Aashni Patel Email & Phone Number

• Created User Stories, UML Diagrams, and Data Flow Diagrams to visualize data flow across systems.• Elicited requirements and conducted As-Is and To-Be process analysis.• Performed Cost Benefit analysis, Risk assessment, and SWOT analysis for projects.• Actively participated in Product Backlog Refinement, Sprint Planning, Daily Scrum, Sprint Review, and Sprint Retrospective meetings.• Added functionalities to payment processing system enabling users to process payments.• Accomplished projects and design documents on HIPAA 835 and 837 calculations, EDI transactions, Health Statements, Explanation of Benefits, Healthcare Reform, and 5010 CMS occurrence and field expansion for 835 and 837 EDI formats.• Coordinated upgrade of EDI Transaction Sets 837, 835, and 834 to HIPAA compliance.• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set.• Loaded EDI 834 files in Facets through MMS (Membership Maintenance Sub-system).• Worked with Utilization Management and Care Management work streams to provide product design and business understanding.• Facilitated Joint Application Development (JAD) sessions to define Care Management and Utilization Management Requirements.• Configured Business rules for automation tasks in care management and utilization management, including auto referrals and education material generation.• Involved in testing modules such as Member, Provider, Claims Processing, Utilization Management, Contracts, and Benefits.• Assisted QA team by reviewing Test Plans and Test Cases to ensure coverage of requirements.• Updated internal systems to integrate new data and functionalities of the payment arrangement system.• Ensured patient data exchanges adhered to HIPAA guidelines and mandates.• Experienced in Waterfall and Agile-SCRUM methodologies.• Utilized MS Visio for creating Use Case Diagrams, Business Process Flows, Activity Diagrams, and Workflow Diagrams.

Ventura County, California, United States

• Regularly attended various meetings including project discovery sessions, review sessions, project health meetings, sprint meetings, daily scrums, and CRB (Change Review Board) meetings.• Prepared and updated Interface Agreements (IA) for clients, collaborating with operations teams to review captured requirements.• Worked closely with Project Managers, Client Management Executives (CME), Account Services Management (ASM), and business owners to document business requirements.• Maintained project timelines aligned with requested release dates and upcoming sprint releases.• Prototyped recommendations to facilitate decision-making in configuration meetings.• Utilized HIPAA Gateway for compliance with HIPAA standards (270/271, 276/277 & 837) for EDI transactions.• Designed, documented, coded, and tested Facets application configurations (Medical Plan, Product, Provider, Pricing, Subscriber/Member, Claims, Utilization Management, Finance, Billing, Accounting, Customer Service, Workflow, Security) to support migration projects, new implementations, and ongoing production needs.• Possessed extensive knowledge of Managed Care Management processes.• Managed EDI 837 and 835 transaction sets for claim processing and audits within the Care Management System.• Validated Configuration team's work across various areas.• Loaded EDI 834 files into Facets through the Membership module.• Expertise in EDI file transfers to Trading Partners in HIPAA 5010 standards.• Prepared and maintained business requirements and functional requirements, ensuring alignment with current and future client needs.• Interfaced with external clients and internal programming staff to ensure requirements were met and incorporated into system design and testing.• Demonstrated strong ownership and time management skills to meet project timelines and deliverables.