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• Akshay Mahale
• Swapna

Summary:         

• Analytical, Methodical, and Resourceful Professional with over 12 years of experience in Business Modeling, Requirement Gathering and Analysis, Data Analysis, Software testing and Project Management.

• Creative and innovative thinker, team player with excellent communication and analytical skills, bringing energy, enthusiasm and leadership to problem resolution.

• Experience with a range of various software products and tools, including BizTalk, SQL Server, MS Visual Studio, EDIFECS, FACETS, JIVA.

• Thorough knowledge in Eligibility, Claims, Claims Reconciliation, FACETS – Provider Data Model.

• Worked on Medicare Advantage Plans, Managed Care (Utilization and Case Management) and also in Insurance regulations and Claims Processing in HMO, PPO & Medicare.

• Experience with various EDI healthcare transactions such as 837 for submitting claims, 835 for payments, 834 for benefit enrollment, 270/271 for health care benefits and eligibility, 276/277 for claims status.

• Experienced in all stages of Software Development Life Cycle (SDLC) with proficiency in Various Methodologies including Waterfall, RUP, and Agile (SCRUM).

• Excellent facilitation skills in conducting walkthroughs, surveys, questionnaires, interviews, brainstorming for Gathering and Analyzing Requirements.

• Adept at creating and transforming business requirements into functional requirements and designing business models using UML diagrams- Use Case Sequence and Activity Diagrams Data-Flow Diagrams & Data Modeling.

• Experienced in conducting Joint Application Development (JAD) sessions with Business users, Business system analysts, SMEs, software developers, and QA team.

• Conducted Daily Scrum meeting, Planning Sessions, Backlog updates, User Stories updates.

• Strong knowledge of SQL, data analysis and data validation using SQL.

• Good conceptual understanding of Data Warehousing. Proven experience in complete project life cycle - Design, Development, Maintenance and Documentation of Enterprise Data Warehouse.

• Extensive experience in creating and maintaining source to target Data mapping documents

• Experience in both manual and automated testing tools in conducting QA testing and User Acceptance Testing (UAT).

• Well versed in different management scenarios like Change Control, Quality Assurance, Defect Tracking, System Integration, and Scheduling.

Skills:

Education:      

• Masters of Science in Computer Information Systems – American College of Commerce and Technology – Falls Church VA.