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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLEPROFILE SUMMARY5+ years of work experience as a Business System Analyst/ Data Analyst exclusively in the Healthcare sector.Extensive experience with Medicare/Medicaid processing as well as the Claims.Strong understanding of various SDLC methodologies such as Waterfall and Agile-Scrum.Extensive experience with Healthcare Claims Adjudication Process Healthcare claims (Professional, Institutional and Dental).Experience in documenting Business Requirements document (BRD) and Functional Specification Document (FSD). Experience in performing Business Process Analysis, involved in application redesigning and enhancements and Gap analysis.Strong understanding of test plans, test cases, test scripts and defects tracking/reporting.Good Understanding of creating Test Strategy, Test Plans and Test Cases for Health care domain.Good in SQL queries.Trained in TriZetto/Cognizant Facets product (Front end and Backend data model)- Member, Provider and Claims.Good knowledge of Software Development Life Cycle (SDLC), Software Testing Life Cycle (STLC) with both Waterfall and Agile methodologies.Strong knowledge of FACETS Claim Processing, Subscriber/Member and Provider module.Trained in JIRA in organizing the business requirements, define their process, create tasks and issues and track work order with workflows.Strong knowledge in Data Mapping,TOOLS AND TECHNOLOGIESMethodologies: Agile, Waterfall, HybridProject management tools: MS Project, JIRADefect tracking: Quality Center and QTestBusiness Applications: MS Office Suite MS Word, Excel, PowerPoint, MS OutlookDatabase: MS SQL Server, MS AccessDomain Knowledge: HIPAA, Claims Processing,Medicaid, Medicare (Part A, B, C,and D), PPO, HMO, Dental claim and POS.Professional project:Client: Ameri Health Caritas, Philadelphia, PARole: Business System AnalystDuration: August 2020- September 2022Location: PA.AmeriHealth Caritas is the Medicaid managed care leader which provides managed care solutions for underserved populations. These include Medicaid, Medicare, and CHIPplus pharmacy benefits management, behavioral health, and administrative services.Responsibilities:Interacted with Subject Matter Experts (SME), claimers, and customers; Conducted detailed interviews with them, recorded the requirements, and reviewed the gathered requirement by both technical and business people.Worked with subject matter experts (SMEs) internally and externally, and participated with software developers in Scrum team meetings, documenting agile software processes.Extensively used Agile Methodology in the process of project management based on SDLC.Tracked and monitored project team using JIRA Agile Scrum Board.Gathered requirements for Medicaid and CHIP insurance coverage and performed data analyses.Conducted business validations, covering the following deliverables: FACETS Providers, FacetsMembers, and Facets Claims.Developed Business Requirement Document (BRD) and Use Case Document (UCD) using Microsoft Office.Experienced with Facets Data Model, Data Dictionary,Created User Stories that have good acceptance criteria.Worked with the product owner to define user stories during product backlog grooming session.Maintained and prioritized Product Backlog and Sprint BacklogInvolved in Sprint ceremonies, i.e., Daily Scrum, Sprint Planning, Sprint Review, and Sprint RetrospectiveAnalyzed the existing reports of the reporting system in the database. Checked the consistency.of the data after the ETL process using SQL queries.Client: IRT Computer Solutions Private LimitedRole: Process AssociatesDuration: July 2013 May 2016Location: Bangalore. IndiaResponsible for gaining a good understanding of User needs and accurately representing them in a well-documented software functional specifications document.Gathered Business Requirements, interacted with the Users, Designers and Developers, Project Manager and QATeam to get a better understanding of the Business Processes.Interacted with the End-Users by interviewing them, by preparing appropriate questionnaire to betterunderstand end-user needs and the business process.Worked with all Facets Provider of software development from requirements gathering to testing, configurationand international deployment.Followed Workgroup for Facets Electronic Data Interchange standards for testing that need to comply with theHIPAA guidelines.Involved in project planning, coordination and QA methodology in the implementation of the Facets in the EDItransaction of the claims module.Followed a structured approach to organize requirements into logical groupings such as requirements forCustomer, Client, Group, Member, and Reporting that critical requirements are not missed.Involved in creating Business Process Documentation. Identified Use Cases from the requirements. Created UMLDiagrams including Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams using. MS-Visio.CORE COMPETENCIESFunctional Testing Test Data Management Healthcare FACETS Data Model Client Relationship Management Team building and Interpersonal skills.IT SKILLSDomain Knowledge: Healthcare with major modules Membership, Provider and ClaimsSDLC: Agile & WaterfallEducation:MBA in Marketing and HR (2012)Bachelor in Computer Application (2010) |
