PROFESSIONAL EXPERIENCE:

●About *+ years of diversified experience in Healthcare and Insurance IT industry.

●Expertise in Project Planning, Project Design, creating functional specifications and data flow diagrams.

●Extensive experience as Business Analyst in the Healthcare Industry with expertise in Affordable Care Act (ACA), HL-7, EDI Transactions (834, 835, 837), HIPAA, MMIS, and Medicaid and Child Welfare.

●Experienced in business process flows, business process worked with executives, developers, and end-users to define the exact requirements.

●Odeling, case tools, business analysis, gap analysis and organizational change management.

●Experienced in conducting sessions and Solid understanding of Membership, Claims Processing, Billing, Benefit/ Eligibility, Authorization/ Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions (837, 834 and 820).

●Knowledge of health care services regulatory environment in compliance with HIPAA, ICD, MITA, MMIS.

●Knowledge on Medicaid, MMIS, HIPAA EDI transactions 278, 820, 834, 835, 837, ICD-9, ICD-10, HL7, HMO, PPO, ANSI X12 Procedural and Diagnosis codes.

●Used Microsoft SharePoint as a Web-based Content Management System as well as a Document/ Project Management tool.

●Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrolment).

●Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/ Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HER, HIX, Medicaid, CDHP (consumer driven health plans)

●Ability to develop business rules, context data flow diagram, entity relationship diagram, workflow diagramming, prototyping and document current state, gaps and future state processes.

●Experience in multi-tasking such as managing numerous simultaneous projects with great attention to detail.

●Experience in solution assessment, validation and applying critical thinking for problem solving approach.

●Experience in Requirements elicitation techniques like conducting user interviews, document analysis, JAD sessions and managing the requirements.

●Comprehensive knowledge of Software Development methodologies (SDLC) such as Waterfall, Agile, Spiral and Scrum.

●Create various documents like the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), and Systems Design Specification (SDS).

●Good Knowledge of software and applications designing tools for the preview of the project at the very beginning.

●Analyzed different types of Risks such as Credit Risk, Market Risk etc. and developed the test scripts with all these parameters to analyses the securities.

●Worked closely with project Stakeholders, SMEs, PM, to understand, analyze, document, validate, and review the requirements and specifications for new applications along with enhancements to the existing applications.

●Efficient in writing Business Requirement Document (BRD), Functional Specification Document (FSD), Use Cases, User Interface Specifications (UIS), System Requirement Specification (SRS) and Report Specifications Documents.

●Skilled in translating business requirements and user expectations into detailed specifications and building business process flow charts using MS Visio and Enterprise Architect to communicate project functionality to the development team employing designing techniques like OOAD and Unified Modeling Language (UML).

●Sound proficiency in analyzing and creating, Use Case Diagrams, Sequence Diagram, Activity Diagram, Data Flow Diagrams, Business Flow Diagrams, Wireframes and Mock-ups using MS Visio and Rational Rose to communicate business and functional requirements to clients and developers.

●Performed AS-IS and TO-BE business process flow for clear translation of Functional to system requirement specification.

●Support the Test Team and the rest of the Development Team in compliance related issues while working with them in the development phases of the projects.

●Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow and Business Process Modelling and Data Mapping.

●Extensive working experience on Medicaid and MMIS projects.

●Capable of managing multiple projects simultaneously

Technical Skills:

Modeling Tools

Unified Modelling Language, MS Visio, Balsamiq

SDLC Methodologies

Waterfall, Waterfall Scrum Hybrid, Agile

Business Skills

Process Modeling, GAP Analysis, Impact Analysis, SWOT Analysis, JAD Sessions, Project Scheduling

Requirement Management

JIRA, MS Office, Confluence

Document Processes

UML Diagrams, Use Cases, BRD, FRD,

Testing Tools

Postman, Swagger

ETL Tools

Informatica PowerCenter

Databases

SQL Server

Domain Knowledge

HIPAA, Medicaid, Medicare, Claims Management, EDI Transactions, HL7, HIX, EMR/EHR, PPO, HMO, POS

Operating Systems

Windows XP/7/10

PROFESSIONAL EXPERIENCE:

State of Tennessee, TN Nov 2022to till date Business Analyst

Description:-Relative caregiver helps support relatives who have taken on the responsibility of raising children of relatives when the biological parent is unable or unwilling. Functionality for this project includes determining eligibility for relatives, creating the appropriate stipend records, and authorizing payments/subsidy for the relative to offset the cost of care.

Responsibilities

●Collaborate with Business to document the TFACTs enhancements and modifications to meet the end-state requirements.

●Preparing Screen specification documents and Mockup using Visio and Axure

●Documenting and Refining the User stories with the teams using JIRA

●Elicited requirements using a variety of techniques (e.g. JAD, interviews, and documented and translated into Epic and Userstories

●Listed down the Epics after completion and submitted to the client to get approval

●Communicating and clarifying the requirements to the development and testing teams and closely working with the teams to ensure the project is on track.

●Tracked the requirements for completion and validating requirements using Backlog Management Document(Requirement Traceability Matrix (RTM)

●Performing UAT Testing on the product end to end

●Making sure all the defects are fixed by collaborating with the Team and retesting the product before Go Live

●Helped with developing presentations for internal team or for the customer. Solicit input from others and pull information together to create a professional presentation.

●Developed test plans, coordinates and conducts user acceptance and integration testing of solutions to ensure they requirements before deployment to production

●Worked on requirement gathering and creating functional solution design to address business process, interface and performance requirements.

●Worked with business and IT teams to ensure all issues are resolved quickly.

Environment: MS Office Suite, Visio, Axure,Jira, Agile Environment, Microsoft Teams

Molina Healthcare, CA June 2021 to Sep 2022 Business Analyst

Description: This was an acquisition project, the Project was an asset purchase acquiring the Medicaid Business serving around 48K Members in three regions with an additional 2k members in MMP this expands Molina's existing Medicaid in 3 new regions. Pursuing assignments of non-overlapping provider contracts and a volume of FTEs will transition to Molina in support of the business.

Responsibilities

●Defining scope of the build or project with Business Architects and PMs

●Interact with the technology team and help them understand the business aspects of the solution

●Communicate and clarify the requirements to the development and testing teams. Coordinate closely with the teams to ensure the project is on track.

●Experienced in performing Gap analysis by identifying existing technologies, and documenting the enhancements to meet the end-state requirements.

●Ensure accurate flow of client ask, information from product managers Product owners to develop error free stories for development

●Supported in deploying and.Creating cross-functional teams that have a unified mission and aligned with applications in Azure DevOps environment.

●Worked on DevOps using automation to follow a regular, iterative flow to push out features to achieve continuous delivery through a shorter cycle

●Ability to take the functional grooming output and translate into stories that can be consumed by construction teams.

●Requirement gathering, analyzing conceptualizing business, and user functional requirements for an airline loyalty program.

●Experience with working in Agile teams and developing Epics and user stories

●Facilitate dependencies, risks and issues across team utilizing scrum of scrum techniques for effective migration

●Dedicated to handle enrollment 834 and payment 820 files across different LoB”s( Medicaid and MMP)

●Participated in daily scrum meeting calls

●Analyzed different Data crosswalks, and complicated logic lookups required by different fields for the source to target transformations.

●Tracked, validated and communicated requirements using Requirement Traceability Matrix (RTM)

●Agile exposure and experience working on JIRA

●Performing basic level of acceptance testing

●Ability to work with business to translate requirements into stories

●User Stories writing experience (ability to translate requirements into actual stories) from the Epics

●Document requirements, system analysis and project documentation such as BRD, Business Process Mapping and functional workflows

●Knowledge of requirement gathering, estimation, planning, assisting in execution activities, creating documents and involved in client interactions.

●Author and system requirement documents in order to solicit approval.

●Conduct focus group meetings with external senior managers

●Functional Knowledge of Medicaid Management Information System MMIS.

●Knowledge and Experience on Membership Enrollment, Billing, Claims Payment

●Processing in relation to HIPAA, EDI, 5010 X12, ICD-10 codes 834, 837,835, and 270, 271 transactions.

●Exposed to Medicare and Medicaid domains of the healthcare systems

●Strong working knowledge of the 834,820, & 835 EDI Healthcare files and Transactions

●Participate in JAD session to understand the existing and New Business requirement and documents the respective design specification for 834 processes.

●Assisted in the development of user documentation.

●Analyze the source data to the target Database

●Review Test cases and perform Functional and User Acceptance Testing.

Environment: Agile, MS Visio, FACETS, EDI X12, HIPAA, UML 2.0, MS Office Suite, MS SharePoint, Test Director, UML, ETL, SSIS, SQL, Rational Requisite Pro, Informatica, JIRA, Rational ClearQuest, SSIS

State of California, CA Oct 2019-June 2021

Business Analyst

Description: My Turn is a platform that allows Local Health Jurisdictions and providers an all-in-one application for public eligibility, public scheduling, clinic management, dose administration, and reporting and walk-in registration for vaccine clinics.

Responsibilities

●Worked on the Program Enrollment page to review and complete all the steps before onboarding the organization onto the application.

●Worked on creating Clinic scheduling and new user forms.

●Negotiated and liaised between business teams, technology teams, and support teams and interacted with providers to set up the clinic.

●Worked with Providers to analyze and validate their requirements Gathered information regarding their Vaccination Program, assess, and interpret business needs. Organized and facilitated meetings with key internal stakeholders and Providers

●Coordinated with the teams to achieve deadlines timely and proficiently.

●Working in an Agile environment, with demonstrated ability to clearly articulate Epics,User Stories and Conditions of Satisfaction to development teams

●Manage project through status meetings with the scrum team, weekly reports, identifying risks, and tracking issues

●Worked on snow tickets to track down the issues.

●Analyzes and researches system problems, coordinating with the necessary parties to track them to resolution

●Provides ongoing internal and external customer support for system questions and problems

●Performs business support responsibilities, including clinic setup, and ad-hoc reporting.

Environment: MS Office Suite, Salesforce Service Now, Agile Environment, Microsoft Teams

Health first, New York, NY Dec 2016 to Sep 2019

Business Analyst

Description: The project was to incorporate the changes proposed in HIPAA 5010 and upgrade the system from HIPAA 4010 to HIPAA 5010 so that the system would be in accordance with the new standards mandated by Health Insurance Portability and Accountability Act (HIPAA). I was involved in analyzing the impact due to changes in length, type and values on present system of 834 & 837 transactions along with preparing for the changes in the present system. I was involved in validating and testing the XML files for various EDI transactions. I was also responsible for creating EDI Export & Import processes. I was involved in test planning during multiple builds and to ensure defect management process was being followed.

Responsibilities:

●Validated basic SQL scripts to verify the application CRUD operations on database using MySQL

●Generated UML Diagrams mainly, Use Cases, Activity Diagrams, and Sequence Diagrams to define the interactions between the user and the system using Microsoft Visio

●Coordinated with the Web Services team in documenting requests and responses for the REST Web Services in JSON. Manually tested and executed the Web services using Postman and helped the QA team in automation

●Supported the team in designing the Test Strategy, Test Cases, and Companion Guide from the development stage to the production stage including internal requirements and external requirements

●Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the business Processes.

●Conducted Risk Analysis and Impact analysis whenever there is any change in the business requirement and proposed solutions while continually updating the business requirement document.

●Conducted JAD sessions and ultimately reducing the time spent in moving all the information from stakeholders and other team members.

●Experience working in cross functional teams including User Experience, Design and Development

●Working using Team Foundation Server for Agile Software Development and work item tracking

●Created and updated data mapping document(s) with reference to the source for 270/271 (Eligibility & Benefit Inquiry & Response), 276/277 (Claim Status Inquiry & Response) and 837 (Health Care Claim).

●Conducted Gap Analysis to analyze the client’s applications programs to determine the impact of HIPAA final on EDI transaction set and defined the changes to bring the affected systems into HIPAA compliance.

●Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).

●Utilize Team Foundation Server and build different phases of software developmental cycle.

●Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transaction.

●Knowledge of the software system and the programs.

●Developed and executed UAT test cases, UAT test Scenarios using HP ALM/Quality Center and followed-up defects using JIRA.

●Created architectural styles such as application architecture, enterprise architecture, and service-oriented architecture with the help of Service -Oriented modeling (SOA).

●Performed Requirement Tractability Matrix (RTM) to track and maintain stakeholders requested requirements and changes.

●Worked with EDI Team for Data Mapping and Building 837 Maps.

●Apply UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.

●Analyze EDI data elements captured by the existing system to validate it against the data elements required for new system.

Environment: Hybrid, MS Project, MS Excel, MS Office, MS Visio, FACETS,JSON, EDI, HIPAA, FACETS, UAT, Team Foundation Server, UML, SQL.

Centene Corp, St. Louis, Mo Mar 2015 to Nov 2016

Business Analyst

Description: The scope of the project was to integrate different sources and create a centralized Data Warehouse with data marts to improve analytical performance, financial surveillance, budget allocation, expenditure tracking and reporting.

Responsibilities:

●Interacted with business users, stakeholders, SMEs and evaluated solutions for problems.

●Worked as a Scribe during JAD sessions, conducted surveys and review meetings to document feedbacks, performed document analysis and facilitated brainstorming sessions to elicit requirements

●Created BRD, FSRD, SRS and the Source Target Mapping Document (STMD).

●Performed GAP analysis, root cause analysis, impact analysis.

●Designed Use Cases and UML models using MS Visio and also created Use Case diagrams, Sequence diagrams, Activity diagrams and Class diagrams.

●Actively participated in Sprint Planning meetings, Daily Scrum meetings, Product Backlog Refinement meetings, Sprint Review meetings and Sprint Retrospective sessions and updated the artifacts using JIRA.

●Assisted the team and the Product Owner to translate requirements into User Stories.

●Validated requirement churns after sprint review meetings based on the feedback obtained from Product Owner, business users and the stakeholders involved.

●Assisted Database team to create several database objects such as tables, views, procedures and joins using PL/SQL.

●Identified various source systems, type of data and created Data Flow diagrams,

●Worked with testing team to design and develop Test Plans, Test Strategies and Test Cases to perform UAT, GUI testing, Functional testing and Fuzz testing.

●Created the Data Dictionary and developed conceptual and logical Entity Relationship (ER) diagrams using Visio.

●Assisted in the implementation of Data Warehouse with data marts using Informatica PowerCentre for ETL process.

●Analyzed and designed the new Data Mart models using Star Schema model.

●Performed Data Mining in existing data and constructed SQL queries.

●Created dashboards, visualizations and reports using Tableau and Ms Excel.

●Assisted in increasing Data Integrity and improving data quality by performing Data Normalization and invoking rigorous data verification and validation.

●Assisted Project Manager in developing timelines for project delivery.

Environment: Waterfall-Scrum (Hybrid), MS Project, Ms Office tools (Word, Excel, PowerPoint) MS Visio, Bugzilla, MS SQL 2008, Oracle 9i, Tableau 7.0, Informatica Platform 9.5

EDUCATION:

Bachelor’s in science, Osmania University, Hyderabad, India

Master’s in science, Osmania University, Hyderabad, India

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