Experience: 14+ Years

Location: Chennai,Kochi,Trivandrum

Skills

Core Healthcare Domain Expertise

US Healthcare Payer & US Health Insurance domain Commercial, Medicare, Medicaid, Duals, Exchanges (ACA) Healthcare Industry Consulting & Healthcare IT HIPAA compliance & Affordable Care Act (ACA) Medicare & Medicaid regulations Core Administration Systems Claims Processing & Adjudication Membership Enrollment & Eligibility EDI Transactions (HIPAA X12 5010 – 834, 837, 835, 270/271) Member Services & Provider Services (end-to-end) Care Management, Risk Management, Quality Management

Consulting & Assessment Capabilities

Discovery & Assessment engagements Current-state analysis (functional & technical landscapes) Future-state definition & solution design Industry best practices, benchmarking & gap analysis Recommendation development & implementation roadmaps Technical remediation planning Statement of Work (SoW) documentation Proposal solutioning (RFP/RFI/RFX – proactive & reactive)

Business Analysis Skills

Requirements elicitation, gathering & documentation Requirements management & ownership Joint Application Development (JAD) sessions Requirements Traceability Matrices (RTMs) Process modeling & documentation MS Visio, UML diagrams, process flows Waterfall & Agile methodologies

Product Ownership / Product Management (Good to Have)

Product roadmap development Product backlog management Epics & user stories Healthcare UI/UX requirements Healthcare data management & database needs Cross-functional stakeholder collaboration

Technical & Interoperability Knowledge

Healthcare IT systems & platforms FHIR (good to have) HL7 (working knowledge) Healthcare data standards & interoperability

Tools & Productivity

Microsoft PowerPoint (advanced) Microsoft Word & Excel (proficient) Presentation development for executive & client audiences

Certifications (Preferred / Good to Have)

AHIP / AHM Certifications (PAHM, FAHM, AHM) Business Analysis Certifications (IIBA – ECBA, CBAP) Certified Scrum Product Owner (CSPO) Healthcare-specific certifications