Chandni Patel
Grand Prairie,USA
Summary
Accomplished Senior Business Analyst with a proven track record at HCSC, specializing in operational excellence and claims modernization. Leveraged financial management and interpersonal skills to enhance stakeholder relationships and drive project success. Proficient in Agile methodologies, consistently exceeding expectations through strategic problem-solving and effective team collaboration.
Overview
10
10
years of professional experience
Work History
Sr Business Analyst
HCSC
06.2023 - 11.2023
- As a Sr business Analyst at HCSC, I was a part of their ongoing project in building a new UI – Claims Modernization
- Assessed risks and developed mitigation strategies to ensure project success
- Evaluated current operational procedures, identified inefficiencies, and proposed strategies to achieve operational excellence
- Built relationships and collaborated with business units, development teams, and other stakeholders to gather, analyze and prioritize requests
- Ensured that complex requirements are executable, testable, complete and not ambiguous
- Documented and elicited requirements through user stories, use cases, process flow diagrams, etc
- Conducted daily refinement sessions on new and ongoing Epics
- Helped write success criteria, epic diagrams and epic user stories in JIRA
- Worked with SME and stakeholders to gather requirements and document them into discovery documents
- Worked closely with development and testing team with building desired UI
- Developed detailed project documentation, including business requirements, project plans, and reports
- Documented report and dashboard specifications from existing systems and tools
- Managed stakeholder expectations through effective communication and regular updates
- Facilitated productive workshops and meetings to gather business requirements and feedback
- Designed and executed comprehensive testing strategies to ensure system functionality met business needs
Sr. Business Analyst
UnitedHealth Group
05.2023 - 11.2023
- At UHG the main goal of the position was to ensure configuring the clinical rules and updating the documents with monthly updates provided and once update was done in the documents, it was configured in ICUE
- Performed Configuration of auth clinical rules, work queue routing rules, quick code look up rules, and other configurations as needed
- Created user stories in Rally to track task hand off during sprint
- Actively participated in cross functional team daily huddle calls to groom user stories, participate in sprint retrospectives, and discuss potential road blocks to change requests
- Primarily responsible for configuring work queue routing requests that will route a case for review once it is submitted into ICUE
- Reviewed change requests to ensure consistency and compatibility to existing system and procedures, including researching, validating, and resolving issues for accurate provider experience
- Troubleshoot configuration issues and identified modifications needed to meet changing requirements and regulatory needs
- Used extensive ICUE rule configuration, business knowledge, and effective communication skills to facilitate and elicit requirements for change requests and specialty projects
- Processed Documentation/Updates within the company documents
- Conducted configuration analysis by reviewing configuration set-up and identifying root cause of findings
- Reviewed testing results and made configuration modifications to correct issues identified during testing
- Identified process improvement opportunities to improve accuracy and timeliness
- Served as SME to PAGE team business analysts and other teams in coaching and developing configuration knowledge
- Actively participated in regulatory and high priority projects that arise during the course of business operations
- Provided detailed acceptance criteria for AIM testing as a back up to the AIM configuration analyst
Business Systems Analyst
CVS/Caremark
10.2018 - 04.2023
- The primary goal of the project was to extract common services such as Eligibility, Formulary and Drug Maintenance out of the different systems and host them independently to facilitate economy of operations, isolation of common business services from core adjudication transaction processing and externalize the data in a way that can be consumed by other external applications within the Organization
- Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders
- Performed Data mapping on the extracted data, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
- Used Infro Interptise resource solution software for ERP development systems
- Have ensured Dynamics AX/D365 ERP systems for financial management
- Involved in the HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims
- Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set
- Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
- Programming with Python and JavaScript
- API authentication in patient portals
- Designed and developed Use Cases and Use Case scenarios, Activity Diagrams, High Level and Low Level Process Flow Diagrams
- Conducted surveys, interviews and JAD sessions and translated them into system Requirements
- Responsible for preparing a Business Requirement Document (BRD), Functional Requirement Document (FRD) and then translating it to functional specifications and test plans
- Performed Gap Analysis in every phase and stages to check the compatibility of the existing system infrastructure with the new business requirements
- Interacted with DBA for the process of data extraction, data transformation, data load, data integration and conversion processes using business intelligence tools on the Benefit Plan functionality
- Worked with PM to prepare Project charter, Project plans, daily, weekly and monthly team deliverables for each phase, drafting WBS and RBS systematically using MS Project
- Worked with relational database models and XML schemas to create technical/system design documents, and developed crystal reports
- Performed OLAP and ETL for storing analytical data in the database and helped the DB team in performing data analysis
- Served as a Peer review member to verify, validate and modify necessary changes made considering technical and business aspects, in the deliverable documents and thereby uploading it on SharePoint
- Consolidated individual Statistical Summary from the team deliverables, various reports, jobs, files and Inventory documents to present it in weekly status meetings
- Lead requirements analysis and inspection, ensuring that requirement statements and business rules are complete, consistent, concise, comprehensible, traceable, feasible, unambiguous, and verifiable, and that they conform to standards
- Facilitated various brainstorming, requirement gathering sessions, and provided training on HIPAA Compliance, HIPAA Standard transactions and current version of X12 HIPAA 4010A1
- Managed requirements traceability information and tracked requirements status throughout the project
- Also managed changes to baseline requirements through effective application of change control processes and change management tools
- Proposed and came up with the RAID document to identify the Risks, Assumptions, Issues and Dependencies involved with every tasks assigned
- Provided highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
- Developed budget tools and templates, and prepared and analyzed highly complex financial and budget reports for management review
- Environment: RUP, COBOL, IBM AS/400, CICS, Citrix, DB2, ETL, MS Excel, MS Word, MS Access, MS Project, MS Visio
EDI Business Analyst
MedAmerica
06.2016 - 09.2018
- Objective of the project was to develop Medicaid Management Information System for State of New York following HIPAA standards
- The web based Health Care Management System is developed using HIPAA guidelines and regulations which keeps track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment
- This application also keeps record of all transactions, subscriber's medical history and provides data to other State agencies as required
- Participates in all phases of testing software and data transfer testing and thoroughly document EDI transactions and data issues, if any, and their resolution
- Validation of insurance enrollment, including Medicaid and/or private insurance programs
- Performed Data mapping on the extracted data, logical data modeling, created class diagrams
- Identifies and researches EDI issues and develops and implements work plans to address the issues
- Interpret data, analyze results using statistical techniques and provide ongoing reports
- Develop and implement data collection systems and other strategies that optimize statistical efficiency and data quality
- Acquire data from primary or secondary data sources and maintain databases/data systems
- Identify, analyze, and interpret trends or patterns in complex data sets
- Filter and “clean” data, and review computer reports, printouts, and performance indicators to locate and correct code problems
- Developed Schemas of EDI X12 Claims (837) and Eligibility forms in XML
- Involved in creating sample mappings for the conversion of EDI X12 transactions code sets
- Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance
- Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277
- Developed EDI specifications and applications structures for data feeds and mappings for integration between various systems, including XML and performed back-end testing on the Oracle database by writing SQL queries
- Work closely with management to prioritize business and information needs
- Locate and define new process improvement opportunities
- Work with large 276, 270, 820, 834, 835, 837, 999 data sets, TRR/MMR
- Validate enrollment processing (EDI) and reconciliation systems
- Strong knowledge of and experience with reporting packages (Business Objects, databases (SQL etc.), and programming (XML's)
- Used Unified Modeling Language (UML) for process modeling and use cases
- Generated daily, weekly, and monthly reports using MS Office Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose
- Developed gap analysis document, logical and physical design and remediation plan
- Captured, communicated, managed system requirements and maintained requirement tractability matrix to keep team members up to date with the latest testing results
- Involved in creation of test plan, test scenarios, test cases for unit, system and system integration testing using HP-ALM
- Environment: SQL, HP Quality Center, Agile, XML, Windows XP, MS Excel, MS word, VM ware
Business Analyst
Optima Health
01.2014 - 05.2016
- Company Overview: Optima Health Corporation provides powerful range of products in cardiac healthcare
- Scope- The project involved the development of a web-based application called EDR (Electronic Data Reserve) database for storing user files
- Played a key role in the planning, testing, and implementing system enhancements and conversions
- Provided key project inputs by working with users in defining the project and system requirements
- Reviewed business process, and functional requirements
- Worked on Hospital data processing for improving database for storing user files
- Analyzed business needs, created, and developed new functionality to meet real time data integration that facilitated decision
- Experience of managing multiple stakeholders across the organization, and in QA integration of systems
- Involved in detailing project mission, data process flow diagrams, and timelines
- Worked with SQL queries for data manipulations
- Used ETL process in helping the DB team in data migration
- Assisted in building a business analysis process model using Rational Rose, Requisite Pro and Visio
- Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams
- Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture
- Developed strategic partnerships with the business unit to develop a solid knowledge base of the business line, including the business plan, products and processes
- Research operational procedures and methods and recommended procedures for improvement –with an emphasis on automation and efficiency
- Assisted Test Lead, Testers understanding business process and help them successful completion of Unit Testing, Integration Testing, Functional Testing and SIT
- Optima Health Corporation provides powerful range of products in cardiac healthcare
Education
Master of Science (M.S.) - Microbiology
Vellore Institute of Technology
04.2004
Skills
- Presentations and decks
- Financial management
- Narrative use cases
- Machine learning
- Business analysis
- Problem-solving abilities
- Microsoft Excel mastery
- Interpersonal skills
- Process mapping
- Business strategy
- Verbal and written communication
- Multitasking
- Client relationship management
- Team collaboration
- Agile methodologies
- Agile methodology
- User acceptance testing
- Software development lifecycle
Timeline
Sr Business Analyst
HCSC
06.2023 - 11.2023
Sr. Business Analyst
UnitedHealth Group
05.2023 - 11.2023
Business Systems Analyst
CVS/Caremark
10.2018 - 04.2023
EDI Business Analyst
MedAmerica
06.2016 - 09.2018
Business Analyst
Optima Health
01.2014 - 05.2016
Master of Science (M.S.) - Microbiology
Vellore Institute of Technology
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