Kshitiz Maharjan
Verona,WI
Summary
Experienced Senior Business Analyst specializing in IT services, primarily within the healthcare sector. Serve as a communicator, facilitator, and mediator, enhancing business processes and effectiveness through technology, strategic planning, and analytical solutions. Skilled at bridging departmental gaps to improve technical efficiency and productivity. Collaborate with internal and external stakeholders across business units to develop analyses and documentation, effectively communicating with production, managerial, and executive teams. Evaluate, analyze, and communicate system requirements on a daily basis while maintaining system processes. Strong communicator and liaison between internal and external stakeholders.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Business Analyst Consultant
Stealth Talent Solution (Contracted to KPMG)
Remote
09.2024 - Current
- Supporting California Department of Health Care Services for Population Health Management Service (PHMs) Project
- Served as a key member of the PMO team supporting a large-scale healthcare transformation program impacting 15M+ Medicaid members, partnering with executive leadership, business stakeholders, and technical teams to drive strategic initiatives and release delivery.
- Facilitated stakeholder decision-making by leading governance activities, status reporting, risk and issue management, and cross-functional workshops across various stakeholder groups, ensuring alignment on program priorities and delivery objectives.
- Reviewed, analyzed, and helped secure approval for **multiple project artifacts**, including System Specification Documents (SSDs), Requirements Documents, Flags & Measures documentation, Report User Manuals (RUMs), decision logs, and release readiness deliverables.
- Supported successful delivery of 4 major system releases (Releases 2–5)** by coordinating requirements validation, business process reviews, stakeholder sign-offs, and implementation readiness activities.
- Supported end-to-end testing, User Acceptance Testing (UAT), defect triage, and production validation efforts for system enhancements, reports, dashboards, data integrations, and configuration changes, ensuring business and technical requirements were met.
- Partnered with SMEs, product owners, and technical teams to review and approve **new and enhanced business measures, eligibility indicators, and reporting logic updates**, improving program visibility and operational decision-making.
- Managed RAID logs, action items, decision tracking, and executive communications, helping accelerate issue resolution and maintain delivery timelines across multiple concurrent workstreams.
- Analyzed business requirements, data specifications, and system outputs to improve data quality, reporting accuracy, and compliance, contributing to successful implementation of population health and care management initiatives.
Senior Business Process Analyst
CAITTA INC.
Herndon, VA
01.2024 - 10.2024
- Support US Food and Drug Administration (FDA) Office of Regulatory Affairs (ORA) Contract
- Led the successful implementation of an enterprise Budget Request Workflow solution, replacing a manual email-based process with a centralized SharePoint, Microsoft Forms, and Power Automate platform, improving budget tracking, governance, and audit.
- Partnered with 20+ stakeholders across business and technology teams to gather requirements, define workflow triggers, approval paths, and reporting needs, resulting in a standardized and streamlined budget planning and allocation process.
- Automated budget request submissions, approvals, notifications, and status tracking, reducing manual effort by an estimated 60%+ and providing leadership with real-time visibility into funding requests and project expenditures.
- Designed and deployed an executive Project Health Dashboard monitoring 50+ active projects, consolidating data from multiple sources into a single reporting platform and reducing manual reporting efforts by approximately 75%.
- Developed automated SharePoint lists, workflows, and Power BI dashboards with daily data refresh capabilities, enabling executives to proactively monitor project health (Green/Yellow/Red status), risks, and portfolio performance from a centralized location.
- Authored business and technical documentation, facilitated JAD sessions, led UAT activities, and delivered user training, contributing to successful solution adoption and reduced operational burden across the organization.
Nursing Home IT Business Analyst
Wisconsin Department of Health Services
Madison, WI
10.2022 - 01.2024
- Supported reimbursement policy, claims processing, and MMIS enhancements for 350+ nursing home facilities statewide, ensuring compliance with Medicaid regulations and improving provider payment operations.
- Partnered with state agencies, fiscal agents, vendors, and healthcare providers to analyze claim adjudication and billing issues, identify root causes, and implement solutions that improved payment accuracy and operational efficiency.
- Utilized SQL, SAS, Business Objects, and MMIS data sources to perform complex claims analysis and research for reimbursement-related inquiries, investigating claim edits, audits, pricing methodologies, policy requirements, provider enrollment data, and member eligibility information to identify root causes and support payment resolution efforts.
- Contributed to a statewide Non-Emergency Medical Transportation (NEMT) initiative by resolving claim rejection issues affecting dual-eligible members, improving reimbursement processing and access to transportation services for nursing home residents across Wisconsin.
- Collaborated with providers and MMIS vendors to address system and billing gaps related to enteral nutrition formula claims, resulting in the successful reimbursement of approximately $1 million for three state-operated nursing facilities.
- Authored business requirements, functional specifications, maintenance directives, and system change requests to support MMIS enhancements and policy-driven initiatives.
- Facilitated UAT, defect resolution, and production validation for system changes, ensuring successful deployment and alignment with business, regulatory, and provider requirements.
IT Procurement Business Analyst
Texas Health and Human Services Commission
Austin, TX
04.2022 - 06.2022
- Collaborated on an IT procurement initiative supporting the acquisition of EHR services for Texas State Hospitals and State Supported Living Centers, gathering business, system, and contractual requirements from multiple stakeholder groups.
- Facilitated stakeholder interviews and JAD sessions, and developed key project artifacts including business process flows, use cases, requirements traceability matrices (RTMs), and conceptual architecture diagrams to support procurement activities.
- Visited State Supported Living Centers to observe clinical workflows, gather pain points directly from clinicians, and translate operational needs into procurement requirements to ensure desired functionality was included in the future-state EHR solution.
- Analyzed existing EHR platforms and business processes, partnering with program staff and clinical stakeholders to identify workflow improvements and support vendor evaluation and solution selection efforts.
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
Product Business Analyst
Babel Health
Pittsburgh, PA
10.2021 - 04.2022
- Partnered with multiple health plans to onboard and integrate encounter data submissions into the EDGE server, ensuring compliance with regulatory reporting requirements and successful transmission of encounter claims to state agencies.
- Collaborated with health plans, technical teams, and vendors to analyze EDI transactions, validate encounter data, troubleshoot submission issues, and implement process improvements that increased data quality and reporting accuracy.
- Facilitated requirements gathering, testing, defect resolution, and production readiness activities, contributing to a 95%+ encounter claim acceptance rate and reducing submission errors during onboarding and implementation efforts.
- Supported end-to-end onboarding activities, including data mapping, file validation, stakeholder coordination, and production support, enabling timely and accurate encounter reporting across participating health plans.
Senior Business System Analyst
Gainwell Technologies
Madison, WI
10.2018 - 09.2021
- Supported multiple MMIS modernization and enhancement initiatives as part of a large-scale Design, Development, and Implementation (DDI) program, collaborating with business stakeholders, technical teams, vendors, and state agencies to deliver solutions supporting Medicaid members, providers, and program operations statewide.
- Played a key role in the implementation of an enterprise document management solution (OnBase), partnering with multiple program areas to define document types, keywords, indexing strategies, and business processes, creating a centralized repository that improved document accessibility, searchability, and operational efficiency across the organization.
- Contributed to the modernization of SSI member services by gathering requirements and supporting implementation of an online member portal and electronic payment capabilities, helping elderly, blind, and disabled Medicaid populations access benefit and payment information without relying on mailed checks or in-person visits.
- Collaborated with financial institutions, vendors, and technical teams to support real-time payment processing, system integrations, and Single Sign-On (SSO) capabilities, improving user experience and streamlining access to Medicaid services.
- Supported the implementation of **Claims Lock/Unlock functionality** within MMIS, enabling users to identify claims under review or adjustment, reducing duplicate processing, strengthening claims integrity controls, and improving operational efficiency while supporting compliance with state and federal program requirements.
- Facilitated **20+ JAD sessions, stakeholder interviews, and requirements workshops** to gather, analyze, and document business and system requirements, producing project charters, change orders, business process models, activity diagrams, and system specifications.
- Authored and maintained key project artifacts including Business Requirements Documents (BRDs), Functional Requirements Documents (FRDs), System Requirements Specifications (SRS), Project Charters, Change Orders, Activity Diagrams, Use Cases, Requirements Traceability Matrices (RTMs), Test Plans, and Test Scenarios to support MMIS modernization initiatives, OnBase implementation, SSI member portal enhancements, and Claims Lock/Unlock functionality from requirements through implementation and UAT.
- Developed test plans, test scenarios, requirements traceability matrices, and defect management processes utilizing ALM and JIRA, supporting successful implementation of MMIS enhancements across claims, encounters, financial, and provider business areas.
Encounters Business Analyst
Anthem Inc.
Norfolk, VA
04.2017 - 06.2018
- Worked as an Encounter Business Analyst to ensure the timely, accurate, and compliant submission of Medicaid encounter claims to the State of South Carolina, contributing to a 97% encounter acceptance rate and helping avoid potential state reporting penalties.
- Conducted detailed analysis and validation of encounter claims using **SQL and X12 EDI transactions (837, 835, 999, 277, and 277CA)** to ensure compliance, data completeness, and adherence to state encounter reporting requirements.
- Leveraged hands-on experience analyzing stored procedures, system logic, and historical encounter data to identify root causes of rejections, resolve erroneous business rules, and improve encounter acceptance and processing efficiency.
- Performed quality assurance reviews, encounter reconciliation, and remediation activities prior to state submission, reducing rejection rates, minimizing duplicate submissions, and improving overall data quality.
- Conducted User Acceptance Testing (UAT) for MDE automation enhancements, validating business requirements, system functionality, and encounter processing outcomes prior to production deployment.
- Coordinated impact analyses, market remediation efforts, and stakeholder discussions to identify encounter submission risks, prioritize corrective actions, and improve reporting accuracy.
- Translated state encounter reporting requirements into business requirements, collaborated with developers to resolve defects through JIRA, and supported implementation of system changes to improve encounter processing and compliance.
- Developed and maintained reporting databases and performance tracking tools, utilizing summary statistics and encounter data analysis to monitor trends, identify submission issues, and support operational decision-making.
Education
Bachelor of Business Administration - Business Management
Monroe College
New Rochelle, NY08-2020
Skills
- Proficient in Agile, Waterfall and Hybrid methodologies
- Highly skilled in Microsoft Office (Word, Excel, Outlook, PowerPoint, Visio, SharePoint)
- Experience with various business tools and applications including MMIS ForwardHealth Interchange & Portal, EDI- 837, 835, 999s, Remittance Advice, Ultra Edit, Tableau, JIRA, Confluence, ALM, OnBase, FACETS, Enterprise Architecture (EA), Business Objects, SAS, SQL
- Proficient in Requirement Gathering, Analysis, Elicitation and Process Mapping, Wireframe, Mockup, UAT
- Capable of translating business requirements to Functional and Technical specifications
- Proficient in creating Project Artifacts such as Business Requirement Documents, Design Specifications, System Test Plans, User Guides, Training materials, and Process flow diagrams
- Experience in collaborating with multi-dimensional Cross Functional Teams, Project SMEs, Internal and External stakeholders as well as Senior Government and Organizational Leadership
- Possess strong Oral and Written Communication and Presentation Skills, with the ability to effectively explain Technical Components and facilitate JAD (Joint Application Development) Sessions with stakeholders
- Demonstrate experience in Leading Cross-functional Teams and Projects, Delivering Results on Time and within Budget
Certification
- Certified Scrum Product Owner (CSPO) Scrum Alliance Issued Jul 2021
- Certified Scrum Master (CSM) Scrum Alliance Issued Aug 2021
Timeline
Business Analyst Consultant
Stealth Talent Solution (Contracted to KPMG)
09.2024 - Current
Senior Business Process Analyst
CAITTA INC.
01.2024 - 10.2024
Nursing Home IT Business Analyst
Wisconsin Department of Health Services
10.2022 - 01.2024
IT Procurement Business Analyst
Texas Health and Human Services Commission
04.2022 - 06.2022
Product Business Analyst
Babel Health
10.2021 - 04.2022
Senior Business System Analyst
Gainwell Technologies
10.2018 - 09.2021
Encounters Business Analyst
Anthem Inc.
04.2017 - 06.2018
Bachelor of Business Administration - Business Management
Monroe College