Abhishek Bharati
Hagerstown
Summary
Results-driven Business/Systems Analyst with 10+ years of experience in healthcare IT, specializing in requirements gathering, process modeling, and system integration. Proven expertise in Medicaid/Medicare claim processing, EDI transactions (837, 834, 835), and HIPAA compliance. Skilled in Agile/Scrum methodologies, SDLC/STLC, and tools like JIRA, MS Excel, and SQL. Adept at bridging business needs with technical solutions to deliver high-impact results. Experienced with analyzing business requirements and translating them into functional specifications. Utilizes strong problem-solving skills to optimize systems and processes for better efficiency. Knowledge of collaborating with stakeholders to ensure seamless system implementation and user satisfaction.
Overview
11
11
years of professional experience
Work History
Business Systems Analyst
Sentara Health Care System
11.2018 - Current
- Assessed business requirements to create focused solutions.
- Trained business personnel in use of systems.
- Developed comprehensive documentation to support end-users and facilitate future enhancements.
- Managed multiple projects simultaneously, consistently meeting deadlines while maintaining a high standard of quality workmanship.
- Work with IT teams to design systems or software solutions that meet business needs.
- Create process models, use cases, and wireframes to illustrate proposed solutions.
- Ensure solutions align with business goals and technical capabilities.
- Led requirements gathering and process automation for the OneSource project, a provider data management system using IBM BPM/MDM, reducing manual errors by 30%.
- Collaborated with Claims and Network Management teams to design and implement automated workflows for provider data updates, including NPIs, taxonomies, and reimbursements.
- Authored user stories in JIRA, prioritized backlog using Fibonacci sizing, and facilitated Scrum ceremonies (Sprint Planning, Daily Standups, Retrospectives).
- Conducted gap analysis, created AS-IS/TO-BE process flows, and developed BRDs/FSDs to align business needs with technical solutions.
- Performed end-to-end system integration testing, validated data using SQL queries, and logged/tracked defects in JIRA.
- Delivered UAT support, conducted demo sessions, and ensured on-time project delivery.
- Identified needed business improvements and determined appropriate systems required to implement solutions.
- Identified critical issues within existing systems, providing recommendations for resolution and prevention of future problems.
- Facilitated communication between technical and non-technical team members, ensuring project alignment across all parties involved.
- Collaborated with stakeholders to gather essential requirements, ensuring successful project outcomes.
- Coordinated data migration and consolidation efforts.
- Analyze data to identify trends, patterns, and insights that support decision-making.
Business Systems Analyst
Molina Healthcare
03.2017 - 11.2018
- Spearheaded the integration of source and target systems for Medicaid/Medicare claims processing, improving data accuracy by 25%.
- Analyzed and mapped EDI transactions (837, 834, 835) to ensure HIPAA 5010 compliance.
- Utilized Tableau to generate actionable insights on provider and claims data for senior leadership.
- Collaborated with data teams to validate reports using MicroStrategy and optimize SQL queries for backend testing.
- Act as a liaison between business units and technical teams to ensure clear communication.
- Present findings, recommendations, and solutions to stakeholders and management.
- Facilitate meetings and workshops to gather feedback and build consensus.
- Develop test plans, scenarios, and cases to validate system functionality.
Business Analyst
Emblem Health Insurance
01.2016 - 02.2017
- Streamlined Medicare/Medicaid claims processing by automating COB (Coordination of Benefits) workflows in Facets.
- Developed mockup screens and wireframes for web and mobile portals to enhance user experience.
- Conducted data mapping and validation using SQL queries, ensuring data integrity across systems.
- Supported HIPAA 5010 upgrades by analyzing ANSI X12 formats and creating companion guides.
- Tracked defects using HP ALM and facilitated UAT sessions for successful product releases.
- Coordinate user acceptance testing (UAT) and ensure solutions meet business requirements.
- Identify and resolve issues or defects during the testing phase.
Business Analyst
UNC Healthcare-UNC Physicians Network
05.2014 - 12.2015
- Supported the implementation of HIPAA 5010 standards by analyzing EDI transactions and performing gap analysis.
- Facilitated JAD sessions to gather requirements and define business processes for Medicare/Medicaid claims.
- Created use case diagrams and activity diagrams using Rational Rose to visualize system interactions.
- Tracked defects and traced requirements using HP Quality Center, ensuring compliance with business rules.
- Monitor and measure the impact of changes on business operations.
- Create and maintain detailed documentation, including business requirements, functional specifications, and user manuals.
- Ensure documentation is up-to-date and accessible to relevant stakeholders.
- Address user concerns and troubleshoot issues post-implementation.
- Develop training materials and conduct workshops as needed.
Education
Bachelors in Hotel Management - Hospitality Management
Global Academy of Hospitality Management
Mahankal -9, Mandikhatar, Kathmandu, Nepal09-2015
Skills
- Methodologies: Agile, Waterfall, Hybrid
- Tools: JIRA, HP ALM, SOAP UI, MS Visio, MS Excel, Confluence
- Databases: SQL Server, Oracle, MS Access
- Languages: SQL, XML, UML
- EDI Standards: HIPAA 5010, ANSI X12 (837, 834, 835, 270/271, 276/277)
- Healthcare Systems: Facets, Wintegrate, IBM BPM/MDM, Medicare/Medicaid systems
Timeline
Business Systems Analyst
Sentara Health Care System
11.2018 - Current
Business Systems Analyst
Molina Healthcare
03.2017 - 11.2018
Business Analyst
Emblem Health Insurance
01.2016 - 02.2017
Business Analyst
UNC Healthcare-UNC Physicians Network
05.2014 - 12.2015
Bachelors in Hotel Management - Hospitality Management
Global Academy of Hospitality Management
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