Bibek

[email protected]
469-498-0821

PROFESSIONAL SUMMARY:
 Senior Business Analyst with 7+ years of experience in the State and HealthCare Industry and IT infra-
structure.
 Experience working in both Agile and Waterfall methodologies.
 Good experience in EDI transactions and knowledge of EDI transaction process flows.
 Expertise in Interviews, focus sessions for requirements gathering, and analysis/design with stakeholders,
SMEs, Developers, and system architects.
 Coordinated action plans, meetings, and analyses regarding topics, often including key business stakehold-
ers and senior management
 Professional experience as a Business Analyst with excellent understanding, analyzing and documenting
Business Requirements, Functional Specifications, Business Process Flow, Business Process mapping using
BPMN (Business Process Modeling Notations) and modeling.
 Experience in projects related to system upgrades, data integration and process improvements in Disease
Surveillance Epidemiology.
 Experienced in using Jira and Confluence to create documentations in Scrum environments such as Epics,
User Stories, and Acceptance Criteria
 Knowledge and expertise in working with Claims, providers, Enrollment, Finance, Benefits, and Vendor
Management Business Areas.
 Maintained the Traceability Matrix table to track the Business Requirements from the design to the testing
keeping track of all requirements in the BRD.
 Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases
 Experience in managing defect tracking process, which includes prioritizing, assigning, and verifying bugs
using ALM and triaging the defect resolution calls.
 Excellent interpersonal, communication, and presentation skills with an attitude to bridge the gap between
team members and the client.

TECHNICAL SKILLS:
Project Methodologies SDLC, RUP, UML, Agile, Waterfall,
Business Modeling Tools: Microsoft Visio, Rational Rose
Platforms: Windows, UNIX/LINUX
Programming Languages: SQL, HTML, XML, Java, .Net
Application: Visual Studio, MS Project, MS Visio, MS Office
Testing tools: HP Quality Center, ALM, SOAPUI,
Office Tools: MS Project, MS Office, MS Visio
Database: SQL Server, Oracle, MS Access

PROFESSIONAL EXPERIENCE:
New York State Department of Health, Albany, NY Aug 2022 – Present
Senior Business Analyst
The New York State Department of Health, headquartered in Albany, serves as a crucial entity devoted to
safeguarding and enhancing public health across the state.
The primary aim of the company is to enhance the health and quality of life of the members and provide cost
effective health care solutions. The project was to develop a software that would check if the person is eligible
in processing Medicaid request forms and Medicaid claims also check if the funds are available to him, also
help the staff into looking each costumer's data to check his eligibility for the Medicaid plan.
Responsibilities:
 Gathered analyzed, documented business and technical requirements from both formal and informal ses-
sions and validate the needs of the business stakeholders.
 Performed Gap Analysis by identifying existing technologies (as is), documenting the enhancements to
meet the end state (to be) requirements; Identified and created business rules and creating detailed Use
Cases.
 Assisted in the preparation of detailed budget documentation, including cost estimates, funding justifica -
tions, and expenditure forecasts.
 Developed training materials and conducted training sessions for CDC personnel and public health part -
ners on the use of surveillance tools and systems.
 Worked with internal stakeholders to understand project objectives, deliverables, and budgetary con-
straints.
 Created BRD and FRD for Medicaid managed care requirements and documenting them.
 Prepared financial models and forecasts to support long-term budget planning and decision-making.
 Assisted in the development and implementation of budgeting processes, procedures, and controls to en-
sure accuracy and compliance.
 Performed gap analysis - As-Is process & To-Be process, for Integrated Eligibility LITE project for implemen -
tation of Lean Agile Principles and Practices.
 Analyzed provider enrollment data to ensure compliance with Medicaid program requirements.
 Understand the Business Rules and can effectively implement them in Business Process Flow.
 Worked closely with CMS representatives to understand specific requirements and expectations regarding
budgetary submissions.
 Identified and resolved issues related to Medicaid provider enrollment, improving the overall enrollment
experience.
 Monitored project budgets and expenditures, tracking actual costs against budgeted amounts and identify -
ing discrepancies or overruns.
 Prepared regular budget status reports and updates for project teams and management, highlighting key
metrics, milestones and risks.
 Assisted in the preparation of CMS funding applications and grant proposals, ensuring alignment with
agency priorities and requirements.
 Conducted thorough data analysis in the field of Disease Surveillance Epidemiology to identify disease
trends and patterns using historical surveillance data.
 Ran the scripts on multiple environments (QA, UAT and Production) to ensure that requirements were still
met.
 Worked closely with Medicaid provider enrollment teams to address challenges and implement solutions.
 Wrote test cases in Quality Center/ALM derived from the Design documents and generated a Traceability
Matrix for testing purposes.
 Created Traceability Matrix to ensure implementation of all functionalities, identify all test conditions and
test data needs.
 Collaborated with epidemiologists and public health professionals to gather historical data requirements
for disease surveillance systems in the realm of Disease Surveillance Epidemiology.
 Used Quality Center/ALM to record documenting information useful in debugging process, evaluating test
data.
 Participated in weekly status meeting with Development and Management Teams.

State of Nebraska (DHHS), Lincoln, NE Jan 2021 – Aug 2022

Business Analyst
I worked with upgrading an existing EDI system to use for dual purposes; first, this EDI system is used as a Na-
tional HIPAA EDI testing tool and for test-data generating, typically for Medicare, Medicaid, or Commercial
Payer HIPAA Projects or HIPAA Training and the second user to provide affordable desktop solutions for
Providers.
Also worked on the extent of UI/UX designs and execution to adhere to defined business requirements in IT in -
frastructure planning and cloud platforms
Responsibilities:
 Coordinate with stakeholders and project managers to gather functional and non-functional requirements
during JAD sessions.
 Analyzed data/workflows, defined the scope, and performed GAP analysis.
 Worked with QA team to design and develop Test Plan and Test Cases to assist in performing User Accep-
tance Testing (UAT), Systems Testing, Integration Testing and Regression Testing.
 Analyzes business and user needs, documenting requirements, and revising existing systems.
 Analyzed the data movement between systems to validate the Business Requirements.
 Ensured accuracy and completeness of Medicaid provider enrollment data and documentation.
 Interfaced directly with the client to gather initial feature enhancements and bug defects, as well as pro-
vide status updates and resolve any issues, risks, or questions the development, QA, and UI/UX team pre-
sented.
 Supported the development of CMS program budgets, including forecasting revenues, expenses, and cost-
sharing arrangements.
 Assisted in the preparation of budget presentations and materials for senior leadership, board meetings,
and other stakeholder forums.
 Responded to ad hoc requests for budgetary information, analysis and support from various departments
and stakeholders.
 Developed and implemented strategies to optimize the Medicaid provider enrollment workflow.
 Attended requirements gathering sessions with the customer based on user feedback and new enhance -
 ments, which were entered into JIRA and tracked for future releases.
 Worked closely with UX/UI team to ensure usability and scalability of the application’s wireframe.
 Conducted risk assessments related to CMS requirements and proposed mitigation strategies.
 Assisted in the development of quality assurance processes to ensure compliance with CMS standards.
 Reviewed CMS contracts and agreements to ensure alignment with project objectives and requirements.
 Created BPMN flows, Functional Specifications to remove ambiguity of the requirements communicated by
clients or SMEs.
 Participated in Daily Agile Scrum “Stand-up”, Biweekly Sprint Planning and Retrospective Sessions and up -
date the team on status of upcoming User Stories.
 Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
 Created screen mockups and wireframes for prototypes for the front-end application of the products.
 Created UML Diagrams like Sequence Diagrams, Activity Diagrams, and process flow diagrams to elabo-
rate the new processes using MS Visio.
 Participated in cross-functional teams and working groups to address budget-related issues, challenges,
and opportunities.
 Assisted in the development of CMS-compliant reporting templates and tools.
 Identified and implemented process improvements to streamline budgeting workflows, increase efficiency,
and enhance accuracy.
 Reviewed and updated documentation related to Medicaid provider enrollment procedures and policies.
 Worked extensively to write use cases and functional requirement case diagrams, activity diagrams, se-
quence diagrams, state diagrams based on UML methodology, and business process flow diagrams using
MS Visio.
 Participated in meetings and discussions regarding Medicaid provider enrollment initiatives and strategies.
 Performed UAT cycles and prepared test scripts for User Acceptance Testing (UAT).
 Monitored and evaluated the effectiveness of changes implemented in Medicaid provider enrollment pro-
cesses.
 Created Use Case diagrams using UML and Business Process Models using MS Visio.
 Worked under Agile Scrum methodology using the JIRA ticketing system to log day-to-day activities

Care first BCBS MD May 2018 – Dec 2020

Business Analyst
The purpose of this project is to aid needy families through technology services. Was able to deploy a solution
that provided off-the-shelf flexibility and affordability, scalability, a flexible business services model, and criti-
cal capabilities to support their transformation and modernization strategies I have been working with multiple
teams on several projects simultaneously and coordinating for implementations of Design, build and test
Facets configuration in support of business requirements.
Responsibilities:
 Worked closely with the development team to ensure the application's performance and stability, and the
application completed the whole end-to-end process.
 Responsible for system integration testing of 837 claim files, 834 eligibility files and 270/271 interface files
to ensure required interactions are met during the SDLC process.
 Performed m requirements analysis and using Rational Rose and Smart Draw created UML specifics such
as data flow diagrams (DFDs), ER diagrams, Use cases, Class, Sequence, Collaboration and Deployment Di-
agrams.
 Developed hundreds of agile themes, epics user stories, success criteria, use cases, rules and non-func-
tional requirements.
 Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
 Used SQL to complete complex table joins within database to create reports for clients.
 Performed UAT cycles and prepared test scripts for User Acceptance Testing (UAT).
 Used MS-Visio BPMN for developing Medicaid AS-IS and TO-BE business process flow.
 Participated in weekly status meetings with Development and Management Teams.
 Conducted requirements gathering sessions with stakeholders from various departments, including busi-
ness users, product owners, and developers.
 Monitored projects efficiently to complete them on time and within budget with the Project Manager.
 Conducted JAD sessions during the various stages of upgrading the matching system and discuss the cur -
rent system preference.
 Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and
Medicare claims.
 Traced requirements using traceability matrix to trace the requirements
 Wrote User stories which included the business logic, expected behavior and user acceptance criteria.
 Participated in functional design sessions, creates and executes SQL test scripts, and aids in the solution of
 data issues.
 Responsible for Business Process Management (BPM) for development of various projects.
 Developed Use Cases, Sequence Diagrams, Activity Diagrams and Class Diagrams.
 Worked on the UNIX platform and experience in backend testing by executing SQL Queries.
 Experience using Agile/Scrum methodologies, analyzed System Requirement Specification (SRS), Func-
tional Requirement Specification (FRS), and design documents.
 Familiarity with BPMN (Business Process Model and Notation) and Six Sigma methodologies, ensuring best
practices in process documentation and continuous improvement.
 Writing requirements documents with various methods including, but not limited to User Stories and Func -
tional Design documents.
 Participated in QA meetings and defect tracking meetings.
 Conducted GAP analysis and filled gaps according to the format set by HIPAA.
 Maintained guidelines and documentation focusing mainly on requirements during UAT testing.

Caresource, Dayton OH Apr 2017 – Apr 2018

Business Analyst
CareSource is a nonprofit that began as a managed health care plan serving Medicaid members in Ohio.
The primary objective of the project is to redefine the way consumers interact with healthcare services. By
focusing on the front-end user applications the aim is to create an intuitive, accessible and user-friendly
platform that simplifies the often complex landscape of healthcare.
Responsibilities
 Performed the requirement analysis, impact analysis and documented the requirements using Rational
Requisite Pro.
 Involved in all SDLC stages under Agile process requirement analysis, implementation, testing (functional
and use acceptance) and deployment.
 Served as a point of contact for CMS and trading partners to do the testing for various types of claims and
real time transactions like 270/271/276/277 for Medicare and Medicaid programs in FACETS.
 Involved in Joint Application Development sessions with SMEs and development teams and documented
functional business requirements as product backlogs using JIRA.
 Analyzed requirements utilizing various methods. (E.g. sample data from SQL queries, Screen Shots, re-
ports, prototype screens, sourcing information, and other data models.)
 Tested various Claims for different plans including Medicare, Medicaid and HMO/PPO.
 Worked with the centers for Medicare and Medicaid services (CMS), the Healthcare Common Procedure
Coding System (HCPCS), Electronic Data Interchange (EDI).
 Documented the server farm requirements and requirements related to security within Share Point and us-
ing Windows Active Directory.
 Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level
Requirements.
 Managed the team of consultants responsible for developing on-demand Medicaid Management System re-
ports.
 Develop creative solutions to complex problems, validate requirements with stakeholders, and provide the
optimal IT solution using JIRA.
 Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
 Planned and defined system requirements to Wire Frames with Use Case, Use Case Scenario and Use Case
Narrative using the UML (Unified Modeling Language) methodologies.

EDUCATION
Bachelor in Electronic and Communication Engineering, Tribhuvan University