SUMMARY

●Senior Business Analyst with **+ years of experience: Specialized in requirement gathering, process documentation, and coordinating various projects in healthcare IT, financial services, and insurance sectors.

●Expert in Healthcare IT Systems: Proficient with Epic Build, Revenue Cycle, Medicare/Medicaid Claims, and HL7 Interface Messages, ensuring compliance with healthcare regulations.

●Liaison and Quality Improvement Facilitator: Bridged internal and external business communities, and led quality and HEDIS project implementations to improve processes and strategies.

●SDLC and Project Management: Extensive experience in all stages of the System Development Life Cycle (SDLC), facilitating Joint Application Development (JAD) sessions, and managing ACA mandates.

●Technical Proficiency in EDI and Healthcare Regulations: Skilled in analyzing and working with HIPAA-specific EDI transactions, ensuring system configurations align with HIPAA 5010, Medicare, and Medicaid regulations.

●Operational Efficiency and Training Initiator: Focused on operational efficiency, facilitating training opportunities, and participating as a subject matter expert in Enterprise IT projects.

●Problem Solver and System Integrator: Led projects addressing provider record issues and payment manager problems within QNXT, and assisted in integrating EAM membership system into QNXT 5.9.

EXPERIENCE

Bright Health plan Minneapolis, MN

Business Analyst Jun ’21 – Present

●Conducted global brainstorming sessions to gather business requirements

●Authored BRD, FRD, use cases, test scenarios, and test cases for ETL and Reporting jobs

●Acted as a mediator between development, QA, and business teams, resolving requirement conflicts

●Designed and maintained system configurations and tested ICD-10 codes with clearinghouses or payers

●Analyzed HIPAA specific EDI transactions and ensured compliance with HIPAA 5010 standards

●Engaged in all SDLC phases, focusing on configuration and testing of various applications

●Involved in testing the ICD-10 codes by sending the test transactions to clearing houses or payers

●Used MS Share point for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents

●Work on fallouts from various applications, journalize manual billing requests, process payments and customize miscellaneous activities in AGILE and documented the same in JIRA

●Responsible for integrating with QNXT. Designing test scripts for testing of Claims in Development, Integration and production environment

●Involved in testing QNXT Member, Provider, Claims Processing, Utilization Management, Accumulators, Contracts and Benefits

●Conducted gap analysis for ICD9 to ICD10 transition and assessed the impact on QNXT adjudication system

AlohaCare Honolulu, HI

Business Analyst Mar ’18 – May ’21

●Led the Joint Application Development (JAD) sessions with stakeholders and developers for clear project understanding

●Utilized Unified Modeling Language (UML) to create use case, sequence, and activity diagrams

●Improved Claims Reimbursement User Interface in compliance with HIPAA 4010/5010 standards through gap analysis

●Performed Backend testing by using PL/SQL queries to test the integrity of the application was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle

●Coordinated with the QA team to review test plans and scripts, ensuring comprehensive coverage of requirements

●Conducted User Acceptance Testing (UAT), gathered user feedback, and developed training materials for the new system

Ventura County Health Plan Inc Honolulu, HI

Business Analyst Nov ’17 – Feb ’18

●Utilized JIRA for issue tracking, user story management, and maintaining a Requirement Traceability Matrix (RTM) including HIX

●Analyzed healthcare system inefficiencies and improved efficiency using Bizagi BPMN modeler

●Conducted data profiling, normalization, verification, and cleansing to ensure data integrity

●Identified the dependency rate of readmissions in the hospital on the other independent variables by considering HCPCS, HIX, CPT, EMR/EHR, Claims Submission data, Administrative Data, CMS Data and Patient Demographic data

●Worked as a part of SCRUM team, in Agile methodologies with SPRINT cycle, daily standup and story implementation as a part of cross functional team.

●Collaborated with QA team to design and develop Test strategy, Test plans, Test cases, Test Scenarios for performing Functional Testing, Regression Testing in both manual and Automation environment and reviewed Test results

Discover Financial Services Chicago, IL

Lead Business Analyst – Discover Student Loan Program Jan ’17 – Oct ‘17

●Worked in OTIS, Core Banking platform, to migrate Student Loan data from legacy system to big-data environment - Hadoop

●Led and worked with the team to develop mapping documents for new attributes coming to Warehouse

●Coordinated cross-functional team meetings, developed technical requirements and identified and resolved defects during migration of data

●Facilitated agile development team meetings to deliver the projects per business requirements and provided additional research requirements that demanded changes to the existing warehouse tables

Senior Business Analyst – Marketing Rewards Program Apr ’15 – Jan ’17

● Responsible for implementing several marketing related programs for consumer credit cards in Agile environment.

●Conducted research for Discover Rewards program by pulling and analyzing data on quarterly basis to capture any fallout under the remediation effort

●Developed user stories for projects in RALLY and worked with product owner and scrum master to assess the timeline for each product initiatives

●Participated in Agile forums including portfolio grooming, program grooming, sprint backlog grooming, sprint review and demo

Business Analyst – Pulse Network Program Apr ’14 – Apr ‘15

Worked as a business analyst ETL, involved in data migration from Discover network to Pulse network under pulse signature debit program.

●Provided detail research and developed a process document on the existing pulse network data warehouse processes

●Worked closely with ETL developers to obtain impact analyses of source files and prepared implementation plan for the project install

●Created and maintained source to target mapping, data dictionary, test cases, and business requirement documents

●Worked closely with business teams for generating COGNOS reports for yearly view

●Helped in enhancing COGNOS cubes to effectively capture larger volume of data

Sears Holdings Chicago, IL

Business Analyst – Marketing Rewards Program Jul ’13 – Apr ’14

● Responsible for monitoring Sears.com scores daily and generating vendor reports for online business units for Shop Your Way Rewards (SYWR) project

●Worked in web analytics to identify new trends based on customer satisfaction survey scores

●Assisted e-commerce business team in developing customer-centered application using several external vendor partners

●Helped in developing internal and external web surveys in Qualtrics for all lines of business and analyzed the current trends

●Monitored cart and checkout functionality in SPLUNK and Tealeaf on a daily basis in lieu with scores.

●Wrote SQL queries to generate detailed sales reports by reconciling SYWR base, bonus and redemption points

State Farm Insurance Bloomington, IL

Business Analyst – Auto, Life and Health Insurance Program Apr ’12 - Jun ‘13

●Responsible for data assessment, profiling and validation of auto, life and health insurance data

●Created business rules in trillium to find the incorrect data and compared with source allowed values

●Researched discrepancies and potential issues and worked with SMEs to find resolutions

●Prepared test cases for data conversion

●Performed audit validation and shared the result findings with stakeholders

●Prepared monthly database tracking and validation reports both at corporate and regional level

Department of Corrections Madison, WI

Business Analyst – Bureau of Technology Management Apr ’11 - Mar ‘12

● Participated in cross-functional team including business, BT meetings to identify defects found during migration of data

●Worked on gathering requirements during inception phase, documented and delivered business requirements using MS Visio and rational tools

●Conducted JAD sessions with business units to perform end-to-end information-based review of processes to identify problem areas and implemented appropriate metrics

●Worked on determining post deployment external access to WICS 3.0 across various counties of Wisconsin – data analysis of security groups needed to develop fobs

●Analyzed historical data to come up with modules based on new state statutes

●Facilitated user groups with UAT testing cycle before product implementation

●Wrote SQL queries for data manipulation and testing during Software Development Lifecycle (SDLC)

EDUCATION

LINDENWOOD UNIVERSITY St.Charles, MO

MBA Decemeber 2010

UP TECHNICAL UNIVERSITY Meerut, India

Bachelor of Management and Technology June 2007

COMPUTER SKILLS

Teradata, SQL, MS-Office, MS Visio, Lotus Notes, Track Record, HP Quality Centre, Trillium 14.0, SPLUNK, TEALEAF, Qualtrics

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