Mansi N. Shah

Email: ad5ap1@r.postjobfree.com

Mobile: 972-***-****

US Citizen

SUMMARY:

* ***** ** ************ ********** as a Business Analyst and an Enterprise Liaison between End Users and Technical Group, especially in healthcare domain.

Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software development methodologies.

Expertise in developing Requests for Proposals (RFP), evaluating responses, and leading IT system selection teams.

Extensive experience in identifying and documenting opportunities to integrate IT systems and resources to fulfill project requirements.

Experience on EDI HIPAA 834, 835, 837 (D,P,I), 277/278 and other Health Care Transactions

Have knowledge of HL7 Messaging protocols, HIPAA transaction and code standards and electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.

Experience with health care systems: QNXT, Medicare Part A, B, C, D, Medicaid systems etc

Excellent Business writing skills in writing Business requirements document, Use Case specifications, Functional Specifications, Business Requirements Document (BRD), System Requirement Specifications (SRS), Test cases, Test plans, GAP analysis, Traceability Matrix, Workflows and Unified Modelling Language (UML) such as Activity diagrams, Collaboration Diagrams, Class diagrams and Sequence diagrams.

Experience in coordinating sessions with stakeholders for documenting requirements, pain points, solutions and communicating with developers and business users for implementation, acceptance testing and sign off.

Experience in facilitating and coordinating Joint Application Development (JAD) and Joint Application Requirement sessions (JAR) with excellent inter - personal and conflict resolving skills.

Successful experience in communication skills both written and orally. Implementation of strong decision-making skills. Extensively involved in all the phases of SDLC, requirement analysis and Graphical user interface (GUI) business specification, development, enhancement, quality assurance, testing methodologies and implementation.

Expertise in coordinating JAD Sessions, UAT cycles, specifically for mobile applications to help users understand the differences across various platforms and devices.

Strong Project Management skills to understand the project scope, objectives, and timelines with MS Project and explain them to various teams and prepared the “As is” and “To be” documents to help identify the benefits and project requirements.

Good management, execution and documentation skills. Excellent knowledge of the MS Office suite.

TECHNICAL SKILLS:

Tools & Programming languages: Proficient in SQL, MS Office Tools, Informatica, Total view, HTML, SQL Server 2005, AWS S3.

Operating Systems: Windows 7/8.1/10/ Server 2005/08

Service Management Tools: Service Manager

Project Management methodologies: Agile - Scrum, Waterfall

Project Management Tools: MS Project, JIRA

PROFESSIONAL EXPERIENCE:

HCSC (Health Care Service Corporation) /BCBS Chicago, Illinois/; Richardson, Texas

Business Analyst (August 2022 - Present)

Responsibilities:

Responsible for functions on projects of moderate to high complexity by working with business partners within multiple business functions to align technology solutions with business strategies

Eliciting, documenting, and refining business requirements for the IT organization

Serving as a liaison across multiple facets of the business community and the IT organization in order to provide technical solutions to meet user needs.

Leveraging an informed knowledge of business areas to identify and/or resolve problems on an ongoing basis.

Partner with lines of business to establish a shared vision across business and IT stakeholders by building consensus on priorities and product execution. This will include activities such as business process determination, approval of user stories and UAT results, strategic planning and tactical activities, specifying requirements for current and future products and representing multiple business stakeholders in user story creation discussions.

Create, illustrate and update projects on provided platforms to stockholders and team mates.

Update project status by using platform such as Wrike and create tasks for team members to complete project work. Report manager on daily basis to provide update on current project and discuss any roadblocks regarding project.

Coordinate with the developers, supervisor, data analysis to discuss the projects details and help them create stories on platform like Jira.

Environment: QNXT, Agile, Jira, MS Paint, MS Word, MS Excel, 3, MS PowerPoint, MS Visio, SharePoint, ETL, RTM, Excel, Wrike, MS outlook,MS teams,Idea card.

Safeway Inc.; Pleasanton, California

Business Analyst (July 2018- August 2022)

Responsibilities:

Develop trusted advisor relationships with product, user experience, business stakeholder and technology leadership.

In partnership with them, identify, prioritize, and execute analytic work that delivers insights into the full breadth of our product offering and customer experience

Develop reporting and analytic dashboards for our product managers, designers, and engineers

Define and monitor key operating metrics for the Product and Technology organizations.

Responsible for collecting and summarizing data that will assist Pharmacy and Retail Operations management in both long- and short-range strategic planning, and the development and implementation of programs.

Develops and maintains a comprehensive understanding of business processes and practices pertaining to all aspects of Pharmacy and Retail Operations within the Retail Hub.

Analyzes corresponding data to effectively recommend system and operational procedure changes, enhancements, development of functional specifications or interface opportunities with costs and or return on investment summarized.

Serves as operation point of contact for various projects to drive project execution. Communicates relevant project information to stakeholders, both corporately and in the field.

Collects, analyzes, makes specific recommendations, and presents information pertaining to proposed programs to meet the business and strategic goals of Pharmacy and Retail Operations and Company.

Plans, designs and deploys appropriate reports and tools.

Collaborates across Pharmacy and Retail Operations, IT, legal and regulatory, process improvement teams, and others, to develop operational solutions

Gathers and documents client requirements; helps identify desired results and provides an understanding of the opportunity or problem.

Reviews high level test plans, business and system requirements based on quality assurance plans.

Gathers and documents functional requirements from business requirements, including page specs and use cases where needed.

Assists in scope definition and managing initiatives from definition through implementation, providing necessary updates and communications to stakeholders.

Provides basic end-user support in post-deployment phases, and supports the assessment and evaluation feedback process to ensure that the requirements necessary to correct issues are addressed.

Understands and identifies the correct resources to help define and validate both requirements and specifications.

Helps identify opportunities for improving efficiency of application portfolio and associated business processes.

Interfaces with stakeholders to answer routine application and requirements questions. Escalates the more complex questions, but follows up for resolution.

Works with business owners and operations to review suggestions, system enhancements and production issues.

Georgia Medicaid - Atlanta, GA

Business Analyst (Nov 2015 - June 2018)

The project involved the maintenance of claims workstation that automatically handles the entire claims life cycle.

Responsibilities:

Met with client groups to determine requirements and goals. Created a Business Requirement Document to underline the scope, dependencies, constraints, use cases, user requirements, non-functional requirements and other important parameters.

Clearly document all requirements within the Business Requirements Document and work with stakeholders to get approval of requirements within timelines

Educate stakeholders on current functionality to ensure all requirements are received

Developed the deliverables using the Agile-Scrum methodology, and helped develop and maintain user stories to track requirements.

Designed and developed Use Case Diagrams for the Facets process modules.

Conducted interviews, meetings and JAR sessions during the process of Requirement Gathering.

Performed extensive Requirement analysis and developed use cases and workflows.

Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams and Timing diagrams.

Active participant of all the scrum meetings, and helped maintain the product backlog and scrum backlog. Co-ordinate with scrum team for efficient delivery within designated sprint cycle.

Performed validation of X-12 270, 271, 835 and 837 Professional and Institutional format files according to EDIFECS engine.

Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA) for Claims Status and Eligibility (270, 271, 276, 277, 834, 837P, 837I, 837D, 835 remittances and NCPDP Claims).

Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.

Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.

Extensively involved in Conducting Market Research, Feasibility Studies, Data Analysis, System Analyses, Gap Analyses, and Risks Analyses.

Helped create the SQL queries and procedures, tested these for correctness.

Participated in Validating ETL process by creating various simple and complex SQL queries.

Created new SSIS packages to extract data from legacy to SQL Server Objects using Visual Studio 2014.

Evaluated testing results for each potential release build using HP-ALM, listing summarized bug information in priority sequence, recommended viability of release for production.

Develop detailed unit test plans and scripts and helped conducted rigorous testing per requirements and assisted in data mapping.

Created performance reports and interactive visualizations of data using Tableau for data analysis

Worked with Quality Control Teams to develop Test Plans in HP ALM and Test Cases.

Interacted with the developers and testers to report and correct bugs.

Involved in the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that HIPAA regulations are met across all the modules.

Environment: MS-Project, MS-Visio, Rational Tools, Developer/2000 (Forms, Reports & Graphs), SQL, and MS Access

Simply Health Plans; Miami, FL

QNXT Consultant & Configuration Analyst (July 2013-Oct 2015)

The project involved vvalidation of Configuration Change Requests (CCRs) daily involving claims testing within QNXT

Responsibilities:

Participate in Technical Design discussions from a functional standpoint to ensure all requirements are included in design

Participate in the review of test scenarios to ensure all requirements are covered

Create change requests for projects.

Review all Medicaid / Medicare agreements, changed if there is change in rates with eff dates

Document all provider rates and reimbursement methodologies

Coordinate with QNXT(3.8/4.2) implementation analyst on validating provider rates and reimbursement methodologies

Work with Claims Configuration to ensure provider contracts are accurate based on the contractual obligations,

Develops an expertise in provider data, reporting, fee schedules, contracts, capitation, vendor setup and member assignments in the QNXT claims platform.

Contract Configuration - creating new contracts of all types (Facility, Physician, DME, ASC, SNF, DRUG).

Contract Type (Medicare, Medicaid, Commercial. Etc) and enhancing existing contracts with knowledge of various payment methods, Custom DRG, Per diem, etc.

Use of Term Restrictions and Restriction Groups in Contract/Benefit Modules.

Benefit Configuration - setting up new Benefit Plans, making changes to existing benefit plans in the all areas including co-insurance/co-pay, deductible, out of pocket maximum, accumulators.

Resolving Service Groups with benefit terms and addition of service groups to all Plans.

Analyze changes across all benefits plans (e.g: SNF to all Plans, benefit terms, contract and contract terms) in order to configure complete solutions for Medicare (example changes in RBRVS rates) and Medicaid

Provided changes to configuration, to support various line of Business, were done prior to migrating to PROD.

Ensured correct pricing/configuration of each benefit plan and contract

Environment: QNXT,Agile, Jira, MS Paint, MS Word, MS Excel, 3, MS PowerPoint, MS Visio, SharePoint, ETL, RTM, Excel.

EDUCATION:

M.B.A (International M.B.A Institute)

Bachelor in Accounting (India)

CERTIFICATION:

Certified Project Manager

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