Anisha Rahman

Business Analyst

SUMMARY:

Around 7 years of Business Analysis experience with diverse knowledge of business processes in the health care
industry. A proven track record in managing client expectations in IT implementations, change requests, and
system enhancement;

 Proficient in Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
 Experienced with enhancing old billing platform to new billing platform.
 Experienced with project enhancement, data migration, and integration.
 Experienced in documenting requirements using JAD sessions and SME workshops.
 Implemented Agile/Scrum Methodology to projects through an iterative approach to expedite project
milestones.
 Experienced in maintaining all design documentation workflow activity diagrams, data mapping, and technical
integration documentation.
 Experienced in building project plans, delivery schedules, and project budgets.
 Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data
Interchange (EDI), Implementation and knowledge of HIPAA (Health Insurance Portability and Accountability
Act) code sets, ICD-9, ICD-10 coding, HMO, PPO.
 Strong sense of urgency, ability to prioritize and communicate effectively.
 Extensive experience in customization and configuration of FACETS,
 Experience with health care Systems: Facets, Medicare Part A, B, C, D, Medicaid systems.
 Assisted with JAD sessions, Gap analysis, and prioritized requirements using interviews, document analysis,
and requirements workshops.
 Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of
HIPAA key EDI (ANSI X12) transactions.
 Experienced in writing and preparing business requirements documents (BRDs), system requirements
specifications (SRS), system design specification (SDS), functional specifications, defining project plan, and
change request.
 Extensive use of JIRA in filing bugs along with determining urgency level and regular follow-up with developers
ensuring that resolution goes out within a specific timeline.
 Customize workflows for multiple projects using JIRA and Service Now to create custom fields, new issue
types, workflow statuses, transitions, post-functions, field configurations, mandatory fields, and workflow
schemes.
 Well-versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI),
and familiar with the Patient Protection and Affordable Care Act (PPACA), Health benefit Exchange.
 Experienced and strong understanding of Eligibility verification, claims processing, and adjudication.
 Developed diagrammatic representations in MS Visio for the design phase.
 Experienced with the use of requirements management, test management, and defect control tools.
 Knowledge of gathering project requirements to determine the scope of SharePoint projects.
 Strong experience and skills in writing business requirements, Use Case Specifications, Version Control,
Change management, workflow, and Unified Modeling Language (UML) diagrams.
 Excellent communication skills and adept at facilitating walkthrough and training sessions.

Education:
Master's in Business Administration from the University of the Cumberland in 2016
TECHNICAL EXPERTISE:

OPERATING SYSTEM Windows Server, Windows, UNIX

TESTING TOOLS: HPQC, Load Runner, Quick Test Pro, Quality Care

FRONT – END TOOLS: Adobe Photoshop, MS Excel, MS Office, MS Project

REQUIREMENT MANAGEMENT Rational Requisite Pro, Caliber RM

MODELING TOOLS: MS Visio, Rational Rose, Caliber RDM

PROJECT MANAGEMENT TOOLS: MS Project, Share Point, JIRA, BUG TRACKING TOOLS Rational Clear Quest,
Rational Clear Case

METHODOLOGIES: (SDLC); Scrum, Agile, Waterfall Model

DATABASE: MS SQL Server, MS Access

Work Experience

Cigna May 2018 - Present

Piscataway, NJ
EDI Analyst/ Healthcare Business Analyst
The project was aimed to support and process various health Insurances claims (HMOs and PPOs, Medicare,
Medicaid, Medical) without any hassle and an effective tool for the end-users for renewal, check status on their
application, and to provide WebMD health online source for well-being.

Responsibilities:
 Performed requirements gathering and analysis, ensured that contributors and all key stakeholders were
motivated to complete assigned tasks.
 Maintained a very close interaction between the IT team, developers, Project manager to avoid any gaps in
understanding or implementation of requirements.
 Worked in X12 EDI Transactions (834 enrollment, 820 payments, 270/271 eligibility/response, 837I, and 837P
institutional and professional claims, 835 Healthcare Claim Payment Advice, 277CA Claim Acknowledgement,
999 transactions)
 Worked with EDI standards (e.g., ASC X12, and NSF).
 Worked closely with the project team in planning, coordinating, and implementing QA methodology on
various phases of the application.
 Involved in the generation and execution of SQL queries to understand the processes used by the pharmacy
department. 
 Worked as a liaison between the business client and development team for the implementation of 5010
transitions in compliance with HIPAA standards.
 Interacted with the technical team for the claim’s transactions design.
 Performed GAP Analysis for new functionality requirements and prioritized them based on the business
needs.
 Analyzed the existing business process and created AS-IS process flow to illustrate the existing system.
 Created workflow diagrams, UML diagrams, use cases, process flow diagrams, test cases, and test plans.
 Managed the Requirements (Business as well as System requirements), performed requirements analysis
along with the creation of Use Case Scenarios.
 Gathered Business/Functional Requirements from Business/R&D Users.
 Worked with the development team to make sure that they understood the user requirements and that the
system developed met those requirements.
 Collecting test data for requirements to perform testing. 
 Adding scenarios, test data, and screenshots used for testing to Test Ready User Stories in JIRA. 
 Prepared and present weekly status reports to management 
 Played an active role during daily scrum meeting and task planning as part of agile methodology 
 Interacted with offshore team to share & provide required information on planned work items for the sprint. 
 Internal review of user stories with management for scenarios/test data/screenshots before the demo.
 Participated in Sprint Demo sessions with business. 
 Well-versed with Microsoft SharePoint to manage project-related documents.
 Involved in writing complex queries in SQL Server. 
 Involved in Sprint retrospective meetings scheduled at the end of each sprint. 
 Involved in UAT & SIT Concerns meetings. 
 Involved in Planning & Product Backlog Grooming User Stories with Business Analyst and Team members.
 Maintained Defect/Issues/Observations tracking sheet. 
Environment: SQL, HP Quality Center, Agile, ALM, Windows, MS Excel, MS word

Delaware Health and Social Services, August 2015 – April 2018

Dover, DE
EDI Analyst/ Business Analyst
Focusing on Medicaid and Medicare and provides managed care services exclusively for government-sponsored
healthcare programs. Currently working on the HIX implementation for ACA. As a Business Analyst, I was
responsible to utilize ICD10 within the healthcare claim process and modify all the impacted systems to adhere to
the requirements.
Responsibilities:
 Built an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part
of the Affordable Care Act (ACA).
 Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
 Thorough knowledge of ICD-10 codes and CPT codes for both Mental and Medical Health and worked
extensively with Inbound and outbound 834 Transaction processing systems.
 Compile, validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare
and Medicaid Services.
 Created, altered, and implemented T-SQL Stored Procedures for the use of processing consumer data and
developing new web-delivered tools.
 Responsible for UAT project planning and Performed Regression, UAT, Integration, User Interface, GUI, and
Usability Testing and wrote test cases and test scripts, execute test scripts and analyzed outcomes, and
conducted research on IT requirements and business requirements in UAT areas.
 Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems
are impacted by the EDI X12 Transaction, Code set, and Identifier aspects of HIPAA.
 Created wireframes of the AS-IS Process of the system as well AS-IS Process To-Be using Balsamiq tool.
 Gathered the requirements for Medicare Systems as part of the Patient Protection Affordable Care Act (ACA). 
 Developed Schemas of EDI X12 Claims (837) and Eligibility forms in XML. Involved in creating sample mappings
for the conversion of EDI X12 transactions code sets.
 Lead SCHIP, CMS request to be able to identify the Medicare-eligible candidates.
 Generated and maintained SQL Scripts to perform back-end testing on the oracle database. Produced
customer functions, complicate SQL commands in Business Object Enterprise XIR2 and Oracle, Crystal Reports
XI environments.
 Assist clients in resolving billing issues for Medicare, Medicaid, and private insurance.
 Acted as an SME on various subject areas including state reporting, death benefits, Medicare, Bill review, and
RX eligibility. 
 Lead projects to design a state-customized Financial Management solution for Health Insurance Exchange
(HIX).
 Developed various test cases for testing HIPAA 8371/P/D 834/835 and 276/277.
 Developed EDI specifications and applications structures for data feeds and mappings for integration between
various systems, including XML, and performed back-end testing on the Oracle database by writing SQL
queries
 Handle the tasks of helping the organization staff in planning data sets for UAT. 
 Created Test Strategy Planning (TSP) and assisted the testing team to implement test plans during the UAT
kickoff

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project,
Rational Rose, Community Manager, BPML, SQL, Clear Case, RUP

Affinity Health Plan, Sep 2013 – July 2015

NYC, NY
Business Analyst
Affinity Health Plan is an independent, non-profit managed care plan that serves the needs of over 210,000
underserved residents of the New York Metropolitan Area (New York City, Long Island, Westchester, Rockland, and
Orange Counties.) Affinity provides healthcare coverage through its Child Health Plus, Family Health Plus, and
Medicaid programs. Affinity Health Plan Implemented Facets Extended Enterprise (TM) administrative system, a
new core system, with updated technology to allow for more efficient claims processing, membership enrolment,
and provider data maintenance. Facets were highly efficient, automated, customizable, and flexible, to help affinity
tackle new business opportunities and compete successfully in the dynamic healthcare industry.

Responsibilities:
 Played a key role in System Development Life Cycle Process consisting of Design and Gap Analysis, Business
Requirements, Systems Requirements, Test Criteria, and Implementation to have the outputs of the project
dealt with the automation of correspondence directed to Insurance policy owners.
 Involved in requirement gathering and database design and implementation of star-schema, dimensional data
warehouse using Erwin.
 Followed the UML-based methods using Rational Software Modeler/MS Visio to create: Use Cases, Activity
Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams. Tuned the batch
programs and online transactions to alleviate performance problems.
 Used knowledge of Health Care Information Systems EMR model to develop a proposed workflow in MS Visio.
 Owned the entire reporting process. Interacted with the ETL team, developer(s), management, and account
holders to get the requirements, document them, design templates, and write specifications.
 Assisted JAD sessions to identify the business flows and determine whether the EDI X12 Transaction, Code set,
and Identifier aspects of HIPAA, impact any current or proposed systems.
 Gathered requirements and modeled the data warehouse and the underlying transactional database
 Perform Gap Analysis of the processes to identify and validate requirements.
 Identified/documented data sources and transformation rules required populating and maintaining data
warehouse content.
 Utilized corporation-developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software
to perform required job functions.
 Implemented data access, storage, and validation routines on the database server using Procedural
Language/Structured Query Language (PL/SQL).
 Involved in the testing phase right from the Unit testing to the User Acceptance testing.
 Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
 Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives
and helped the developers to have a clear-cut picture of the project.
 Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
 Closely work with the SAS team to understand and convert the code with ODI developer into SQL.
 Developed & executed several Optimized queries in SQL on this data.

Environment: RUP, UAT, GAD (Gap Analysis Document), Agile, SAS, Big data, Microsoft Office Professional
(Outlook, Word, Excel, Visio, Access)