Dr. POONAM UPADHYAY

CANADA PR HOLDER

ac8mcx@r.postjobfree.com +614******** www.linkedin.com/in/dr-poonam-upadhyay/

Visa Status: Canada PR USA (Business Visa / B1) Australia (Subclass 457)

PROFILE

Highly-skilled and versatile Business Analyst with more than 7 years of rich background in Product Design and Consulting, Solution Feasibility Analysis, and Business Case Development in Healthcare Provider and Payer Industry across USA, Australia and India

Proven ability in understanding the business requirements of customers, providing effective solutions, resolving issues and executing the necessary changes to facilitate organizational development

Demonstrated history in Salesforce CRM, Case Management System (IDD and BH Services), RCM and Long term care/Home care application design and development

Technically proficient and experienced in working with JIRA, Confluence, draw.io, TFS, MS Visual Studio, MS Visio, MS Excel, MS Project Balsamiq prototyping solution, Infosys REAP Framework(Requirement Management Tool), Infosys RAPID prototyping Solution, Infosys Influx(Business Process Management tool)

AREAS OF EXPERTISE

~ Proposal Writing ~ Due Diligence ~ Requirement Gathering & Analysis ~ Product Design ~ Process Mapping ~ Business Case Development ~ CRM ~ Intellectual & Developmental Disability Services ~ Behavioral Health Services ~ Hospital Billing & Reimbursements, HMIS, RCM, EDI Transactions, AR Management and Hospital Financial Reporting ~ HC Reform ~ PPACA ~ HIPPA ~ Claims Management ~ Member & Benefits Setup ~ Enrollment

WORK HISTORY

INFOSYS LIMITED, Pune, India Mar 2011 - Ongoing

Senior Consultant

Since Jan 2018

Consultant

Jan 2016 - Dec 2017

Senior Associate Consultant

Jan 2013 - Dec 2015

Associate Consultant

Mar 2011 - Dec 2012

#Title 1: System Transformation Project – CRM on Salesforce Platform based on Agile Scrum Methodology

Working in the capacity of Senior Business Analyst and Process specialist, replacing the legacy system OSCAR based on Agile Methodology in various sprints and releases

Creating Business process maps including As-Is and propose To-Be, requirements documentation and business rules based on PHI reform and Australian healthcare regulations.

Working with the cross-functional teams to understand requirements, build a solution consistent and efficient

Conducting business and vendor discussions, Co-ordinate and manage the expectations and relationships with all the internal and external stakeholders of the project

#Title 2: Intellectual and Development Disability Case Management Application Development

Spearheaded a team of business analyst for requirement gathering, detailed functional specification and the developed various modules of IDD Case Management Application

Managed scope estimation and efforts of each iteration, client discussion, bridged the gap between the client and internal technical team

Detailed Business process mappings, Use case diagrams, Use cases, and End to end workflows

Efficiently conducted reviews of functional specifications, walkthroughs, and provided support during the development and testing phases

#Title 3: Due Diligence of Intellectual and Developmental Disability Case Management Application Development

Conducted due diligence of requirements in Atlanta to develop IDD case management application

Interacted with various stakeholders involved in IDD case management to develop questionnaire, finalize requirement traceability matrix, high level business process maps, and Use case complexity analysis

Presented due diligence report with the revised estimates based on signed off requirements

#Title 4: Fix EDI Project

Worked as a Consultant for member enrollment 834 EDI module

Enhanced member enrollment via different applications within BSC systems like EDIFECS, FACETS and MEET

#Title 5: Home health/Long term Care Continulink Application, Development Project based on Agile Methodology

Prepared product design specifications and created working prototype as per the requirements

Achieved product design within the budget and time

Implemented UAT along with the product owners based on the agreed user acceptance criteria

Performed sprint demonstration, conducted retrospective reviews with the client and incorporated client feedback

#Title 6: Digital transformation – UI/UX revamp for HMIS solution

Leveraged expertise on UI/UX; resulted in revamping their existing application portfolio based on Design thinking heuristic principles

Studied as-Is Patient Journeys; analyzed Gaps and provided to be State recommendations

#Title 7: Hospital Revenue Cycle Management Application Development Project based on Agile Scrum methodology

Developed conceptual design, UI mockups and functional specification documents

Collaborated with the development and quality team to support the deployment

As a SME, implemented Billing, Claims, Reporting and Auditing requirements in SFM

Created knowledge management artifacts and attended knowledge management sessions

#Title 8: ICD 10 Impact Assessment Project

Identified and reviewed the Business Process impacts due to migration from ICD-9 to ICD-10

Efficiently analyzed various artifacts including medical policy, benefits, and claims to identify ICD codes usage at HTH for code mapping

Analyzed claims data with Infosys Proprietary tool utilizing the ICD-9 to ICD-10 forwards custom maps

Successfully developed a financial neutrality impact assessment report

#Title 9: ICD-10 impact avoidance Project

Developed requirement gathering questionnaire, conducted as-IS process analysis, and key metrics identifications and analysis

Analyzed client's existing system to identify the key metrics and functions impacted across the different payer's processes like Member Benefits, Provider Contract, Claims, Operations, Disease Management, and Utilization Management

Conducted DRG shift analysis, assess impact on financial and clinical neutrality

Prepared ICD-10 impact avoidance report

#Title 10: Health Insurance Exchange Project

Health Insurance Exchange Project Development: Conducted requirement gathering, requirement analysis, Use case building, functional prototype building, functional testing and gap analysis of the solution

Pre-sales support for Health Insurance Exchange: Coordinated with the presales team in proposal writing and implemented RFPs by showcasing the functionalities of the developed solution

ACADEMICS

Post Graduate Diploma in Hospital Management, Administrative Staff College of India, Hyderabad - 2011

Bachelor of Homeopathic Medicine and Surgery, ACH Medical College and Hospital, Bhubaneswar – 2008

CERTIFICATIONS

Certified as Fellow, Academy of Healthcare Management (FAHM) by The Academy of Healthcare Management and America's Health Insurance Plans

Infosys Certified in Healthcare Claims Processing (HI301)

BA 201 Certified for Business Analysis- Infosys Certification

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