Business Analyst Data

Aman Altaf

Sr. Business Analyst

Contact

Location: Dallas-Fort Worth Metroplex TX, USA

Phone: 631-***-****

E-mail: ********@*****.***

LinkedIn Profile: linkedin.com/in/aman-altaf-53181a240

Profile highlights

Experienced Agile Healthcare Business Analyst and Agile Senior Analyst Lead, with over six years of proven experience leading full scale Software Development Life Cycle’s (SDLC) for several dynamic technology product projects, across various verticals. Proven track record in robust Technology Product Requirement Gathering, Epic Ownership, Use Story and Acceptance Criteria creation, Development, User acceptance testing (UAT), Delivery and ongoing product support across various cross functional technologies and platforms. Leveraging the latest methodologies and frameworks for delivery, served as Lead and a Coach to support the delivery of technology Products to market through agility and customer first thinking.

●19+ years of Healthcare Revenue Cycle Management (RCM) in the Pharmaceutical, Medical and Government Insurance Domain.

●17+ years of Healthcare Billing (Claim Adjudication) experience

●12+ years of Face-to-face. Management Experience in a healthcare setting.

●8+ years of Owning and Operating Healthcare Billing Companies.

●6+ years of Agile and Hybrid Healthcare Business Analysis and Product Delivery.

Languages

Urdu, Hindi, Punjabi, French and Moderate in Spanish

Certifications

Licensed in Life and Health Insurance in all 50 States

Skills

Modeling, Design Road mapping MS Visio, Lucidcharts, Draw.io, Creatly, Figma, AirTable

BI Reporting Tableau, Splunk, eazyBI, Power BI

Delivery Management Jira, Confluence, Jira Align, MS Project WorkBoard, Trello, Azure DevOps

Technologies MS Office 365, Excel, PowerPoint,L SQL, HTML, CSS, JavaScript, VB

EDUCATION

New York City College of Technology – City Tech

2001 - 2007

Bachelors in Computer Information Systems (CIS)

Networking/Data Warehousing/Web Design

WORK EXPERIENCE

HCSC – Blue Cross BlueShield of TX [Sr. Business Analyst]

July 2022–June 2023

Led the fully AGILE end-to-end SDLC cycle and business process workflows for 4 different major work streams as part of a huge “Cost Share Estimate Tool” (CSET) project, resulting in 35% increase in efficiency and 100% adherence to CMS & HCSC best practices. Went from supporting 500 Billing codes (CPT, HCPCS, ICD-10, DRG) to the full 20,000 for 2024.

●Created the Business Requirement Document (BRD) with detailed Executive Summary, Project Objectives, Scope, Business Requirements, Key Stakeholders, Project Constraints and Cost-benefit Analysis.

●Created and owned Epics on Jira with High level Business need, Impacted Products, Features, Product modifications, Success Criteria, IT Dependencies and Constraints.

●Used MS Visio, MS Excel and MS PowerPoint decks to present Solutions to Business for approval.

●Facilitated meetings with cross functional teams to create User stories on Jira to solution for the linked Epics. Followed up with all products and participated in several cross functional Daily Stand ups (DSU) and JAD sessions for Sprint planning in order to meet deadlines.

●Tracked the work in the backlog and used Jira for the creation of dashboards related to each workstream.

●Resolved issues such as Change Requests related to requirements during system testing and UAT plan preparation.

●Assisted QA’s and Devs with UAT based on Requirements Document and helped prepared the Test Cases.

●Groomed and refined all Dependencies, Assumptions, Testing notes and additional Rules for Acceptance Criteria in all Functional and Technical User Stories.

●Handled Scope creep and de-scoping of several Epics and workflows as needed to meet Regulatory Requirements by CMS before Deadlines.

●Efficiently and simultaneously supported multiple workstreams by prioritizing, managing and executing effectively with compressed timelines.

Workstreams

1.Finished Migration to Pivotal Cloud Foundry (PCF) with Resiliency shared on two, Azure North Central & South Central, accounts and Disaster Recovery in place for the third one to meet GOLD standard. Delivered full Migration with keeping Infrastructure and Security in place and Eliminated Downtime in case of Disaster.

2.Implemented Enhancements to current Member Benefits API’s as a Long-Term solution. Leveraged Legacy system data on

Enterprise Data Warehouse (EDW) to predict volumetric Data of Member Traffic for Annual Enrollment Period. Increased scope of API and avoided cost of extra servers by using current Infrastructure. Kept MuleSoft in place and avoided having to invest in other API Gateways. Worked with Load Balancing team to go from supporting 500 Billing codes (CPT, HCPCS, ICD-10, DRG) to the full 20,000 for 2024.

3.Internally Leveraged Dental, Vision and Pharmacy Benefit Tools to be used to meet the new Transparency Mandate set forth by CMS. Created several Epics on Jira and handed them off to all Ancillary divisions, with Requirements, to meet the new standards. Ultimately Saved the company 100’s of thousands of dollars by leveraging existing tools.

4.Automated and Managed Reference Data Files by coordinating with Ingestion and Consumption teams on Reference Data Management (RDM) Platform to reduce time spent on Manually entering Client Demographic data. Improved on resource constraints we were currently experiencing with the manual process.

HCA Healthcare of TX [Sr. Business Analyst]

July 2020–March 2022

Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle, gathering Business Requirements, as part of the Business Requirement Document (BRD), from stakeholders to set Priority Level, Critical Level and Requirement descriptions from stakeholders for Provider Management and Member Claims management enhancements.

●Managed Modification and Maintenance Service Requests through the stages of Initial Review, Analysis, Design, Build, Product Test, User Acceptance Testing and Deployment.

●Established project plan and timelines in MS Project.

●Modeling the ‘as-is’ and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.

●Worked with legacy team to use Jira for creation of User Stories, Acceptance Criteria, Business Rules, Dependencies, Assumptions and Testing notes for requirements. Followed up with Developers and participated in system testing.

●Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.

●Extensively interacted with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations. Collaborate with business stakeholders from time to time to update deadlines for a particular sprint in a project.

●Connected with team members for problem solving and find the problems they are facing and create Teams meetings to address the situation and find solutions.

●Ensured that all teams have required accessibilities on Jira for each project and find alternatives and address their problems meet deadlines.

●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.

●Worked on Claims processing system.

Workstreams

1.Assisted the Data Analyst in finding gaps on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes. Managed Denials by working closely with my Data Analyst with Determining Patient data accuracy, Eligibility checks, Correct coding (ICD10, CPT, HCPCS and DRG), Formulary checks, Benefit levels, and Pre- Requirement screening such as Prior Authorizations, Tried and Failed, Step therapies and Concurrent Reviews. Interacted with pharmacy and hospital claims from 3 major PBM’s (CVS Caremark, Express Scripts and Optum Rx).

2.Made Enhancements to the Provider Enrollment Portal. Implemented additional Specialties to the drop down and created a 2 step Authentication for security saving Providers time and securing Portal.

Cardinal Health of OH [Jr. BA/Business System Analyst]

March 2018–April 2020

Joined as a Jr. BA shadowing Business Systems Analyst for gathering, documenting and verifying business requirements across two projects. Supported Migration of Cobalt to Facets and Enhanced Cardinal Health Nurse’s Portal.

●Developed, coordinate and support Information Technology Division on all operational requirements of FACETS claims processing system and production management.

●Supported Migration of Cobalt to FACETS and tested full Healthcare Revenue Cycle Management from Patient data accuracy, Eligibility checks, Correct coding (ICD10, CPT, HCPCS and DRG), Formulary checks, Benefit levels, and Pre- Requirement screening such as Prior Authorizations, Tried and Failed, Step therapies and Concurrent Reviews.

●Involved in the meeting with Business Process Owners, SME (Subject Matter Experts) and store users for Requirement gathering in Definition Stage.

●Assisted in developing Project Proposal, Business Case and Business rules.

●Gathered business requirements from stakeholders and translate them into detailed requirement specifications.

●Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted.

●Used SDLC (System Development Life Cycle) methodologies like the Agile and the waterfall. The role was Hybrid

●Prepared Business Requirement Document based on Waterfall approach and then broke it down into User stories through Agile Methodology on Jira.

●Analyzed Business Requirements and segregated them into high level and low-level Use Cases, Activity Diagrams/State Chart Diagrams (UML).

●Worked in design and development of Project document templates based on SDLC methodology. Templates were saved on SharePoint and were to be converted to Jira.

●Helped with data modeling and defining the conceptual and logical model of the data warehouse.

●Work with architects and Business Analyst to design SRS.

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

●Maintained Requirement Traceability Matrix.

●Analyzed Business Requirements and segregated them into high level and low-level Use Cases, Activity Diagrams/State Chart Diagrams (UML).

●Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.

●Created Process Flow diagrams, use case diagrams (UML) using MS-Visio

●Prepared wireframe and web layouts for the application.

●Prepared Test Strategy, Test Plan, test report and Gap Report.

●Performed UAT based on Requirements Document and prepared the Test Cases using Quality Center.

●Maintained Traceability Matrix in Excel.

●Used MS-Visio analyzed business requirements and process through Use Cases, Class, Sequence, and Activity diagrams, and adapted UML standards to define modularized Data Process Models.

●Developed a Business Acceptance testing strategy and plan.

●Created test files and analyzed test results using MS-Excel.

●Coordinated and facilitated the execution of User Acceptance testing.

Prescription Billing Inc, NY

September 2017- February 2018

Automated our Billing Preparation by hiring a developer to save time.

●Created Business Requirement Document by naming requirement and turning it into User stories for testers and developers.

●Elicited requirements ensuring they were current and accurate for Prior Authorization process.

●Registered with Jira and Confluence on Atlassian to create User Stories, hold Sprint planning, managed my own backlogs, created and groomed acceptance criteria with developer, assisted in UAT testing and deployment.

●Worked on EDI 856 ASN (Advanced Ship Notice) set up in regulation with the Drug Quality and Security Act (DQSA) and made sure it was in compliance.

●Worked on EDI 850 set up to order inventory for clients by replacing the traditional process of ordering Pharmaceutical inventory via email.

●Used Microsoft Team Foundation Server (TFS) as a ticketing tool

●Responsible for Medicare Part D, Medicaid, Private Insurance Claims Resolution/Reimbursement for state health plans Using Micro Merchant Systems, Prime Rx.

●Involved in integration of FACETS with legacy and third-party vendor applications like CoverMyMeds for Initiation of Prior Authorizations

●Analyzed and document Medicaid EDI transactions issues related to implementation of HIPAA 5010 and ensure these issues are documented and addressed in the approach to the HIPAA 5010 version.

●Worked on SSRS reports and Workflow set up for the purpose of client reporting.

●Involved in multiple launches of physician portals by understanding the end-to-end business needs and structure of the portal to deliver the precise product.

●Involved in conducting GAP analysis to understand the AS-IS and TO-BE requirement documents.

●Supported full Revenue Cycle Management from Determining Patient data accuracy, Eligibility checks, Correct coding (ICD10, CPT, HCPCS and DRG), Formulary checks, Benefit levels, and Pre- Requirement screening such as Prior Authorizations, Tried and Failed, Step therapies and Concurrent Reviews.

Previous Employment History

●2+ years of owning and operating a Specialty and Compound Drug Billing Company (SCB) with my brother.

●2+ years of Compound Billing Specialist at NuCare Pharmacy

●3+ years of Managing Pharmacies in Brooklyn, NY

●2+ years of Assistant Management of Pharmacies in Brooklyn, NY

●3+ years of Pharmacy Technician

Contact this candidate