Sumaita Ahmed

I'm currently supporting AmeriHealth Caritas Government Programs on Medicaid managed care, Medicare Advantage D-SNP, and Marketplace workstreams spanning claims modernization, prior authorization, HEDIS governance, and member experience.

I translate operational needs into BRDs, FRDs, user stories, process maps, data mappings, EDI companion guides, and UAT plans. My work includes CMS-0057-F Prior Authorization API readiness, FHIR R4 requirements, Medicaid claims enhancements, provider data management, and member portal capabilities.

Previously at CHRISTUS Health, I supported Revenue Cycle and Provider Operations teams with claims, enrollment, provider data, Epic Resolute Professional Billing, EDI, SQL validation, and quarterly release testing.

I began building enterprise business analysis foundations at GameStop, where I worked on e-commerce, PowerUp Rewards, omnichannel fulfillment, POS modernization, and supply chain analytics. I bring hands-on experience connecting operations, data, and technology across Agile delivery teams.