PG in Finance and Computers Healthcare IT professional with an enterprise wide experience of 5+ years in the Healthcare industry. A rare talent who could be a solution provider for mundane operational issues in the Revenue Cycle Management vertical with profound depth of the domain coupled with IT tools. Have very good exposure towards all walks of US healthcare - RCM with specialization on handling projects on EDI comprising legacy formats of NSF; indigenous standards till 5010 HIPAA mandated X12N standards. Knowledge of medical terminology, ICD-10, CPT, HCPCS, Revenue codes, CMS 1500 and UB-04 with exposure to EDI/HL7/HIPAA standards. I have experience in requirements gathering tools and exposure to requirements traceability. Well versed with the latest changes in US Healthcare industry. Have sound understanding towards most of the physician and hospital practice systems. Have been a compliance officer for a huge healthcare services organization and have been instrumental in devising and practicing effective methodologies of implementing HIPAA standards. Payers & Health plans – Medicare, Medicaid, BCBS, Commercial, WComp, Medigap, etc. Claim Adjudication (Re-pricing of Claims, Pre-Adjudication Edits) Healthcare products – PPO, HMO and POS


To take a challenging role on business operations as Business Analyst and give a efficient and effective solution that would help the organization to achieve the best solution in business which would increase its productivity in market.


Seeking a challenging position with an expanding and dynamic company where I can implement skills that I have learnt through my education and past experience as well as enhance my knowledge by dedication and hard work. To associate with a progressive company to contribute my knowledge, skills and ability for the growth of the company that offers security and professional growth while being resourceful, innovative and flexible.

Synopsis of Strength

Strong Analytical skills - Ability to analyze requirements from client and developer perspective, ability to keep the larger picture in mind.

Able team player with good communication and interpersonal skills.

Flexible and quickly adapt to new business domains.

Willingness to learn and adapt to new challenges

Work History

Work History
Jun 2010 - Present

Business Analyst


·Analysis of new MIS/business requirements / strategic road map for client specific enhancements and translation into product-specific designs/ detailed Requirement Definitions/and Use Cases.

·Support the development team during the software build process (consultancy, documentation,    review etc.)

·Leading team of Associate BA’s.

·Production and review of test plans for new developments/releases/reports.

·Production and review of high-level requirements specifications / functional analysis.

·Functional testing of new developments / releases.

·Responsible to conduct SCRUM MEETING and lead the meeting as a SCRUM MASTER following AGILE methodology

·Review Product Documentation (BA – Product).

·Demonstration of new functionality and seeking inputs on future direction of product (Understand client requirements).

·Review User Manuals (BA – Domain).

·Provide internal training in Healthcare Domain (BA Domain) with strong work ethic.

·Production of User Acceptance Documents and Checklists in support of Alpha & Beta programs.

·Directly interface with clients by responding to higher level Support calls.

·Perform Specification, Design, Testing, and Documentation of the development projects and/or MIS related needs.

·Functional testing of new developments / releases.

·Perform User Acceptance Testing of developed software, Elicitation, triage defects/bugs using Microsoft Visual Studio - Team Foundation Server 2010

·Initiate and lead user focus groups, design team and Participate in the product design using MS Visio, BALSAMIQ, etc. on Projects like: SFM (Sunrise Financial Management) project and US Healthcare Revenue Cycle Management Project.

Test the application and Interact and liaise with the QA and technology team to resolve functional & technical queries through consultation, guidance, documentation and review as a good skilled problem solver. Go-to-person and manage cross-function teams.
Feb 2009 - Jun 2010

Sr. Claim Associate

UnitedHealth Group

·Handling team of 11 people

·Conduct team meetings, team huddles and process update.

·Team Management and Improvement Sessions is an important part of my KRA.

·Attend Client calls from USA regarding routine updates, query resolutions with Quality Auditors.

·Responsible to handle Medical (HCFA1500), hospital claims(UB04/UB92) and CMS (Medicare & Medicaid)

·Conduct 1 on 1 session with team members

·Six Sigma Yellow Belt Training Completed and have utilized this in my process improvement.

·Maintain the following Process reports and data:-

1.Performance Report (Weekly, Monthly)

2.Quality Report (Weekly, Monthly)

3.Inventory Report (Daily, Weekly, Monthly)

4.Attrition Report (Monthly, Yearly)

5.MIS Reports (Weekly, Monthly, Yearly)

6.Turn Around Time Report (Daily, Weekly, Monthly)

7.Production Report (Daily, Weekly, Monthly)

8.            Incentive Report (Monthly, Yearly)

Feb 2007 - Jan 2009

Sr. Business Associate


·Member of pilot batch of a new process which has been established in Fiserv HealthCare named FACTS.

·Handling team of 10-14 people.

·Complete understanding of medical and software terminology HL7, Medical Code sets, (CPT, CD9, ICD10, ICD9, etc.)

·Understanding of Healthcare EDI transaction sets (835,837,277,272,275 etc) and paper claims equivalent

·Give refresher and Process Training to New Batches.

·Responsible to handle the high dollar claims for the team

·Responsible to handle Medical (HCFA1500), hospital claims(UB04/UB92) and CMS (Medicare & Medicaid)

·Attend Client calls from USA regarding routine updates, query resolutions etc and further give update to the team.

·Responsible for conducting Process and Refresher Training to new batches of FACTS, Fiserv Health

·Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards

.         Adhere to quality improvement initiatives

Sep 2005 - Feb 2007

Executive Operation

IBM Daksh

·Process the electronic claims for Aetna (a leading healthcare provider in USA)

·Responsible for the accurate processing and completion of (HCFA1500), hospital claims (UB04/UB92) and CMS (Medicare & Medicaid), Dental Claims and Vision Claims.

·Member of pilot batch of a new process which has been establish in IBM daksh.

·Proficiency in product lines applicable to processing unit

·Ability to understand and apply plan concepts to include:- Deductible, Coinsurance, Copay, Out-of-Pocket

Maximums, Coordination of Benefits (COB), carve-out and alternate benefits inside limits & exclusions State variations and Explanation of Benefit (EOB)


Jan 2006 - Feb 2008

PGDBA in Finance

SCDL, Symbiosis, Pune
Jun 2002 - Nov 2005

Bachelor in Commerce

University of Delhi




MS Visio



MS Office

Using MS Word to write functional specification, feature rules about product Using Excel to maintain data values, database entries, product management Using PowerPoint for presentation design, workflow, features


Jan 2010 - Present

Six Sigma Yellow Belt

UnitedHealth Group
Oct 2003 - Sep 2005

"A" Level

DOEACC Society
May 2002 - Oct 2003

"O" Level

DOEACC Society