Joy A Email & Phone Number

United States

Responsibilities:Worked with management professionals, analysts as well as other business teams on requirement gathering.Conducted JAD sessions with stakeholders, system owners, architects and developers to present project scope documents and gather high level business requirements.Facilitate meetings with external clients and internal teams to gather and clarify requirements.Prepare requirement documentation including User Stories, Functional Specifications Documents (FSD), and Business Requirements Documents (BRD).Drive strategic alignment by ensuring that Epics and User Stories are aligned with the organization's overall goals and objectives.Collaborate with senior management to define and prioritize Epics and initiatives that deliver maximum business value.Lead the refinement process of Epics into detailed User Stories, ensuring clarity and alignment with stakeholder expectations.Conduct market and competitive analysis to identify trends and opportunities .Define and monitor key performance indicators (KPIs) to track the success and impact of Epics on business outcomes.Lead cross-functional teams in the development and execution of Epics, ensuring alignment with timelines and budgets.Ability to document SAS programs and processes for future reference and audit purposes.Familiarity with CMS data privacy and security guidelines.Established under the Affordable Care Act (ACA), HIX offers a range of qualified health plans, often with subsidies available for eligible individuals.Interview stakeholders and record technical requirements for Microsoft Office 365 implementation and deployment.Manipulated, cleansed& processed data using Excel, Access and SQL. Based on business requirement, developed the Complex SQL queries with Joins, Stored procedure, Views, Trigger to implementing the business rules and transformations.Helped in the UAT testing, test plans, test cases and worked with the business users for UAT test execution

Washington, District Of Columbia, United States

Responsibilities:• Closely monitor data migration during the process, to identify and resolve any problems that arise.• Conducted an advanced analysis of both the source and target system and whether the data migration willinterfere with normal business operations or contribute to downtime.• Once the migration is complete, ensure there are no connectivity problems with source and target systems. The goal was to ensure all data migrated is correct, secure, and in the proper location. • Validated Inquiry flow from blue web to JIRA.• Created User story for workflow validation.• Worked extensively with developing business rules engine enabling the business rules such as referral, priorauthorization, eligibility, claims processing and billing essential.• Development of 820, 834, 837 Claim billing, 276 Status, 834 Enrollment, 835 Claim Payments, 829 and manyother healthcare maps.• Create metadata and provide assistance for development of Canonical Data Model for members, groups, billing& payments.• Worked with business area SMEs/analyst to develop and finalize test plans/use cases.• Conducted detailed and comprehensive Business Analysis by working with end users and other stake holders identify the system, operational requirements, and proposed enhancements.• Worked closely with managers to plan mapping of the data fields to effectively migrate the data to JIRA fromALM.• Worked closely with project owner to prioritize product backlog management and provide continuous deliveryof features.• Efficiently used Agile/Scrum Methodologies for gathering requirements and facilitating user stories.• Manipulated, cleaned & processed data using Excel, Access and SQL, Tableau.• Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).• Analyzed and worked with HIPAA-specific EDI transactions for claims, member enrollment, and billingtransactions. Worked specifically on EDI Health Care Claim Transaction set (837).

Al, Montgomery

•Identified and conducted stakeholder analysis to gather Business Requirements, interacting with stakeholders, gathering requirements, and assigning priorities to each of them.•Facilitated Agile sessions, as well as conducted ceremonies with business/technical stakeholders.Monitor and evaluated E&E system performance and provide recommendations for improvement.•Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.•Created user stories for business requirement and technical responses and upload them in JIRA of each project.•Prepared Business Requirement Specification Document (BRD) and converted into Functional requirement specifications document (FRD).•Worked extensively with Compliance, Accounts Payable, Accounts Receivable and Chart of Accounts, Cost Accounting, Tax and Revenue (including IVA, GDPR, Global Privacy Laws, US GAAP), within the largescale ERP.Identify and mitigated risks associated with E&E processes and systems.•Prepared and present reports on E&E-related metrics to senior management.