Scrum Master Health Insurance

Rahul Bhati

Summary:

● **+ years of experience in the Government contracting and Healthcare Industry with extensive requirement gathering for custom solution in the cross functional areas like PBM and Health insurance

● An experience as a Sr Business System Analyst and Product Management technical, analytical and best practice methodology (Agile) skills.

● Experience in providing monthly reporting to executives for forecasted opportunities and risks to the long-range business plan and presented mastered reporting and forecasting techniques as well as created a forecasting model in Excel.

● Gathered requirements and created process flows for future Med D web portal after different JAD sessions with stakeholders.

● Responsible for the full HIPAA compliance lifecycle life cycle from gap analysis, mapping, implementation and testing for processing of Medicaid and Medicare Claims.

● Developed “As-is” and “To-be” business process models.

● Transformed the business requirements and solution into Project Charter, Client Requirements Document (CRD) Conceptual Design Document/Functional Specifications (FSD) and Software Change Request Documents.

● Collaborated with Supervisor, Subject Matter Experts, and Product Managers to find the best approaches to address the client’s requirements.

● Experience in create new Power BI dashboards and reports to modernize business intelligence (BI).

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

● Expertise in Test driven development & Unit testing methodologies for performing UAT System Integration testing (SIT), BAT (Business Acceptance Testing).

● Experience in delivering application lifecycle tracking tool, within modified project timelines and within budget.

● Instrumental in identifying gaps, bringing matrix teams together to crosscheck review potential interdependencies and priorities.

● Proven experience in User Acceptance Testing.

Skills:

● Technologies: Microsoft .Net, Web Services (SOAP, WSDL, UDDI), J2EE

● Environment Languages: Visual C#, Visual Basic, JavaScript, HTML, DHTML, CSS, XML, XSL, XSLT

● App Server: Microsoft IIS 7.0/IIS 6.0/IIS 5.0, Microsoft Server 2003, Windows NT, Mainframe

● Databases: MS SQL Server 2008/2005/2000, Siebel, MS Access, Oracle 11i/10g/9i, MySQL, DB2

● Tools: Sybase Power Designer 15, Visual Studio 2008/2005, MS SharePoint 2007, iRise, Telelogic DOORS, Rational Suite (RequisitePro, ClearQuest, ClearCase), Rational Rose, Axure Pro, Blueprint, eClinical, Remedy

● Applications: MS Office 2013 Suite, MS Project, Lotus Notes, MS Outlook, MS Visio, VMware, FileNet P8,

● Others: Agile Practices, SQL, Cyber Security, Automated Testing, Gap Analysis, Documentation, GUI, Informatica Power Center, Power BI, SharePoint, MS Suite

Education:

● MS-Environmental Engineering. University Of Southern California (Graduated)

Certifications:

● Certified Scrum Master (CSM), Scrum Alliance

● Certified SAFe 5 Scrum Master, Scaled Agile

Professional Experience:

11/2021 – 02/2024

Cognizant (Client: Centene)

Business Analyst/Scrum Master

● Project: Worked on AZ North Migration for Eligibility and Auto Provider Assignment (PAPA) Projects.

● Served as a liaison between the internal/external business community and the IT organization using Agile methodology in order to provide technical solutions to meet user needs throughout the SDLC.

● Performed gap analysis and documented the current state using process flows and swim lane diagrams. ● Checked member records coming from different sources (834, Softheon, Market prominence).

● Follow up on questions related to PAPA stories in backlog and get answers from the product owner. ● Create or add new details to agile stories to create or add new content.

● Performed UAT testing for the eligibility files received in queue.

02/2021 – 11/2021

Premera Blue Cross

Business Analyst

● Project: Enterprise wide need to update the PBM efforts with current PBM Express Scripts, this project is focused on re platforming Express scripts to update the data exchanges, incorporate seamless Business between Carve outs and Carve ins like Amazon and Microsoft, Major systems were updated like small groups, CDH, FACETS and improved the interfaces.

● Served as a liaison between the internal/external business community and the IT organization using Agile methodology in order to provide technical solutions to meet user needs throughout the SDLC.

● Facilitated team organization and ceremonies such as sprint planning, daily stand-ups, sprint/iteration, reviews/demos, and retrospectives.

● Trained a development team of 5, 3 developers and 2 QA members to utilize Agile methodology with Scrum.

● Developed training materials and execute training for basic Agile/Scrum concepts and terminology, and advanced role base training (Product Owner, Scrum Master, Team Member, etc.).

04/2020 – 02/2021

Florida Blue

Sr. Business Analyst/Scrum Master

● Project: Supporting CMS vendors for onboarding and enrolling new members for the Medicare Supplement Programs and Medicare Advantage Programs. This project was to onboard a new vendor BSwift partnered with CMS for EGWP plans.

● Functioned as a liaison between Production Technology, Account Management teams and business clients in gathering, defining and understanding client’s needs.

● Facilitated Scrum related meetings, Sprint planning, Daily Scrum, Pre-Grooming, Grooming, Sprint Review, and Retrospective sessions.

● Worked on creating data mapping from the current Sapphire to future BSwift.

● Created and made changes to new enrollments in Sapphire application.

● Provided support for BSwift as a new vendor for Enrollment.

● Used Rally to create user stories for Medicare/BSwift EGWP plans.

● Worked on creating Discrepancy file based on the audit file.

● Was actively involved talking to stakeholders making changes for the new 834 EDI companion guide.

02/2019 – 11/2019

FEP BCBS

Sr. Business Analyst/Scrum Master

● Project: FEP is a specific plan for Federal employees program which interacts with all the blues in different states, this project was a modernization of legacy systems to send the claims as standardized 837 as compared to the company specific FCRs.

● Functioned as a liaison between Production Technology, Account Management teams and business clients in gathering, defining and understanding client’s needs.

● Supervised all ceremonies including sprint planning, sprint retrospective, sprint demo, daily stand ups. ● Tracked and managed product backlog, burn-down metrics, velocity, and task breakdown.

● Developed and implementation of Agile, Scrum, best practices and processes.

● Scrum key activities – Backlog grooming, story jam, story mapping, iteration planning, release planning, daily standup, retrospectives, and iteration demos.

● Conducted Scrum meetings and updated Burn down chart with the progress of each SPRINT.

● Updated Agile tracking systems to provide transparency on product, team progress and sprint backlogs.

● Used Jira to maintain the backlog, create and monitor sprints, create reports such as the sprint burn down, maintain capacity, and receive updates as the team write history into the work items.

● Coached the team in adopting scrum/agile framework, principles, and practices while assuming scrum master duties.

● Provided support for FEP Next Gen Project moving from mainframe systems to B2B ITX so as to standardize the FCR to standard 837 claims.

● In depth knowledge of Claims processes from Payer side which were later part of the training program to vendors. ● Worked on Archival Error handling in the new system and global error handling.

● Created stories in Jira for Batch summary, exception handling and load balancing. Worked as a data analyst to create mapping documents for Trans Audit Tables, created routing logic flows for Pend/Denied claims and groomed the stories with the team.

● Wrote simple queries against facets Database for troubleshooting errors.

● Created Claim process flows in Facets.

● Performed UAT requirement analysis.

● Created and executed UAT scenarios.

● Participated in review meetings to capture defects not captured before UAT testing.

● Integrated Facets with ETL tool Informatica.

● Prepared and maintained technical documentation including flow charts, models, and procedures, user guides, scorecards and reporting to assist with the ongoing operation and maintenance of technology solutions.

● Created new stories for development and assisted testing team to create test cases.

05/2016 – 12/2018

Northrop Grumman Corp

Business Solution Consultant/Scrum Master

● Provided support for Benefit Rate Increase (BRI) and made all necessary changes/modifications as requested by representatives from Office of IT Programmatic Business Support (OITPBS).

● Worked extensively with the Product Owners throughout the process answering their questions and explaining to them the functionality created by the development team.

● Worked extensively with the development team creating the user interface forming a bridge between them and the development team creating the backend database and system functionality.

● Worked with the technical writer to produce detailed and accurate documentation explaining all the various aspects of the software application being developed.

● Assisted with writing test cases and executing them for UAT testing.

● At the end of a Sprint, during Sprint Review meeting made presentations to the Product Owners displaying actual functionality created.

● Coordinated with Developers and DEVOPS working on different functionalities and provided them key information they required to finish their User Stories.

● Participated in Supplemental Medical insurance (SMI) separation from BRI Kick-Off meeting. Participants included representatives from SSA and Northrop Grumman.

09/2015 – 02/2016

Xerox Inc

IT Business Analyst

● Project: Strataware is a proprietary bill review software known in the industry. Strataware helped their Client Liberty Mutual to convert 3 years of Billing History from their current bill reviewer Coventry. The main goal would be to successfully load all the bills in Strataware without duplication and supporting old bills and closed bills in the past. As a Business Analyst I functioned as a liaison between Production Technology, Account Management teams and business clients in gathering, defining and understanding client’s needs.

● Functioned as a liaison between Production Technology, Account Management teams and business clients in gathering, defining and understanding client’s needs.

● Worked with different modules of Strataware-Smartcoder, Smartview, Pathways, Pricing.

● Create new Power BI dashboards and reports to modernize business intelligence.

● Involved in data mapping from Coventry to Strataware, applied business rules for the conversion processing.

● Created a list of new fields added moving forward with new client Liberty Mutual not in the Strataware layout from different FSDs.

● Created and executed test cases and review test cases and created Requirement traceability matrix ● Created Pathway Vocab rules t in Pathway module.

● Created Bill History Conversion FSD for Strataware and Liberty Mutual.

● Investigated old bills and created new bills to understand the system in Strataware.

● Transformed the business requirements and solution into Project Charter, Client Requirements Document (CRD) Conceptual Design Document/Functional Specifications (FSD) and Software Change Request Documents.

● Collaborated with Supervisor, Subject Matter Experts, and Product Managers to find the best approaches to address the client’s requirements.

● Involved in the HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing

04/2015 – 07/2015

Laureate Inc.

Business System Consultant

● Project: Laureate did an enterprise wide major Business Intelligence migration including IT Infrastructure for this project called Laureate 1. In this capacity, I was responsible for defining the scope of various projects, communicating with customers, liaising with the development teams, and project management from inception through completion for the LHEG properties.

● Established priorities and foster strong relationship with the business.

● Provided a concise specification of customer’s project requests.

● Monitor database used to track placements.

● Assisted with system and UAT testing with other BAs in the team.

● Facilitated optimization of revenue by monitoring daily reports.

● Provided sales force profitability analyses; forecasted returns by lot and owned daily sales report submission to executive leadership.

● Developed Procedures manual for tracking placements.

● Properly represented project status in the BI Project Tracker.

● Understood Fixed Income, Bonds and Bond Trading Cycle, Equities and Equity Trade Cycle, Derivatives (Options and Futures), Portfolio Management, Wealth Management, and Sales and Marketing.

● Involved in updating user stories after talking to different stakeholders within Sales, Marketing, and Enrollment etc. ● Worked closely with Tableau developers to create views and dashboards.

04/2014 – 12/2014

Catamaran Inc.

Business System Analyst

● Project: Worked as a Business Analyst on Med D requirements for Eligibility migration from CMS and Independence Blue Cross to Highmark’s provider portal, and claims system implementation.

● Involved in gaining understanding of Med D Portal on Catamaran side and building process flows.

● Involved in meetings with Independence Blue Cross, Highmark and Catamaran stakeholders for B2B discussions and Eligibility testing files.

● Prepared requirements for charter and understanding the process of Med d flows related to Claims and Accumulator. ● Involved in preparing FTP document for file transfers.

● Worked with software developers to specify and implement improved reporting capabilities for Independence BCBS Med D web portal using the agile SDLC.

● Gathered requirements and created process flows for future Med D web portal after different JAD sessions with stakeholders.

● Worked on checking Eligibility files and updating the file with new coverage codes and assisting testing of Eligibility file. ● Identified gaps in daily extracts on both platforms by data mapping, Excel.

● Captured Data flow diagrams and formatting of the data flowing modeling through interfaces.

● Collaborated and participated with all interrelated teams including project management, development, QA, support, training, technical, and infrastructure teams as appropriate.

● Worked as team JIRA administrator providing access, working assigned tickets, and teaming with project developers to test product requirements/bugs/new improvement.

● Created technical documents documenting JIRA project configurations.

● Prepare unified business process maps to show the common functionality in both the platforms. ● Participated in customer weekly JIRA progress updates.

04/2013 – 12/2013

CareFirst BCBS

Business System Analyst

● Project: Argus system will no longer support prescription claim adjudication for CareFirst’s different lines of Business (Small, Mid, Large groups and Med D). Therefore, CareFirst BCBS will need to convert from Argus to CVS Caremark as the new Pharmacy Benefit Manager (PBM) for CareFirst Rx and MMRX plans. NASCO had all the large groups and mid-size and small groups were in FACETS.

● Served as a liaison between the internal/external business community and the IT organization using Agile methodology in order to provide technical solutions to meet user needs throughout the SDLC.

● Translated business requirements into functional specifications for the IT organization for NASCO large groups, managed changes to such specifications in SDLC.

● Responsible for managing the SDLC documentation on 4 concurrent projects.

● Used the HP ALM tool for putting the requirements and maintaining traceability.

● Gathered information about the organization’s work processes and information flows for NASCO & FACETS.

● Documented existing process in technical model format in order to evaluate and define new IT solutions and implementation processes in SDLC.

● Worked on Medicare Part - D

● Used swim lane diagrams and context flow diagrams during gap analysis.

● Supported several simple to moderately complex business processes.

● Investigated and analyzed feasibility of low to moderately complex enhancements, automations and processes.

● Analyzed, defined and interpreted business needs and issues by gathering, analyzing, documenting and validating the Business area(s) and user(s) technical (functional/non-functional) requirements.

● Participated in the creation of complex PRD (Project Requirements Document) which includes defining Business, User, functional and non-functional requirements needed for approval by Business and for use by Design, Development and Testing teams.

● Participated in creation of Requirements Management Plan (RMP) for complex projects and created RMP for less complex projects, to define, organize and schedule requirements management and development activities.

● Participated in the tracking and management of open issues and assisted in planning for resolution for complex projects.

● Maintained communications with technical counterparts to adopt best practices and ensure integration of specific application architecture into overall enterprise technology strategy.

● Led testing efforts by defining, developing and implementing practices and procedures for complete end user test plans.

● Ensured all user acceptance tests conducted and documented according to standards. Identified and documented system deficiencies and recommends solutions.

● Responsible for overall success of user acceptance testing, including results verification and release. ● Assured that all artifacts comply with corporate SDLC policies and guidelines.

● Worked closely with system analysts to help create Proof Of Concepts (POCs) and alternative.

● Developed key project deliverables including requirements specifications, use cases, system test cases, training and documentation and user manuals for projects of for low to moderately complex.

● Supported the production of Requirements Traceability Matrixes (RTM) and RTM gap analysis reports for complex enhancements, automations and implementations.

● Used project management techniques to establish roles and responsibilities, monitor project and request status and workload, and ensure deliverables of high quality, effectiveness and timeliness.

● Managed assigned enhancements, automations and implementations from concept through implementation.

Previous Employment:

● 09/2012 – 02/2013, Horizon BCBS, IT Business Analyst

Project: CVS Caremark system will no longer support prescription claim adjudication for Horizon Commercial and Individual business in 2013. Therefore, Horizon BCBS will need to convert from Caremark to Prime as the new Pharmacy Benefit Manager (PBM) for Horizon Rx and MMRX plans. As a result, a crosswalk is need to be established to map current state Horizon CAG Hierarchy to Future State Prime CAG Hierarchy. This crosswalk will be referenced by Informatica when building Group and Membership files for historical load.

● 05/2011 – 08/2012, CVS Caremark, Business Systems Analyst

Project: Worked in different types of Projects such as CBR (Client Billing & Reporting) and Prior Authorization (Pricing & Drugs). Supported PMO by assisting with projects focused on application, SDLC, etc.

● 08/2009 – 05/2011, Huntington Bank, Business Systems Analyst

Project: Responsible for creation of corporate compliance program related to Bank Secrecy Act and Anti-Money Laundering

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