• Developed cost estimating process for quoting new business that was adapted by entire division.• Conducted User Story Workshops and trained Team Members on how to effectively write User Stories• Conducted user interviews, gathered requirements, analyzed the requirements, and managed change requirements by implementing Organization Change Management (OCM) Methodology.• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans. knowledge of HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.• Provided EDI interfaces with Commercial and Government Insurance Payers that included Medicare and Medicaid.• Proactively identified any risk/dependencies in time for the assigned project activities before their likely occurrence. Highlighted emerging issues as the audit lifecycle progresses and provided ad- hoc advice and guidance for the best approach.

• facilitated meetings with Claims, Finance, Web services, Correspondence, and development teams to gather requirements and complete missing work pieces and task to ensure transition is smooth, enhancements are made, maximum outcome is achieved and well documented as well as organize various existing documents, minutes of meeting, requirements and notes in order to make it easy for transition from legacy system to new system.• Reviewed the HIPAA compliances and guidelines pertaining to Protected Health Information (PHI) and Personal Identification Information (PII). Communicated the importance of International Classification of Disease (ICD 10) and Current Procedural Terminology (CPT) codes. Collaborated to discuss the Effectiveness of Health Data (HEDIS measures).• Maintaining, uploading, and tracking all requirements, Approvals and pending tasks in Jira, internal trackers and on SharePoint.• Migrated EDI systems from Gentran Server to IBM Sterling B2B Integrator platform that completed on schedule.• Migrated about 200 EDI partner relationships from legacy to IBM Sterling B2B Integrator• Monitoring and verifying whether EDI transactions are on time and resending file in case of any outbound interruption, requesting the Trading partner to resend the file if we haven’t received it on time.• Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.• Managed and participated in Scrum Ceremonies as, Backlog Grooming/Refinement, Sprint Planning meeting, Daily Scrum, Sprint review meeting and Sprint Retrospective.• Spearheaded incident management processes using ITSM tools such as Remedy and Service Now, ensuring swift resolution and minimizing disruptions to business operations.• Leveraged expertise in SQL and PL/SQL to perform complex data analysis, troubleshoot database issues, and optimize query performance, resulting in improved system efficiency.

• Communicated across all the Stakeholders regarding various aspects of Electronic Data Interchange (EDI) and HIPAA and HITECH compliance to keep the health data protected from any users who are unauthorized to have access to the health data• Evaluated the quality of care provided by the platform using relevant tele health focused metrics and KPIs in accordance with healthcare industry standards HIPAA, HL7, FCA, PHI, ICD, FHIR, HEDIS, ISO and GDPR.• As part of requirement gathering process the project team conducted multiple rounds of questionnaire and interviews with Subject Matter Experts (SMEs) and Product Owner. The objective of the interview was to gain a comprehensive understanding of requirements that served the basis for the development of project including functional and non-functional requirements,• Increased EDI claims submissions from 2500 claims per month to 175,000 claims per month.• Analyzed AS-IS system by performing Document Analysis & system Analysis for efficiency & comprehended the business workflow. Collaborated closely with cross functional teams to gather requirements and design the TO-BE system.• Analyzed technical & business risks and collaborated with developers & data engineers to create migration strategies.• Created various documents such as Business Requirements Document (BRD), Functional Requirements Documents (FRD), System Requirement Specification (SRS), and other relevant documents essential for development team• Worked closely with the development team to create mock-ups, wireframes, and UML diagrams like Use Case diagrams, Activity Diagrams and Sequence Diagrams using Lucid Chart that illustrated a blueprint, envisioned system architecture and data models.• Identified file changes and data relationships associated with Facets application upgrade and defined impact on customer implementation.

• Familiarized with data warehouse, data mart and Business Intelligence concepts by performing literature review.• Conducted thorough analysis of existing business processes to ensure comprehensive understanding for the project.• Collaborate with stakeholders to identify and document the requirements for integrating the M3 order management system with the Enterprise Data Warehouse (EDW). This involves understanding the data needs, data sources, business rules, and integration points.• Facilitated highly collaborative Joint Application Development (JAD) sessions and conducted interviews with SMEs and stakeholders to gather detailed functional, non-functional, user, and system requirements using collaborative techniques.• Develop the GIS maps (TP specific) which translate EDI data to Application Files.• Analyzed Data mart business requirement and identified and located various disparate sources for data extraction.• Work closely with technical teams to design and develop the integration between the M3 order management system and the EDW. Assisted in developing Conceptual and Logical Data Models with the help of Entity-Relationship (ER) Diagrams. Established Facts, Dimensions and identified a schema for the data marts.• Conducted exploratory analysis of the source system to determine data mapping and transformation requirements.• Work with change management teams to ensure a smooth transition from the existing systems to the integrated solution. Help in identifying and managing any organizational or process changes resulting from the integration of the M3 order management system with the EDW.• Conducted and participated in walkthroughs to discuss certain issues with the development, design, and QA team.• Executed SQL queries to retrieve data from database and validated as per requirements.