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• Responsible for gathering business requirements from business owners and SMEs through interviews and discussions, reviewing existing documents including centennial care contracts and responses.• Part of Technology Integration and worked as a liaison between core workstreams and product teams, Internal Provider Finder (IPF), preparing system requirements for successful implementation of Project• Preparing technical EPICs and user stories from requirements and getting validation and due dates from business owners as a part of the PPP phase• Prepared EPIC diagram with Solution architect for Technology Integration• Delivering EPICs/user stories to product teams with EPIC diagrams (System/Application details with file/data transfers), getting estimates for planned work, and reporting back to business• Prepared data mapping document with source and target data fields and data types.• Worked on creating data reports using Tableau.• Liaisoning with third-partyvendors (Transportation, Pharmacy, Dental, Translation service, etc.) for proposed change requests and creating EPICs/user stories for the same.• Worked extensively on different workstreamsthatinvolve member enrollment, claims, and payor• Worked on creating stories for EDI transactions involving 276 and 277 and EDI 837 for payment remittance involving insurance providers (payors).• Experience in following MITA goals for secure data exchange and integration of out-of-network services to the care coordinator portal.• Driving weekly calls with internal product teams and external vendors to discuss updates including UI changes, compliances, data sources• Meeting test coordinators to provide additional information as and when required and get updates on ongoing testing activities as a part of the PPP phase• Prepared non-technical EPICs/user stories for State and community outreach workstreams.• Providing utility services to the customers.

• Collaborate with CMS business project sponsors to define the scope of projects and timelines associated with the completion of the project.• Sorted, scanned, assured the quality of uploads, and reassembled all the documents once uploaded onto Salesforce.com• Prioritize and manage projects and initiatives to the requirements of CMS business needs.• Act as a Coordinator of On-shore & Off-shore resources.• Conduct meetings and facilitate collaborative discussions for requirement changes and new functionality needs as per Salesforce specifications.• Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)• Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.• Worked on different 5010 HIPAA EDI transactions and code sets including 278 (Referrals), 834 (Enrollment), 270/271 (Eligibility), 276/277 (Claim status), 837 (Claims), 835 (Claims Payment).• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation, and testing for Medicaid Claims.• Played the role of a Business Analyst in a Waterfall SDLC environment by participating in meetings and planning the project.• Managed requirement activities using an iterative and incremental methodology such as User Stories and Acceptance Criteria.• Analyzed the “As is” and “To be” system documents to show the current and proposed functionalities of the system using MS VISIO.• Developed and maintained Requirement Traceability Matrix (RTM).• Prepared SWOT analysis and impact analysis for the project.• Created Used Case documents and captured the process flows for various claims processes, Providers processes,and Subscriber processes.• Worked withHIPAA-compliant ANSI X12 837 formats for both professional claims and institutional claims.• Matched the requirements for programs such as Medicare and Medicaid which are part of the Social Security Act.

• Facilitated Joint Requirement Planning (JRP) sessions with SMEsto understand the Requirements for Loan Origination to Loan Processing.• Gather requirements by conducting meetings and brainstorming sessions with end users and SMEs and document them using Requisite Pro - the documentation tool offered by Rational.• Participated in the identification, understanding, and documentation of business requirements, including the applications capable of supporting those requirements.• Monitor questionable debit card and account activity by looking at trends, patterns, and velocities. Locating stolen and counterfeit card behavior and ID theft. To reduce losses to bank customers and to the bank itself.• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database• Introduced Agile and RUP methodologies to reflect the liquid nature of front-office improving time-to-market• Establish documentation for an agile methodology for implementation with a very water-fall-centric development team.• Conducted Asset Management, and Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.• Analyzed User Requirement Document, Business Requirement Document (BRD), Technical Requirement Specification, and Functional Requirement Specification (FRS).• Collaborated with business users and the software development team within the AGILE framework to ensure rapid and successful implementation of the solution• Utilized Agile SCRUM methodology to develop User Stories, Product Backlog, and Sprint Backlog.• Worked extensively with MS Excel and MS Access• Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario, and Use Case Narrative using the UML (Unified Modeling Language) methodologies.

• As a business analyst, responsible for Requirements gathering from various insurance companies to develop a system to check for the outstanding balance from various accounts using the highly efficient Waterfall software development methodology.• Liaison between the Business needs (business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.• Experienced in creating gap analysis from “As-Is” to “To-Be” process.• Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.• Ensured that the claims processing was strictly under the HIPPA compliance regulatory document to safeguard patient information.• Part of the team assisting in documentation involved in this project such as Request for Proposal (RFP/RFI), proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, and release document. Deliver Statement of Work (SOW).• Define, measure, analyze, and improve KPIs for each milestone and project.• Authored Business and Functional requirements (BRD) with a data flow diagram, sequence diagram, flow charts, use cases, and training manuals for the Provider Portal web-based application.• Developed and maintained Requirement Traceability Matrix (RTM).• Developed training material and trained the users on newly developed applications.• Analyzed and wrote technical documentation for risk analysis on customer support issues.• Extensively worked in creating Test Procedures, Test plans, and Test Cases for User acceptance testing (UAT).• Experienced in Quality Center for Tracking defects and interacting with team members in fixing errors• Prepared and presented monthly collection reports.• Involved in training and quality of the overall workflow process.• Documenting workflow and results of analysis for the aging accounts.

• Worked closely with the Product Owner in defining the product roadmap and capabilities for enhancements to the enterprise claims management application • Actively participated and drove continuous improvement for process and productivity to improve overall customer satisfaction and delivery of the services, meeting the requirements of the product • Continually verified requirements individually and collectively through the project lifecycles, writing formal specifications, and process workflows, and communicating such documentation with stakeholders and technology teams. • Assisted testing teams in translating requirements into test cases and ensured application architecture and systems functionality met business requirements. • Acted as the focal point to coordinate the resolution of “difficult issues” about cross-team collaboration including communication of status, escalation with management, etc.• Performed ad-hoc analysis to meet the needs of all internal business partners leveraging various data sources • Prepared presentation materials to be shared with management, business groups, and other relevant stakeholders • Worked closely with the Product Owner in designing and implementing a more accurate, efficient, and productive process of capturing the business requirements in the form of user stories • Assisted the Scrum Master in facilitating Scrum Ceremonies like Daily Standup, Spring Review, Planning and Retrospective