Anu M Email & Phone Number

United States

 Single-handedly managing transition of multiple manual operation modules like Dental, Life, Disability and other products to the new centralized application and its integration with third party applications like Commercial Banks, popular clearing houses, Front office portal (both member and employer), payment processing applications etc.Working on the UAT and Production environment to ensure smooth transition of the business operations.Managing data migration from legacy systems to cloud servers, working on data migration from third party applications too that were being used for invoice generation, check printing, vision claims, dental providers etc.Ensuring applications ability to support integration and reflection of accurate data to the front office portal.Working closely with developers to ensure applications ability to interact with clearing house’s to process EDI transactions and claim intakes.Managed development of requirements and design documents and change management for cloud migration.Gathered & finalized of specs / defining business and functional requirements for BI reporting by conducting workshops and setup QA Environment installing JMeter and LoadRunner. Designed and development of test cases based on healthcare payor change requirements or enhancement to existing l EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271.Worked on creating the Data Mapping document (Source-Target Mappings) from the Source to Target system which comprises the definition of every column on Target system, their significance and corresponding source column.Performed manual and automated test procedures for functional testing of Web services using SoapUI.Used SOAP UI to test web services and validated all operations in WSDL.Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Erwin, Data Stage, Data Warehousing, WebSphere and Cognos.

United States

Gathered, documented, and analyzed business data requirements, workflow processes, and process improvements. Demonstrate excellent elicitation skills during SME interviews.Effectively elaborated the Current process and recommended a clear picture of the proposed process for the projects in the organization. Used Agile Methodology to configure and develop process, standards, and procedures. Designed the Business Requirement Document (BRD) based on feedback from senior management. Conducted JAD sessions with SME including business owners, sponsors, and analysts.Created user stories and upload it to ADO (Azure DevOps) and give walkthroughs to business and development teamTranslated business requirements to technical requirements by working with technical team.Performed gap analysis for integration requirements, reporting needs.Used JMeter to analyze overall server performance under simulated heavy load.Prepared Business process diagrams, State diagrams, Activity diagrams, and Sequence diagrams using MS Visio.Traced requirements to deployed system to ensure all the requirements are met. Informed Project Manager of technical issues/bugs and resolutions.Experienced with Medicare/Medicaid Claims processes from healthcare Payer side.Experience in Medical Claims Process Documentation, Analysis, and Implementation in 835/837/834/270/271/277 (X12 Standards) processes of Medical Claims Industry from the Payer side.Used HIPAA 5010 TX codes to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance.

California, United States

Single-handedly managing transition of multiple manual operation modules like Dental, Life, Disability and other products to the new centralized application and its integration with third party applications like Commercial Banks, popular clearing houses, Front office portal (both member and employer), payment processing applications etc.Working on the UAT and Production environment to ensure smooth transition of the business operations.Managing data migration from legacy systems to cloud servers, working on data migration from third party applications too that were being used for invoice generation, check printing, vision claims, dental providers etc.Ensuring applications ability to support integration and reflection of accurate data to the front office portal.Working closely with developers to ensure applications ability to interact with clearing house’s to process EDI transactions and claim intakes.Designed and development of test cases based on healthcare payor change requirements or enhancement to existing l EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271.Experience with Patient Billing, Payor Compliance, Payor Reporting and Analytics.Preparing scripts to help convert enrollment sheets into 834 EDI files, working closely with the integration team to ensure EDI files are accurately translated and reflected in the application.Working primarily with JIRA, WIKI, BOX, SQL Open L Tablets, AWS, Salesforce, Clearing houses, Azure, and Google Cloud.Worked on numerous underwriter configurations and commission schedules for Group-based products and plans.Managed and monitored various scrum events through agile delivery process working closely with project manager, product owner and stakeholders to ensure their expectations are met.Conducted Gap Analysis for the system considering AS IS and TO BE features.Gathered requirements, developed Process Model, and detailed Business Policies.

Virginia, United States

Conducted Joint Application Development (JAD) sessions with stakeholders to elicit requirements.Documented and created Business Requirement document (BRD) and Functional Requirement document (FRD).Organized and facilitated Agile and Scrum meetings, which included Sprint planning, Daily Scrums or standups, Sprint Review and Sprint Retrospective.Created and maintained Product Increment, Product Backlog and Sprint Backlog defining new systems operations for the project.Used SQL tools like TOAD to run SQL queries and validate the data in warehouse.Facilitated User story grooming sessions. Helped the team in breaking down the Epics into User Stories and tasks.Coached team members on how to effectively use Kanban and Scaled Agile Framework values as a guide.Designed and developed various UML diagrams like Use cases, Activity diagram and Sequence diagram using VersionOne.Created swim lanes, wireframes, screen mock-ups using Balsamiq to present the visual view of the feature within the website.Played integral part in creating test plans, test scenarios and test cases.Configured JIRA/Confluence to provide effective linking/tracing of epics, user stories, success criteria and visual models.Written several complex SQL scripts for validating Reports.Overviewed end to end defect management. Bug fixes, retesting, break fixes, impact analysis and production assurance.Testing Mainframe applications for modifications madeAnalysis and modifications of PLAS Mainframe system for process flow corrections.Involved in writing SQL statements to extract data from the relational database.Experienced with Medicare/Medicaid Claims processes from healthcare Payer side.Experience in Medical Claims Process Documentation, Analysis, and Implementation in 835/837/834/270/271/277 (X12 Standards) processes of Medical Claims Industry from the Payer side.Worked with multiple teams to improve the overall claim and reimbursement processes.

Texas, United States

Gathered, documented, and analyzed business data requirements, workflow processes, and process improvements. Demonstrate excellent elicitation skills during SME interviews.Effectively elaborated the Current process and recommended a clear picture of the proposed process for the projects in the organization. Used Waterfall Methodology to configure and develop process, standards, and procedures. Designed the Business Requirement Document (BRD) based on feedback from senior management. Conducted JAD sessions with SME including business owners, sponsors, and analystsTranslated business requirements to technical requirements by working with technical team.Performed gap analysis for integration requirements, reporting needs.Prepared Business process diagrams, State diagrams, Activity diagrams, and Sequence diagrams using MS Visio.Traced requirements to deployed system to ensure all the requirements are met. Informed Project Manager of technical issues/bugs and resolutions.Experienced with Medicare/Medicaid Claims processes from healthcare Payer side.Experience in Medical Claims Process Documentation, Analysis, and Implementation in 835/837/834/270/271/277 (X12 Standards) processes of Medical Claims Industry from the Payer side.Used HIPAA 4010 TX codes to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance. Wrote and executed SQL queries to verify that data has been moved from transactional system to Data warehouse, data mart reporting system in accordance with requirements.Involved in designing future state processes for HIPAA 5010 transaction processing for EDI's 837, 835, and 834 and ICD 10 Code sets. HIPAA 4010-5010 Conversion Analysis - Involved in the documentation of HIPAA 5010 changes to EDI837, 834, 835, 276, 277 Transactions. Extensively used complex SQL to retrieve and manipulate data in the database for data validation within the UAT phase

Texas, United States

Interacted with Product Owner & Agile Development Team on documenting Scrum artifacts like Product, Release & Sprint Backlog. Assisted in facilitating Scrum Ceremonies like Sprint Planning, Daily Scrum/Stand Up meeting, Sprint Review and Retrospective meeting. Facilitated Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes and conducted meetings with the Product Owner. Participated in product iteration and sprint planning activities along with the breakdown of product backlog into user stories and associated tasks. Reviewed the user stories from Product Backlog and reprioritized them along with my internal team. The highest prioritized goals were transferred to a Sprint Backlog.Worked closely with the reporting team to generate business intelligence reports using Cognos and visualized these reports using Tableau.Utilize SQL server to run basic queries and obtain necessary data for Medicaid and Medicare Encounters. Wrote SQL queries to create mock up reports as per the business requirements and got user approval

Hyderabad, Telangana, India

Analyzed the system by performing as-Is study and created To-Be process flow to determine whether solutions meet the high-level business requirements. Elicited business requirements from core business units via JAD sessions, teleconference meetings, semiformal and formal meetings. Utilized corporation developed Hybrid approach. Documented the requirements in pre-existing Business requirement document (BRD). Created and maintained Product Increment, Product Backlog and Sprint Backlog defining new systems operations for the project. Conducted Sprint planning meeting with developers and testers to review user stories, assign story points and cards to a respective sprint. Planned and defined system requirements with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies. Worked closely with user experience (UI/UX) team for creation of wireframes and prototyping for web portal. Provided support across different domain areas such as Auto Assignment, Payments, Claims Data and Appointment Logs, Auto Estimations, Flood Claims etc.Wrote and executed SQL queries to verify that data has been moved from transactional system to Data warehouse, data mart reporting system in accordance with requirements.