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Nidhi Patel
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Raleigh, North Carolina, United States
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Business System AnalystAmeriHealth CaritasSep 2023 - Current (2 years 10 months)The project implemented increased scalability, capacity, and service delivery, streamlining internal processes for real time data integration between legacy systems and external vendor systems. The focus was to enhance workflow processes for the entire claims processing cycle, involving HIPAA ANSI X12 transactions like 837, 270, 271, 274, 276, 277 and 278. Enabling the IT teams to identify and resolve system errors in the adjudication process. • Assisted in creating implementation guides for various EDI X12 transactions such as 834, 835,837,270, 271 , 274. • Responsible for importing all reports from Web Report Studio, Stored Process, BI Dashboard and Information Map to Information • Coordinated Agile based planning/review activities and- Business Systems AnalystConduentDec 2021 - Aug 2023 (1 year 9 months)Primary responsibilities were the maintenance and development applications to process HIPAA x12 EDI files such as 834 enrollments and 835 payments advise. • Engaged in Business requirement gathering sessions, collecting, and defining requirements and translating them into functional design, test planning and user documentation processes. • Translated Business user concepts, requirements, and ideas into comprehensive Business Requirement Documents (BRD). • Worked on EDI transactions: X12,834, and 835 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes. • Provided recommendations and advice to business groups on process impr
- Business AnalystHumanaAug 2019 - Nov 2021 (2 years 4 months)The Project was for creating and maintaining applications that would provide information in a consolidated manner to its managed care and strategic pricing business partners, in a timely manner, necessary for making key business decisions. • Created Business Process Mapping Diagrams and Documentation for the process improvement recommendations. • Used MS Visio for flowcharting, Use Case process model and architectural design of the application. • Implemented the RUP methodology guidelines with its various workflows and artifacts in Requirements Management and Development • Worked on EDI transactions: 270, 271, 834, 835, and 837 (PID) to identify key data set elements for designated record set. • Interacted with Claims, Payments and Enr
- Business AnalystUSAAMar 2017 - Jul 2019 (2 years 5 months)As a Business Analyst performed requirement analysis, solution design analysis and code reviews on multiple projects for Enterprise Services team and worked with Portfolio team on API development. • Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD) • Collaborated with both technical and business stakeholders to understand reporting and data requirements based on customer and internal needs. • Created and maintained Business Use cases and System Use cases, Use Case diagrams, Flow Diagrams, Business Flow Diagrams (BPMN), Activity diagrams, Sequence diagrams throughout the SLC using MS Visio • Resolved pre-UAT and post-UAT issues for the final acceptance document to be signed by the client/
Education
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- Bachelor of PharmacyGujarat University