Avani Patel Email & Phone Number

Denver, Co, Us

United States

Aurora, Colorado, United States

Payer System Implementation:• Contributed to User Acceptance Testing (UAT) and Quality Assurance (QA) efforts for various interfaces, including 834, 837, 820, and 835. Additionally, played a key role in the successful conversion of provider and member data, ensuring seamless integration with other systems such as pricing tool, provider payment system and correspondence vendors, care management applications, and the provider portal platform. Demonstrated strong attention to detail and comprehensive testing methodologies to validate the accuracy and functionality of these critical interfaces and systems. • Created knowledge base documentations for 20+ interfaces of new claims system for processes and troubleshooting.• Acted as a trusted Subject Matter Expert (SME), bridging the gap between new and old systems by providing comprehensive answers to questions and concerns from stakeholders, internal IT teams and vendor partners. • Leveraged deep knowledge of the existing system alongside a thorough understanding of the functionalities and capabilities of the new system to address inquiries effectively.Provider Portal | Provider Online Directory:• Elicited user interface and data business requirements and functional requirements for provider portal and provider online directory. Prioritized business requirements within a phased project framework to ensure agile development and the delivery of impactful solutions. • Maintained Requirement Traceability Matrix throughout implementations as well as changes post go-live of the project for both provider directory and provider portal data. • Collaborated with stakeholders from multiple departments, compliance, security, product owner, developers, quality assurance team, external vendor partner and internal IT teams for both provider portal and provider online directory. Troubleshooting and triaging error files for the data that being loaded into provider portal databases.

United States

Project: 1 the project was to implement a new program offered by CMS for dual eligible, which require 120 days or more of Long-Term support and services (LTSS). This new program would provide an entire range of Medicare and Medicaid services along with and extensive list of LTSS services.Project: 2 Project was to update all impacted systems for implementing an initiative, to drive members towards Value based providers. The program will provide $0 copay for all professional services to members if received from Value based providers. Impacted systems include Claims, Benefits, Membership, IVR, Customer service portal, Member portal and Provider portal.Engaged in comprehensive system analysis, bridging as-is and To-Be processes while collaborating with Subject Matter Experts (SMEs). Created agile assets including User Stories, Product Backlog, Sprint Backlog, and Burn down Charts. Orchestrated and directed Sprint planning, also orchestrating Product Demos. Employed Joint Application Design (JAD) sessions and vendor/stakeholders interviews for requirements gathering. Transformed Use Cases and BRDs into Functional Requirement Documents (FRDs). Provided vital project support through Project Plans, timeline tracking, and reporting. Delivered high-level monthly updates via PowerPoint. Managed documents on SharePoint, ensuring version control. Created diverse diagrams and facilitated JAD sessions through Outlook. Instituted Requirement Traceability Matrix (RTM). Produced user-centric documentation, encompassing manuals, training materials, FAQs, and SOPs.