Project Manager Customer Service

ASTHA BAJPAI

909-***-****,** Mechanics Street, Bayonne, NJ, USA

E-mail: abjwl4@r.postjobfree.com

Professional Summary

Experienced Senior Business Analyst with over three years of proven skills in requirement gathering, interacting with developers, documenting various business processes, coordinating various projects in Healthcare Industries

Expertise in Business Modeling and UML Diagrams (Use Case Diagrams, Activity Diagrams, Sequence Diagrams) using MS Visio and Rational Rose.

Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), and Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding.

Proficient in transforming business requirements into user requirement specification, Functional Requirement Specifications Document (FRD) and Use Case Narratives.

Extensive knowledge of Unified Modeling Language (UML).

Strong visual modeling, business process modeling skills using Rational Unified Process (RUP), Proficient in utilizing, MS Visio for data mapping & process flows

Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).

Experienced with EDI files 835, 270/271, 276/277 file formats

Extensively participated in verification of EDI file formats against Standards

Hands on experience with the 837 and 835 ANSI X12 transaction understanding loops segments, elements and structure

Knowledge of HL7 and v2.x standards

Proficient in business scope definition, developing functional and technical specifications, creating business and application use case documentation, leading business and technical analysis sessions, supporting development and testing teams throughout the Software Development Life Cycle (SDLC).

Extensive knowledge of Patient Protection and Affordable Care Act (PPACA)

Trace and inform business requirement changes through the lifecycle of the project using Rational Requisite Pro while maintaining customer needs and maintain a Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.

Extensive Knowledge about National Provider Identification (NPI) and the differences between HIPPA 4010 and 5010.

Analyzed HIPAA 5010 related to 837,835, 834. Transactions and performed gap analysis between HIPAA 4010 and 5010

Extensive knowledge about the various types of health insurance programs such as : Medicaid, Medicare (Part A, B, C and D), PPO(Preferred provider organization), HMO (Health maintenance organization)

Prepared Fraud and abuse detection in medical claim process use case and RTM(Requirement Traceability Matrix).

Worked on Case Management function and claims process in healthcare using MS Visio.

Proven ability as a team player and to work independently with excellent communication and people skills and presentation skills.

Strong problem solving and analytical skills with in-depth understanding of system development methodologies, techniques and tools

Prepared ICD-9-CM to ICD-10 conversion activity diagram and ICD-10 Implementation phase package flow diagram using UML Diagrammer.

Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost Benefit analysis, ROI Analysis and Requirement Traceability Matrix (RTM)

Preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, Component-Based Diagrams, Collateral Diagrams, including the Business Workflow Chart.

Technical Experience

Business Modeling UML, MS Visio

Requirement Analysts Rational RequisitePro

Programming Languages Perl, HTML

Processes RUP, SDLC, SCRUM Methodology, JAD

Change Management Rational Clear Quest

Databases PDB, KEGG, GenBank, PubMed, Uni-Prot, DDBJ,

Operating Systems MS-DOS, Linux, Unix, Windows (2000, NT, XP, VISTA)

Project Management MS Office Suite, MS Project, Clarity

Other Tools Visio,, Rational Rose, Rational Requisite Pro, Software Modeler, Microsoft Office 2010

( Project, Word, Excel PowerPoint, Access, Visio),UML Diagrammer

Standard Skills HIPAA,ICD9-10-CM,Patient protection and Affordability Care Act, Electronic Medical Record, Electronic Health Record

Professional Experience

Teaching associate Aug2011-March2012

University of Nevada Las Vegas

• Teaching biology, biochemistry and ecology classes.

• Presented theory and concepts to students pertaining to laboratory experiments

• Demonstrated all laboratory experiments in all Biological Science lab courses

• Presented and developed information for students concerning laboratory safety

• Prepared and modified laboratory manuals and procedures as needed

• Collaborated with academic counterparts of lab courses to effectively synchronize the learning experience

• Enriched the student experience of the lab component through the development of multi-media instructional aids such as videos, demonstrations, web content, etc.

• Resolved student/lab issues such as attendance and special situations

• Prepared and maintained lab experiments and equipment for scheduled lab times

• Maintained current First Aid certification and acted as first point of contact for incidents

• Participated as a supervisor/advisor for student design projects as time permits

• Resolved problems of a technical nature

• Preparing quiz, grading marks proctoring exams of undergrads,

• Undergraduate teaching laboratory

• Teaching lab hygiene and laboratory safety methods.

• Course discussion and suggestions to faculty

2. Working title: Research associate

• Project: Yeast genetics and protein protein interaction using system biology approach

• Place: Dr Schiller lab, University of Nevada Las Vegas, NV.

• My role: Prepared Database for Protein directionality, Yeast transformation experiments.

• Prepared new Tables for directionality of protein protein interaction in Navicat.

• Literature review and journal club presentations

• Prepared status report every week and presented and discussed issues and development of projects.

• Various microscopic techniques.

Research associate Sep2010-Feb2011

Biomedical Research Center, Sheffield England UK

• Project: protein targeting to cell membranes; molecular mechanisms. Molecular chaperone action in posttranslational protein targeting

• Three way Cloning, Mutagenesis, Mini Prep Plasmid preparations.

• Presenting weekly reports, mentoring undergrad students for lab work.

• Regulated lab meetings with senior Scientist and lab members

• Bioinformatics approaches for Disease pathway

Volunteer Research associate April2010-Sep2010

University of California Irvine

• Project: TBX3 gene, data curation.

• Lab meetings with Professor and lab members.

Brickwork Health Nov2008-Nov2009

Business Analyst

Brickwork Health provides a full range of products and services including research health insurance, comparison on Indian Health Care, and coverage for specialty services such as workers’ compensation.

The objective of the project was to carry out gap analysis in order to identify the changes being proposed in the upgrade of HIPPA 4010 to HIPPA 5010. The emphasis on the project was mainly to perform gap analysis and impact assessment on the secured web portal used by various users dealing with claims transactions according to HIPPA regulations.

Responsibility:

• Created business use-cases, flow diagrams and validated business rules and data elements for EOB and Adjustments application.

• Gathered Business Requirements, analyzed data/workflows, and defined the scope

• Met with client groups to determine User Requirements and Goals, thus converting User Requirements into Business Requirements and User and Technical Requirement Specification.

• Mapping 4010 and 5010 differences

• Participated in various Healthcare presales initiative for EHR applications, HIPAA 4010-HIPAA 5010 and ICD9 – ICD10 conversions.

• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards

• Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents .

• Knowledge of HL7 and v2.x standards.

• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards

• Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams.

• Knowledge of electronic health record (EHR)

• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the teams assessment of the project and its schedule.

• Analyzed business Requirements, performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams using Rational Rose

• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team

Environment: Requisite Pro, UML, Microsoft Office (Project, Publisher, Excel, Word, PowerPoint and Visio), Project Manager, SDLC, SQL.

STRENGTHS

Well organized with self-motivation, hardworking, and initiative to achieve both personal and corporate goals and interested to learn new technologies. Good interpersonal skills and team spirit to achieve the targets and requirements.

ACHIVEMENTS

• Selected under UK-INDIA graduate work experience programme for Biomedical research centre England.

• Successfully participated in National Science Olympiad.

• Won Debate competition at Regional level twice.

• Awarded by National Natures Club (organized by WWF& UNO).

• Got scholarship by ELITE institute of computer education.

• Worked with Bill Gates Foundation on studying Indian Health care system.

• Presented scientific poster at University of Nevada Las Vegas.

• Did training on US Healthcare system at Global Systems.

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