SIDRA KHALID

Experience (Yrs) Last Used at

Skill Set Required/Desired Have (Client/Project)
Experience working as a Senior Business
Analyst Required 7 yrs Clearlink Partners
Experience writing, refining, and analyzing
SQL queries to answer questions and
resolve issues Required 6-7 years Clearlink Partners
Experience creating test scenarios, test
cases, and test scripts mapped to workflow,
and system design requirements Required 7-8 years Clearlink Partners
Experience testing and debugging
applications Required 6-7 years Clearlink Partners
Curiosity with the ability to problem-solve in Anthem and
a creative but vigilant manner Required 6-7 years Clearlink Partners
Critical thinking skills with a strong
emphasis on accuracy, precision, and logical
reasoning Required 7-8 years Clearlink Partners
Solid verbal and written communication
skills Required 10+ years Clearlink Partners
User-level experience with Microsoft Office
Suite, especially Excel Required 7-8 years Clearlink Partners
Anthem
HealthCare &
Experience in public health or medical Cooks Children
related industry Highly desired 10+ years Health Plan

PROFESSIONAL SUMMARY

 An experienced Business Analyst / System Analyst with exposure Healthcare and Pharmacy.
 Experience in SDLC, Agile, Waterfall, Rational Unified Process, and SCRUM software
development methodologies.
 Proficient at coordinating with stakeholders, vendors, Subject Matter Experts (SMEs), Project
Manager (PM) and end users and elicitation of requirements through Joint Application Design
(JAD) sessions, Brain storming sessions, interviews, Surveys and questionnaires, prototyping,
benchmarking, Requirements workshops, document analysis, Joint Application Requirement
(JAR) sessions and Rapid Application Development (RAD).
 Skilled in gathering and converting User Requirements into High Level and low level
documents (HLD/LLD) like Business Requirements (BRD), Functional Requirement
Documents (FRD), Functional Requirement Specifications (FRS) System Requirement
Specification (SRS),and visualizing graphical user interface (GUI) using mockup screens.
 Expertise in Gap Analysis, SWOT analysis, risk analysis, cost-benefit analysis, feasibility
analysis, and impact analysis.
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  Experience with health care systems: QNXT, Medicare Part A, B, C, D, Medicaid systems,
Technical Report Type 3 (TR3) Implementation Guide, and Companion Guide.
 Experience in configuration of claims processing applications, claim adjudication process,
claims management process, real time claims adjudication, Electronic Medical Records /
Electronic Health Records (EMR/EHR) and Medicaid Management Information System (MMIS),
and Medicaid Information Technology System (MITS).
 Have knowledge of HIPAA transaction and code standards and electronic data interchange
(EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims
encounters process.
 Communicated effectively with the team members, stake holders and remained a focal point
of contact for any issue resolution with respect to the requirement and testing of the
application.
 Proficient in creating and managing Use Cases, User Stories, Test cases, Test plans, Test
reports, Test scripts.
 Skilled at performing User Acceptance Testing (UAT), handling Change Request, and
Configuration management.
 Used tools like JIRA and RALLY to create and maintain Product Burn-down chart, Sprint Burn-
down/ Burn-up chart.

EMPLOYMENT HISTORY

Clearlink Partners July 2022 to Present

Senior Business Analyst

Project: Clearlink Partners is an industry-leading independent clinical and operational consultancy

specializing in total cost of care. The project includes help managed care organizations, health
plans, providers, and health systems improve enterprise-wide alignment and navigate a dynamic
healthcare ecosystem. Business Analysts are also responsible for translating the needs, business
cases, and approaches into actionable scope and requirements.

Roles and Responsibilities:

 Highly skilled in creating visions
 Engagement with business and operational stakeholders to elicit, document, and review
business needs and expectations from problem definition, and goals and objectives through
translation to detailed requirements, acceptance criteria.
 Highly skilled in creating high level business requirements, detailed requirements, and non-
functional requirements.
 Created use cases, user stories, and job aides
 Strong understanding of user acceptance criteria / test cases
 Structure approach, plan, and target deliverable to complete Current State Assessments of
business and operational functions as well as facilitating Future State (To-be) Assessments
of business and operational functions.
 Support range of delivery methodologies from Agile to Waterfall (client-driven)

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  Translate ideas or concepts into S.M.A.R.T. goals, scope statements, high level
requirements, detailed requirements, use cases, process models or other mechanisms to
accurately capture and convey business needs.
 Work with all project team members to ensure business needs and views are properly
represented throughout the lifecycle of the engagement.
 Facilitate meetings, as necessary, to review captured business needs and obtain cross-
functional approvals.
 Work with a subject matter expert to create current state/future state workflows.
 Works closely with stakeholder and clients.
Environment: MS SharePoint, MS Visio, MS Access, MS Excel, MS Word, MS PowerPoint, Notepad++,
OneNote,

Anthem HealthCare October 2018 to June 2022

Business Data / System Analyst

Project: Implementation of new market and adding new programs to an existing market.
Developing and gathering new requirements for accurate file submission to the health plan. Each
program code has different plan code that offers affordable health care plans.

Roles and Responsibilities:

 Worked on implementation of new markets with defining and managing the scope of new
systems requirement.
 Responsible for the development and maintaining EDI Data Mapping documents 277, 835,
837.
 Responsibilities include developing and documenting requirements, ensuring all compliance
standards are met, coordinating testing, evaluating and identifying possible application
system issues.
 Create, maintain, and organize backlog of features, epics, stories, and tasks in JIRA.
 Validated Inbound and outbound 837 transactions, including loading and correcting any
errors with the process of EDI outbound files.
 Execution of Weekly and Monthly reports and processes and the creation of ad-hoc reports.
 Validated and Created queries for the analysis of data relating to claims, members and
providers.
 Involved in Source Data Analysis, analysis and design mappings for data extraction.
 Responsible for maintaining HIPPA validation for 837 outbound files for various markets
(Washington DC, Washington State, Kentucky, Virginia Anthem, Virginia CCC+)
 Helped in the implementation process while tailoring test plans to client use cases and
configurations.
 Lead validation work sessions with the client.
 Demonstrated strong competency across the product suite and in providing best practice
configuration recommendations or adjustments.
 Have worked in coordination Data Integration, Standardization, and Configuration teams to
resolve issues with client products/results.
 Performed User Acceptance Testing for the ANSI X12 Version 5010 / EDI transactions (HIPAA)
for Claims Status and Eligibility (277, 837P, 837I, 837D, 835 remittances and NCPDP Claims).

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  Remediated errors received from state for different markets for claims with missing segment
elements.
 Performed Data mapping to validate and customize Claims daily load into FACETS for
processing the transactions.
 Conducted Requirements Clarification Sessions with concerned project members to clarify
requirements.
 Good interpersonal skills, committed, result oriented and hard working.
Environment: Facets, Jira, MS Sharepoint, MS Visio, SQL, Oracle, MS Access, MS Excel, MS Word, MS
Powerpoint, Notepad++, UltraEdit, DBeaver.

Cooks Children Health Plan March 2016 to September 2018

Sr. Business Analyst

Cooks Children Health Plan is a local, non-profit company that cares about local community. Health
plan provides health care for CHIP, STAR, and STAR Kids (Medicaid) members in the Tarrant service
area. The counties include Tarrant, Johnson, Denton, Parker, Hood, and Wise. The project involved
implementation of a web-based claims processing and management application to manage health
insurance claims electronically providing real-time patient insurance information including 278, 837
I, P and D.

Roles & Responsibilities:

 Prepared scope of the project and developed new business process along with process
mapping and user task analysis. I also evaluated documentation analysis and business
process analysis to identify the problem with existing system and find out new and advance
way to develop business process, which was able to make the process more accurate.
 Worked on Claim processing (online and batch adjudication), Case management, Customer
service, Member/subscriber administration, Provider network management and reporting.
 Worked on claims, Claim adjudication Membership, Eligibility.
 Worked with developing team to create advance claim submission process for Medicare and
Medicaid patients as well as EDI transaction such as: 837 (P, I, D), 835, and 276/277.
 Used Electronic Medical Record (EMR) to extract useful information regarding patients for
claim submission to the insurance company.
 Conducted JAD session with business side to identify and gathered high level requirements
and evaluated the priority level on the basis of meeting discussions and comments on
requirements.
 Developed a vision plan that defined the primary goals and objectives of the project.
Analyze user stories and segregated them into high level and low level.
 Utilized corporation developed Agile SDLC methodology used scrum work pro and Microsoft
office software to perform required job functions.
 Wrote various SQL queries to create, update, modify tables, create reports and retrieve
information from the database. Derive the required data by SQLs and export into Excel files
 Developed user guides, provides user training, and supports the user in development of
work processes.
 Supported UAT to evaluate the system performance and also developed system plan to
quality center, review design, view test cases.
 Generated reports for quality metrics using SQL Queries.

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  Provided weekly status updates to project stakeholders on the progress of project
development activities.
Environment: SQL Server, Windows XP, Clear Case, Clear Quest, UML, Java, MS Visio, MS Project, MS
Office (MS Word, MS Excel, MS PowerPoint), MS Access, XML.

BCBS Baton Rouge January 2014 to Feb 2016

Business Analyst

Responsibilities:
 Involved in updating and/or reworking previous documentation on their Membership
Enrollment System for Florida to get them in sync and up to date with their current new
system in place.
 Involved in System Integration, Compliance and User Acceptance Testing and Validation of
Medicaid claims processing and Electronic Data Interchange (EDI) translation in compliance
with the 5010A Health Insurance Portability and Accountability Act (HIPAA) transactions 837
I/P.
 Analyzed the gathered requirement and reviewed Business Requirement Document (BRD)
/Functional Specification Document (FSD)
 Reviewed and streamlined existing CRM processes, information, and data requirements to
ensure accurate adoption metrics reporting. Deactivated users to release licenses. Analyzed
if the system abides HIPAA regulations as portal displays member's private information.
Performed data analysis and ran various SQL queries to critically evaluated test results.
 Gained understanding of Medicaid policy and billing requirements and documented needed
changes to policies and billing manuals related to ICD10 through facilitation with internal
KMHP program areas.
 Creating artifacts such as URS, FRS, Traceability Matrix, project plan, BRD, test plans, and
test cases.
 Involved in Processing 837 Healthcare Claims (Institutional &Professional) in PORTAL.
 Documented business needs for ICD10 resulting from the HIPAA 5010 gap analysis.
 Used requirement elicitation techniques such as JAD Sessions and Document Analysis to
gather information regarding the application from the KMHP SME and EDS along with the
State of Florida people.
 Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction
syntax like ANSI X12, Implementation and Knowledge of HIPAA 5010 code sets, ICD 10
coding and HL7.
 Experienced with the HL7 data transactions.
 Performed activities to comply with annual HEDIS data collection and analysis, preparing
recommendations to increase rates as appropriate.
 Conducted meetings with the project managers to review the project plans.
 Recommend best practices for project plans to the project managers for their successful
implementation.
 Involved in testing Member, Provider, Claims Processing, Utilization Management,
Accumulators, Contracts and Benefits.
 Carried out UAT by developing test plans, test scenarios, test cases, and test data to be
used in testing based on business and user requirements, technical specifications of the
product.

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  Involved in bi-monthly Technical and Operational Issues (T&O) Conference Calls with AHCA,
EDS and various providers who worked with AHCA to answer and resolve issues pertaining to
a smooth transition from AHCA's previous fiscal agent ACS to EDS.
 Maintained open and clear communication with the team on change requests.
 Determined the requisite training for both internal staff and Medicaid provider groups and
assisted in the development of training materials.
 Maintained project documentation in a central repository and created a weekly report on the
updated project plans and maintained them.
Environment: Agile, Jira, MS Paint, MS Word, MS Excel, 3, MS PowerPoint, MS Visio, SharePoint, ETL,
RTM, Excel.

EDUCATION

Bachelors in Computer Science -2014, HITEC University Taxila, Pakistan

Master of Science - MS, Digital Forensic and cybersecurity, Risk policy and compliance-May
2026, University at Albany