ANJAN PABLA

As Business Analyst Having 2 years of experience with increasing responsibility in healthcare domain and Information Technology Having 2 years of Business Analyst computerized Developed client requirements and their detail design documents to implement commercial claims processing on a Medicaid platform. Good working knowledge of Claims processing, Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction Set EDI X12 837, 270/271, 276/277, 278, 834, 835 Gathered requirements and implemented Managed Care Medicare programs Held JAD sessions for internal Claims processing department Performed on - site Health Plan reviews for Medicaid encounter compliance Implemented and maintained all EDI payer files for private, Medicaid and Medicare insurance plans Designed and implemented a Pharmacy Medical Administration Record (MAR) Gathered requirements and use case scenarios for all HIPAA X12 transactions to be upgraded to a new platform for compliance, validation and routing that included process flows Implemented Hospital & Home Health Pharmacy Systems Claims Fraud & Abuse Extensive Claim experience for Provider, Payer, Clearinghouses, Pharmacy Expert level knowledge of healthcare industry applications and processing, EDI transaction sets and formats. Good understanding of Software Development Life Cycle (SDLC), Rational Unified Process (RUP), Agile/Scrum methodology, Unified Modeling Language (UML), Object Oriented Analysis and Design Concepts (OOAD), Business Process Re-engineering (BPR), Test Lifecycle, Data Modeling. Experience in writing Business Requirements Documents (BRD), System Requirement Document (SRD), Use Case Specifications, Functional Specifications, and Technical Specifications across the Deliverables of a project. Strong Experience in Smoke, Functional, Regression, Performance and User Acceptance testing for the highly structural and complex systems. Extensive experience in Black Box Testing, Functionality Testing, System Testing, Regression Testing, UI Testing, User Acceptance Testing (UAT), Bug tracking system & process and Database Testing using SQL. Expertise in Population Health Management and Risk Adjustment experience Technical Skills Strong knowledge of FDA and Cgmp regulations Excellent analytical and problem solving skills Strong communication and interpersonal skills Proficient in Microsoft office and Quality Management Systems (QMS) Quality Processes Operation Monitoring Complaint Resolution Process Documentation Performance Monitoring Employee Training Product Inspections Test Result Interpretation Specification Review Staff Supervision Final Product Approvals Team Support and Oversight Quality Control Regulatory Knowledge Critical Thinking Deadline Adherence Strong Work Ethic Routine Analysis Time Management Attention to Detail Defect Identification Manufacturing Processes Effective Multitasking Interpersonal Communication Excellent Researching Skills Proactive [Job Title] with [Number]+ years product management experience in small start-up business environments. Effective driver of product development lifecycle from concept to delivery. Communicative and collaborative with proven history of improving business operations to support corporate growth and revenue.