Business Analyst

KAUSHA AMIN

************@*****.*** 848-***-**** McAllen, TX - 78501

SUMMARY

Highly accomplished Business Analyst with over 6 years of experience specializing in business process optimization, data analysis, and healthcare compliance. Proven ability to lead cross-functional teams, conduct business process modeling, and design solutions that drive operational efficiency. Extensive experience in Medicaid and HIPAA-compliant projects using tools like Power BI, SQL, UML, and RUP, delivering value in both healthcare and financial services industries.

Expertise in HIPAA EDI transaction codes (834, 835, 837, 270/271, 276/277) with hands-on experience in Medicaid projects and healthcare claims processing.

Proven ability to lead and facilitate Joint Application Development (JAD) sessions, gathering requirements, creating Business Requirements Documents (BRDs), and translating them into functional designs.

Solid understanding of Software Development Life Cycle (SDLC) methodologies, including Agile and RUP frameworks, with a focus on project success from inception to delivery.

Power BI dashboard creation expert, skilled in using Power Pivot, Power View, and Power Map for enhanced data visualization and business insights.

Demonstrated experience in developing use cases, process flows, ER diagrams, and data models, using tools like MS Visio and Rational Rose.

Strong skills in data mapping, data migration, and SQL query execution to ensure data accuracy and integrity across healthcare systems.

Excellent communicator with a track record of working effectively with business users, senior management, cross-functional teams, and technical teams to ensure successful project outcomes.

Experience in managing Requirement Traceability Matrices (RTM) to ensure that all business and functional requirements are tracked throughout the project lifecycle.

Adept at identifying process inefficiencies and leading initiatives that drive cost savings, operational efficiency, and business process improvements.

TECHNICAL ENVIRONMENT

Tools & Technologies: Power BI, MS Visio, Rational Rose, Requisite Pro, ClearQuest, SQL

Frameworks: RUP, Agile (Scrum)

Compliance Standards: HIPAA, Medicaid, X12 834, 835, 837

Programming: SQL for database queries and data analysis

PROFESSIONAL EXPERIENCE

Business Analyst

Optima Health – Edison, NJ March 2022 – Present

Managed 834 Re-enrollments/Renewals and the reconciliation of patient encounter data, focused on improving business processes for Medicaid healthcare claims and ensuring compliance with HIPAA.

Analyzed and managed 834 re-enrollment and claims reconciliation processes, contributing to increased operational efficiency.

Developed and published Power BI reports and dashboards, making critical data accessible to stakeholders via web clients.

Led business research initiatives to identify opportunities for process improvements, resulting in cost savings and operational enhancements.

Gathered business requirements through requirement elaboration sessions and translated them into detailed business solutions.

Utilized UML methodologies to create use cases, workflows, and ER diagrams for database design.

Developed As-Is and To-Be process workflows and managed change requests using Rational ClearQuest.

Executed SQL queries for data analysis and performed data mapping and data migration for patient encounter data.

Facilitated scrum meetings to ensure cross-functional team alignment, contributing to successful sprint deliverables.

Created test cases for HIPAA EDI transactions (834, 837, 835), improving the accuracy and compliance of claims processing.

Established a repeatable process for the Concept phase, helping to define risks and assess the impact of new product developments.

Collaborated with cross-functional teams to define KPIs for the product development lifecycle, leading to a 10% improvement in overall project delivery time.

Business Analyst

Conduent – NYC NY July 2020 – February 2022

Led the business analysis for a major EDI healthcare integration project aimed at streamlining the processing of HIPAA-compliant transactions across multiple healthcare providers. Focused on optimizing claims submissions, benefits enrollment, and enhancing the Medicaid data exchange process.

Conducted comprehensive business analysis for HIPAA transactions including X12 270/271, 276/277, 835, and 837 to ensure seamless exchange of healthcare claims and benefits information.

Gathered and defined requirements for the integration of multiple EDI transactions, working closely with stakeholders to identify gaps and ensure compliance with HIPAA standards.

Managed the end-to-end EDI workflow, mapping data from upstream and downstream systems to ensure accurate claims adjudication and enrollment processing.

Led efforts to analyze and document business processes, identifying areas of improvement in claims submission and eligibility inquiries, resulting in a 15% reduction in claim processing time.

Collaborated with development teams to create data models, ER diagrams, and class diagrams to support the EDI mapping process.

Implemented SQL queries to extract data for analysis, improving the accuracy of claims validation and reconciliation.

Developed and executed test cases for EDI transaction sets (834, 837, 835), ensuring data integrity and compliance with healthcare regulations.

Created detailed UML diagrams to visualize and communicate system changes and integration workflows with cross-functional teams.

Coordinated UAT testing with the QA team, resolving defects, and ensuring the final product met all business and functional requirements.

Facilitated daily scrum meetings to monitor progress, address blockers, and ensure timely delivery of the project within the Agile framework.

Business Analyst

Charles Schwab Corporation November 2018 – June 2020

Focused on process improvement initiatives for automation of operational and administrative business processes, ensuring timely project delivery and enhancing business workflows.

Conducted weekly meetings to define Policies and Procedures for site construction projects, improving project alignment across teams.

Led the creation of Business Process Mapping Diagrams and documentation, offering detailed process improvement recommendations.

Applied RUP methodology for requirements management and development, adhering to its workflows and standards.

Gathered and documented functional requirements and use cases for business process automation, streamlining operations and reducing manual effort.

Designed and documented AS-IS Business Workflows in line with UML standards, ensuring clarity and alignment with project goals.

Facilitated JAD sessions to define functional requirements and finalize Functional Requirements Documents (FRD).

Led efforts to gather business and technical requirements for the data warehouse, identifying data sources and defining transformation rules.

Created and analyzed use case diagrams, sequence diagrams, and activity diagrams using MS Visio.

Managed the creation of Traceability Matrices to ensure alignment of functional requirements with use cases and test cases.

Played a key role in process definition and business requirements gathering, helping to deliver a technological solution for automating sales methodology.

EDUCATION

B.Pharm + MBA

Narsee Monee Institute of Management Studies (NMIMS)

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