Rachid Abkari

adcpz1@r.postjobfree.com

Cell: 301-***-****

Professional Summary:

* ***** ** ********** ** Business Analysis in Healthcare IT and Pharmaceutical domains

A Business Analyst with years of IT implementation in Health care and industry standards, SDLC practices and UML tools.

Experienced with Microsoft SQL and SQL Queries and knowledge with data and databases

Benefit Investigation, Financial Assistance, Prior-Authorization, Nurse education experience in the insurance and healthcare systems

EDI claims and transactions and loops 270, 271, 276, 277, 834, 835, 837

Experience designing and reviewing test cases. Experience with QA (GxP) process methodology

Knowledge of SharePoint or similar collaboration portal

Self-starter with strong problem-solving skills

Specialty Pharma Business analysis and expertise

Excellent verbal and written communication skills.

Safe Agile methodologies and demonstrated Agile Analysis expertise, leadership, excellent communication skills, attention to details, listening abilities, computer proficiency, and results orientation.

ERP experience and hands on expertise

Experience with clinical and financial data using knowledge of healthcare claims, including various coding guidelines (e.g., CPT, HCPCS, ICD-9 & 10-CM), healthcare finance, and regulatory agency guidelines.

CRM experience and Operations

Knowledge of health and human services programs such as Medicaid, CHIP (Children’s Health Insurance Program), TANF (Temporary Assistance for Needy Families, and SNAP (Supplemental Nutrition Assistance Program)

Demonstrated ability to establish effective working relationships across a large, cross-functional team

Develop system use cases/system requirements and guide the development and implementation of such cases

Helped in Testing the product in UAT

Understood the functionality the system is supposed to deliver and as such, had the knowledge needed to validate the system (confirm whether the solution meets business needs or not).

Agile software development practices.

Product Backlogs within an Agile environment

Organized and managed test sessions, wrote test cases, executed system tests and prepared the defect reports

Worked independently on complex tasks which required analysis and action.

Experience with UAT sessions: an opportunity for users to see the solution in action and confirm that it meets their needs

5 years of hands-on experience in creating, modifying and maintaining requirements and design

Education

Master's in Systems Development and Design UMBC, Catonsville, MD - Dec 2011

Bachelor’s in communication and linguistics, University of Mohamed V, Rabat, Morocco - Jul 1997

Skill set:

Operating Systems : UNIX, Windows 95/98/NT/2000/XP, 2007, Windows

Automation Tools : MS Visio, Rational Rose, Rational Clear Case, Rational Requisite Pro

Business Modeling Tools : Provision, Excel, Power Point, UML, Agile, Waterfall, DRAMS

Business Process Modeling : Blue works live IBM Tool, CRM, Power BI tools

Bug Tracking Tools : Rational Clear Quest, Quality Center 9, Guidewire, Rational req. Pro Clear Quest Standards & Methodologies : Waterfall, Scrum, RUP, SDLC, Agile, HIPAA, Claims, EDI837/835/834/ICD 9 and ICD 10

Project Summary:

Business Analyst at LGA

Frederick, MD

Dec 16 2018 Dec 2019

Kept the team informed throughout the software development lifecycle, following up on change requests coming up during UAT sessions.

developed training manuals, workflows, job aids and presented materials in a classroom or one-on-one setting

Wrote better tests, better stories and helped refine them to make them more understandable and testable.

Data Analytics, Data Transformation, Data Modeling experience

Watched for quality problems and worked to fix the process for any bugs and defects

Determined operational objectives by studying business functions gathering information and evaluating output requirements and formats.

Designed new business workflows by analyzing requirements, constructing workflow, charts and diagrams.

Expert in medical insurance, payer contracts and participating agreements

constructed swim lane diagrams constructing use case diagrams and studying system capabilities and writing specifications.

Analyzed existing or new file mapping and work with internal & external vendor teams.

Designed mockup screens and worked with business stakeholders & Enterprise architects to get signoff to work collaboratively with cross-functional teams to refine requirements work with development team and tailored requirements accordingly.

Executed test plans and provided approaches to developers

Created user stories and maintained backlogs Participate in sprint grooming sessions Participate in daily standup meetings.

Project: Medicaid GBD Unit - Quality management and Credentialing

Business Analyst

Anthem, Norfolk, VA

5800 Northampton Blvd, Norfolk VA

Sep 2017 Aug 2018

Project: State government projects Medicaid GBD Unit - Quality management and Credentialing

Analyzed complex end user needs using Pega NextGen Application to determine optimal means to determine those needs

Medicaid/Medicare Experience

Medicare Enrollment functional and Facets knowledge.

Extensive Experience in “Requirement Gathering, Refining and Client Issues Handling”

Ability to elicit business requirements and translate into technical documents

Experience authoring and updating SOP's.

Experience in navigating deviations, CAPA's and CC's.

Experience with complete software development life cycle.

experience working on or with state-based health and human service system

Working knowledge of HP ALM software

Experience training adults in small and large group settings using multiple media formats

Process improvement and as is and to be requirements

Swim lanes, flowcharts, and UML diagrams

Test techniques and compliance frameworks like section 508

Wrote user stories in Jira and refined, and groomed them with the team Met with business areas to define the scope and break down work into phases

Aligned business needs in a story based / agile process

Gathered requirements from Product Owner, Quality managers at various plants

Environment: Windows 7 Professional, MS Excel, MS Project, SQL Server Management System 2012 UML, MS Office suite, MS Visio, IBM Blue works Live Reconciliation, Aggregation, Financial services, CPL, Data analytics, Informatica, HDH, ICOE, Clear quest, Jira, Facets, Nextgen, Pega, Medicaid Famiy, process improvement, UAT Testing, data modeling, data marts, SQL

Business Analyst

Active Health Management, NY

1333 Broadway NY May 2017 to August 2017

Project: Activity rewards application design

Active Health Management is a subsidiary to the Aetna company, that's working to transform healthcare for patients, providers and employers. I created items and finalized requirements to design a reward-based application for members

Received multiple change request from the client and was able to resolve those issues and suggest fixes to avoid impacts to the project scope.

Used Safe agile, Atlassian, Jira and Rally

OTS software package experience (guidewire)

Created mock ups, prototypes and traceability matrix

Supported client-side framework on multiple platforms using Angular

Government Integrated Eligibility or Health and Human Services

Implemented project using Sage Agile methods

Organized and facilitated discussions and backlog grooming sessions. Identify and write clear and concise user stories for implementation by development teams.

Mapped user stories and aligned them with business needs in an Agile Development environment

Collaborated with Strategy, Design, and Development teams to create websites and landing pages and optimize conversions and overall user experience

SQL, Azure and Power BI tools experience

Worked independently on complex tasks which required analysis and action.

functional/regression testing experience

Business Analyst

Horizon Blue Cross Blue Shield of New Jersey

Newark, 3 Penn Plaza, NJ Sep 2016 to April 2017

Projects:

Migration of Benefits to the Central Product Library (CPL)

Small Group Recertification Process - Automation and Business Process improvement

Horizon BCBS NJ /Vendor Implementation – Data Feeds Transfer

Served as a liaison between the business team and the project team by assisting the business in identifying, understanding, and documenting their business needs

Understood the importance of the developer experience to maximize impact, distribution and success for those building on top of APIs

Produced business design documents (BDD)

Gathered business requirements for the related enhancements in the administration process by conducting meetings, interviews, and JAD sessions with stakeholders.

Analyzed evaluated and recommended enhancements to client's customer experience across digital channels and touchpoints.

Testing; Record testing defects in ALM Testing; Record testing defects in ALM

Agile and scrum experience, Safe agile principles applied Lean

Participated in a project where migration to salesforce cloud was implemented

Performed Requirement gathering and Business Impact Analysis.

Wrote the BRD diagram to ensure high level design is accepted by the client.

Environment: Windows 7 Professional, MS Excel, MS Project, SQL Server Management System 2012 UML, MS Office suite, MS Visio, IBM Blue works Live Reconciliation, Aggregation, Financial services, CPL, Data analytics, Informatica, HDH, ICOE, Clear quest, Jira, Salesforce

Business Analyst Remote

National Government Services/ Anthem

Baltimore, MD - June 2015 to Jun 2016

National Government Services, Inc. has served as a Medicare contractor with the Centers for Medicare & Medicaid Services (CMS) since 1966.National Government Services is International Organization for Standardization—ISO 9001:2008 Certified. National Government Services serves over 28 million People with Medicare in 23 states and 5 U.S. Territories. National Government Services serves 276 members of Congress. The goal of the project was The SHOP (Small Business Health Organizations Program) Reconciliation and Payment Aggregation Services.

Responsibilities:

Project: Small Business Health Options Program

Worked on Data analytics and intelligence to monitor and solve the various queries using SQL server

Quality Center experiences

Experienced with configuration workflows, test case development, performance and load testing, End to End testing,

Data modeling and Data analytics expertise

SQL, Azure and Power BI tools experience

Benefit management and investigation, claims and auth appeals

Implemented Lean-Agile software and systems in enterprise level based on Lean and Agile principles.

It's designed to meet the needs of all stakeholders within an organization.

Used Google Analytics and API feeds of data

Used my expertise to analyze feeds and reporting tools to align the needs of business with IT coding and implementation

Updated the Interface document and wrote new requirements to the system design document

Analyzed departmental computing projects, including goal definition, time lines, data, processing, controls and standards

Knowledge of health and human services programs such as Medicaid, CHIP (Children’s Health Insurance Program), TANF (Temporary Assistance for Needy Families, and SNAP (Supplemental Nutrition Assistance Program)

Demonstrated ability to establish effective working relationships across a large, cross-functional team

Business Analyst

Lash Group,

9715 Key West Avenue Rockville, MD 20850 Aug 2014- May 2015

Lash Group is a patient support services company that provides high touch to highly automated patient access and adherence programs, based on the product’s needs.

The Project Goal was to support Sanofi/Genzyme and to manage the Specialty Pharmacy Provider (SPP) distribution process. Lash Group outlines the shared specifications that the other partner organizations will use as requirements for building an automated system facilitating data exchange

Responsibilities:

Experience with Pharma secondary data like Specialty Pharmacy / distributor data, Claims data

Used a replica of Patient First in my analysis of Pharma requirements of the application

Worked with BI (Benefit Investigation) Delivery Manager and Operations to analyze and document business processes and requirements

Defined and analyzed data requirements needed to support the business processes within the scope of corresponding information systems ( data modeling)

Established, reviewed, revised, interpreted and implemented policies, procedures and program standards supporting the Program

Quality Center Experiences

Coordinated testing efforts between US and offshore QA teams.

Created system and training documentation to include instructions on new features, release notes, and user manuals

SQL, Azure and Power BI tools experience

Translated requirements to Specifications and technical artifacts

QA/ Analyst

Xerox Healthcare

555 S Aviation Blvd, El Segundo, CA 90245 Dec 2013- July 2014

Xerox Healthcare professionals optimize resources and re-engineer healthcare data management processes. They help identify new ways to work, transforming patient data and documents into intelligence that can be accessed and shared seamlessly. In turn, they make more informed decisions that drive healthy patient outcomes and foster business success.

Responsibilities:

Worked on MMIS, EDI, Pharmacy OS+, Claims, remittance advice and payments

Performed Change requests and traced all changes in the DSD

Medicaid and MMIS health care business process and system knowledge

Supported applications and requirements between IT and business using tools and requirements management tools like req pro

Knowledge of health and human services programs such as Medicaid, CHIP (Children’s Health Insurance Program), TANF (Temporary Assistance for Needy Families, and SNAP (Supplemental Nutrition Assistance Program)

Demonstrated ability to establish effective working relationships across a large, cross-functional team

Develop system use cases/system requirements and guide the development and implementation of such cases

supported HR systems (Core HR, Recruiting, On-boarding, Compensation, Performance Management, Talent Management, Workforce

Provided analysis and reviewed documents to track defects and CTC's

Met with SME's and PMP's to plan out the resolution of deliverables per state requirements

Agile software development practices.

Environment: Windows XP Professional, XML, MS Access, EDM Quality, EDM CRF, MS Excel, MS Project, RUP, Oracle, UML, JD Edwards, MS Office suite, MS Visio, Crystal Reports, DRAMS, Oracle Client, Req. Pro, CQ, Clear Quest, EDIFECS, Doors, ALM, Agile, Jira

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