PRADNYA RAMESH SIDANKAR

Role : Business Analyst/SME/ Team Manager

• Acted as liaison between US clients, onshore Resolution Manager, coders, and IT teams to gather and document requirements.
• Conducted gap analysis and requirement workshops for Risx-FACS (claims and coding platform).
• Authored User Stories, Acceptance Criteria, Wireframes and managed backlog in JIRA.
• Participated in Agile ceremonies: Sprint Planning, Daily Stand-ups, Reviews and Retrospectives.
• Collaborated with QA for test case design, functional testing, defect tracking, and UAT.
• Built Power BI dashboards and automated Excel reports, improving claim error tracking time by 30%.
• Delivered SOPs and training material, enabling smooth system adoption.

Role : Business Analyst/SME//Trainer

• Worked on CBI Software Enhancement Project (Waterfall) with responsibilities extending beyond coding to BA deliverables.
• Conducted requirement gathering and gap analysis with coders, auditors, and supervisors.
• Prepared BRD, FRD, Use Case Diagrams, and Activity Flows using MS Visio.
• Supported QA testing, defect triage, and UAT execution.
• Implemented real-time validation rules, audit automation, and coder performance dashboards, reducing denials by 25%.

Provided end-user training materials and process documentation for smooth adoption.

Role : Medical Coder/Auditor/ Claim analyst

• Performed end-to-end medical coding, auditing, and claim validation for US payer clients.
• Specialized in ICD-10, CPT, HCPCS coding with HIPAA compliance.
• Partnered with auditors and billing teams to resolve claim discrepancies and improve coding accuracy.
• Conducted root cause analysis on denials, recommending process changes to reduce rejections.
• Generated reports on coding volumes, audit outcomes, and denial trends for management review.
• Mentored junior coders, clarifying payer-specific rules and compliance standards.