Exposed to using IC9/ICD10/HL7 coding standards in the Medicaid domain of the healthcare systems and industry for inpatients, outpatients, and reimbursement methodology.Elicited and documented business and technical requirements for HIE implementations, ensuring alignment with Northwell Health's strategic goals and regulatory standards.Involved in HIPAA 5010 gap analysis of ANSI X 12 4010 and ICD 10 initiatives.Managed Business Requirements Document (BRD), Functional Requirements Document (FRD), and Non-Functional Requirements Documents (NFRD) to align with project objectives and specifications.Collaborated with the HIE development team to build and deploy custom solutions using the InterSystems stack of technologies, ensuring seamless integration of healthcare data across multiple applications

Worked within the project team to identify and interpret state Medicaid policies as applicable to customer-defined algorithm research as well as assisted with the internal development of new healthcare analyticsUsing SQL query to produce data for 270 EDI files and create 270 files and submit to MEVSNET to check dual snip member for Medicaid benefits eligibility.Conducted financial analysis for Medicaid and CHP+ programs, tracking expenditures, justifying budget amendments, and ensuring efficient allocation of state and federal funds.Policy review to implement the blueprint requirement for Medicaid/MMIS and tax benefits per CMS guidelines.Reviewed the files for any errors, missing segments, and for missing data on X12 file. Ensuring the file has complete data before the encounter submitted to Colorado Medicaid

Oversaw data exchanges with H&W insurance carriers, ensuring that all participant and plan data was accurately transmitted and processed, in line with carrier-specific requirements and deadlines.Coordinated data collection and performed analysis on the effectiveness of H&W products, identifying trends, performance gaps, and areas for improvement in product capabilities.Managed the administration and oversight of QLE processing, ensuring that benefits changes based on life events were handled efficiently and in compliance with regulatory guidelines.• Led the oversight of the annual open enrolment process, ensuring all configurations, communications, and systems were correctly aligned to offer a seamless participant experience.Served as the primary point of contact between Plan Sponsors, participants, and insurance carriers to resolve issues related to enrolment discrepancies, coverage changes, claims processing, and billing. Coordinated data collection and performed analysis on the effectiveness of H&W products, identifying trends, performance gaps, and areas for improvement in product capabilities.Implemented tools like Tableau and Power BI to monitor real-time H&W product performance, visualizing key performance indicators (KPIs) and ensuring timely identification of issues or trends.

Demonstrated excellent knowledge of AML and Banking security regulations including the US Patriot Act and Bank secrecy Act and is experienced in the execution of transaction Audits and delivery of trainingMainly worked on Credit risk which is the major component were Credit valuation Adjustment (CVA and Stressed CVA).Involved in the process of bulk of the CCAR schedules. Main schedules were the FRY -14A.5 and FRY-14Q – Schedule L – Counterparty.Conducted AML reviews and ensured adherence to existing financial regulations and supervised money market sweeps and monitor exposure to risk.Worked with QA team on conducting user acceptance testing (UAT) and involved in preparing a detailed user manual for the application.Creating and maintain the database using SQL and Excel.Developed and managed the formal SDLC implementation using Agile/Scrum MethodologyParticipated in GAP analysis around the idenficiation of business rules and system Process flow, user administration, requirement and assumptions.

Assisted in creating Functional Design Specifications (FDS), detailing how the business requirements would be implemented within the system, ensuring clarity for development teams.Created UI mockups to review the requirements and provide feedback on the screen design.Analyzed User and functional requirements to point out gaps between used SQL queires to extract the data from the database.Contributed to sprint planning sessions by prioritizing user stories, estimating tasks, and setting achievable sprint goals, enabling the team to deliver high-value features within defined timelines.Coordinated with concerned developer/developer teams for design reviews as per the business requirement for both UAT and production testing.Assisted in change management efforts by documenting system updates, supporting user communication, and ensuring that training materials were aligned with new system functionality. Assisted in creating and maintaining a Requirement Traceability Matrix (RTM) to ensure that all business requirements were tracked throughout the SDLC, from initial requirements gathering through to final testing.