Scrum Master Business Analyst

Aruna Bhaskaran

Linkedin: https://www.linkedin.com/in/aruna-bhaskaran-526705231/

Email: **************@*****.***

Phone: 805-***-****

Current location: Simi Valley, CA

SUMMARY

8+ years of experience in working as a Business Analyst & Scrum Master understanding client requirements, summarizing client needs, and translating into technical options and solutions that meet end user business needs.

Experience with QNXT 6.1 system configuration for Medicare Advantage and Medicaid plans and recommend configuration improvements to increase auto adjudication of claims.

Experience in Revenue Cycle Management (RCM) for Scheduling, registration, eligibility, authorization, claims processing and payment

Work with Product Owner to define product features and write epic user stories on monitor and track

Business value delivery. Meet with business and IT stakeholders to solicit requirements and create user. stories using the INVEST criteria.

Experienced in analyzing business requirement at all stages of Software development of life cycle SDLC.

Broad experience with SDLC requirement gathering and deployment using Agile Scrum, Waterfall.

Experience in claims management process, Knowledge of and Medicare Services. CMS, Health Assessment Systems, Hl7 Standards, HIPAA, PPACA.

Engaged in large MDM implementations in diverse MDM technologies like IBM Infosphere MDM Virtual (formerly known as Initiate), IBM Infosphere MDM Hybrid, IBM Infosphere MDM Physical (formerly known as WCC).

Document all data mapping and transformation processes in the Functional Design documents based on the business requirements

Worked as a Technical analyst/Business consultant with Health Edge Payor system organization

Tracking using HP QC and JIRA and reviewed them in subsequent iterations of the application development process

Understanding of EDI business practice and the ability to understand the client's needs.

Work with Product Owner to define product features and write epic user stories on monitor and track

Development JAD sessions with clients and referring to accessible documentation and procedure.

Strong understanding of FACETS and Facets Data Model working on data model and data extracts.

Experienced working in Facets online modules such as Billing, Provider, Claims and Membership modules.

Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, HIPAA 5010 X12, 834, 837,835.

Socialize and decompose EPICs with development

Knowledge and Experience Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, enrollment, Medicare, MMIS, Medicaid, CDHP (consumer driven health plans)

Facilitated Agile Scrum Ceremonies: Sprint Planning, Daily Scrum Call, Sprint Review and Sprint Retrospective Meetings.

In dept. knowledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall.

Work on each release JIRA, then walkthrough test results with the business people to close them.

Experienced with Federal contracts, X12 transactions, health care act, EDI transactions 270, 271, 834, 835, 837.

Designed and implemented basic SQL queries for testing and report/data validation

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), 276/277 (Claim Status/Claim Status Response).

Knowledgeable about preparing RTM documents and also Experience in conducting Impact Analysis.

PROFESSIONAL EXPERIENCE

Sentara Health Plans, Virginia Beach, VA(Remote) Feb 2023 – Present

Sr.Business Analyst/Scrum Master

Working with the project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.

Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery.

Analyzed data spread sheets to map the systems Claims, Members, Benefit, Provider, Billing, Payment, Contract, Capitation modules with SCAN Health Plan enterprise data ware house.

Write SQL scripts for adding, changing or deleting various benefit or contract data to or from QNXT that would take several man hours to complete via the front end software.

Ability to work with functional teams in an Agile/SCRUM and SAFE environment.

SDLC, EDI X12, FHIR, HL7, HIPPA, PBM, HEDIS, CMS, ERP, commercial payer.

Performed multiple source system analysis to identify the source data that needs to be moved into the target tables.

Created data flow diagrams, data mapping from Source to stage and Stage to Target mapping documents indicating the source tables, columns, data types, transformations required and business rules to be applied.

Gathered requirements on FACETS EDI 834 Benefit Enrolment and Maintenance subsystems.

Worked on EDI transactions (270,271, 276,277, 834, 835 and 837). Performed front end to backend mapping and analyzed the start to end of transaction.

Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.

Created, assigned, and maintained tickets in JIRA for bugs and defects.

Developed and executed test cases test Scenarios using Quality Centre and followed-up defects using JIRA.

Worked on entire Software Development Life Cycle (SDLC) right from Requirement Gathering, Converting Business requirements into technical specifications, Impact Analysis, Root cause Analysis for problems or incidents, high level Estimates.

As scrum master communicated dependencies and potential risk to the completion of the sprints including resources, costs and systems

Acted as liaison between business owners, developers and QA team to ensure enterprise data needs were met and worked closely with-it Project Managers to report project progress. Validated data mappings, data discovery with development team.

Worked closely with systems analysts to ensure functional specifications are properly accounting for business needs. Facilitated meetings, as necessary, to review captured business needs and obtain approvals.

Assist configuration analysts with QNXT application functionality and testing.

Develop business use cases, business and data requirements, and related documentation in support of Enterprise Data Management.

Provider inquiry about the status of Remittance Vouchers (RVs). This involved checking the MMIS provider subsystem and checked the setup of their Remit Media.

Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/Outbound QNXT interfaces.

Strong knowledge of managed claims management process, Knowledge of Medicaid and Medicare Services. CMS, Health Assessment Systems, Hl7 Standards, HIPAA, PPACA

Experienced of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.

Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System MMIS. Socialize and decompose EPICs with developmen

Modified and translated segments of HL7 messages to properly send to EPIC.

Involved in various Facets batch jobs for Claims, Membership, Payment, Billing.

Involve in estimation process from High Level Estimatest detailed estimation.

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

Gathered and documented business BRD, FRD from both formal and informal sessions and validated the needs of the business stakeholders.

Responsible for review of business capabilities and requirements to define data needs and enterprise data management. Includes data analysis of business and user needs and documentation of data and mapping requirements.

Coordinates with both business and IT partners to ensure business, data needs and views are properly represented throughout the project lifecycle and coordinate communication regarding implementations.

Experience in Web Focus and SSRS reporting. Created test cases and test scenarios based on HL7 interoperability specifications like workflow, performance, Load and networking.

Manage Business intake, provide Super High Level Estimates, participate in Business requirements workshop and translate the requirements into high level solution options

Prepared Mapping document, data flow diagram, Process flow diagram using MS Visio.

Involved in gap analysis in changing old MMIS and testing new MMIS. Conducted reporting requirements from the data ware house and analyzed the tables and columns to be added in the oracle data ware house from the sql server through transformation engine.

Worked on Agile Methodologies to implement the project.

Scan Health Plan,Long Beach, CA Jan 2021 – Feb 2023

Business Analyst

Working with the project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.

Analyzed the change detection process on QNXT database tables to capture the daily changes done by Users through Online QNXT Application.

Conducted Agile/SCRUM rituals like Identify, document, and validate Business and Functional Requirements to manage inbound and outbound extracts related to PHS and external vendors effectively.

Involving in business analysis and project management, coordinating between the team members according to the business requirements.

Creating and maintained procedures and documentation.

Organizing and conducted Orion Rhapsody Route to receive and process HL7 ORU^R01 Version 2.5.1messages to Webserver

meetings, briefings, demonstrations, conducted JAD sessions, and wrote minutes of project meetings.

Actively resolved day-to-day technology needs of the business unit with a focus on the analysis of processes.

Assist in the development of a Business Plan for the future of Health Edge’s web presence applications

Used Data warehousing for Data Profiling to examine the data available in an existing database.

Work with other BA to create an environment to foster knowledge transfer related to agile practice and product features and functionality

Involved in Joint Application Development sessions with SMEs and development teams and

documented functional business requirements as product backlogs using JIRA

Experienced in Claims Master and Revenue Cycle Management (RCM) suite

Configure provider contracts for business is moved to the health Edge software platform.

Worked as the business consultant as the HealthEdge Payor system organization specifically for UCLA clients.

Familiarity with data extraction, analysis and reporting using HealthEdge HRP.

Adhere to existing configuration procedures established by department seniors and/or management.

Assisting QA Team to test and validate the inbound and outbound data via Batch Processing.

Facilitate Requirements Workshop to identify, document, validate, and prioritize the Business Requirements with project stakeholders, business users, and end-users.

Provide high level estimates for requirements phase on ‘Change Requests’ received from client.

Research Medicaid and Medicare requirements for system automation.

Worked with claims and configuration departments to resolve and reduce provider issues by analyzing and researching Medicare and Medicaid guidelines, fee schedules, and provider credentialing, contracting and licensing requirements

NoSQL (Cassandra, impala, Hue), RDBMS such as Oracle, MS SQL Server using SQL, PLSQL for data integrity.

Delivered all key documentation for the above including Business Case, BRD, FRD, Use cases, Business Rules, Process flows

Identify and document Process Flow Diagram and Data Flow Diagram for multiple projects that provide the base for IT EDW team and Senior Architect to create the Technical Design Document.

Involving in complete SDLC process in upgrading Facets system, system analysis, system support, migration support, profile changes, security tracking, and code deployment.

Extensive use of JIRA to create user stories.

Assisted and designing and documenting the RCM Notice of Authorization (NOA) and Authorization GDP module

HIPAA related EDI development for 837, EDPS, 835 and other EDI processes using Pervasive EDI translator.

Allscripts, EHR-EMR, Pharmacy, Drs, Hospitals across continuum of care.

Involved in project scope meetings with the Pricing manager to understand the type of requests andissues handled by the pricing team and documented the high level business requirements to theproduct backlog using JIRA.

Have in-depth knowledge of Software Development Life Cycle (SDLC) methodologies, assisting and working as Scrum Master on several projects, vast experience working in Agile, Waterfall, RUP methodologies. Primarily in Agile methodology

Conducted surveys of health plans, Medicare & HEDIS to document encounter reports.

Assist Technical Team to better manage the Data Governance process throughout existing Data Warehouses, Facets and Epic systems.

Prime Healthcare, Ontario, CA May 2019 – Dec 2020 Business Analyst

Performed extensive Manual Testing to verify the application is complete and stable.

Identify timelines for the different kinds of testing to be performed and estimate the risks involved.

Performed test data analysis and ensure data requirements are met prior to start of various testing phases.

Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.

Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.

In-depth knowledge of conducting User Acceptance Test (UAT), data quality checks using SQL, gap analysis and Requirement Traceability.

Experience in Functionality Testing, User Acceptance Testing, Database Testing, Regression testing and Risk Based Testing

Prepared the Functional Specification Document FSD and Software Requirement Specifications SRS as per SEI-CMM standards.

Conducted the JAD Sessions with stakeholders and developers to have a clear picture of a project.

Conducted interviews with key stakeholders to analyse existing data and gather requirements.

Used UML to create use case diagrams, sequence diagrams and activity diagrams

Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as per HIPAA 4010 /5010 guidelines using the gap analysis.

Developed flowchart and process diagram using MS Visio.

Wrote SQL scripts for creating performance evaluation reports

Performed Gap analysis and implemented updates for the Data Warehousing Application.

Managed and documented the change requests.

Maintained Requirement Traceability Matrix.

Responsible for scheduling meetings with users, SME’s and stakeholders to identify problems resolve issues and improve the process to ensure a stable and accurate solution.

Adventis Health Systems, Rockville, MD April 2018 – April 2019

BusinessAnalyst

Worked with internal and external users to define requirements and coordinated user management and developer expectations.

Worked on EDI transactions: X12, 835, and 837 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analysing and documenting related business processes

Prepared Business Requirement Documents BRD's after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.

Facilitated and led JAD sessions aimed at functional requirement walkthroughs for all the impacting projects and updated the documents based on recommendations if any.

Determine primary, secondary and tertiary coverage on accounts for Managed care and Medicaid payers.

Managed delivery of IVR channel specific API requirements, web services delivery, user stories, backlog and production support. This includes APIs for Sprint, AT&T and Verizon clients to trigger call flows requirements.

Currently leading, coordinating EMR/EHR (Helix Suite) implementation to achieve meaningful use stage

Worked closely with the on shore and off shore technical team members including developers, designers and Scrum Master

Very knowledge of the technology of the RCM platform including the Automated Work Distributor,

Work Flow Editors, Goal Driven Process (GDP) variables and Knowledge Rules.

Used AGILE methodology and worked in short SPRINTS to achieve goals

Created various reports such as billing payment reports, Billing Grouping Payment and discount reports

Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.

Gathered high-level requirement for all the external projects in a release.

Performed the requirement analysis, impact analysis and documented the requirements.

Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.

Working on Lifecycle, Create and follow up on JIRA tickets for the change requests received fromvarious business partners.

Performed data analysis and data profiling using complex SQL on various sources systems including Oracle and SQL Server

Created user stories and acceptance criteria for the functional and non - functional requirements for the project and conducted estimation by working with the scrum team

Acted as a Medicaid and Medicare SME during discovery analysis

Impact analysis and feasibility study of system to incorporate new functionalities in ETL

Strong Knowledge of waterfall and agile SCRUM project methodologies to deliver projects

Developing a single application to process data from multiple integration points, convert the data for reporting purposes and feed data into mainframe system to be compliant to reporting requirements.

Assist configuration analysts with QNXT application functionality and testing.Manage QNXT User Security.

Extensive hands-on SQL Query skills using Oracle SQL and SQL Server.

In depth Understanding of HIPAA X12 EDI transaction 834 for enrolment and eligibility, X12 EDI transaction 820 for Payment Order/Remittance Advice, Acknowledgement transactions 999 and TA1.

Worked as a part of scrum team, in an agile methodology with sprint cycles, daily stand ups and story implementation. large cross functional project and support teams.

Created defect tracking using HP QC and JIRA and reviewed them in subsequent iterations of the application development process.

Performed Analysis on Data mapping between different data models.

Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.

Followed Scrum and SAFE Agile Methodology for the SDLC.

Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatics was used for ETL process and Business Objects.

Integrated various systems with HEDIS and create design for HEDIS and other systems to pull data in HEDIS.

Successfully conducted JAD sessions, which helped synchronize the different objectives of stakeholders and helped the developers comprehend user requirements.

Created and maintained procedures and documentation.

Organized and conducted meetings, briefings, demonstrations, used various elicitation techniques to gather the requirements, and wrote minutes of project meetings.

Tenet Healthcare, Dallas, TX May 2016 – Mar 2017

Business Analyst

Worked with SME's and business users to gain in-depth understanding of the business' mission, objectives, purpose and processes.

Enhanced the business to articulate and prioritize their ideas, and assisted in development of training materials for new technology and process improvements.

Collaborated with the QA testing team to develop the test plan, test conditions and test cases to be used in testing based on business requirements, technical specifications and/or product knowledge.

Conduct project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.

Functional experienced in Claim Life Cycle and Health Care Payer domain process along with various line of health insurance system like PPO, HMO, POS.

Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.

Involved in the User Acceptance testing UAT to check the reliability for end users.

Facilitated interview, one on one and brainstorming sessions with SME's User's in understanding the requirements pertaining to billing Origination to billing Processing.

Configure complex Medicaid healthcare benefits on the QNXT platform.

Experience designing and developing SQL statements and queries for Oracle Sybase and SQL Server 2000 database. Prepared documents to conduct user acceptance testing.

Responsible for the development and implementation of HIPAA EDI Map sets 270, 271, 276, 277, 820, 834, 835, 837 and 5010.

Reviewed the application systems and determined how to map the new applications data to the EDI System.

Assisted and written System Requirements Documents SRD, including Functional and Non-Functional requirements.

Gathered business requirements through interviews, surveys, prototyping and observing from account managers, finance manager, and independent advisors and got an accurate understanding of their needs.

Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as per HIPAA 4010 /5010 guidelines using the gap analysis.

Worked in the environment involving Agile PLM (Product lifecycle management) Administration and configuration and customization, this includes the discussion and understanding the customer issues and defining the Agile Users/ Workflows/ Roles and Privileges.

Interacted with Software development team and Business users as a liaison in helping developers to understand the business requirements, Functional requirements BRD, FRD thereby ensuring the proposed applications complies with the business specifications.

Involved in defining the source to target data mappings, business rules, business and data definitions

Create story board of back log items in Agile and develop item according to business needs.

Assist Technical Team to better manage the Data Governance process throughout existing Data Warehouses, Facets and Epic systems.

Conducted business validations covering the following deliverables: Facets Providers, Claims, Finance and Membership

Developed Use cases and activity diagrams and analysed business requirements.

Created UML-based feasibility studies and Use Case Models to communicate those ideas to the developers.

Followed the UML based methods using Microsoft Visio to create: Use Cases Diagrams, Activity Diagrams, and Sequence Diagrams.

EDUCATION

Bachelors in IT from Pondicherry University, Pondicherry, 2013

CSM Certification- https://bcert.me/sejqlgsgh

Six Sigma Green Belt,Global Association for Quality Management,Certificate Number: G-105818

Certified Business Analysis Professional CBAP from International Institute of Business Analysis, Certificate Number: 102972257

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