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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLE9+ years of experience as a Business Analyst in IT primarily in Pharma and healthcare industries. Coordinated with business and IT across all phases of software development life cycle. Experienced in gathering, analyzing, and documenting business requirements and developing Business Requirement Documents and Functional Requirement Specifications.EXPERIENCEJAN 2020 CUREDI BUSINESS ANALYST, PHARMSCRIPT (SOMERSET, NJ)Gathered information from the accounts department and stakeholders to determine thecurrent and future needs and requirements that can be accommodated.Coordinated with the IT team and other clients to discuss the flow of needed data.Worked with the development team using Agile methodology to develop process,standard, and procedures.Managing the claims submitted by the providers through the clearing house from thereSFTP site to client specific folder paths validating these files and load them to theadjudication system.Troubleshoot various file transmission issues and perform reconciliation.Compare the claims that pass validation and claims that were loaded to the adjudication system.Defined business requirements and acceptance criteria/test cases that support EDI.Interfaces related to healthcare business platform including but not limited to835,837, and 834 transaction data and x12 integration NCPDP,HL7 have transformed data from all sources.Identifying production bugs.Performed SQL queries to test the location of data and if there are any changes needed.Provided Micro strategy powered solutions to create workflows and deliver high level ofpatient care and outcomes.Strong verbal and writing communication skills - both technical and non-technical.Knowledge of Contracting project management, Ad Hoc reporting, and analytics,Credentialing enrollment, Medicaid pricing and premium business processes in acommercial and Pharmaceutical managed market.FEB 2017 DEC 2019BUSINESS ANALYST, REGION CARE NURSING AGENCY (QUEENS, NY)Gathered internal and external enhancement requests from a diverse group of stakeholders including Customers and Doctors.Proficiently documented Business Requirements Document, User story Specifications, Functional Specifications, and workflows.Communicated with the different vendors and clearing house to figure out their requirements.Created file specification and requirement specification document after the detailed analysis of gathered requirement.Understood the business problems and opportunities in the context of the requirements and help recommend solutions that enable the organization to achieve its goals.Worked with development and QA to review all requirements documentation, receive feedback, and ensure all issues related to the requirements are resolved in a timely manner.Utilized Agile methodology to configure and develop process, standard, and procedures.Participated in daily scrum meeting to discuss the daily task and any functionality issues.Performed UAT, modified requirement to improve functionality based on user input.JAN 2014 JAN 2017MEDICAL BILLING CLERK, HEALTHIMAX (EDISON, NJ)Enter and track all daily census and face sheets from Beneficiary Facilities for correct Billing to Medicare, Medicaid, and Private InsurancesGenerate patient invoices at end of the monthContacting the facility on the status of Medicaid pending residentsPreparing and verifying the Prebill and Sales details.Answer phone calls from the Patients POA and answer there billing related queriesSubmitting the OTC for out of state patientsChecking the eligibility for Medicaid for the patientsEDUCATIONNHA MEDICAL BILLING & CODING CERTIFICATION, Param InstituteMASTERS IN BUSINESS ADMINISTRATION (FINANCE), Gujrat University, 2006BACHELORS IN COMPUTER APPLICATIONS, Bhopal University, 2003SKILLSMicrosoft Access and SQLSDLC, Waterfall, Agile/Scrum, Use Cases, Storyboards, Scenarios, UML, Joint Application Development (JAD).MS-Visio, JIRA.LinuxSharePointSAPEpic, Practice Fusion, AthenaHL7FrameworksDocu TrackMicrosoft teams |
