- 13+ years of consulting and industry experience in Business Analysis, System Analysis, data Analysis, Systems design, Mainframe development and QA.
- Product Owner for Population Health Management Products.
- Data Analytics lead for various markets and CMS and NGHS Audits.
- Expertize in Requirements Gathering and Analysis, Requirement Specification, Business Process Analysis and Use Case Documentation - for Agile projects
- Excellent writing skills in creating Business Requirement documents (BRDs), System Requirement specifications (SRS), System Design Specifications (SDS), Functional Specifications and defining project plans.
- Well versed in Requirements/Change Management, Impact Analysis and Gap Analysis
- Accomplished experience through whole SDLC from requirement analysis till deployment.
- Participate in winning proposals (RFPs) for organization by providing Healthcare solutions and acting as Healthcare SME.
- MicroStrategy Solution Architect for client specific Reports.
- Healthcare domain expertise
- Membership, Provider, Benefits/Benefits Migration
- Claims adjudication, Payment, EOB/EOP.
- NASCO, QBlue, QNxt, ITS, CPL, Identifi, FACETS.
- EDI Transactions - 834, 837 I/P, 270/271, 276/277 and 835.
- HIPAA, PHI, HL7
- Healthcare Reforms - 5010 and ICD10 initiatives.
- Medical Management System (MMS) - Care Radius, Identifi.
- Population Health Management, Care/Utilization Management.
- Appeals, SLA, Compliance and Grievance process
- Business and Data Analytics, MicroStrategy BI
- CMS and NHGS Audit
- COBOL, SAS, REXX, SQL.
- IMS, DB2, VSAM, MS-SQL
- QMF, SPUFI, Fileaid, Xpeditor, Endevor.
- Mercury Test Director, RequisitePro, Clearquest, Clearcase, Visual Source Safe, TFS, VSTS
- SharePoint Designer
- SQL Server Management studio
- MicroStrategy BI Reports
- Azure Environment migration
Sr. Business Analyst
- Product Owner for Identifi Care (CM) and Identifi Reporting applications.
- Coordinate the Azure environment migration effort
- Data Analytics consultant for client specific slicer reports.
- Single point of contact for CMS and NGHS Audit requirements.
- Requirement gathering and documentation of same for Identifi Utilization Management (UM).
- Work on Agile platform and create User Stories and Use Cases for Evolent’s population health management solution applications.
- Provide demo of the applications in the sprint demo meetings.
- SME for main functional areas such as Care Plan, Care gaps, Problem, Goals, Interventions (PGI), Authorizations, Appeals and SLA configuration.
- Integration of Pharmacy module into Identifi Care suite - Medication Review and Med reconciliation
- Single point of contact for the NOVI Assessment tool Integration with Identifi Care Applications.
- Single point of contact for new Complaints module within Identifi application - Created POC for the same.
- Gather requirements for Evolent’s Business Intelligence tool MicroStrategy for various reports.
- SharePoint designer for the IT Product Management team.
- Conduct JAD sessions with Stakeholders and users to understand the requirements of various Work requests and enhancements in Horizon s benefit application repository called CPL, customized by FJA.
- Perform downstream system impact analysis and create approach documents.
- Participate in Business Modeling by understanding the needs of the business, and also document Business Use Cases as well as System Use Cases.
- Analyze and capture requirements for successful implementation of new Integrated Medical Management system, Care Radius that offers full suite of medical management functions.
- Ensure new Medical Management system (Care Radius) has all the functionalities implemented that will replace the old system, Care Planner Web (CPW) without any gaps.
- Played key role in Horizon s major initiative to meet ICD 10 complaint.
- Acted as one point contact for ICD 10 project that includes complete systems and process analysis, application design and programming, internal testing, training, and external testing with trading partners.
- Proposed strategies for Horizon to optimize process, improve system transactions and utilize a richer data set for many internal functions that will allow for more efficient operations and potential reductions to errors and omissions.
- Implemented solution with incorporation of the ICD - 10 enhancements while maintaining the ICD-9 functionality.
- Performed Impact analysis and Gap analysis for ICD 10 and ensured a smooth migration.
- Received many client appreciation and star performer award for the successful implementation of ICD 10 project.
- Single point of contact for the QBlue HOS Migration project
- Conduct JAD sessions and gather requirements from different stakeholders and individual Claim engines SMEs for migrating claims into NASCO from QBlue.
- Prepare BRDs and Process flows for Accumulator, Authorizations, Referrals and COBs for different claim engines.
- Propose new screens and new fields in existing CICS screens in NASCO to accommodate claims from different engines.
- Validate Use cases and assist in UAT testing
- Proposed strategies to migrate benefits from Lotus Notes forms such as BIFs, NAEGs and GEI to web based product, CPL, customized by FJA.
- Created and presented many POCs (Proof of Concept) for CPL migration project.
- Build a team of Business Analysts and Technical Analysts at onsite and offshore and lead the project.
- Worked with IBM team to create Views in Lotus notes forms and guided team to create Agents to export data from Lotus Notes forms.
- Proposed strategy to create Interim database to load benefit data and capture errors before loading into the actual CPL database, which resulted in huge savings for Horizon.
- Received many appreciation for the successful implementation of the CPL product and in honor the interim database was named as Nisha s database in Horizon.
- Analyze NASCO claims scenarios and EOB/EOP messages to check the appropriateness of the EOB/EOP messages generated.
- Conduct SME review for EOB/EOP message codes and recommend verbiage to give more clarity on the message passed.
- Review and eliminate the duplicate EOB/EOP messages and make the messages unique.
- Fix the glitches in the EOB/EOP generation system with respective to claim scenarios and make sure the messages are CMS and DOBI compliant.
- Sr Business Analyst for NASCO BlueCard ITS application.
- Propose strategies and solutions to support claims, inquiries, membership, provider data, financial information and performance standards enhancement.
- Coordinate global Certification testing and Partner plan testing with other BCBS.
- Sr Business Analyst for Legacy System to Facets Migration Project.
- Acted as the system owner for FACETS - ITS Claims adjudication module and ensured smooth migration of the claims adjudication module to Facets.
- Worked on EDI Transaction 837(I, P, D) - Healthcare Claims input.
- Coordinated partner plan testing for BlueCard.
Confidential, Basking Ridge, NJBusiness System Analyst
- Business System Analyst for the NDB - Provider Data application.
- Business Analyst for the 5010 and ICD 10 Initiative for NDB application.
- Impact Analysis of different EDI Transactions such as 270/271 - Eligibility, Coverage or Benefit Inquiry/response, 835- Health Care Claim Payment/advice, 837(I,P) - Healthcare Claim, 834 - Benefit Enrollment Request and status.
- Gap analysis for HIPAA 5010 and ICD 10 initiatives.
- Support various enhancement projects for PRIME Admin where the Administrative part of the policies like New Business, Plan changes, ID cards processing, eligibility, downstream feeds, external / internal interfaces is handled.
- Support various enhancement projects for EXBA which is maintained for the billing and adjustments.
- Developed many Mainframe programs to support the enhancements for PRIME and EXBA.
- Propose strategies to sunset EXBA application and ensure successful implementation of new Web application eBill.
- Received Star performer award for implementing new MQ system to connect Prime eBill with downstream PeopleSoft application.
- Acted as Release Engineering coordinator and coordinated all release activities for the Major release for PRIME in June 2007.