PROFILE:

• Effective communicator, honored with organizational awards and affiliations, multi - faceted leader and liaison.
• Resourceful Business/Quality Analyst with 7+ years of diverse experience under healthcare domain. Worked closely with health care professionals, county governments and pharmaceutical companies.

PROFESSIONAL SUMMARY:

• Expert level experience of SDLC, waterfall, Agile, hybrid methodology.
• Well versed with Design, Development and Implementation (DDI) activities, transition activities and project solutions related to replacement of legacy systems.
• Adequate expertise upon BRD, FRD, TDD development, analysis and evaluation.
• Worked closely under PMO/ PM teams.
• Adequate knowledge of data analysis and data processing.
• Experience with RFP analysis, as is to be process, requirement gathering, elicitation, decomposition and evaluation.
• Experienced with Functional, non-functional testing, test case, test plan. Expert level experience with Quality Improvement Process.
• Adequate SQL experience SQL Query development, SQL scripting and MS SQL for data discovery, requirements validation, reports and testing.
• Developed test cases, test plans and testing strategies, test plans, business process model and project roadmaps.
• Developed critical reports including but not limited to CAP, HIP and Remediation process plans and post completion evaluation reports.
• Excellent written and communication skills, organizational skills, concept sessions evaluation skills, skilled in documenting defects, conflict resolution, vendor management, stakeholder management, excellent communication, leadership and management traits, problem-solving skills, ability to work under pressure and deadline.
• Excellent with SharePoint and JIRA, ITIL, IEEE.
• Knowledge of Federal and State healthcare programs and related business areas like eligibility/enrollment managed care, PBM, Accountable Care Management.
• Expert level knowledge upon Medicaid, MITA Framework, CMS Seven conditions and standards.
• Adequate knowledge on provider enrollment and eligibility determination.
• Proven track history of company benefits while working with Revenue Cycle Management Model.
• Successfully performed end to end healthcare system implementations and healthcare transaction cycles.
• Experience in providing ongoing critical reviews, reports, assessments and analysis, transition planning,

TECHNICAL SKILLS:

Methodologies: Waterfall, Agile, RUP, RAD, JAD, Spiral, V model

Project Management software: Version One, ITIL

Business Application: MS Visio, MS Office, MS Project

Requirement management tools: DOORs, Blue Works, Version One, SQL

MS Office Suite: MS Excel, MS OneNote, MS Outlook, MS PowerPoint

Performed Analysis: Root cause analysis, risk and issue analysis, SWOT analysis, scope management, scope assessment, requirement analysis, defect evaluation and assessment, defect management.

QA/BA tastings and templates used: Ishikawa- Fishbone, Pareto Chart, MECT checklist assessments, DDI deliverables, EPMO assist and asses, concept sessions and sprint evaluations reports, Positive testing, negative testing, regression testing, integration testing, system testing, user acceptance testing, performance testing, smoke testing, use case testing, functional testing checklist.

PROFESSIONAL EXPERIENCE:

Confidential, NY

Quality Analyst/Sr. Business System Analyst

Responsibilities:

• Performed Quality Analysis of design, development and implementation (DDI) activities related to replacement of MMIS including any transition activities and project solutions as per industry standards and MITA.
• NYMMIS adopted agile methodology (Version One) along with IEEE, ITIL v3.Conept sessions.
• As BA/QA participated in SCRUM meetings, concept sessions throughout Agile Methodology and performed requirement gathering, decomposition and elicitation for state team. Developed FSD.
• Generated operational status report, quarterly consolidated status report and any ongoing report under leadership direction. Provided support in confirming seven condition and standard as per MECT checklist and CMS guideline.
• Provided insight to BAs and SMEs with emergent activities within industrial standards adhering to the baseline. Analyzed evaluated and provided insight and action plans to improve RFP which may satisfy vendor and client requirements from CMS modularity stand point.
• Generated CAP, Remediation plan, decomposed requirement analysis.
• Performed independent and group testing including UAT, regressions and unit testing as per the contractual requirement. Generated test plan and test reports adhering to SLA.
• Validated, analyzed current state policies and RFP, suggested process improvements based on quality assurance audits.

Platform and tools: HE, Agile Version One, DOOR, Blue Works, share point, JIRA MS-suites (Word, PowerPoint.), version one.

Confidential, Jefferson City, MO

Business Analyst

Responsibilities:

• Developed BRD and FRD and FSD. Provided solutions for complex risks and issues. Conducted or assisted in JAD sessions, worked thoroughly on requirement analysis with state BA team members.
• Elicited the current system to create the user stories with “As is “process followed by “To be” document from FAMIS to MEDES. Gathered new requirements, reconciled conflicts, decomposed high-level requirements.
• Provided support to state team to implement agile methodology from traditional waterfall methodology which was initially adopted by Missouri senior leadership.
• Performed User Acceptance Testing. Implemented IEEE 829 standard templates to develop test plan.
• Closely monitored and reported quality of project operations and deliverables, provided timely modifications and recommendations.
• Performed risk and issue analysis, MECT CHECKLIST, provided deliverables and reports.
• Defined, planed, scheduled and controlled various teams and team activities throughout the project.
• Provided recommendations and audit reports, project status reports and project health analysis.
• Performed GAP analysis, Impact analysis, root cause analysis and cost benefit analysis, defect analysis, risk and issues analysis among QA and BA teams to asses and evaluate project process model on timely basis.

Platform and tools: Agile, Microsoft Office (Word, PowerPoint, JIRA, SharePoint, MS-Project)

Confidential, New Jersey

Contract - coordinator/ reimbursement analyst

Responsibilities:

• Successfully co-ordinate with multiple internal and external stakeholders to negotiate generates best and deficient outcome. Communicated with external vendors like PBMs, specialty pharmacy vendors to deliver efficient reimbursement strategies.
• Communicated with CMS and drug pricing negotiation committees to assure company billing pricing process, company benefits, CMS applicable regulations and baseline contract is flowing hand in hand throughout the reimbursement process.
• Confidential, PBM entities, CMS committee, drug pricing committees conducted JAD sessions pre agreement where my team played role of reimbursement analyst and strategy developer.
• Developed reimbursement strategies, performed cost benefit management. Learned and modified revenue cycle management.
• Communicated with stake holders, performed vendor management.
• Analyzed request for proposal and contract evaluation throughout the project.
• Communicated with third parties, partners and end customers in the reconciliation process.
• Successfully handled data assessment and analysis.
• Work with the Client’s IT team, systems vendors and consultants to design and implement system fixes/enhancements.
• Conducted concept sessions, workshops and stand-ups successfully towards efficient outcome within given timeline and financial boundaries focusing on facts like conflict resolution, client vendor relation management.

Tools: Revenue management models, Share point, JIRA, MA-Excel.