NUDRAT RAFA
Philadelphia,PA
Summary
Detail-oriented Business Analyst with 5+ years of experience supporting healthcare and insurance systems. Strong background in business analysis, system support, SDLC (Agile & Waterfall), and data-driven process improvement. Proficient in writing SQL queries for testing, validation, and reporting, and in developing process optimization strategies that enhance business performance and data integrity.
Overview
9
9
years of professional experience
Work History
Business Analyst
East Coast Anesthesia P.C.
New York, NY
02.2021 - Current
- Gathered and documented business and functional requirements for anesthesia software enhancements.
- Collaborated with developers and stakeholders to deliver EMR enhancements through structured requirements, test planning, and UAT. Verified anesthesia record accuracy, offline sync workflows, and OCR extraction processes prior to production release.
- Processed and validated 100+ insurance claims daily, ensuring compliance with payer, regulatory, and organizational standards.
- Analyzed diagnosis and procedure codes to reduce denials and improve reimbursement accuracy.
- Collaborated with billing and insurance carriers (Aetna, UHC, Cigna, Emblem, Fidelis, MetroPlus) to resolve system and data discrepancies and increased revenue by 40%.
- Developed operational and financial reports using Tableau & Excel.
Business Analyst
Project HOME
Philadelphia, PA
03.2025 - 08.2025
- Partnered with clinical and IT teams to translate business and operational requirements into functional specifications supporting NextGen and Apteryx system integration with eCW.
- Performed data cleanup, validation, and reconciliation for 1,200+ patient records, ensuring alignment across integrated systems (NextGen, Apteryx, and eCW).
- Maintained an Excel tracker for explosion code management and rule engine integration to ensure accurate Medicare/Medicaid billing and standardized claims workflows.
- Tested multiple web and plug-in versions of eCW with Topaz signature pads and scanners to assess compatibility, deploying the optimal version across front desk, medical, and dental teams to ensure seamless device integration and operational efficiency.
- Worked with vendors (eCW, Apteryx, BossDesk) to troubleshoot application and integration issues, escalating complex problems as needed.
- Resolved CBH claim denials by adjusting payer-specific rules in eCW, eliminating the auto-appended HE modifier on T1015; generated EBO reports and resubmitted claims to restore reimbursement.
- Configured rule engines in eCW to route non-credentialed provider claims into a pre-credentialing queue, ensuring compliance and preventing rejections.
Business Systems Analyst
Independence Blue Cross
Philadelphia, PA
10.2024 - 01.2025
- Collaborated with business stakeholders to analyze and document business and functional requirements for resolving 500-700 subscriber accounts placed on hold each week.
- Authored detailed Business Requirements Documents (BRDs) and Functional Requirements Documents (FRDs) supporting ORMB and H30 system enhancements.
- Translated business needs into functional specifications for outsourced development and QA teams, ensuring alignment with billing, financial consolidation, and Oracle EPM workflows.
- Managed and resolved 5-10 ServiceNow ITSM tickets weekly related to subscriber invoice and delinquency hold issues.
- Reviewed SQL queries and created process flow diagrams to assess system discrepancies and identify improvement opportunities.
Compliance Specialist
Renaissance Home Health Care
New York, NY
06.2020 - 02.2021
- Supported cloud-based healthcare applications (HHAeXchange) by maintaining accurate client and caregiver records.
- Verified eligibility and compliance using ePACES and internal systems.
- Assisted with data analysis and reporting, building dashboards to track compliance, availability, and performance metrics.
- Ensured sensitive data was handled according to security and compliance guidelines.
Business Systems Analyst
Queens Social Adult Day Care Center
New York, NY
02.2019 - 03.2020
- Maintained and monitored a database of 500+ service users, ensuring data quality, integrity, and audit readiness.
- Identified data gaps and inconsistencies impacting billing and reporting.
- Supported process improvements that increased claim acceptance and revenue by 7%.
Insurance Claims Processor
Mega Insurance Brokerage
New York, NY
01.2018 - 02.2019
- Managed client and compliance data using Salesforce CRM.
- Supported workflow automation and reporting initiatives.
- Developed carrier comparison and performance reports.
Admin Assistant
Fund Tax Service (FTS)
New York, NY
04.2017 - 01.2018
- Performed administrative and clerical duties, including distributing staff schedules, coordinating meetings, and maintaining office documentation.
- Prepared and assembled tax return packages for clients - including reviewing returns and K1s, preparing transmittal letters, and managing certified mail receipts.
- Assisted with HROI (Human Resources Operations Interface) tasks such as maintaining employee data records, supporting payroll coordination, and facilitating communication between HR and accounting teams to ensure accurate processing and compliance.
Education
Master of Science - Business Analytics, Data Analytics
Baruch College/ CUNY, Zicklin School of Business
New York, NY12-2023
Bachelor of Science - Human Resource Management, Communication
Baruch College/ CUNY, Zicklin School of Business
New York, NY05-2020
Skills
- SQL
- MS Access
- Oracle Analytics Server (OAS)
- Waterfall
- Agile
- Microsoft Visio
- Data Warehouse
- ETL
- DH ETL
- Tableau
- Domo
- Smartsheets
Languages
Hindi
Full Professional
English
Full Professional
Bengali
Full Professional
Timeline
Business Analyst
Project HOME
03.2025 - 08.2025
Business Systems Analyst
Independence Blue Cross
10.2024 - 01.2025
Business Analyst
East Coast Anesthesia P.C.
02.2021 - Current
Compliance Specialist
Renaissance Home Health Care
06.2020 - 02.2021
Business Systems Analyst
Queens Social Adult Day Care Center
02.2019 - 03.2020
Insurance Claims Processor
Mega Insurance Brokerage
01.2018 - 02.2019
Admin Assistant
Fund Tax Service (FTS)
04.2017 - 01.2018
Master of Science - Business Analytics, Data Analytics
Baruch College/ CUNY, Zicklin School of Business
Bachelor of Science - Human Resource Management, Communication
Baruch College/ CUNY, Zicklin School of Business