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SHIVANI - HEALTHCARE BUSINESS ANALYST

[email protected]

Location: Raleigh, North Carolina, USA

Relocation: Yes

Visa: H4EAD

SRI SHIVANI Sr. Business Analyst Current Location: Raleigh, NC Visa status: H4EAD Mob# Phone# +571 751 1099 Email# [email protected] Professional Summary Experienced Business Analyst with 8+ years of experience in user interface analysis, requirements gathering, and model creation. Deep understanding of healthcare information systems, EMR models, and EDI transactions. Experienced in the EMR model for Health Care Information Systems and vast knowledge in defining and managing processes for Electronic Health Records. Experienced in almost all EDI transactions, such as (270/271 Benefit Inquiry- Eligibility, 276/277 Status Request- Payment Adviser, 278 Request for Review/Response, 834 enrolments, 835 Payment/Advice, 837 Claims integration, 837P. Apply functional and technical knowledge of SharePoint/Nintex capabilities to recommend solutions that streamline stakeholder business processes Skilled in managing claims processes, ensuring compliance with CMS regulations, and conducting risk analysis. Extensive experience in Gathering critical information from meetings and JAD sessions with various stakeholders, while producing useful summaries and meeting minutes. Experienced in managing claims management process, Knowledge of Medicaid and Medicare Services CMS, Health Assessment Systems, Hl7 Standards, Hl7 message, FHIR (HL7) and HIPAA. Knowledgeable in healthcare terminology, including medical codes (ICD-10, CPT), clinical workflows, and healthcare information systems. Has extensive experience in direct/database marketing, customer segmentation, reporting, regression analysis/modeling, big data, CRM, SAS/SQL coding and SAS/Macro coding. Strong understanding of Relational databases, Data Warehousing, ETL, fact and dimensional models, and Business Intelligence - Reporting with experience in the life sciences and healthcare domain. Experience with HEDIS and clinical data and possess knowledge of clinical quality assurance on NCQA compliance and guidelines in quality of patient care. Proficient in creating business requirement documents (BRD), functional requirements documents (FRD), s diagrams, Activity diagrams, Class diagrams, and Sequence diagrams. Experienced in analyzing complex healthcare data, including claims, patient, and clinical data. Experience with data analytics, data visualization, and reporting using SQL Queries, and MS Excel (Lookup, Macros, Pivot Tables, etc.) Business Analyst specializing in Electronic Data Capture (EDC) systems with a proven track record of optimizing data collection and management processes. Experience in Requirement Management, Change Control, & CRM systems along with extensive knowledge in Object Oriented Analysis, MS Office Suite, MS Project, MS Visio, & gathering user requirements & technical documentation. Experienced in Microsoft Business Intelligence technologies, including MS SQL Server Integration Services (SSIS), MS SQL Server Analysis Services (SSAS), and MS SQL Server Reporting Services (SSRS). Experienced in several AWS services and auto-scaling configurations. Experienced in performing Gap analysis by identifying existing technologies, and documenting the enhancements to meet the end-state requirements. Proficient in test data management, API, Web Services Testing, and documenting in Open API Specification (OAS 3.0) using Postman and documenting it using the Swagger tool along with automating test workflows. Proficient in the Software Development Life Cycle (SDLC), with a thorough understanding of various phases such as Requirements, Analysis/Design, Development, and Testing, Use cases. Experience in assisting testing teams with Test Plans, Test Cases, and Test Scenarios using Case Documents, conducting User Acceptance Testing (UAT), and managing defects using defect-tracking systems. Experienced in UML to create use case diagrams, sequence diagrams, and activity diagrams. Experience in writing change controls and documenting requirements in JIRA following the Agile process. TECHNICAL SKILLS Software Development Methodologies: Agile, Waterfall, Scrum, RUP, Kanban Management Tools: MS-Project, Confluence, Rational Requisite Pro, Rally, JIRA, Blue works Languages: SQL, HTML, XML, C, C++, R Version Control: GitHub RDBMS: SQL Server, Oracle, MySQL Modeling & Design Tools: MS Visio, UML, Visi Rule, Gliffy Other Tools: MS Word, Excel, Outlook, PowerPoint, SharePoint, HP ALM QC, Service First, Blue Works, Go CD, Postman PROFESSIONAL WORK Regions Hospital, MN Sr. Business Analyst 2022 May- Present Project: The Project deals with the development of an online health information exchange (HIE) and a secure web portal to enable authorized providers to have fast and easy access to patient s electronic health records. The web portal features EMR functions and Integrated Clinical Decision Support tools for better care management. It has also been involved in the Development of a healthcare cost Containment System and the implementation of an automated inter-operable web application that tracks patient medical history and healthcare plans via the Viewer application and electronic health records Including the Medicare Part D (pharmacy) and Medicaid features The Viewer/EHR system provided online access to mobile patient records and improved communication in public health. Responsibilities: Worked with the core team to design a business requirement collection approach based on the project scope and SDLC methodology. Designed and developed project document templates based on DLC methodology. Worked on defining and managing Electronic Health Records (EHR), Health Information Exchange (HIE), Health Exchange (HEX), Protected Healthcare Information (PHI), and Healthcare reform processes. Work as Business Analyst in Agile Team. requirements collection for the SharePoint portal development Act as a liaison between Health Authority and clinics participating in the EMR Adoption Program. Provide vendor-neutral advice and guidance for clinics relating to EMR software selection and acquisition, planning, implementation, optimization, and best practices. Business requirements and scope for SharePoint2010 to SharePoint 2019 and Office 365 implementation Coached through the transformation and provided the necessary and s, building knowledge and skills to facilitate the agile transformation. Migration of content from SharePoint 2010 to Office 365 and SharePoint 2016 both Manually and using Metalogix Development of the corporate deployment of SharePoint Portal with over 5000 active users Involved in Joint Application Development sessions with SMEs and development teams and documented functional business requirements as product backlogs using JIRA. Performed cost benefit analysis for supplier efficiency programs and other supply chain projects that may affect Supply Chain KPIs. Developed and maintained data standardization documentation, including annotated CRFs (Case Report Forms), define.xml files, SDTM (Study Data Tabulation Model) datasets, and ADaM (Analysis Data Model) datasets. Used different ad-hoc analyses, the Reports assisted in defining strategy for each customer category and Informatics was used for the ETL process and Business Objects. Provide end user support and training, troubleshooting SharePoint portal related issues Involved in the development, requirements elicitation, documentation (use cases), design, and implementation of electronic health record systems. Spearheaded the assessment, implementation, and customization of EDC systems, ensuring alignment with business needs and regulatory requirements. Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system. Utilized SQL joins to combine data from multiple tables or datasets, ensuring the necessary relationships are established to retrieve the required information accurately. Develop implementation guidelines and principles for practice-based clinical applications, including various practice management and EMR systems. Coordinated the integration of clinical applications and electronic health record (EHR) systems to the HIE. Development of custom Microsoft InfoPath based web forms applications backed by SharePoint workflow processes Analysed business and user needs, through research and fact-finding combined with a basic understanding of applicable business processes, systems, and industry requirements. Used and assisted in Test Director, PL/SQL for testing the application. Interviewed distributed IT services across the different departments to gather requirements and capabilities of the existing services. Performed AS-IS and TO-BE analysis for EDIFECS Standards - HIPAA 5010 Database Setup for new version releases. Provided training and support to end-users, ensuring smooth adoption of EDC systems and adherence to standard operating procedures (SOPs). Used knowledge of the Health Care Information Systems EMR model to develop the proposed workflow in MS Visio. Assisted in the ETL Informatica Mappings for importing data from ODS into subsequent data marts. Facilitate conference calls and JAD sessions with developers and business SMEs to incorporate designed changes in the system, utilizing workflow diagrams, UML diagrams, processed models, activity diagrams, and use cases. Act as a liaison between the Health Authority and clinics participating in the EMR Adoption Program, providing vendor-neutral advice and guidance for clinics relating to EMR software selection and acquisition, planning, implementation, optimization, and best practices. Conducted quality checks on SDTM datasets, performed data mappings, and resolved discrepancies to align with CDISC standards. Contribute to the definition and management of processes for the Electronic Health Record (EHR), Health Information Exchange (HIE), Health Exchange (HEX), Protected Healthcare Information (PHI), and Healthcare Reform. Complete gap analysis on the "as-is" and "to-be" states, which may require tight collaboration with the data analytics team and other teams situated in various regions of the country. Ensure HIPAA Compliance Auditing is maintained throughout the project. Used knowledge of the Health Care Information Systems EMR model to develop the proposed workflow in MS Visio. Created workflow diagrams, UML diagrams, process models, activity diagrams, and use cases, for incorporating design changes in the system. Scheduled conferences, and facilitated JAD sessions with business SMEs and developers. Conducted gap analysis on the "as-is" and "to-be" states which required working very closely with the data analytics team and other teams which were located in other locations across the nation Tested the centralized availability of patient electronic health record data at the front and back end. Client: Medical Mutual, Cleveland, OH Role: Business Analyst/ Scrum Master Aug 2019- Apr 2022 Project Summary: - In this project, I led a comprehensive analysis of stakeholder business priorities and effectively identified and documented business problems and solutions according to corporate standards. Using Agile methodology, I facilitated Joint Application Development sessions and conducted stakeholder interviews, ensuring seamless communication between technical and business teams. Responsibilities: Gathered requirements and developed Process Model towards understanding the stakeholder business priorities to effectively identify business problems, assess proposed solutions, and represent the needs of stakeholders. Requirements analysis and document them according to corporate standards and procedures and prioritize them for assigned areas. Facilitated Joint Application Development (JAD) sessions, as well as conducted interviews with appropriate business/technical stakeholders. Managed the transformation of clinical trial data into SDTM format, ensuring data quality, consistency, and compliance with CDISC standards. Collaborated with cross-functional teams to gather and analyze requirements for clinical trials, ensuring alignment with project objectives and regulatory standards. Worked with development/technical team members to ensure that the defined business requirements are met. Worked in Agile methodology of system development. Identified and conducted stakeholder analysis to gather Business Requirements, interact with stakeholders, gather requirements and assign priorities to each of them. Work in SharePoint Designer to develop Workflow, create External Content Researched REST API data through Postman, Swagger and in bulk through bash scripts. Involved in Claims Processing, Enrollment (834), Group and Individual Member billings Conducted UAT (User Acceptance Testing) with End Users for final Sign-off on the project. Involved in testing Claims payment and implementation, HIPPA compliance ANSI X12-837 EDI Transaction Code 837-claims encounter, 834- Benefit Enrollment, 835 - Claim Payment. Collaborated with cross-functional teams to assess data needs, translate requirements into CDISC standards, and oversee end-to-end data standardization processes. Coordinated activities and evaluated performance of project team and reports performance. Conducted meetings to allow different stakeholders to communicate their perspectives with each other. Prepared Business Requirement Specification Document (BRD) and converted into Functional requirement specifications document (FRD). Worked on Change Management and change control on a pharmaceutical regulatory tracking system for change submissions Conducted gap analysis between existing data structures and CDISC standards, proposing and implementing solutions to bridge the gaps and improve data quality. Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims. Use Metalogix SharePoint tools for content migration and SharePoint portal governance Supported and tested API integration with SailPoint IdentityIQ provisioning. Created Confluence-based API documentation. Monitored ETL pipeline performance, identified bottlenecks, and implemented enhancements to ensure scalability and reliability. Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment. Automated processes by using SAS Macros, SAS SQL and other modules to enhance effectiveness and efficiency of SAS and SQL coding and analytics deliveries Provided training and guidance to internal teams on CDISC standards and their implementation, ensuring understanding and adherence across departments. Analyze supply chain performance in conjunction with customers' system/ needs to improve the supply chain process. Track vendor performance and take necessary action for improvement. Responsible for Bug free delivery of Sales and Service Oriented applications. Supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature. Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module. Develop the detailed business requirements based on the High-Level requirements and information gathered from multiple business partners. Conducted and participated in walkthroughs of requirements and Use cases with business and IT team members. Designed Use case Diagrams, Workflow diagrams, Activity diagrams for most of Use Cases identified using UML/Visio. Prepare for migration and recreation of workflows in SharePoint 2010 and Office 365 Performed weekly, monthly and quarterly production and sales reports using SAS and Excel, enabling owner to understand business performance and make marketing strategies accordingly Highly involved in Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system. Played major role to create the Business Requirement Documentation (BRDs), using MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype and overall system. Reviewed test cases and test plan for UAT testing. Client: Metro mile, SFO, CA Role: Systems Analyst/Business Analyst Sep 2018 Aug 2019 Project Summary: - In this project, I spearheaded a comprehensive approach to requirements management and documentation, employing Waterfall methodology to meticulously create Business Requirements and System Requirements Specification Documents. Utilizing tools like HP Quality Center and Azure DevOps, I effectively converted business needs into functional specifications, ensuring seamless communication with stakeholders through Joint Application Development sessions and Stakeholder Management. Responsibilities: Worked on Waterfall methodology and created a Business Requirements Document and System Requirements Specification Document. Prepared BRD, FRD, and used HP Quality Center to manage, analyze, and convert business requirements into functional specifications. Conducted Joint Application Development (JAD) sessions with IT groups and identified the Key Changes and participated in Stakeholder Management to communicate effectively with them. Maintained and kept track of stakeholder's requests for enhancements and changes using Azure DevOps. Converted Business specifications into Business and Functional Specifications. Designed SAS queries to access multiple databases and extract geo-demographic data from customer, transaction, customer value segment, product, customer campaign history tables Lead system requirements definition, design, testing, training and implementation support. Worked as a UAT Testing Lead and coordinated with SMEs in defining, designing, conducting and evaluating results. Wrote complex SQL queries to extract and validate the data from the Facets database. Worked with key business stakeholders to understand the Tableau Report requirements and then create Visual Design of the Reports as well as conducted detailed multiple stakeholder walkthroughs on each Tableau report developed. Managed clinical trial data collection, cleaning, and validation activities, ensuring adherence to CDISC standards and regulatory requirements. Created Tableau reports for healthcare modules such as Enrolment, Claims, Operation and Finance in Tableau Desktop that was published to the internal team for review and further data analysis and customization using filters and actions. Conducted in-depth design and development session with developers and testers to explain the requirements and clarify functional questions regarding system development and testing, including supporting an offshore team involved with development activities. Worked as Tableau production support and made sure the Tableau dashboards are up and running. Assisted the Project Manager with project administrative tasks, such as work plan administration, time tracking, and project schedule maintenance. Various versions of the documents generated during the project were maintained and managed using Jama and performed defect tracking using Jama. Used MS Office extensively (Word, Excel, PowerPoint) for analysis, presentation, and documentation throughout the project. Prepared monthly Status Reports for Enhancement Requests to the project team that was used inefficient tracking and monitoring of open issues of the project. Designed and developed Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams using Lucid Charts. Client: Capgemini Pvt. Ltd, Hyd, India Role: Business Analyst June 2015 - Oct 2017 Project: The project involved developing various life and home insurance products, including life insurance requirements, calculators, and policyholder benefits. I worked on a project to develop an online insurance application that replaced the old existing application for individuals, families, homes, and automobiles. Additionally, I worked on integrating the application with a claim processing system to inspect and verify claims. Responsibilities: Created and updated documentation outlining operating guidelines and client specifications. Adhered to the Scrum framework in the Agile approach to ensure project goals were accomplished quickly and effectively. Analyzing existing business processes and workflows related to insurance applications to identify areas for improvement and streamline the application development process. Collaborating with stakeholders to gather and analyze requirements for the development of the online insurance application, including life insurance products, calculators, and policyholder benefits. Participated in implementation sessions with customers and partners who wanted to work with Guardian Life Insurance. Creation of new JIRA Projects and setting up the projects based on user requirements. Conducted JAD sessions with business and technical teams. Facilitating communication and collaboration between business stakeholders, development teams, and other relevant parties to ensure alignment and timely delivery of the application. Assisting in the development of user training materials and providing support to end-users during the implementation and adoption of the online insurance application. Used SQL queries for data analysis and source-target mapping specifications. Documenting the integration processes, including interface specifications, data mappings, and error handling procedures, to ensure clarity and facilitate future reference and maintenance. Configured FTP definitions in the file handler to accept and deliver EDI files in a pull-and-push fashion from and to clients. Elicited, and wrote functional requirements (FRD) for four main features within the retail reporting application. Coordinated meetings with users and stakeholders to gather Requirements. Used MS Word and Visio to document the data flow of the AS-IS process and TO-BE process. Used UML to create use case diagrams, sequence diagrams, and activity diagrams. Prepared Use Case Documents, assisted testing teams with Test Plans, Test Cases, and Test Scenarios, conducted User Acceptance Testing (UAT), and managed defects using defect-tracking systems. Created project templates based on the SDLC methodology. Independently handled daily, weekly, and monthly customer monitoring and update requirements. CERTIFICATIONS Certified Scrum Master by Scrum Alliance [Certificate ID: 00152918] EDUCATION Jawaharlal Nehru Technological University - Hyderabad, India Bachelor of Technology in Computer Science & Engineering - May 2014 Keywords: cprogramm cplusplus continuous deployment active directory rlang information technology golang hewlett packard microsoft procedural language California Idaho Minnesota North Carolina Ohio