Magellan Health Services, Inc. provides managed behavioral healthcare, radiology benefits management, specialty pharmaceutical management, and Medicaid administration products and services in the United States. The company provides services to health plans, insurance companies, employers, labor unions, and various governmental agencies The company's radiology benefits management services consist of managing the delivery of diagnostic imaging services, which are provided under the contracts with managed care companies, health insurers and other health plans, Medicaid, and Medicare members. I was involved in updating an existing quoting and enrolling program based on the business requirements and also integrated eligibility check application so application can check before offering plans like Medicare.
· Gathered Business Requirements, analyzed data/workflows, and defined the scope
· Generate queries and data dictionaries, analyze data and create visualization/ dashboard related to audience and direct-to-consumer insights working with data sets.
· Work closely with development team to manage data warehouse, facilitate meetings and manage any new requirements/backlogs.
· Met with client groups to determine User Requirements and Goals, thus converting User Requirements into Business Requirements and User and Technical Requirement Specification
· Worked on IBM mainframe environment for Medicaid Management Information System impact assessment.
· Dealt with the EDI transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
· Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD). Developed Software Requirement Specification (SRS) document using Visio and MS Office.
· Extensively interacted with both business team and development team in coming up with a Sequence diagrams.
· Developed internal algorithms, condition-action tables and decision trees and tables that incorporate member's personal and medical information.
· Actively involved in the creation of comprehensive resource center through collection, documentation and extensive editing of relevant medical literature.
· Participated in agile process – planned iterations, created tasks, assigned tasks to quality assurance team based on the priorities and estimated capabilities of quality assurance team for every iterations
· Core member for conception, implementation of Business Intelligence initiatives
· Prepared high level business use case and developed it into multiple system use cases and Activity diagrams.
· Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
· Developed UI document with UI designs and mock-ups through wireframes. Utilized Story boards and screen mock-ups to obtain client feedback and approval. Suggested changes when the user interface was confusing or needed rewording.
· Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/Advice).
· Authored Companion Guide to support all the information needed to process HIPPA transactions with Dean Health.
· Worked in conjunction with the project manager, design team and developers to prepare project status reports and presented reports to clients in order to keep them current. Utilized prototypes and structured walkthroughs to ensure that all relevant requirements are properly addressed.
· Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents
· Responsible for claim adjudication like Medicare claims, professional claim, institutional claims.
· Applied the RUP model throughout the entire development and testing process.
· Involved in development of Business and Technical Requirements in preparation of Design and Functional Specifications for Business Needs and Processes.
· Worked closely with Business users to determine the workflow of the product.
· Performed walkthroughs of the prototype with end users to better understand user needs.
· Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
· Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams
Technical Environment: Windows XP, SQL, Business Objects, Microsoft Office(MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), RUP, MS Project, Rational Requisite Pro, MS Word, Visio, SQL, MS Excel, HP ALM/Quality Center.
Technical Environment: Microsoft Office ( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),RUP, MS Project, Visio, Oracle, Rational Rose, UML, MS Project, FileHandler Enterprise
Technical Environment: Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), MS Project, NSI X12- EDI UML, Rational Requisite Pro, MS Word, Visio, SQL, MS Excel.
Technical Environment: Microsoft Office (MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),Rational Requisite, RUP, Oracle, SQL
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