Rishika G

About Rishika G

With over ten years of work experience, where I gather business requirements, prepare…

Experience

1. Senior Business Analyst

   Cvs Pharmacy

   Jun 2022 — Present · MA, US

   Involved in gathering business requirements, design, and development for the BPA, EPSDT, EDMS, EDI, Claims, Financials, Recipient, Prior Authorization and Managed Care modules. Ensured all artifacts compiled with HIPAA 5010 policies and guidelines. Worked on EDI transactions like 270,271,834,837 and 835. Gathering requirements and preparing functional documents for Facets 4.71. Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS. Did gap analysis for HIPAA40•••37P and 835 transactions and HIPAA 50•••37P and 835 transactions. Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS. Also, accountable for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS. Assisting the project manager in creating the business case and project plan. Involved in analysing and processing of claims with prior authorization for ICD10 diagnosis and procedure codes. Worked on Medicaid and CHIP program requirements, including complete end to end life cycle data flow of eligibility, enrolment, claims, encounters, payment and post-payment