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Krenjkumar Patel

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Spring, Texas, United States

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work
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Jobs verified_user 0% verified
  • Community Health Choice
    Business Analyst
    Community Health Choice
    Apr 2023 - Current (3 years 3 months)
    As a Business Analyst, I collaborated with claims operations, provider relations, and IT development teams to design and implement system enhancements for EDI 837 claims, 835 remittance advice, and 278 prior authorization transactions. My work involved translating regulatory mandates and business needs into actionable functional requirements, managing data validation processes, and supporting end-to-end UAT cycles. • Facilitated requirement sessions with claims, enrollment, and compliance teams to define business rules for claims adjudication and prior authorization workflows. • Authored detailed mapping specifications for HIPAA 837 (P/I) and 835 transactions, incorporating payer-specific business logic. • Assisted in redesigning pre-adjudi
  • S
    Business Analyst
    Superior HealthPlan
    Nov 2021 - Mar 2023 (1 year 5 months)
    Superior HealthPlan, a statewide managed care organization serving Medicaid, CHIP, Medicare Advantage, and Marketplace members, launched a project to enhance its EDI transaction processing and provider data integration. The initiative aimed to improve claims turnaround, reduce provider disputes, and strengthen compliance with Texas Medicaid and CMS reporting requirements. As a Business Analyst, I worked with claims processing teams, provider relations, and IT integration specialists to design enhancements for EDI 837, 835, and 270/271 transactions. I played a key role in gathering requirements, mapping data exchanges, validating test results, and supporting provider-facing portal improvements. • Conducted workshops with claims and provider
  • Liberty Mutual Insurance
    Business Analyst
    Liberty Mutual Insurance
    Jun 2020 - Oct 2021 (1 year 5 months)
    As a Business Analyst, I worked with underwriting, claims operations, and IT development teams to translate business needs into detailed functional requirements, streamline data exchange processes, and improve reporting accuracy. The role required coordinating between multiple internal departments and third-party vendors to ensure system changes met operational, compliance, and user experience goals. Additionally, I leveraged my experience in public sector service by collaborating with claims operations, provider relations, and IT development teams to design and implement system enhancements for EDI 837 claims, 835 remittance advice, and 278 prior authorization transactions. My work involved translating regulatory mandates and business need
Education verified_user 0% verified
  • Gujarat Technological University
    Bachelors In Computer
    Gujarat Technological University