Fred Boakye

• Served as a primary liaison between business stakeholders, engineering, QA, vendors, and trading partners, ensuring solutions met HIPAA and healthcare compliance requirements.
• Led discovery and requirements sessions across claims, billing, formulary, inventory, and pharmaceutical EDI workflows, translating business needs into clear functional requirements.
• Defined and maintained user stories, acceptance criteria, and backlog priorities, balancing regulatory compliance, product value, and delivery timelines.
• Supported Agile delivery through daily stand-ups, sprint planning, backlog refinement, demos, and close collaboration with Scrum teams.
• Analyzed and documented end-to-end business processes, system scope, and objectives, providing strategic recommendations to support client technology goals.
• Leveraged ServiceNow and Azure DevOps to manage, analyze, and resolve tickets, improving workflow efficiency and operational reliability.
• Validated EDI mappings, transaction flows, and exception handling, including 810, 832, 855, and 856 transactions converted to X12 formats.
• Performed SAP EDI setup verification and collaborated with technical teams to ensure accurate configuration prior to production release.
• Coordinated and executed SIT and UAT activities for core product functionality and pharmaceutical EDI integrations, validating outcomes with business users.
• Designed and implemented enhancements, including a Billing and Inventory Management tool, improving product tracking and data visibility.
• Created and executed test scenarios and integration test plans using tools such as Lucidchart to verify requirements were met in system design.
• Identified, documented, and resolved system and process defects, with a focus on HEDIS data integrity and regulatory reporting accuracy.
• Analyzed operational and transaction-level data to identify trends, reduce errors, and improve system performance and reliability.
• Prepared audit materials, management reports, metrics, and executive presentations, clearly communicating progress, risks, and corrective actions.
• Mentored junior analysts on healthcare product analysis, pharmaceutical EDI concepts, and best practices in documentation, testing, and stakeholder engagement.

● Collaborated with cross-functional teams and product owners to gather, groom, and document user stories, define epics, features, and acceptance criteria using Agile/Scrum practices in Azure DevOps and JIRA.

● Assisted in planning, analyzing, and optimizing healthcare business processes, supporting Medicaid and Medicare claims operations and regulatory requirements.

● Partnered with business stakeholders and clients to gather, analyze, and document functional and system requirements using Jira, Azure DevOps, and ALM tools.

● Translated business needs into clear functional specifications, process flows, conceptual data models, data dictionaries, and volume estimates for technical teams.

● Served as a liaison between business and IT, ensuring requirements were accurately communicated and implemented across the SDLC.

● Developed and executed test scenarios and test cases, supporting system testing, integration testing, and UAT; analyzed results and supported defect resolution.

● Executed system and regression tests from approved test plans and documented outcomes in Jira and Azure DevOps.

● Participated in technical reviews and inspections to validate that approved changes met business intent and compliance standards.

● Analyzed healthcare claims and operational data using SQL and advanced Microsoft Excel (PivotTables, VLOOKUP/XLOOKUP) to identify trends, gaps, and improvement opportunities.

● Supported business process re-engineering initiatives to improve claims accuracy, throughput, and user experience.

● Managed requirements traceability and change requests, ensuring alignment between business needs, system design, and testing artifacts.

● Utilized ServiceNow for incident tracking, enhancement requests, and cross-team coordination.

● Communicated complex technical and business concepts clearly to stakeholders, leadership, and technical teams to drive alignment and timely delivery.

• Supported a Claims Engine Maintenance initiative by performing data mapping activities and developing SQL queries for analysis and validation.
• Entered, validated, and monitored data within claims processing systems to ensure accurate and timely adjudication.
• Worked extensively within HIPAA-compliant healthcare data environments, supporting EDI transactions including 834, 835, 837, and 270/277.
• Developed and maintained EDI maps and technical specifications for multiple ANSI X12 transaction sets.
• Analyzed system behavior and identified root causes related to state-specific Medicaid and regulatory requirements.
• Ensured revenue cycle operations aligned with HIPAA, Medicare, Medicaid, and commercial payer policies.
• Validated claims processing logic, including accurate calculation of copays, deductibles, coinsurance, reimbursements, and member liability.
• Contributed to Agile SDLC initiatives, participating in iterative development, backlog grooming, and sprint execution.
• Applied working knowledge of Medicaid, managed care, member enrollment, premium billing, and claims system logic.
• Used SQL to extract, analyze, and reconcile data from multiple databases and data sources.
• Maintained epics, user stories, and acceptance criteria using tools such as JIRA and HP-ALM.
• Participated in the development and enhancement of provider and member-facing portals.
• Assisted with the design and support of HEDIS reporting and quality measurement tools.
• Analyzed managed care, Medicare, and Medicaid datasets to identify trends, risks, and opportunities for operational improvement.
• Created and maintained UML diagrams to document business processes and system requirements.
• Used UML models and Balsamiq workflows to translate complex technical concepts for non-technical stakeholders.
• Developed dashboards and reports using tools such as Excel, Power BI, and Tableau to monitor key performance indicators.
• Collaborated with state Medicaid agencies, healthcare providers, MCOs, and internal stakeholders to gather and refine requirements.
• Supported the development and execution of test plans and test cases across system and integration testing phases.
• Participated in project meetings, providing analytical and documentation support to senior analysts and project managers.
• Evaluated existing Medicare and Medicaid processes, identifying gaps and recommending process and system improvements.
• Acted as a liaison between business teams and IT to align technology solutions with revenue cycle and operational needs.
• Provided end-user support and training on Medicare, Medicaid, and related healthcare applications.
• Ensured EDI transactions complied with ANSI X12 standards and regulatory requirements, including HIPAA mandates.
• Led and supported user acceptance testing (UAT), including documentation, defect tracking, validation, and release readiness.
• Partnered with account executives and industry relations teams to support accurate communication of fee changes, billing, collections, and rebate distributions.
• Interpreted encounter data, submission requirements, and performance metrics in accordance with regulatory and health plan guidelines.
• Collected and analyzed billing, claims, payment, and accounts receivable data to generate insights that improved financial performance and operational outcomes.

● Led and facilitated stakeholder sessions to gather, analyze, and document functional and non-functional requirements for business-critical initiatives.

● Conducted requirement impact assessments and documented detailed user stories and acceptance criteria using Azure DevOps and JIRA.

● Supported Agile Scrum ceremonies including sprint planning, backlog grooming, daily stand-ups, and retrospectives across cross-functional teams.

● Collaborated daily with Product Owners, QA, offshore developers, and IT/business stakeholders to ensure alignment and clarity throughout the SDLC.

● Created and prioritized product backlogs, ensuring traceability of user stories and epics to business goals using Azure DevOps.

● Performed Gap Analysis to evaluate compatibility between existing systems and evolving business requirements.

● Developed and maintained a Requirements Traceability Matrix (RTM) to monitor progress and ensure coverage across deliverables.

● Conducted root cause analysis on production issues and collaborated with technical teams to draft technical specifications.

● Utilized SQL, MS Excel (Pivot Tables, VBA, Macros), and Access for ad hoc reporting, data validation, and performance analysis.

● Ensured consistent use of standardized plans, procedure codes, and best practices across documentation and configurations.

● Regularly communicated project status, risks, and dependencies to business leaders and cross-functional stakeholders.

● Supported QA and UAT activities through review of test cases, validation of acceptance criteria, and resolution of defects.