Prachi Agrawal acwehc@r.postjobfree.com

**** **** *** * ***** Pete, FL 33704 916-***-****

Summary of Qualifications

Dynamic and highly motivated professional with 10+ years of experience working as a Data Analyst, Business Analyst with proficiency in Functional and Technical aspects of Oracle EBS R12/11i covering Healthcare, Banking, Financial and Supply Chain Business verticals.

Deep understanding of enterprise data warehouses (EDW).

Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.

Very strong in Quote to Cash, procure to Pay and Record to Report business processes. Possess strong business process modeling skills.

Expert in evaluating data models to design Tableau solutions and fine tuning dashboards and worksheets in large BI using tableau.

Knowledge in the Informatica/ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).

Specific experience in Medical Management system implementation for Utilization Management, Case Management, Disease Management, Medicare, Medicaid, Duals systems and related programs

Extensive working knowledge with clinical systems, including Clinical Optimization, Observational Medical Outcomes Partnership (OMOP) Common Data Model, Comparative Effectiveness Research (CER), Extract, Transform and Load (ETL) data, and harmonization of clinical study databases.

Extensive experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis and Impact Analysis, SWOT analysis, Cost Benefit Analysis, Risk Analysis.

Experienced in creating Data Flow Diagrams, Use Cases, Use Case Diagrams, Activity diagrams, Entity Relationship Diagrams.

Excellent working knowledge of TFS (Team Foundation Server) and CRM.

Designed data model, analyzed data for online transactional processing (OLTP) and Online Analytical Processing (OLAP) systems.

Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.

In-depth knowledge of Rational Unified Process (RUP); risk engineering; design using UML, Rational Rose, and Visio, Process workflows.

Experience with relational databases and writing SQL queries.

Experience in HIPAA 4010 and 5010 EDI healthcare transactions like 837, 835, 834, 820, 270, 271, 276, 277, and 278.

Worked with different Business Areas like Claims and Enrollment to document proposed ICD 9 – 10 Code changes.

Results-oriented Joint Application Development (JAD) Facilitator and meetings coordinator with excellent interpersonal skills.

Skilled in scope planning, schedule development, budgeting, and cost control – leading in both technical and operational planning as well as strategy development.

Strong experience with different project methodologies including Agile-Scrum Methodology, Waterfall, Modified-Waterfall, Iterative, Incremental and RUP.

Certification

HL7 2.7 certification.

Technical Skills

SDLCs

Waterfall, Scrum Agile

Soft Skills

Client facing (all levels), oral / written communications, presentations, demos

Methodologies

Requirements elicitation, and validation, JAD, Business Process Reengineering (BPR), Object-Oriented Analysis & Design (OOA&D), Enterprise Application Integration (EAI), Enterprise Data Warehouse (EDW), Service Oriented Architecture (SOA), Legacy system decomposition.

Language/Schemas

Solid knowledge of .NET and JAVA, SQL, HTML, XML, CSS, EMV.

Artifacts

Project Vision, Project Scope, Business Requirement (BRD), Business Solution (BSD), High-Level Design (HLD), Use-Case, User Story, User Story Backlog, TFS, Test Plan/Test Case, UAT Plan, UAT Script, Implementation Plan, RFP.

Web Prototyping

Axure (Dynamic), Visio (Static), Wireframes.

Diagrams

Workflow, Process Flow, As-is / To-Be, Data Flow, UML (Use-Case, Class, Activity) .

Databases

Oracle, SQL Server, DB2, Access.

Tools

Team Foundation Server (TFS), JIRA, SQL, MS Office, Visio, CRM, Enterprise Service Bus (ESB), HP Quality Center, Mainframe utilities.

Education

SSIT, Visveswaraiah Technological University Karnataka India

Bachelor of Engineering (Information Technology) May 2004

Professional Experience

JSA Healthcare (DaVita) Fort Lauderdale, FL

Sr. Business Analyst/lead/Data Analyst January 2015 – Present

Domain- Healthcare

Description: JSA Health care is a next generation system for coding quality improvement, assisting clients with revenue cycle and denial management for all insurance payors. Working as a Lead Business Analyst requires working with client, stakeholder, involve in requirement gathering, authoring requirement and design specifications, involvement in the system testing and UAT testing.

A Lead BA Consultant with experience in the full project lifecycle and ability to effectively apply a broad set of business analysis tools and techniques.

Facilitated (JAD) Joint Application Development sessions in order to identify business rules and requirements and then documented them in a format that can be reviewed and understood by both business people and technical people.

Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analysing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.

Managed and tracked change control process of requirements and design changes using Rational Requisite Pro. Documented the changes, issues and their impact on the system design and delivery

Addressed specific knowledge of claims, enrolment, and premium business processes in a commercial, Medicare, or Medicaid health plan/TPA organization.

Processed HIPAA/EDI X12 v5010 healthcare-related file formats including 820, 834, 835, 837, 270, 271, 276, 277, 999, TA1 and 824 transactions.

Working on the activity diagrams, File Transfer Specification (FTS), Required Repository Template (RRT) in Coordination of Benefits, Benefits translations, Utilization Management, Referrals.

Implemented a large national ICD-10 hospital and insurance billing revenue & coding project, medical CPT, ICD-10-CM, and ICD-10-PCS coding experienced for hospitals and clinics.

Configured Medicaid Benefits and contracts within the QNXT claim processing system, used claims test pro and ICD 9 to ICD 10 conversion tool to mock up data.

Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.

Used Team foundation server (TFS) source control to deploy application.

Extensively interacted with both user group and development team and coming up with structured charts, Class and sequence diagrams

Involved in testing Medicare management applications and Managed care organizations HMO, PPO etc.

Involved in testing Medicaid management information system(MMIS) applications

Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence

Diagrams, State Diagrams, Activity Diagrams and business process and workflows.

Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA. Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.

Generated Excel spreadsheets to document the claim processing errors for review and the processing of corrections.

Prepared 5010 GAP documents involved with 837 and 835 transactions in collaboration with other team members.

Involved in designing & determined 3-tier architecture for the claim processing system.

Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases.

Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.

Prepared and executed different Test Cases and Test Scripts.

Defined Functional Test Cases, documented, Executed test script in Facets system.

Responsible for integrating with Facets, designing test scripts for testing of Claims in

Development, Integration and production environment.

Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.

Accepted inbound transactions from multiple sources using FACETS. Exposure to HIPAA Compliance requirements and HL 7 standards

Captured all HIPAA-related EDI data in the repository using FACETS. Supported integrated EDI batch processing and real-time EDI using FACETS.

Environment: ALM, SQL, MS-Office Suite, Facets, HL7, BRD, EDI, HIPAA, Test Cases, SQL, SSIS, ETL

Deloitte Consulting Melville NY

Sr. Business analyst/QA Analyst Sep 2010 – Sep 2014

Client – Taylor Made Adidas Golf, Carlsbad, CA Oct 2012 – Sep 2014

Domain-Supply chain

Provided Application Support for custom Order Management and Supply Chain system, Oracle Financials, and Application Servers.

Responsible for ASCP, Order to Cash, procure to Pay and Asset Management enhancements. Involved in redefining aging buckets, dunning procedure.

Followed Agile and Scrum methodologies to plan, manage and track project teams

Conducted scrums, Sprint planning, backlog grooming sessions and retrospective

Prioritizes and sequences the Backlog according to business value and/or product goals

Configured, ensured data integration. Conducted functional unit testing and assisted user approval testing (UAT).

Utilized Team Foundation Server (TFS) to house requirements, product artifacts, and test scripts.

Worked on enhanced supply, demand planning for Depot Repair, Repair Orders parts procurement, Risk Analysis.

Helped guide the project’s transition into the Scrum framework.

Coordinated with Oracle support team in applying patches, testing and release planning.

Demonstrated the ability to quickly learn new technologies, successfully contribute solutions, and apply the technologies.

Developed Use Cases for the regulatory reporting tool. Verified that the use Cases matched the application's every single requirement.

Environment: Oracle 11i (AR, AP, GL, and iExpense), Scrum, Oracle 9i, SQL Developer, UNIX, BOM, WMS, SQL Server, MS Office.

Client – Sutter Health, California and Bangalore Aug 2011 – Sep 2012

Domain- Healthcare

Prepared Business Requirement Document for the Tool required to maintain Pharmaceutical inventory.

Involve in an in-depth Gap analysis, generate reports and maintain documentation of the gaps captured during the brainstorming Sessions.

Designed, analyzed and performed integration and wrote system requirements on different leading healthcare software’s such as FACETS.

Validated EDI Claim Process according to HIPAA compliance.

Gather business requirements for Center for Drug Evaluation and Research (CDER) compliance related projects on drugs and administration.

Create wireframes screens in every module to ease development and testing teams more feasible to understand the functionality.

Direct and manage the change control to ensure the incoming issues are new requirements or the bugs which need to be fixed.

Performed Analysis on NextGens EMR/EHR application.

Gather and document the impact assessment on the project, change request, request from work stream owners and adhoc requests from project management teams.

Present the process of the ongoing project in a form of Dashboard to the senior management.

Prepare impact analysis report document based on the version changes in the ICD 10 version releases.

Used the Agile methodology; as the Scrum Master, oversaw and implemented the Agile approach. Worked with a product owner and six developers. Ran the daily Scrum meetings and performed backlog grooming.

To provide assurance that the EHRs meet basic quality, safety, and efficiency standards

Worked with Product Owners to identify and create product features and user stories in the Product Backlog within Team Foundation Server (TFS) for multiple projects.

Perform Data Analysis on the historical data using SQL Server 2008, which will be useful for the pilot run of the ICD 9- ICD 10 conversion.

Review the functional test cases and coordinate the UAT for the sign off from the customer end.

Conduct project related presentations and provide reports to the higher management and executives.

Environment: .NET, MS-SQL Server, MS SharePoint, MS Office, iRise, ICD-9, ICD-10, HP Quality Center, IBM Rational tools and Windows XP /2003.

Client – First American Title Insurance, Santa Ana, CA and Bangalore. Sep 2010 – Aug 2011

Domain-Insurance

Project Description: Migration from legacy CRM to Pega based CRM.

Responsibilities:

Worked on defining AS- IS business processes of the Marketing, Sales and Service systems for migration from legacy CRM tool to Pega based CRM.

Created Data dictionary of the existing reporting and analytics data for sales, service and marketing reporting needs.

Conducted JAD session with key business stakeholders for requirement elicitation

Created User Stories, acceptance criteria and workflow for various CRM modules like campaign management, customer 360 views.

Created functional decomposition diagram for the future state requirements

Prepare artifacts (Documentation: Functional Specification, Use Cases, Test Cases; Diagrams: Data Flow, Activity, Sequence, and Use Case) to help Developers and Project Team better understand processes.

Provide gap analysis between systems being sunset and the new to-be system.

Create process models, specifications, use cases, diagrams, and charts to provide direction to IT and project team.

Coordination with offshore team on resolving questions of the technical team and follow up on project plans / deadlines.

Perform regression testing/validation through the functional user interface using Quality Center (Mercury) suite.

Environment: Oracle 10g, HP Quality Center, Product Service Portal, Pega CRM, MS Office, UML, Java, Oracle 10g/11g

Wipro Infotech Bangalore, India

Sr. Business Systems Analyst Apr 2010 – Sep 2010

Client: EMC (BKS, INC) Duluth, Georgia

Domain- Healthcare

Assisted with Oracle implementation, provide technical/functional support for the Oracle 11i modules and integrated various third party applications in a Multi-Organization and Multi-Currency setup.

Worked with key members of cross-functional departments (HR, Sales, Project Management Office, and Finance) and the development teams to design and implement new business processes, and to identify and resolve Oracle E-Business Suite (EBS) application issues.

Used SQL Editor to write SQL statements for querying data for analysis and testing.

Facilitated User Acceptance Testing (UAT) for the application as a Business User, created test cases for manual testing and utilized Load Runner for performance testing as well as mass updates to the system.

Tested critical bug fixes and coordinated with developers in release of bug fixes meeting tight timelines.

Provided internal customers with relevant information to effectively manage the business and recommended process changes in areas where there was opportunity for improvement.

Developed complex ad-hoc SQL scripts to analyze data, locate data infractions, create reports for tracking financial trends for Senior Management.

Environment: Oracle 11i (OM, HR, OTL, AR, AP, INV, BOM, PA, Quote, CRM, Self-Service), Oracle 10g/9i, TOAD, SQL Navigator, Brio, LoadRunner.

Tata Consultancy Services, India

Business analyst/QA analyst May 2005 – Feb 2010

Client – Deutsche Bank, Location: Bangalore

Domain- Banking

Business Analyst with focus on Enterprise Datacenter migration. Deutsche Bank developed a centralized Enterprise Data Warehouse (EDW), Data Governance group, which accommodates business analytics and reporting requirements.

Create business process descriptions, use cases, scenarios, source to target mappings, and workflow analysis.

Ensure proper identification and management of project risks and their report to the respective governance body.

Write Business Requirement (BRD), Functional Requirement (FRD), Use Case Documents.

Perform GAP Analysis and outline current and future state in Visio diagram.

Requirement gathering from BU’s as well as support QA, UAT, and post-production roll out.

Establish and maintain a project plan, regional site requirements, preparation, goals and procedures.

Schedule project team meetings and develop meeting agendas.

Support the program lead in defining strategy, stakeholder management, and overall program leadership topics.

Provide detailed weekly executive updates.

Environment: MS Office, MS Visio, C#, ORACLE, SQL, TOAD, Silverlight, WPF, WCF, Service oriented Architecture.

Client – Lehman Brothers, Location: New Jersey, NJ

Domain- Financial

Data Analyst/Data warehousing

Played key role in System Development Life Cycle Process consisting of: Design and Gap Analysis, Business Requirements, Systems Requirements, Test Criteria, and Implementation to have the outputs of project dealt with the automation of correspondence directed to Insurance policy owners.

Validate data field mapping between legacy and OBIEE platform, andconduct user acceptance testing.

Designed and implemented basic SQL queries for testing and report/data validation.

Involved in developing and analyzing the Data in the Teradata Data warehouse and mapping to the Business attribute requirement to create functional and technical documents.

Analyze and determine the data quality for the source system and target systems.

Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.

Extensively involved in data modeling.

Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for incorporation in a phased, iterative manner.

Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database

Gathered requirements and modeled the data warehouse and the underlying transactional database

Perform Gap Analysis of the processes to identify and validate requirements.

Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.

Extensively used calculations, variables and sorted inputs, drill down, slice and dice, alerts for creating business object reports.

Generated complex reports using business object XI and web intelligence

Closely worked with the data architect and ETL team to bring in additional attributes to support the data requirements and in creating pop specs to source them into the data hub.

Closely worked with the service developers while implementation of the tech specs, providing solutions to data related concerns.

Generated test data for Business Users and testing teams in Access.

Created SQL Reports and queries for statistics for the business users to validate the data.

Was a Data Steward managing and governing the DB.

Use Cases and other Process Flow Models were designed using Visio and Rational Rose.

Environment: RUP, UAT, OBiee, Microsoft Office 2003 Professional (Outlook, Word, Excel, Visio, Access), Microsoft SharePoint 2003.

Client – American Express, Location: Bangalore

Domain- Financial

QA Consultant

Managed the Test Script Development, Test Execution, QA Process/Procedure and Test Automation teams.

As the primary contact from QA for each Business Vertical, reviewed submitted projects per release, generated high-level estimates plus projected timeline of all QA tasks.

The current manual test scripts were separated out by main business functionality. Prioritization was used to identify the quickest impact to locate defects in the parts of the application that were used the most or were error prone. This work was done using Visual Studio.

These tests were run daily in the production environment to make sure all interface connectivity was working correctly. These tests were also run after System Test received a new build.

Generated daily metrics published to upper management.

As QA consultant created and tracked the project plan for the QA phase of multiple enhancement projects. Tracked each task, met the project and release timeline.

Reviewed all the QA artifacts with the business and development teams and validated requirements traceability to the test plan and test suite.

Environment: SERVE web and mobile applications, client/server, Oracle, Quality Center, Visual Studio, Jira, Toad, XML

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