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Nisha Thapaliya

@nishathapaliya

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Healthcare Business Analyst at Excellus BCBS, resolving EDI and FACETS data gaps across claims and enrollment.

United States

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What I'm looking for

I’m currently open to Healthcare Business Analyst, Business Systems Analyst, and Healthcare Systems Analyst opportunities.

At Excellus BCBS, I work on Claims and Enrollment enhancements in FACETS, identifying gaps between EDI transactions and system data. I analyze business rules and data mappings, and support system enhancements and UAT to help ensure accurate healthcare data flow.

At CarolinaEast Health System, I supported the transition from a legacy EHR to EPIC by documenting clinical workflows and integration requirements. Earlier, I worked on eligibility and benefits systems at Connecticut Department of Social Services and on FACETS claims and enrollment processes at Beacon Health Options.

Experience

Work history, roles, and key accomplishments

Current

Healthcare Business Analyst

Current

Excellus BCBS

Aug 2025 - Present (1 year 1 month)

Elicited and analyzed business requirements for claims and enrollment processing in FACETS, focusing on EDI integrations and data accuracy. Developed BRDs, FRDs, and managed Agile ceremonies while supporting system enhancements and UAT.

Facets X12 SQL Azure DevOps Jira Power BI SoapUI Balsamiq Microsoft Visio Agile Scrum UAT HIPAA XML REST APIs

Business Systems Analyst

CarolinaEast Health System

Aug 2023 - Jun 2025 (1 year 10 months)

Supported the transition from legacy EHR to EPIC, documenting workflows and integration requirements. Gathered requirements, performed gap analysis, and managed Agile deliverables while creating wireframes and dashboards.

Epic Electronic Health Records (EHR)HL7 FHIR SQL Power BI Azure DevOps Balsamiq Microsoft Visio UML Agile Scrum UAT REST APIs SoapUI XML JSON

Business Systems Analyst

Connecticut Department of Social Services

May 2021 - Jul 2023 (2 years 2 months)

Gathered and analyzed requirements for Medicaid, SNAP, TANF, and other state assistance programs. Authored BRDs, FRDs, and SRS documents, supported EDI transactions, and performed UAT and data analysis.

Medicaid Medicare SNAP TANF ACA X12 SQL Power BI Azure DevOps Microsoft Visio Lucidchart Agile Scrum UAT HIPAA XML MMIS

Business Analyst

Beacon Health Options

Apr 2020 - Mar 2021 (11 months)

Gathered requirements for Medicaid and behavioral health operations, focusing on FACETS claims and enrollment. Reviewed EDI 834 files, performed gap analysis, and supported UAT and integration testing.