- Professional experience of over 8 Years in gathering user requirements, documenting requirements and functional specifications.
- Excellent Communication, Analytical, Interpersonal, Presentation and Leadership Skills.
- Highly proficient in Microsoft Office Suite, Basic Computer Programming and numerous other software applications
- Database Technologies, Basic programming languages, Microsoft Office Suite
- Exhibit active participation and co - ordination in all phases of SDLC.
- Strong understanding of software development methodologies like Agile, SCRUM, RUP, Waterfall
- Familiarity and knowledge of healthcare reforms: NCPDP.0, Medicare and Medicaid, PBMs. Knowledge of HIPPA regulations and its privacy codes.
- Proven ability to understand detailed patient history, evaluation of patient problems, diagnosis and treatment procedures.
- Understand medical terminology and workflows.
- Accustomed in gelling well with individuals of all ages and with diverse cultural and economic backgrounds within a highly stressful and challenging environment.
- Excellent communication, presentation and negotiation skills.
- Exemplified ability in managing time and prioritizing tasks
Confidential, Plano, TX
- Key member of Process delivery team that proposed One Claims processing system as product strategy for commercial and Government healthcare payers.
- Identified, evaluated, and proposed Agile Methodology for solution delivery
- Liaison with cross-functional teams to develop Healthcare Claims Processing system, Healthcare portal, Care Management solutions.
- Introduced the BPM methodology, and artifacts creation to streamline the requirement management process
- Evaluated and implemented repository based Requirement Management approach using Caliber RM & Quality center & Requirement traceability matrix
- Collaborated JAD sessions to Analyze as-is business processes
- Created Use cases, workflow diagrams, and mockup screens to facilitate requirement elicitation for the healthcare Payer application.
- Implementation of Business Rule engine and suggested techniques to define, document identify and segregate business rules.
- Liaison with technical team, Test strategy team, Products strategy team for finalization of requirements scope, delivery and test strategy .
- Participate and facilitate User acceptance testing activities.
- Health Risk Assessment solution which provided a foundation toolset for Corporate Wellness initiatives.
- Cost effective Pharmacy Benefit Manager with excellent reporting tools and ease of use.
- Web based Workers Compensation claims re-pricing solution
- Used Agile Methodology for solution delivery. Reported all relevant Agile metrics (burndown charts, team velocity etc)
- Interpreted and documented business partner functional business requirements and test cases for technical team. Provided post-implementation support for multi-site, multi-user business partners.
- Documented project SRS and Functional Design documents and developed use cases, adhering to SDLC.
- Documentation of the business processes along with SMEs (Subject matter experts) by identifying the functional and system requirements.
- Converting the requirements into effective functional designs and to get functional designs endorsed by the solution office.
- Was responsible for Sprint planning, execution and deployment.
- Design of high level analysis dataflow diagrams, domain class diagrams, entity-relationship diagrams and reports from the use cases or other high level diagrams.
- Presentation of functional designs to development and testing team for further implementation.
- Design of the high level workflow based test cases.
- Review of the test cases for compliance with FD(functional designs).
- Documented requirements and functional specifications
- Defined and analyzed requirements gathered from users
- Designing Business Process Flow to fit the requirements into the new system
- Analysis of Medical Insurance Claims of the clients in USA
- Telephonic interaction with the clients pertaining to the claims if required.
- To identify the reason/s for denial of claims and prescribe a feasible solution for clearance.
- Handling Correspondence and Appeals Section.
- Reverse engineering the legacy system to define the existing functionality and data mapping.
- Utilized Use Case diagrams to communicate requirement to the teams.
- Developed visual models i.e. data flow diagrams (DFD), State diagrams, class diagrams and activity diagrams to augment the understanding of business flow.
- Used UML business modeling techniques to design and develop functional modules. Pioneered the utilization of use cases in modeling. Did feasibility and impact analyses for new initiatives.
- Analyzed functional requirements and user interface design with a use case - driven approach.
- Actively involved in client meetings to integrate their needs/requests. Execute their requests on questions regarding data issues.
- Wrote functional specifications and high level design documents for all the projects executed and designed using UML object oriented methodology and approach.
- Handling correspondence related enquires, analyzing and identifying reason of denial, low payment and prescribe feasible solution for clearance of insurance claims (USA).
- Issuing work orders for calling US insurance based on analysis of the claims.
- Running reports based on time cycle and suggesting suitable action plan to be taken.
- Analyzing, reporting and developing recommendations on data related to medical insurance.
- Analyzing different practices using different statistical and reporting tools.
- Gathering and Analysis of Software Requirements
- Identifying Business Goals and Transforming the Requirements into Functional Specifications
- Creating Project Proposals, SRS, Use Cases, DFD, Project Plan, UI Mockups, etc.
- Estimating the Project cost
- Communicating/Explaining the requirements to Development & Testing team
- Coordinating with the Development & Testing team during and after project development
- Reviewing of Test Cases
- Tracking & Reporting Project Progress Status
- Support to clients post project development