Amreen K. Email & Phone Number

Washington, Dc, Us

Long Beach, California, Us

Long Beach, California, Us

Long Beach, California, Us

• Elicited requirements from end users to solve a business problem and identify the desired results.• Create and grooming the product backlog based on the prioritization and discussion with cross-functional and technical teams• Facilitating daily scrum, sprint planning, sprint demo and retrospective meetings• Keeping the organization, particularly the project’s stakeholders, up to date on the progress of the scrum team’s projects• Provided extensive coordination and assistance to the Quality Assurance, Development, Operations, and Production teams, and actively contributed to project scheduling, preparing meeting minutes, templates, dashboards/reports, best practices, and process improvements. • Facilitated effective sprint planning sessions, daily stand-ups, sprint reviews and retrospectives, promoting team ownership• Participated in story writing session to ensure the INVEST model is being followed• Coached the teams to interact in ways that ensure clear communication of product requirements and team commitments and self-organizing behaviors in the team while promoting the use of Agile practices.• Able to identify “as-is” state vs. “to-be” state using a variety of applicable tools and techniques depending on the project and its complexity including but not limited to use-case diagramming, ERD diagrams, data flows and business process workflows.• Prepared Process flows (MS-Visio), Business Requirement Documents, Program Requirement Documents, System Wireframes (Balsamiq), System Config Documents, Data Specification Documents.• Created change request, mockups, epics, user stories that illustrate current and future workflows to facilitate market research, user testing, and product and prioritize accordingly for project delivery design.• Documented process to identify actors, inputs, outputs, and dependencies.• Created business user training materials related to system enhancements and new applications; and provided training on new processes and systems.

Baltimore, Md, Us

• Utilized detailed understanding of the claims domain to update existing process documentation to meet claim engine technical requirements.• Utilized Blue Web (FAM Vol II) and FEPDirect to develop and test requirements for Medicare, Medicaid, Master files and Compatibility Edits. • Effectively used ALM to add requirements, create libraries, complete PRL sign off, and baseline requirements• Worked collaboratively with the business/technical team to document functional and nonfunctional business technical requirements to improve claim accuracy, processing and reimbursement.• Conducted walk-through sessions to review Functional, nonfunctional and interface requirements with the development, testing, and Director’s office teams to ensure the accuracy of requirements.• Meticulously analyzed complex claims data, rules, process flows and claim edits to recommend solutions to improve business processes.• Developed business and technical requirements by analyzing current state process flows.• Analyzed requirements to determine clarity while resolving inconsistencies, ambiguities, and contradictions.• Conducted meticulous analysis to successfully reengineer key business processes and flows to increase claim processing efficiency.• Utilized standardized tools to create business process workflow templets, UI mockups, system Specs and system testing.• Evaluated information gathered from multiple sources, reconciled conflicts, decomposed high-level requirements.• Communicated with different business groups to elicit and to analyze business requirements.

Dublin, Oh, Us

• Participated in Joint Application Development (JAD) session with the team and the Stakeholders to analyze business scope and flow• Utilized corporation developed Agile SDLC methodology • Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS• Wrote Epics and user stories, managed sprints and backlog grooming, and tracked project progress in JIRA• Expertise in Claims, Subscriber/Member, Plan/Product, Claims and Provider of Facets. Used Facets support systems to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.• Interacted with Claims, Payments and Enrollment hence analyzed and documented related business processes• Collaborated with CMS program and technical staff to review the proposed program definition/ruling and provided recommendations to program design and high-level risks and/or impacts• Involved in overall program management of the Health Care Financing Administration (HCFA/CMS).• Analyzed Medicaid claim and financial data as well as reviewed applications for completeness to process applicants for Federal Medicaid Program• Conducted UAT to confirm that all derivative products can be successfully processed through stages of the trade life cycle• Prepared Test cases (using test data available from CMS test document) during Design phase with presence of QA team and implemented plan for integration and functional testing

• Participated & designed a new matrix covering all the conceptual parameters of the new system as per the need of the business.• Extensive knowledge on relevant cross-industry data & messaging standard organizations & HIPPA/EDI industry-specific organizations to maintain a point of view as to the current applicability & risks associated in implementing standards or new technologies to client environment• Experience with HL7 V2.x healthcare interface standards & HIPAA requirements for electronic healthcare transaction• Worked on all Major HL7 interfaces: ADT (Admit Discharge Transfer), SIU (Scheduling Information Unsolicited), ORM (Order Response Message), ORU (Observation result Message)• Detailed working knowledge & hands-on experience with HL7 interfaces technical analysis & development• Worked on requirements related to Booklets, ID Cards, EOB’s, EOP’s & Customer Service portal• Conducted on-site/web conference presentations, data conversions, system implementations & end user training. Provided ongoing assistance with enforcement of technical policies, software releases, system upgrades & any related problems• Used BPM, as-Is & To-Be modeling processes• Used Microsoft Visio to document Use Cases, ad-hoc reports Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams• Prepared Business Process Models that included modeling of all the activities of the business from the conceptual to procedural level• Analyzed the problem domain, specified features, established baseline architecture, developed the Project plan, & risk analysis• Provided analysis of Web Portal & Content Management Systems• Articulated UML through Use Cases document by specifying actors, normal flow, sub flow, alternative flows for each & every use case• Wrote SQL queries, where, distinct, join statements for back-end testing.• Provided report to management via excel reports of workload & work completion on a daily, weekly, & monthly bases• Conducted UAT

• Involved in gathering the requirements from business to determine the users of the system and the functionality that should be provided to them.• Conducted JAD sessions and walkthroughs to gather the requirements.• Tracked business Requirement Traceability Matrix (RTM) and handled scope creeps.• Elicited and decomposed requirements related to Claim Adjudication and Reimbursement processes, and billing, banking SMEs to finalize business requirements.• Determined which claim system to interact with to display data on the UI.• Proactively communicated and collaborated with an internal/ external business community and the IT team to analyze information needs and functional requirements.• Translated requirements to the developers and guided the team when issues arise related to the business requirements.• Translated business requirements into functional specifications for the IT team, managed changes to such specifications, and educated the IT team on the direction of the business.• Worked with associates to understand the business rules, systems and integrated them into the requirement document.• Coordinated with different application teams involved in the claim adjudication process.• Worked with SharePoint for storing project documentation.• Assisted in establishing the procedure for back up of DB2 and SQL Server databases/users in QA environment.• Authored Companion Guide to support all the information needed to process HIPPA transactions with Well Care Group.• Prepared and maintained Traceability Matrix. Utilized Quality Center to plan and execute tests, track defects and create change alerts. Conducted User Acceptance Testing (UAT)

Tampa, Florida, Us

● Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD).● Involved in HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 835, 820, 278, 999/TA1, and 277 CA.● Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.● Coordinated, implemented and provided on-going support of the Quality Performer as outlined in the Specifications Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS).● Used HP Quality Center for writing Test plans and Test Cases.● Worked on documenting business rules to be defined in the business rules management engine (IBM ODM).● Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment.● Developed Process Flows using MS Visio.● Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team.● Executed Test Cases Manually, once the application is stable and documented the successful or unsuccessful completion of each test case in HP Quality Center (QC) for End-to-End Scenario based testing.● Consulted with healthcare third-party Administrator Company to develop conversion specifications for member, enrollment, and authorizations.● Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed.● Attended various government payer conferences, reporting back all new federal/ state mandated billing laws or changes.