS Visio for developing UML Diagrams.

Experience in Production Support and Unit Testing.

Highly organized with the ability to manage multiple projects and meet deadlines.

WORK HISTORY

Business Analyst / Humana Health Insurance / 08.2021 - Current Conducted discovery sessions (requirement gathering session) with the SMEs, PSM/SRE team and the business team

Created detailed Business Discovery Design document with the data flow diagrams

Identified actors and use cases for Design document using Protegrity data protection solution from the requirements and prepared future state diagrams, Business Process Flow, Activity Diagrams and Workflow Diagrams to understand the interaction between actor and the system using MS Visio

Walked through the document with the application team, business team and the Data protection engineering leadership

Created use cases and use case diagrams from the gathered requirements

Actively participate in Program Increment planning (PI), Product Backlog/Refinement meeting, Sprint planning, Daily Scrum, Sprint review and Sprint retrospective meetings

Lead sprint grooming sessions to groom user stories with the developers/QA and work with the product owner to prioritize the user stories

Taking ownership and applying time management skills to adhere to project timeline and deliverables

Utilized MS OneNote to update meeting notes and provide weekly status report to PM

Utilized Power-point template to provide weekly project status report to POD director

Involved in all phases of the project from initiation to deployment

Collaborated with teams using MS Teams and SharePoint services

Build and maintain close relationship with the stakeholders to ensure efficient development process are being followed and business priorities, rules are met, and that project development is on schedule

Environment: Waterfall, Microsoft Office Suite, MS Visio.

Business Analyst / Celtic Health Insurance / 03.2019 - 07.2021

Project: Enhancement/Implementation of the Medical Record System

Gathered detailed requirements that completely defined the project

Documented and updated requirements; prepared and distributed RFPs and evaluated responses

Created high-level models and user prototype interfaces to identify and validate business processes and solutions

Acted as a liaison among Stakeholders, both Business and IT side, in order to elicit, analyze, communicate and validate requirements for changes to business processes

Facilitated Business/Functional Requirements review, approval and sign-off sessions

Facilitated all Scrum ceremonies like Sprint Planning, Daily Scrum Meeting, Sprint Review and Sprint Retrospective Meetings to identify pitfalls and overcome them in the next release cycle

Worked to effectively interact and communicate with Claims and IT leadership

Maintained a calendar and monitor FTP sources for payer claim line files and reports

Demonstrated strong competency and comfort working with and analyzing large sets of data utilizing various tools (SQL, Teradata, Oracle, etc.)

Perform data mining while ensuring validity and quality of data in support of project

Identified solutions to the development and technical team and Functional Requirements

Participated in technical requirements and design sessions

Conducted 1:1 interview session and JAD sessions with Stakeholders, SMEs and Business Owners to discuss the scope of the conversion

Involved in creating reports and documents like Requirements Document and Management Plan, Issue/Alternatives Documents, Project Summary and Plans

Prepared Activity Diagrams, Sequence Diagrams and Use Case Diagrams for extensions

Reviewed defects reported from UAT efforts and analyzed for root cause and took actions based on the findings

Conducted Business Process (AS-IS/TO-BE) sessions with various department directors and staff to ensure Testing Plan and Test Approach would meet the identified Business Requirements

Worked in the Agile methodology using Scrum with primary focus on the management part of the software development in small iterations of four weeks' sprint

Used SQL query to create Test Data

Environment: Waterfall, Microsoft Office Suite, MS Visio, SQL Server.

Business Analyst / Clover Health / 11.2016 – 02.2019

Project: Enhancement to the Claims Processing System

Followed RUP Methodology for the entire SDLC

Conducted 1:1 interview with high-level management team as well as Subject Matter Experts

Worked collaboratively with Subject Matter Experts, Developers and Testers to perform GAP Analysis of the existing system functionalities with TO-BE system

Created Use Case Documents and used Rational Rose for creating UML Diagrams

Researched, interpreted and summarized Medicare Advantage claims processing rules, altered or created policies and procedures to adhere to those rules

Conducted analysis of healthcare data related to Medicare Advantage membership specific to providers, claims, utilization, pharmacy, and financial data

Translated requirements to technical staff to ensure the requirement were incorporated into system design

Contributed to the development of the Medicare analytics/reporting road-map and strategy

Configured metadata for the data dictionary, data lineage, and transformation for the relevant data area

Created and executed Testing Scenarios, Cases & Conditions involving User Acceptance Testing, Regression Testing, Integration Testing, and System Testing on loading professional Claims

Verified and entered claims data within predefined templates containing loops and segments

Coordinated with other teams for a smooth deployment in Validation and Production Environments

Worked closely with business partners in the development and monitoring of network strategies and initiatives supporting Medicare Advantage segment goals

Worked on data modeling and produced data mapping and data definition documentation

Updated internal processes (submit claims, check eligibility), updating data collection and data reporting

Worked to plan, lead and management of IT, SAP and business releases including project planning and optimization of release activities

Updated SQL queries as per the client requirement to ensure data integrity and enforce business rules

Generated reports from Excel database for Tableau Dashboard

Environment: MS Visio, Rational ClearQuest, Rational Rose, JIRA, MS Project, Microsoft Visual Studio, TFS 2015, Rational Requisite Pro, Rational ClearCase, HP Quality Center, ALM, SQL Server.

EDUCATION

Bachelors in Business Administration BBA

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