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Experience Summary:

Participated in and contributed to all Agile Ceremonies, which includes daily scrums, planning, grooming, review, and retrospective.

Optimized membership experience through seamless interactions and personalized services.

Proficient in managing the Requirement Gathering process and product backlog by prioritizing User Stories to meet deadlines/successful execution of the project.

Translate Business Requirements into Functional Requirements for the Developing and QA Teams.

Experienced working with multiple cross-functional teams simultaneously, both offshore and onshore.

Skills, Tools and Certifications

Skills & Expertise:

Good Understanding of Pharmacy and Insurance industry compliance, Procedures.

Expertise in Pharmacy claim process and Pre-Authorizations

Partnering with Business divisions

Collaborate with development team on fixing issues.

Effectively communicate and present solutions pertaining to delivery needs

Business process and Operational knowledge with pharmacy applications.

Ability to perform Regulation acceptance Testing

Talent Onboarding, Offboarding, Change in Assignments.

Demand Mapping with clients

Manage onsite demand tracker

Managing critical reports

Industry experience:

10+ years of diversified Healthcare Pharmaceutical experience with 2+ years background in business analysis, PMO activities.

Successfully supported as Co-Ordinator /MHI-BAA-Digital and Omni-Channel & MCG and Eligibility teams.

PMO/ Molina Beeline activities – Talent Onboarding, Offboarding, Change in Molina assignments,

Demand Mapping with US mapping team, Manage Onsite demand tracker, Critical reports, Molina and Infosys Compliance trainings follow ups and ensure100% completion.

Tools/Technology experience:

Microsoft Office Suite

JIRA

SQL (Basic)

Pharmacy operating Softwares (RxConnect, PrimeRX & PioneerRX)

PMO

Business Analysis

Key Engagements Summary

Gather requirements for New and Refill pharmacy members.

Initiate Pre-Authorizations as permitted by state law for Medicaid and Medicare members.

Validate Pharmacy labels as per HIPPA regulations.

Provide direction/guidance to lower-level Pharmacy technician staff.

Maintain patient records and confidentiality (HIPPA)

Participated in daily meetings with pharmacy staff on controlled drugs and other class medications.

Prioritize/Adjust (ed) in outreaching to providers on suspected medication abuse situations as per government regulations.

Explain Pharmaceutical and Insurance procedures to pharmacy members undertaking any tests.

Participated in Business Analyst training comprised of Project Management best practices and design thinking to find disruptive solutions

Project Co-Ordinator/MHI-BAA-Digital and Omni-Channel

PMO/ Molina Beeline activities – Talent Onboarding, Offboarding, Change in Molina assignments,

Demand Mapping with US mapping team, Manage Onsite demand tracker, Critical reports, IT

Molina and Infosys Compliance trainings follow ups and ensure100% completion. Preparation and sending of critical reports to network operation team after coordinating with MCG and Eligibility teams.

Educational Qualification:

Business Analysis for Digital Transformation

Diploma in Pharmacy Technician

Diploma in Customer Service

BAS-HI201-Basics of Health Insurance

SQL

Payer 101

Agile Scrum in Practice

Key Certifications and Licenses

National Certified Pharmacy Technician

Certified in fundamentals of Medicare Part A

(AHIP)

Certified Pharmacy Technician (CPhT)