Summary
Overview
Work History
Education
Skills
Languages
Certification
Languages
Timeline
Generic

Gurucharan Singh

Lorton

Summary

  • Dedicated and focused project management specialist with several years of experience excelling at prioritizing, completing multiple tasks simultaneously and following through to achieve project goals. Flexible, detail-oriented and adaptive team player with expertise in equipment operation, staff training and development, customer service and process improvements.
  • Project Manager versed in all aspects of project and personnel management. Results-oriented and high-energy professional with talent for leading by example and inspiring peak performance. Dedicated to fostering strong effective team relationships.
  • Hands-on Project Manager recognized for flawless execution and finding solutions to complex problems. Communicative and reliable professional polished in developing scopes and objectives and maintaining comprehensive project documentation. Commended for unexcelled record of completing critical projects on schedule and within budget.
  • Strategic-thinking project manager with several years of experience in budgeting and forecasting and risk management. Observant and resourceful professional dedicated to delivering project objectives within stipulated time, resource and budget constraints. Outstanding collaborator comfortable working with others in executing projects to achieve company objectives.
  • Multi-talented Project Manager offering many years of experience orchestrating operations activities, financial support, and resource management to achieve project objectives. Poised and cooperative in driving stakeholder meetings to determine estimates and build financial forecasts. Determined and motivated professional recognized for fostering positive morale among project contributors.
  • Forward-thinking professional with deep understanding of resolving customer problems with efficiency and civility. Expert in product issues with dedication to increasing productivity through close analysis of tasks. Proven history of increasing customer satisfaction.
  • Results-driven Project Manager known for high productivity and efficient task completion. Specialize in risk management, process improvement, and stakeholder communication. Excel in leadership, problem-solving, and adaptability to drive project success.
  • Strategic Business Analyst with superior risk mitigation skills and a record of financial performance enhancement. Evaluate business needs and implement actionable improvements to increase profitability.
  • Insightful communicator with expert-level proficiency in various software. Pragmatic Business Analyst versed in business practices and internal controls. Methodical about completing comprehensive reviews and proactive in recommending optimal changes. Articulate in communicating with personnel across business levels.
  • Resourceful Business Analyst leveraging clear and concise communication skills and aptitude for handling challenges head-on. Competent team player with a proven record of implementing solutions and leading and managing teams. Analytical Business Analyst develops clear picture of company's present status by analyzing data and comparing past and future trends. Brings innovative and targeted solution-based approach to strategically solve problems. Familiar with job-related computer software.
  • Ambitious Business Analyst diagnoses existing inefficiencies and proposes innovative solutions based on specific needs. Logical and analytical leader with willingness to do whatever possible to drive successful outcome. Passionate about achieving maximum results in an efficient and cost-effective manner.
  • Dependable employee seeking opportunity to expand skills and contribute to company success. Considered hardworking, ethical and detail-oriented.
  • Dedicated professional with demonstrated strengths in customer service, time management and trend tracking. Good at troubleshooting problems and building successful solutions. Excellent verbal and written communicator with strong background cultivating positive relationships and exceeding goals. Willing to take on any task to support the team and help the business succeed.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Project Manager/Sr. Business Analyst/Scrum Master

L. A. Care
LA
06.2022 - Current
  • Developed strong connections with internal business partners, cultivating trust in service delivery and firm understanding of client needs.
  • Facilitated stakeholder meetings and workshops to gather insights and feedback.
  • Conducted user acceptance testing UAT sessions with key stakeholders.
  • Translated conceptual customer requirements into functional requirements for developers and project team.
  • Tracked project progress and provided regular status updates to stakeholders.
  • Supported change management efforts throughout all stages of project's lifecycle.
  • Created detailed process maps to illustrate current and future state workflows.
  • Improved business direction by implementing changes based on collected feedback.
  • Integrated standardized tools and templates to streamline cross-functional project management and create visibility to critical project information.
  • Presented findings and recommendations to senior leadership for approval.
  • Established strong relationships with stakeholders through effective communication.
  • Reviewed existing policies, procedures, and business rules for optimization opportunities.
  • Led interviews with key business users to collect information on business processes and user requirements.
  • Maintained up-to-date knowledge of industry trends, technologies, and best practices.
  • Identified potential risks and developed mitigation strategies accordingly.
  • Proposed solutions to meet defined specifications and needs.
  • Monitored post-implementation performance metrics and recommended necessary adjustments.
  • Analyzed complex business problems to recommend strategic improvements.
  • Collaborated with cross-functional teams to ensure project success.
  • Assisted in design, development, and implementation of new systems or processes.
  • Translated business needs into technical requirements for IT development.
  • Defined business requirements and provided analysis to increase operational efficiency.
  • Conducted interviews to gather customer requirements via surveys, questionnaires and workshops.
  • Developed comprehensive business and functional requirements documentation.
  • Developed reports and dashboards to report on key business intelligence.
  • Conducted regular status meetings with internal teams and external partners to track progress against established milestones.
  • Ensured compliance with applicable laws, regulations, policies and procedures throughout the life cycle of each project.
  • Drafted reports summarizing progress made on projects for review by executive leadership team.
  • Collaborated closely with senior management on long-term strategic planning initiatives related to projects in development or execution stages.
  • Actively sought out feedback from stakeholders throughout the duration of a project in order to identify areas needing improvement or adjustment.
  • Analyzed data from various sources such as surveys, interviews, focus groups. to inform decision-making related to projects.
  • Developed and maintained project plans, timelines, and budgets.
  • Created and implemented processes to ensure successful completion of projects.
  • Provided guidance to team members regarding tasks assigned to them.
  • Maintained records of all documents related to each project including specifications, change orders, invoices.
  • Coordinated resources across multiple departments and teams as needed for successful completion of projects.
  • Managed multiple projects with competing deadlines simultaneously.
  • Identified risks associated with each project and developed strategies for mitigating those risks.
  • Advised other departments on best practices related to managing large-scale projects.
  • Implemented effective communication protocols between internal teams working on different aspects of a given project.
  • Created project plans with established timelines, assigned to appropriate teams and managed workflow throughout construction.
  • Developed solutions to project risks and issues, meeting quality and timeline goals and objectives.
  • Kept up-to-date with industry trends in agile software development methods.
  • Created dashboards using various tools such as JIRA, Confluence, Trello, to track project progress and milestones.
  • Encouraged continuous process improvement initiatives through retrospectives.
  • Supported the development team in understanding user stories, acceptance criteria and definition of done.
  • Collaborated with other Scrum Masters across teams to ensure consistency in processes and tools used.

Project Manager/Sr. Business Systems Analyst

Molina Healthcare
Long Beach
04.2019 - 05.2022
  • Company Overview: Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.
  • The project was related to the enhancement of the healthcare system so that Medicaid claims (LTC) can be processed.
  • My responsibilities were to analyze the existing EDI transaction processes and documentation of the enhancements, evaluate and document applicable Rules/Edits, document the Clinical Operation process enhancements.
  • Involved in the full software development life cycle (SDLC) starting from initial requirement gathering to design, testing, documentation, and implementation.
  • Involved in performing GAP analysis and highlighted related issues.
  • Developed End-to-End Business Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrolment and Maintenance), 835 (ERN-Electronic Remittance Notification), and 837 (Claims Submission) Transactions.
  • Participated in the development and grooming of Project Backlog Stories (Requirements) with business and technology partners.
  • Worked and coordinated the Legacy Claim Adjudication to QNXT Migration Project.
  • Prepared Product backlogs, Sprint backlog and managed User stories.
  • Attended Scrum meetings, which included Sprint Planning, Daily Scrums or Stand-ups, Sprint Check-In, Sprint Review & Retrospective.
  • Worked with different business users and analysts by conducting interviews to collect requirements and business process information.
  • Performs in-depth investigation, analysis, and evaluation to determine project feasibility.
  • Responsible for gap analysis in changing the CAP system and involved in testing new QNXT.
  • Involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837, 835, and 834.
  • Involved in designing a new claims adjustment process for the runout claims.
  • Involved in creating BRD and FRD for Medicaid managed care requirements and documenting them.
  • Responsible for creating UML modeling plans, Sequence Diagrams, Activity Diagrams, use cases, process flows, Wire Frames and business requirements documentation using MS Visio.
  • Analyzed and modeled the system using Data flow Diagrams, Functional Diagram, and Process Diagram.
  • Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, provider agreement management) and the project team.
  • Involved in gathering business requirements, design, and development for the EDI, Claims, Prior Authorization, and Managed Care modules.
  • Involved in end-to-end analysis of Claim Processing and Subscriber/Member module.
  • Worked with the Business Team to review UAT validation scenarios and execute the UAT test cases.
  • Involved in setting up existing business rules in QNXT for claims processing.
  • Maintained the Traceability Matrix table to track the Business Requirements from the design to the testing keeping track of all requirements in the BRD.
  • Performed Data Analysis and created SQL queries involving Joins, Functions, and Stored Procedures.
  • Performed Data mapping, and logical data modeling, created class diagrams and ER diagrams, and used SQL queries to filter data.
  • Wrote SQL queries to validate data after testing the changes.
  • Molina Healthcare is a managed care company headquartered in Long Beach, California, United States. The company provides health insurance to individuals through government programs such as Medicaid and Medicare.
  • Environment: Agile Scrum, MS PowerPoint, JIRA, QNXT, MS SQL Server, MS Access, MS Excel, MS Visio, MS Project, MS SharePoint, SQL, HTML, UAT, Windows.
  • Conducted regular status meetings with internal teams and external partners to track progress against established milestones.
  • Drafted reports summarizing progress made on projects for review by executive leadership team.
  • Collaborated closely with senior management on long-term strategic planning initiatives related to projects in development or execution stages.
  • Developed and maintained project plans, timelines, and budgets.
  • Created and implemented processes to ensure successful completion of projects.
  • Maintained records of all documents related to each project including specifications, change orders, invoices.
  • Managed multiple projects with competing deadlines simultaneously.
  • Monitored progress of each project to ensure timely delivery of deliverables in accordance with established quality standards.
  • Implemented effective communication protocols between internal teams working on different aspects of a given project.

Business System Analyst

State of Louisiana
Baton Rouge
10.2017 - 03.2019
  • The project was related to the enhancement of the Medicaid Management Information System (MMIS).
  • It included technical and professional services related to the analysis and assessment of the current MMIS and EDI claims, documentation of business and technical requirements, preparation of cost analysis, and implementation of the new MMIS automation system.
  • Involved in the full software development life cycle (SDLC) starting from initial requirement gathering to design, testing, documentation, and implementation.
  • Responsible for the full lifecycle from gap analysis, mapping, implementation, and testing for Medicaid Claims.
  • Actively participated in Sprint Planning Daily Scrum stand up, and sprint retrospective meetings.
  • Studied the existing business process and created an AS-IS workflow to illustrate the existing system.
  • Participated in organizing and implementing a plan and roll-out of the Scaled Agile Framework.
  • Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
  • Responsible for the requirement-gathering phase and project plan.
  • Responsible for requirements analysis, design, and development of technical requirements.
  • Involved in Functional, System, End to End, Front End, Data Driven, User Interface, Integration, Regression, GUI, Security, Database, Usability, Unit, Black box, white box, UAT, and Back End testing on Client-Server and Web-Based Applications.
  • Responsible for conducting the Change Management process.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation, and testing for processing of Medicaid Claims.
  • Performed gap analysis by matching the requirements for managed care programs.
  • Performs in-depth investigation, analysis, and evaluation to determine project feasibility.
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837, 835, and 834.
  • Upgraded HMO Medicare EDI and reporting.
  • Used processing system to handle the complex requirements of managed care programs, eligibility, provider and plan/product data, claims, utilization management, reviews, case management, and customer service information.
  • Wrote SQL queries to interact with the client data sources and retrieve the updated data files.
  • Document all the changes for the enhancements and recommended changes.
  • Analyze the current state and recommend changes for the future state of the products.
  • Assisting the project manager in creating the business case and project plan.
  • Responsible for Medicaid Claims Resolution/Reimbursement for state health plans using MMIS.
  • Participate in User Acceptance Testing (UAT) with End users.
  • Worked closely with the development team and assisted in defect triage to ensure the deliverables and the quality of the applications.
  • Analyzed business and technical requirements to identify data needs and sources.
  • Environment: Agile, Waterfall, SQL, MS Project, XML, HTML, API Client, SAFe, MS Visio, MS Excel, SharePoint, ANSI X12 – EDI.

Business / Systems Analyst

Rhode Island Department of Health, DOH
Woonsocket
04.2016 - 09.2017
  • The project was to upgrade the system that currently uses HIPAA 5010.
  • Gap Analysis was performed, and changes were identified to upgrade the claims, Enrollment, and Medicaid Management Information System (MMIS) to comply with the new standards mandated by HIPAA.
  • Worked in the Agile process of project management based on SDLC.
  • Gathered requirements by coordinating with external vendors, and the internal team.
  • Held regular JAD meetings with the system architects, developers, and quality testers during the entire project to ensure that the critical as well as the minute details of the project were discussed, and issues were resolved beforehand.
  • Analyzed Gap Analysis of the HIPAA 5010 processes to identify and validate requirements.
  • Created several SQL Server objects like Tables, Views, Queries, Stored Procedures, Functions, triggers, and Indexes.
  • Facilitated Daily Scrum Meetings and Monthly Reviews meetings.
  • Conducted sprint retrospective and followed up on action items for continuous improvement.
  • Collaborated with application developers, business owners, and operation engineers to ensure the creation of production Business Intelligence designs and implementations.
  • Created high-level Use Cases from Business Requirements and created diagrams like Use Case and Activity diagrams using MS-Visio.
  • Responsible for reviewing the High-Level Design Document (HLD) and Low-Level Technical Design (LLD) for Claims Managed Care.
  • Facilitated meetings among the Change Management, Problem Management, and other relevant teams to discuss the impact of the changes, and problem tickets and prepare project milestone plans.
  • Responsible for Medicaid and Medicare Claims Reimbursement for state healthcare plans using MMIS.
  • Designs and develops the logical and physical data models to support the Data Marts and the Data Warehouse.
  • Reviewed vendor files for any errors, missing segments, and missing data on the X12 file.
  • Ensure the file has complete data before the encounter can be submitted to Medicare and Medicaid.
  • Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications.
  • Validated Enrollment and 834 EDI files, request for batch job to load the files and validate membership in MMIS.
  • Created various Data Mapping Repository documents as part of Metadata services needed to build the Data Warehouse.
  • Compared SQL results with application results by writing SQL queries.
  • Involved in loading the flat files into Oracle Database and involved in writing Complex SQL Queries.
  • Validated the data by writing and executing SQL queries.
  • Environment: Agile-Scrum, HP ALM/Quality Center, SQL, Tableau, Data Warehouse, TFS, EDI, EDW, ETL, UAT, MS Office Suite (Word, Excel, PowerPoint, Visio, SharePoint, Project), Windows.

Business/ Systems Analyst

Community First Health Plans Inc
San Antonio
01.2015 - 03.2016
  • The project was concerned with providing the ability to enroll new members through the Health Insurance Exchange (HIX) to comply with the Health Care Reform and obtaining business requirements from business users and stakeholders using interview sessions, brainstorming sessions, and personal interviews to get a better understanding of the Enrollment requirement changes from the Health Insurance Exchange (HIX).
  • It also dealt with the Design, Development, and Documentation of the ETL (Extract, Transformation, and Load) strategy to populate the Data Warehouse from various source systems.
  • Analyzed Service Requests and Change Requests available in JIRA and about everyday business needs.
  • Analyzed Business Requirement Documents (BRD).
  • Support UAT testing and created defect guidelines documents for users using JIRA.
  • Supported integrated EDI batch processing and real-time EDI using FACETS.
  • Created and executed test cases using SQL queries to validate backend data and end-to-end data flow.
  • Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Center for Medicare and Medicaid Services) are met.
  • Analyzed 'TO BE' scenarios based on the data that are currently required to generate reports.
  • Interoperability with all types of massage services.
  • Understood and articulated Business Requirement Documents (BRD) from user interviews and then translated requirements into functional and technical specifications.
  • Reviewing and testing reported defects in the concerned applications in both UAT and Production testing environments.
  • Streamlined Claims, HL7 and FHIR (837 EDI X12) Migration project by gathering functional specifications.
  • Set claim processing data for different Facets Module.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation, and testing for Medicaid Claims.
  • Incorporated Agile (Scrum) methodology to create User Stories and acceptance criteria.
  • System Integration testing for Facet's core modules with external systems.
  • Captured all HIPAA-related EDI data in the repository using FACETS.
  • Prepared data visualization and data analytics reports with Tableau Software.
  • Performed back-end testing using SQL queries to validate data and perform Data integrity testing.
  • Participated in developing and implementing End-End testing.
  • Acted as a liaison between end users and Facets for user problems, outstanding issues, training needs, and new software releases.
  • Worked with SOAP UI to test cases with XML, WSDLS, and web services.
  • Build a communication and influence plan with Weekly and monthly reviews to help bring business partners and stakeholders along on the journey.
  • Tested ETL jobs as per business rules using ETL (Data Warehouse) design document and analyzed the log files created after the job run.
  • Utilized Benefits Matrix to translate Business Requirements and build Medicaid and Medicare Advantage Plans in Facets.
  • Conducted Smoke Testing of the new ICD-10 UAT region and recorded testing results in RTM.
  • Demonstrated troubleshooting and problem-solving skills, especially with initially ambiguous or incomplete details in highly complex and available environments.
  • Tested HIPAA Transactions and Code Sets Standards such as 837/835, 270/271, 276/277 transactions.
  • Utilized Agile Methodologies to configure and develop processes, standards, and procedures.
  • Performed back-end testing using SQL queries to validate data and perform Data integrity testing.
  • Organized and facilitated Agile and Scrum meetings, which included Sprint Planning, Daily Scrums or Stand-ups, Sprint Check-In, Sprint Review & Retrospective.
  • Business Requirement Documents (BRD) through interviews, surveys, and observing from account managers and UI (User Interface) of the existing Broker Portal system.
  • Wrote User Stories -- Elaborated User Stories and Acceptance Criteria; Reviewed user stories with team.
  • Worked with Vendor Interface Program to load data from the legacy system into a temporary table on Excel to validate the data.
  • Extracted and compiled data to analyze and create structural business need.
  • Facilitated JAD session to find out the impacted area of functionality of Facets due to upgrade and cooperate with the developer to come up with a solution.
  • Perform Extensive EDI testing on X12/4010 837,835, 270, etc., worked with state vendor to validate inbound /outbound EDI transactions to Facets.
  • Scripted Business Rules for Client Side & Server-side validations, and services, assisted UI team in drafting agreements for various web methods in XML.
  • Develop standards, methods, and procedures to determine quality.
  • Write test scripts and execute scenarios for End to End and UAT testing.
  • Directly involved in the ETL process of customer information from the source to the target internal database using SSIS.
  • Checked the data flow from the front end to backend and used SQL Queries to extract the data from the database.
  • Performed source-to-target mapping documentation including the handoff to the development team.
  • Delivered data and system analysis documentation that incorporate the business and data requirements including technical requirements.
  • Requirement gathering from Inception and creating RTM, Functional Specification Documents, and Data Mapping Analysis for System Integrations.
  • Support the Product Owner to groom backlogs to refine them and translate those into user stories.
  • Participation in requirement / Use Case analysis, risk analysis, and configuration management.
  • Performed on-site Health Plan reviews for Medicaid encounter compliance.
  • Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
  • Collaborates with external providers to resolve any issues in the functionality and interoperability of new applications, infrastructure, and other services with existing IT systems.
  • Extensively performed User Acceptance Testing (UAT).
  • Ensured the accuracy and consistency of the data during the data-loading process.
  • Provided support for complex business Data Modelling and Management, for billing, claims, and submission.
  • Worked on HIPAA Code Sets Standards according to the test scenarios such as 835 / 837 transactions.
  • Performed GAP Analysis to identify the segments and data elements of 5010 EDI transaction involved in the simulated claim processing system.
  • Work with solutions/delivery teams to implement data quality processes during acquisition, ETL, and delivery stages for Business Intelligence solutions and changes to the Data Warehouse.
  • Created SQL queries to read data from databases.
  • Created a conceptual diagram using Visio of the business process to find out the impacted area and to fix the problem.
  • Enhanced test cases and scripts by adding the required functionality as per the new BRD.
  • Provided the management with test metrics, reports, and schedules as necessary using MS Project and participated in the design walkthrough and meetings.
  • Environment: Agile/ Scrum, FACETS, HP ALM/Quality Center, SQL queries, Data Warehouse, HTML, XML, HIPAA, EDI, MS Office, MS Visio, MS Project, SQL, SOAP UI, UAT, UML, Windows.

Business Analyst

Common Spirit Health
Phoenix
12.2013 - 12.2014
  • I worked as a Business Analyst on member enrollment extract which includes collecting the right requirements by asking the right questions to the business.
  • Preparing documents like FRD, DFDs, Data, process flow diagrams, etc using different tools.
  • The plan wanted to have a monthly automated extract for its members with 78 data elements and some conditions.
  • It helps the Plan to improve productivity and improve services.
  • Create Business Requirement Document (BRD), Functional Requirement Document (FRD), Technical specification Document (TSD).
  • Reviewed, analyzed, and created detailed documentation of business systems and user needs, including workflow, program functions, and steps required to develop or modify application programs.
  • Played an active role during daily scrum meetings and task planning as part of the agile methodology.
  • Consulted with IT Personnel to determine business, functional, and technical requirements for specified applications.
  • Developed effective reporting tools for the business unit and completed existing projects from original concept through final implementation.
  • Held meetings/Joint Application Development (JAD) sessions with key stakeholders and program directors and prepared accurate and detailed business requirements, user interface guides, and functional specification documents to document detailed requirements for change requests and better understand the policy that was driving the change.
  • Designed data flow and mined data for HIPAA/ICD/EDI claim analysis that helped expedite the process of Medicaid claim processing.
  • Managed timelines and resources to set priorities and satisfy the client's needs by meeting strict deadlines for software development requests for web applications with little supervision.
  • Managed any change requests related to the working project plans to meet the agreed-upon timelines using Microsoft Project and SharePoint to manage and document project tasks.
  • Creating of verifying Tableau reports by writing complex SQL statements with joins, aggregate functions, and filter &search criteria to verify the integrity and correctness of the report outputs.
  • Analyzed HIPAA 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers, and other related entities.
  • Worked in all aspects of IT coordinating between the business professionals and the IT professionals to bridge the gap between technical and business jargon and ensure all business requirements for system modifications were properly conveyed to developers.
  • Was instrumental in writing the Requirement documents for Facets Enrollment, Billing and Claim Modules, and enrollment process.
  • Worked on HIPAA Transaction Sets 837P and 837I Standards as per the test scenarios.
  • Met with various groups, including business owners, SMEs (subject matter experts), and marketing team, for requirements gathering in definition Stage.
  • Specialize in HIPAA 5010 implementation including GAP analysis.
  • Capturing and maintaining Functional Requirement Document.
  • Perform and assist with critical path reporting & updating data from internal systems.
  • Coordinated with the UAT testing group and provided technical assistance in planning and implementing the Test Schedule for UAT.
  • Involved in web services API testing using SOAP UI and Postman tool.
  • Maintaining DEDs (Data Exchange Document) and S2T (source-to-target Document).
  • Used Postman/SoapUI or other REST service testing & development tools.
  • Created Data and Process flow diagram using MS VISIO.
  • Compiled requirements obtained from key stakeholders.
  • Facilitate review sessions with Business, DEV, and PV teams.
  • Involved in Deployment process with DEV and PV team.
  • Prepared Business workflow models that covered business processes.
  • Prepared workflow diagrams to analyze 'AS IS' and 'TO BE' scenarios and Design new process flows.
  • Worked on different EDI X12 transactions like Claims (837), Premium Payment (820), Enrollment (834), and Eligibility (270) to send the outbound file to an external vendor.
  • This includes HIPAA EDI X12- 834, 837, 835, and 270/271.
  • Gathered requirements on FACETS EDI 834 Benefit Enrollment and Maintenance subsystems.
  • Update and maintain SharePoint.
  • Involved in Waterfall methodology for the SDLC.
  • Created Data Mapping Documents and Metadata for the Enterprise Data Warehouse (EDW).
  • Checked the data flow from the frontend to backend and used SQL Queries to extract the data from the database.
  • Participate in quality improvement initiatives to develop and improve incoming quality levels.
  • Work with solutions/delivery teams to implement data quality processes during acquisition, ETL, and delivery stages for Business Intelligence solutions and changes to the Data Warehouse.
  • Debugging the SQL statements and stored procedures for various business scenarios.
  • Set up Enterprise Data Warehouse (EDW) and associated ETL service to generate business reports.
  • Performed Data mapping, and logical data modeling, created class diagrams and ER diagrams, and used SQL queries to filter data.
  • Maintained and tracked the project plan using MS Project.
  • Assisted the QA team in User Acceptance Testing (UAT).
  • Daily and weekly status reporting to senior management.
  • Environment: Waterfall, DB2, CQ, MDH, EDW, TOAD, Putty, Service Now, MS Visio, Excel, Word, Outlook.

Education

Master of Science (M.S.) - Physics

Kumoun University
Nainital, India
07.2002

Bachelor of Science (B.S.) -

Kumoun Univarsity
Nainital, India
07.1999

Skills


  • Project management
  • Agile methodologies
  • Stakeholder engagement
  • Change management
  • Risk assessment
  • Communication skills
  • Time management
  • Budget management
  • Project development
  • Project feedback data
  • Coaching and mentoring
  • Waterfall
  • MS Project
  • MS Visio
  • JIRA
  • SOAP UI
  • SQL
  • XML
  • HTML
  • MS Access
  • SQL Server
  • MS Azure
  • Oracle
  • Windows
  • UNIX
  • SOAP
  • REST
  • MS Office Suite
  • MS Excel
  • User Acceptance Testing
  • Risk Assessment
  • Team Leadership
  • Time Management
  • SQL Proficiency
  • Decision Making
  • Customer Needs Assessment
  • Agile Methodologies

Languages

  • English, Fluent
  • Hindi, Native
  • Punjabi, Native

Certification

  • PMP

Languages

English
Professional
Hindi
Professional
Urdu
Professional
Punjabi
Professional
Spanish
Elementary

Timeline

Project Manager/Sr. Business Analyst/Scrum Master

L. A. Care
06.2022 - Current

Project Manager/Sr. Business Systems Analyst

Molina Healthcare
04.2019 - 05.2022

Business System Analyst

State of Louisiana
10.2017 - 03.2019

Business / Systems Analyst

Rhode Island Department of Health, DOH
04.2016 - 09.2017

Business/ Systems Analyst

Community First Health Plans Inc
01.2015 - 03.2016

Business Analyst

Common Spirit Health
12.2013 - 12.2014

Master of Science (M.S.) - Physics

Kumoun University

Bachelor of Science (B.S.) -

Kumoun Univarsity

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Gurucharan Singh