Alok Sharma

Email: aloksharmaatx@gmail.com
Cell: 512-694-0686
Visa- USC Holder

 Over 8+ years of extensive experience in Sr. Dynamics CRM Business Analyst and
business process re - engineering with proven ability to articulate business values exposed to
diverse business processes.
 Strong knowledge of the Software Development Life Cycle methodologies
(phases and gates) like Agile and Waterfall models.
 Expertise of UML in visualizing and documenting the artifacts using Use Cases,
Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow
Diagrams, Sequence Diagrams using MS Visio.
 Experienced in Selenium automation using Selenium Web Driver, Selenium IDE,
Java, Junit.
 Hands on experience in requirements gathering, analysis, design, functional
testing and training with strong focus on Microsoft Dynamics CRM.
 Strong understanding of project life cycle and SDLC methodologies including
RUP, RAD, Waterfall and Agile.
 Skilled in mapping client requirem ents with Microsoft Dynamics CRM application
functionality.\ Good knowledge of systems which were used to enable inbound/outbound HIPAA
EDI Transaction in support of HIPAA 834, 835, 837, 270/271 transactions.
 Medical Claims experience in Process Documentation, Analysis and
Implementation in EDI X12 Standards processes of Medical Claims Industry from the
Provider/Payer side.
 Well versed with Automation Frame work developing POM classes using java in
Selenium Web Driver.
 Proficiency in SQL and in applying and executing SQL queries from Oracle, TOAD
databases for Back-End Testing, and build statistical reports.
 Experience in facilitating Joint Application Development (JAD) sessions, Rapid
application development (RAD) sessions , conducting user interviews and acting as a liaison
between the customers, development team and testing team.
 Experience working on Provider data management for Provider attributes like
networks, locations and specialties for Individuals.
 Worked on Different Modules like Billings, Membership, Claim and Provider in
MMIS application.
 Worked in Agile environment in recent assignments.
 Expertise in developing documents for Functional Requirement Specification
(FRD), Software Requirement Specification (SRS), Business Requirement Document (BRD), Use-
case Specification and Non-functional Requirements.
 Excellent experience various EDI files such as 837 Claims Processing, 834 Benefit
Enrollment, 820 Payments.
 Analytical, methodical and resourceful approach to problem solving, identifying
root causes and corrective actions to meet short and long-term business, financial and system
requirements
 Experience with Data Management, Data Visualization and data governance.
 Excellent verbal/written communication skills and strong analytical abilities and
can perform well both independently and as a team player
 Strong experience in conducting User Acceptance Testing (UAT) and
documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
 Interface with clients from Operations, Marketing, Sales, Technologies, and
Outside Vendors and act as their customer interface point as the lead of the Projects.
 Highly motivated team player with excellent Interpersonal and Customer
Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, and
Leadership Qualities.

Technical Skills:
Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling,
JAD/JRP
Sessions, Gap Analysis and Impact Analysis.
Methodology: RUP, Agile, OOAD and Waterfall.
Management Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track and
MS Visio, MS Project, JIRA
Testing Tools: HP ALM
Database: Oracle DB2, MS SQL Server, TOAD.
Reporting Tool: Cognos
CRM- Salesforce CRM, PRM,
Operating Systems: UNIX, Windows
Office tools: MS Office (Access, Word, Excel, Power Point, Outlook), MS Visio, MS Project

PROFESSIONAL EXPERIENCE:

Beacon Health options, Boston, NY

Jul 2020 – Jan 2021
Business Analyst
This project focused on upgrading the legacy systems for a new account Availity MA. The project
engagement involves assessment and remediation of the system to make the new system
5010/ICD10 Compliant and make sure we are generating the EDI acknowledgements like
TA1/999/277CA whenever deemed necessary. The Claim Processing System used by the Client is
EDIFECS and Informatica.

Responsibilities: (Analyst, EDI Analyst)

 Analyzed the current EDI files received, documented and reported the necessary changes to
be made in the Claims processing process followed.
 Created detailed analysis on bsuienss processes, user stories and tasks for the Sprints as part
of Agile.
 Worked on UI for Informatica and Availity.
 Trouble shooted file transmission problems and assisted customers with EDI and Medicaid
Insurance claim related inquiries explained and enforced guidelines in the X12
Implementation guides (837P, 837I, 837D, 270/271).
 Analyzed 4010A1 and 5010 TR3 Implementation guides to identify and document the changes
for HIPAA EDI Transactions such as 837 P, 835, 276/ 277 and 270/271.
 Worked on finding the product gap and done the gap analysis with the BTRD provided.
 Monitored the Profiles and routes in EAM.
 Worked on Guidelines, Maps and routes in Edifecs
 Analyzed and reported SNIP errors using Edifecs Transaction Manager.
 Used SQL developer for getting the query results and generating the custom reports using
Excel functioanalties.
 Worked on FTP/SFTP tools like Winscp, SSH Tectia and UNIX servers.
 Done the ECL codeset deployment in all the servers using the UNIX box.
 Involved in the deployment of Edifecs patch from the product for the EAM and XEServers.
 Involved in the UI testing for Informatica and Availity and created the use case document.
 Developing reports based on the given requirements, data reports on business intelligence
tools.
 Reported Production issues, root cause analysis for task failures / exceptions in production
  Coordination with the client, BA’s and the offshore team on periodic duration.
 Been responsible for driving the Standup calls and other Business requirements calls.
 Developed a guide that explains step by step workflow of the 837 and 834 transactions.
 Provide support to the Claims Maintenance and Authorization process.
 Finding the bugs during testing and getting involved in bug fixes and support activities for
both Edifecs and Informatica.
 Post production move, Root Cause analysis for task failures / exceptions in Production
 Done the reverse mapping for the 837 claims code and documented the same.
 Part of infrastructure team to support offshore.
 Coordinated and collaborated with cross functio0nal teams on daily basis.
 Following transcation are being handled as part of this project.
o Realtime transactions – 27x
o 834 – Eligibility
o 837 – Claim (I/P/D)
o 835 – Remittance

Department of Medicaid Services, Frankfort, KY

Feb 2017 – March 2020
CRM Business Analyst

Responsibilities:
 Enhancing MS Dynamics CRM 2016 usability by designing and optimizing
navigation, forms, and layouts.
 Responsible for defining the integration points between multiple systems with
CRM and data mapping and specification writing
 Gained training on Enterprise Asset Maintenance, introduction to financial in
Microsoft Dynamics CRM course, trade and logistics.
 Analysed User Requirement Document, Business Requirement Document (BRD),
Technical Requirement Specification and Functional Requirement Specification (FRS).
 Extensive MS Dynamics CRM experience, particularly in 2015 and 2016 versions,
that has included the following: Design, development, implementation and management of MS
Dynamics
 Created workflow scenarios, designed new process flows and documented the
Business Process and various Business Scenarios and activities of the Business from the
conceptual to procedural level.
 Worked on Microsoft Dynamics CRM for handling the customer claim inquiries,
validation and case creation.
 Working closely with senior management to develop strategic plans.
 Worked as an Interface between the Users and the different teams involved in
the application development for the better understanding of the Business and IT Processes.
 Worked on various Microsoft Dynamics CRM configurations including Custom
Objects, Page Layouts, Form Layouts, Fields values, Data viability, Reports and Dashboards.
 Maintaining effective user relationship by performing front-line support of MS
Dynamics CRM 2016 users.Translated high-level strategy & product direction into features, epics
and user stories; prioritized in the product backlog for selection for sprint backlog.
 Created Dynamic CRM data cleansing modules to identify duplicate student data
using rules from a rules table in the database.
 Implemented common, centralized, flexible enterprise wide architecture and
simplification of IT systems to support key business and CRM initiatives.
 Designed configuration of MS Dynamics CRM as per the business user's
requirements and needs.
 Assisted in migration of current CRM to MS Dynamics CRM with added features
and functionality.
  Implemented software and hardware components for Microsoft Dynamics CRM
and XRM applications Setup various offers and campaigns in Microsoft Dynamics CRM and
presented them based on customer segmentation
 Responsible for Medicaid Claims Resolution/Reimbursement for state health plan
using MMIS.
 Identified and defaulted credit conditions and document packages by specific
products, business channels or other unique identifiers, which resulted in improved productivity
and service levels.
 Worked directly with other product owners, system engineers, program
managers, developers, testers, and customers to define features and technical user stories.
 Exported Microsoft Dynamics CRM data to Microsoft Office Excel PivotTable to
see patterns and trends in data
 Conducted JAD sessions with management, SME, vendors, users and other
stakeholders for open and pending issues.
 Involving in mapping customer requirements to MS Dynamics CRM 2016.
 Worked on different data sources, creating logical data models and establishing
relationship between entities using Crystal Reports, MS SSRS
 Worked on projects which used Agile and Waterfall methodologies.
 Responsible for providing analytical support in the Design, Development and
Implementation of Project.
 Assigned tasks among development team monitored and tracked progress of
project following agile methodology.
 Managed Dynamics CRM system through inputting new engagements, adding
leads, options, and necessary stakeholder information
 Reviewed Medicaid MMIS vendor deliverable during System Development Life
Cycle; worked closely with business and IT folks along with SME’s to amend, create, and
updating process flow charts from “AS IS” to“TO BE” system.
 Analyzed and redesigned workflows in order to optimize end to end process by
using BPR (Business Process Reengineering).
 Responsible for validating claim processing transaction of MMIS.

New Jersey Department of Health & Human Services, Trenton, NJ

June 2015 – December 2016
Business Systems Analyst
This project focused on implementing Enterprise administrative system, a new core system with
updated technology to allow for more efficient claims processing, membership enrollment, provider
data maintenance & getting access to customer records. I was involved in MMIS project which will
replace the Medicaid claims payment system. As a, Business Systems Analyst I participated in all
aspects of gathering requirement for the MMIS system project and UAT. I have worked on the
claims and provider modules of the MMIS system. I was involved in gathering requirement
application modules like Enrollment, Membership and Claims.

Responsibilities:
 Conducted weekly meetings for deciding the Policies and Procedures to be
followed while constructing.
 Followed Agile methodology for the SDLC.
 Conversion and data mapping focused on were 270,271, 834, 820, 835, and 837.
 Responsible for performing changes to provider data using the incoming data
feeds Identified business directions & objectives that may influence the required data and
application architectures throughout the Project life cycle.
 Involved in automated regression and functional test suites by developing test
cases, test suites using Selenium Web Driver, JAVA and JUnit.
 Configured SeleniumWeb Driver , TestNG , Maven tool and created selenium
automation scripts in java usingTestNG prior to agile release.
 Extensively participated in verification of EDI file formats against HIPAA ANSI X12
Standards.
 Responsible for ensuring HIPAA EDI Trading Partner transactions meet
established standards.
 Analyzed and worked with HIPAA specific EDI transactions for claims, member
enrollment, billing,transactions.
 Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key
data set elements for designated record set. Interacted with Claims, Payments and Enrollment
hence analyzing and documenting related business processes.
 Assist Medicaid staff in designing/modifying MMIS processing cycle reports
 Gathered requirements and involved in the testing of web portal of MMIS
system.
 Worked on HIPAA Transactions and Code Sets Standards according to the test
scenarios such as 270/271, 276/277,837/835 transactions.
 Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care
Claimsnpayment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment / Dis-
enrollment to a health plan)
 Analyzed EDI 820 (Payments and Remittances) and 834 transaction (Enrollment
and Maintenance) for the conversion of health insurance enrollment.
 Created UAT test plan and involved in the testing of web portal of MMIS system.
 Created test scripts and test cases for approved business use case and
requirements for System and UAT Testing
 Created reports with metrics and KPIs to highlight project success and outlined
all major functional areas.
 Provided demos and presentation walkthroughs to upper management.
 In-depth knowledge of healthcare organization operations including outsourced
operations, health insurance, HIPAA, and Medicaid/ MMIS, including MITA.
 Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and
other payers of government carriers.
 Monitored the compliance mapping of transactions to the EDI transactions
standards.
 Designed and developed Use Cases using UML and Business Process Modelling.
 Wrote data conversion and data migration scripts for ETL validation process.
 Conducted requirement analysis in accordance with MITA standards.
 Facilitated meetings to analyze services and process. Conducted detailed
assessment of operational workflow.
 Developed Conceptual Data Model & Logical Data Model in alignment with MITA
Information Architecture.
 Prepared Business Requirement Documents (BRD) as well as high-level project
plans and conducted detailed analysis to convert business requirements into functional
specifications.
 Worked on Enrollment, Claims, Authorizations and Referral aspects.
 Worked on training User groups - Clients and users on the application
functionality and provided User training and post implementation support.
 Responsible for checking member eligibility, provider enrollment, member
enrollment for Medicaid and Medicare claims.
 Facilitate, the process for requirements validation that follows the MITA
process/sub-process business model.
 Used Jira for some specific project teams to manage user stories ,defects &
triages issues.
 Performed Gap Analysis to check the compatibility of the existing system
infrastructure with the new business requirements.
 Validated the translated HIPAA files with the proprietary Common Claim Record
implementations.
 Worked on Data mapping, logical data modeling used SQL queries to filter data
in SQL Server database

State of Washington Medicaid Management Information System (WA-MMIS)

March 2014 - May 2015
Business Analyst

I worked on a Medicaid Management Information Systems (MMIS) project serving as a

liaison between the internal and external business community (Claims, Billing, Membership,
Capitation, Customer service, membership management, provider management, advanced
Healthcare management, provider agreement management) and the project teams
Responsibilities:
 Gathered requirement for the facets implementation and performed solution
analysis.
 Conducted SME interviews, gathered requirements, and analyzed the
requirements for the Claim processing system.
 Identified Claim Processors requirement and documented technical
specifications for the claim Inquiry system
 Provided Sprint Burndown and Sprint Velocity during the sprints.
 Worked with Product Owner to outline dependencies across features so that
stories could be prioritized accordingly.
 Planned and facilitated Sprint Planning, Sprint Review, and Sprint Retrospective
calls.
 Worked with other scrum teams as needed.
 Worked with product owner to facilitate preparation and prioritization of the
product backlog and worked with the team to finalize Sprint backlog.
 Analyzed, resolved and tracked discrepancies in the eligibility reconciliation
process for multiple stakeholders.
 Conducted a detailed research on how the claims migrate on the system through
each step in the process flow.
 Participated in Agile Planning Sessions and assumed the Product Owner role for
the agile initiative.
 Created Detailed Test Plan, Test Approach, Test Matrix, Test Strategy documents
based on the information gathered through business requirements and design/application
walkthroughs.
 Developed test Scenarios and Test Scripts Based on Requirements and Design
Documents.
 Involved in QA Testing of Inbound 837 Claims processing, 835 Remittance
Advice, Benefit Enrollment (834) for EDI transaction sets.
 Facilitated daily Scrum Meetings and reviewed the sprint backlog in scrum
meetings
 Used SQL statements for Back-end testing.
 Met with various HMO, PPO, Medicaid/Medicare, and Tricare Representatives
discussing benefits of contracts on behalf of facilities or appeals from denials and compliance
issues
 Drove multiple projects with different work streams towards completion of
testing, defect resolution, implementation, and support in an Agile/Scrum development
environment.
 Used and HP ALM for Requirement Traceability, and write maintain test cases,
create test sets, schedule test runs and used HP ALM to report bugs.
 Logged the errors, reported defects, determined repair priorities and tracked the
defects until resolution using TFS.
 Worked with user to define user acceptance test cases. Involved in UAT testing
(User Acceptance Testing) Implementation.
Sisters of Charity Hospital, Buffalo, NY
Jan 2012 –February 2014
Business Analyst
The HI-Exchange Project dealt with development of an online health information exchange (HIE)
and a secure web portal to enable authorized Sisters of Charity Hospital providers to have fast and
easy access to patient& electronic health record. The HI-Exchange web portal features EMR
functions and Integrated Clinical decision Support tools for better care management. The project
dealt with development of a Health Care Cost Containment System and implementation of an
automated inter-operable web application that tracks patient medical history and health care plans
via Viewer application and Electronic health records. The Viewer/EHR system provided online access
to mobile patient records and improved communication in public health.
Responsibilities:
 Assist with creation and maintenance all necessary documentation and training
materials for Epic Ambulatory application
 Performed analysis, design, development and maintenance of the Epic
Ambulatory applications and other clinical information systems.
 Experience with EPIC user and provider record provisioning, including the
development of role-based access, security classes, and user profiles
 Ensure seamless integration messaging exchange with various vendors like HIE
hospitals, and various EHRs.
 Experience in Epic Resolute product implementation and deployment
 Hands on experience with Epic Hospital Billing and Ambulatory.
 Experience with Epic Healthcare Information Systems.
 Used Complex SQL queries using joins and sub-queries to test the reports
generated by the different modules as a part of back-end testing.
 Conducted user interviews, gathered requirements, and analyzed the
requirements.
 Worked with the business team to collect the business requirements, security
and service level requirements and documented them.
 Analyzed set behavior and contribution to business performance, critical
business metrics & tracking underlying business trends using Business Objects.
 Implemented enterprise integration strategies forHIE(Healthcare Information
Exchange).
 Gather and analyzed HIE implementation as per HIPPA regulation.
 Responsible for SQL performance tuning and troubleshooting technical
problems in SQL Server using SQL
 Profiler and the Database Engine Tuning Advisor Coordinated closely with the
developers during the testing life cycle and detecting bugs and raising the defect and assigning
them to the developers.
 Developed functional specifications for the EMR system enhancements
(enhanced security & privacy rules, transaction standards, code sets, identifiers) as per HIE
standard and HIPAA complaint.
 Conducted and lead status report meetings with the business and the IT team on
a weekly basis.
 Manage Scope and change throughout the life cycle of the product.

EDUCATION:
Bachelor in Alternative Systems of Medicine – Indian Board of Alternative Medicine – 2005