Name: Rashmi Nyayapathi

Skills: Business Analyst Healthcare

Phone No: 408-***-****

Email: adree8@r.postjobfree.com

Professional Summary:

• Over 10 years of work experience IT Industry 2 years as a Business Analyst in Healthcare Industry.

● Strong work experience with industry standards such as HIPAA & ISO.

● Highly efficient in Business Analysis and documentation gathering.

● Knowledge of Blue exchange standards and regulations for compliance.

● Exceptional skills in healthcare business process review and design, as is analysis use cases, documentation, gap/fit analysis, impact assessment, testing and training.

● Strong expertise in Health Insurance Claim process of government plans Medicare and Medicaid and CMS.

● Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD) and vBRD.

● Successful in bridging the gap between healthcare clients and the software developers by acting as liaison between them.

● Highly familiar with understanding all phases of project development life cycle (PDLC) using standard methodologies including analysis, design, and development of software applications.

● Sound knowledge &experience using Unified Modeling Language (UML), Rational Unified Process (RUP)

● Ability to create and adapt processes to monitor projects, communicate project goals to stake holders and set performance expectations.

● An energetic, self-motivated team member, effective communicator with excellent relationship building and interpersonal skills.

● Strong analytical, problem solving and organizational abilities. Technical Skills:

Business Modeling Tools: UML

Healthcare-Systems:-Facets/QNXT

Methodologies: Rational Unified Process (RUP), SDLC (Waterfall Method, Agile Methodology, Iterative Waterfall)

Microsoft Tools: MS Word, MS Excel, MS PowerPoint, MS Project Server, MS Outlook, MS Office

HIPAA-Tools/Claims-Processing:HIPAA ANSI X12 EDI Transactions,

(837/835/834/270/277, HIPAA Gateway)

Work Experience:

Client: Blue Shield of California, Sacramento, CA June 2021-Present

Role: Business System Analyst

As a not-for-profit company, Blue Shield of California founded in 1939 and headquartered in San Francisco, CA. The organization serves over 3.4 million health plan members and nearly 65,000 physicians across the state. Blue Shield of California was founded by the California Medical Association.

Project Description

As a BSA, was working under Care1st Member Migration, of Blue Shield of California and Care1st Health Plan. In the Member Migration responsibilities include oversight of all business and system activities necessary for successful migration of all members into Facets Database, which is a large scale, complex, and system-wide initiative including people, process and technology impacts related to the Care1st Health Plan migration to Blue Shield of California Core Facets and Ancillary Systems. Responsibilities

● To write requirements based on meetings with business partners to support member migration and Care1st integration. Was working as a requirement analyst for supporting requirements gathering and facilitation to generate a BSC vBRD to pass to IT and configuration to support development.

● Used EDI tools to verify mapping to X12 format.

● Provides complex analytical support through the analysis and interpretation of data in support of cross-functional business operations.

● Involved in implementation of HIPAA EDI Transactions (835,837).

● Was working on as is analysis, preparing and analyzing complex reports for management review.

● Defines complex business requirements and provides analysis toward operational efficiency by conducting CISCO WebEx sessions and JAD sessions with IT and Configuration to coordinates with internal and external stakeholders.

● Facilitated Electronic Data Interchange (EDI).

● Made presentations to various levels of management. Works under limited supervision, using established procedures. Advanced knowledge of and ability to perform analyses such as, GAP analysis, process mapping, root-cause analysis, risk analysis and requirements gathering.

● Gathering the requirements, writing them on using REI, and making BRDs, and walkthroughs internally with BSC and externally with Care1st Health Plan.

● Recommend changes for system design, methods, procedures, policies, and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.

● Having a good experience and knowledge on Facets Core Applications such as Subscriber/family, Claims Processing, billing and Provider, PCP assignment.

● Very well experienced, involved in writing the Requirements on REI (Requirements Elicitation Integration) and prepared Requirement Traceability Matrix (RTM) in the Requirement Management in ALM. MS Office Suite, MS Visio JIRA, SharePoint and MS Project software.

Client: AETNA Hartford, CT March 2020 –May 2021

Role: BUSINESS ANALYST

Project – Aetna Medical Analytical Reporting: The project involved extraction of data from both external and internal sources of Medicare data for Aetna and loading of data warehouse for Aetna. The process is driven by comparing HICN numbers received from CMS with HICN in Aetna data stores.

Responsibilities:

● Translated business requirements into functional requirements and approaches for developers.

● Represented the organization in client meetings, document meeting outcomes, and coordinated all internal and external follow-ups to close issues in support of the project requirements.

● Analyzed corporate healthcare business processes to develop customized solutions.

● Analyzed HIPAA EDI transactions in X12 responses and of 837, 835, 277CA and 999 and looked for defects.

● Worked as a functional and technical analyst to support healthcare client’s system.

● Assisted in representing as the point of contact in the HICN core team for responding to any questions/ queries related to business.

● Worked on claims which involve specific logic for Medicare and Medicaid Claims.

● Do data analysis for various version changes of EDI messages on different sub-systems.

● Provided specifications for the development team for data loads as well as the reporting layer.

● Collected and documented nonfunctional requirements related to data security, performance and data availability for the data loads as well as the reporting layer.

● Suggested solutions to the development team for the issues reported by business user group.

● Actively involved in making sure that the Business needs are met based on requirements from each system to process claims in a cost-efficient manner.

● Reviewed the project deadlines, schedule changes along with keeping tab on effort spent on the entire team and simultaneously communicated the same to the business community.

CHARLOTTE-MECKLENBURG-SCHOOLS Aug2017-

Feb2020

PHILLIP O BERRY ACADEMY OF TECHNOLOGY HS

I worked as a HS Science Teacher @ PHILLIP O BERRY ACADEMY OF TECHNOLOGY SCHOOL and help the students in various Science subjects –Honors Earth-Environmental/ Forensics and Biology. .I also Participated in various organizations @ SCIENCE-FAIR JUDGES –UNC /QUEENSCITYSTEM SCHOOL (2019-2021) and Volunteered @ UNCC for the EARLY COLLGEGE SCHOLARS PROGRAM/ SCIENCE JUNIOR SYMPOISUM-JUDGES @ PHILLIP O BERRY (2019-2021)

● Developed Content Standards and Objectives for Secondary Science.

● Prepared courses for scholars on topics including Earth and Environmental. Biology, Forensics, Microbiology and Molecular biology

● Developed and executed daily lessons in Earth and Environmental /Biology and Forensics Facilitated and implemented daily lesson plans with differentiated instruction.

● Implemented literacy-based curriculum for scholars as a Next step ready

● Instructed through lectures, discussions, and demonstrations vocabulary, listening, speaking and exercising.

● Utilized technology in lessons for the HYBRID teaching Models like using most of the APP’s such as Zoom Teaching, Zoom Polls –Open-ended discussion, Google forms, Padlet, Creating Digital e-book, Jam-board/ AVID

/WICOR and MTSS TIER Strategies /Virtual Stations and Folder stations and Implement STEM concepts like HANDS –ON labs

● Developed and implemented lessons that utilized cooperative/collaboration learning strategies and differentiated instruction in the Balanced Literacy curriculum.

● Conducted after-school sessions intended to prepare struggling students with topics on the content area

● Monitor students weekly and implement more strategies to increase their growth towards Mastery on the content.

● Focused instructions on Accommodation’s scholars to support EL /504 and IEP settings.

● Implement SCIENCE FAIR in classroom and Participated as a SCIENCE FAIR JUDGE -@ UNIVERSITY OF CHARLOTTE (UNCC) and

QUEENCITYSTEM school.

● Developed proficiency both in Traditional /Power-point and Virtual setting

● Actively participated in School /District wide PD has implement in my classrooms

● Acquired Leadership qualities and support the school as a SLT Team

● Completed all RALC COURSE WORK and DIGITAL COMPETENCY

● Established and maintained positive relationships with students –parents

/colleagues and fostering an environment to support scholars Prosperity Presbyterian Church Preschool Sept 2015-May 2017

5533 PPC Drive

Charlotte, NC, 28269

I have been working for a Preschool as a Volunteer Pre-K Substitute Teacher and performing the following responsibilities

● Responsible for a class of students ages 4-5 years.

● Develop lesson plans designed to introduce students to colors, letters and numbers.

● Facilitated communication between teachers and students.

● Recorded observations about student learning, activity progress and the individual development skills/Worked with the lead teacher in the classroom and manage accordingly the curriculum.

● Helping students transition from the preschool to kindergarten

● Phonics and fun math /Making crafts/Art

● Basic Science hands on experience

Stepping Stones Learning Center

2691 Crow Canyon Rd Mar 2010-Oct 2010

San Ramon, California- 94583

I have been working for a Preschool as a Pre-K Assistant teacher and performing the following responsibilities

● Teach and provide activities for preschoolers-curriculum

● Assist students in developing self-esteem and confidence

● Always ensure classroom management

● Liaise with parents to provide feedback and discuss concerns

● Encourage students' positive self-image and expression Circle time

● Phonics and fun math /Making crafts/Art /c Science hands on experience

● Story telling/ Rhymes and Indian Dance

.

Harry S. Truman VA-Hospital

800 Hospital Dr

Columbia, Missouri-65201-5297 Mar 2008-Sept 2008

I have been working for Dr. Sower's Lab in VA Hospital at University of Missouri as a Research Lab Assistant and performing the following responsibilities,

● Run the Western blots

● Estimation of protein concentration

● Protein Assays (Bradford reagent)

● Animal handling rats and mice

● IPGTT test

● Collect tissue samples from the surgery animals and homogenize all the tissues and extract the fractions of Mitochondrial Cytosolic, and Plasma membrane, analyze data

● Glucose Uptake (Soleus muscle tissue -Rat

● Gel Electrophoresis

● Tail cuff measurements

● Inject IP, SQ of research animals (mice/rats)

● Pre-Surgery Label set-ups

● Reagents preparations

● Protocols data documentation.

● Synthesized and purified proteins using chromatography methods and other scientific methods.

● Conducted engineering research to develop solid modeling procedures.

● Tested and evaluated system performance of individual components and evaluating overall system performance.

● Trained laboratory personnel in molecular techniques including western blotting, immunohistochemistry, PCR.and obtained an ANIMAL HANDLING TRAINING CERTIFICATE.

And hands on experience in laboratory protocols, quality procedures, and laboratory equipment like Centrifuge, PH meter, incubate shaker, Autoclave, Incubator, Hot air oven, Pipetting skills, UV Spectrophotometer, & Ultra Centrifuge EDUCATION Master of Science in Microbiology (2003) (GPA: 3.5) Major: Microbiology

Minor: Immunology/Biochemistry/Biotechnology

MASTER'S THESIS: Toxicology and how it effects the body and its diseases.

Bachelors of Science in Home Science (2001) (GPA: 3.0) Major: Nutrition & Dietetics/Microbiology

Minor: Biochemistry/Early Childhood Education

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