Niharika Gupta

Sr. Business Analyst/Scrum Analyst mailto:ad0aay@r.postjobfree.com ad0aay@r.postjobfree.com Cranston, RI

LinkedIn: https://www.linkedin.com/in/niharika-gupta-97287125a/

Education: Bachelor of Commerce from Calcutta University, Kolkata, India, 2007

PROFESSIONAL SUMMARY

•Over 8+ years of Experience as a Business Analyst / Scrum Master in Healthcare with good experience in capturing, analyzing, and documenting complex business requirements and expertise in the Software Development Life Cycle (SDLC).

•Knowledge and Experience on Membership, Billing, Claims Payment Processing about HIPAA, EDI 4010, 5010 X12, ICD-9 ICD-10, codes 834, 837,835, and 270, 271.

•Exceptional knowledge on Medicaid, Medicare, MMIS, HIPAA EDI transactions 278, 820, 834, 835, 837, ICD-9, ICD-10, HL7, HMO, PPO, ANSI X12 Procedural and Diagnosis codes.

•Strong knowledge of MMIS, HIX, EMR, EHR, LIS, CCDA, and healthcare reforms like PPACA, EMTALA, and TIBCO.

•Experience in leveraging advanced statistical analysis techniques and data modeling to extract actionable insights from large datasets in the pharmacy benefit management (PBM) domain.

•Excellent working Knowledge of various Software Development Life Cycle (SDLC) methodologies like the Waterfall Model and Agile (SCRUM, User stories, Sprints) with an in-depth knowledge of RUP's Iterative Software Development Life Cycle process.

•Well-versed in Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HL7, and ICD-9 to ICD-10 coding.

•Skilled in developing detailed functional specifications through JAD sessions, interviews, and on-site meetings with business users and development teams.

•Experienced in facilitating Scrum events (Daily Standups, Sprint Planning, Sprint Reviews, Sprint Retrospectives) and coaching teams to improve their Agile practices.

•Experience in analyzing Business and Technical specifications, developing Use-Case diagrams, Activity Diagrams, Class Diagrams, Data Modeling, Data Mapping, and flow diagrams to test requirements and procedures and formulate robust Business Models using Unified Modeling Language (UML) Techniques, Visio, and Rose tools.

•Expertise in documenting the Business Requirements Document (BRD), Technical Requirement Document (TRD), and User Stories, generating the UAT Plan, Conducting JAD Sessions, maintaining the Traceability Matrix, and assisting in post-implementation activities.

•Strong understanding of Data Analysis, Data Profiling, Data Migration, Data Integration, Metadata Management Services, Data warehousing, Data Mapping, Data Validation, and Data Modeling.

•Experience in managing data migration, Data conversion, Data quality, Data governance, Data integrity, integration, and metadata, ensuring seamless transfer, accuracy, and compliance.

•Experience in conducting data analysis using SQL, Azure, and Oracle PL/SQL, extracting insights, and providing actionable recommendations for improved business processes.

•Expertise in MS SQL Server suite of products like SSRS, SSIS, and SSAS.

•Worked on tools such as Jira, Visio, Azure DevOps, Rally, Confluence, Postman, and Swagger.

•Expertise in QA skills including UAT, and Regression testing. Documented Test scenarios and Test Cases

WORK EXPERIENCES

Baxter International Vernon Hills, IL

Sr. Business Analyst Scrum Master Dec 2021 – Present

Project Description: The objective of the project is to analyze and optimize the electronic data interchange (EDI) claims process, specifically focusing on the 835 and 837 claims and their corresponding transactions. The project involved working with data in compliance with the Health Insurance Portability and Accountability Act (HIPAA) standards.

Responsibilities:

•Involved in requirement gathering, design, development, testing, and implementation of the web application and used agile development life cycle with daily scrum meetings.

•Facilitating Joint Application Development (JAD) sessions to engage stakeholders in the development and validation of data-driven solutions.

•Documented and gathered Functional specifications for 837 (claims), 278(Authorizations), 270/271 (Eligibility and Benefit Response), 276/277 v4010/5010 (Claim Status Request), 835 v4010/5010 Health Care Claim Payment Advice.

•Collaborate with the Scrum Master to facilitate Scrum ceremonies and ensure that the Scrum framework is followed effectively.

•Maintained comprehensive Test Cases for EDI transactions, focusing on 835 and 837 claims.

•Documented precise business and functional requirements for HIPAA 4010 and HIPAA 5010 transactions, aligning stakeholder requirements with HIPAA standards to ensure compliance during testing and troubleshooting claims using CPT4, ICD-9, and ICD-10 codes.

•Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.

•Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid/Medicare Claims.

•Collaborating with cross-functional teams using Agile and Scrum methodologies, managing projects effectively through tools like Jira.

•Serves as Subject Matter Expert (SME) for the development team during construction and unit testing

•Collaborating with stakeholders to gather and document detailed functional requirements (FRDs) and business requirements (BRDs) related to healthcare informatics projects.

•Actively participated in creating the user stories and prioritizing user stories along with tracking, burn down charts to estimate sprint delivery.

•Support the team in adopting and using Agile/Scrum tools and technologies effectively.

•Worked on the creation of Narrative Use Cases, Data Flow Diagrams, Activity Diagrams, Work Flow Diagrams, and Sequence Diagrams to define the Business Process Model and Data Process Model using UML Rational tools/ MS Visio.

•Developed Tableau dashboards, Crystal reports and SSRS BI reports for data insights and to monitor the health of data load activities. Validate the release pipelines and approve the builds on Azure DevOps.

•Extraction, Transformation, and Load processes (ETL) to populate an operational data store from various sources including other databases like Teradata, SQL, Oracle, spreadsheets, and flat files.

•Participating in User Acceptance Testing (UAT) to validate data solutions and ensure they meet business needs and quality standards.

McKesson Malvern, PA

Business Analyst Scrum Master Mar 2019 to Nov 2021

Project Description: The project aimed to achieve seamless compliance and operational excellence within McKesson's healthcare domain by implementing and integrating two crucial standards - HIPAA 5010 and ICD-10. This transformative endeavor involved mapping data elements, streamlining workflows, and ensuring secure health information exchange. The successful execution enhanced data accuracy, interoperability, and data-driven decision-making, elevating patient care and billing efficiency.

Responsibilities:

•Collaborating with stakeholders, Subject Matter Experts (SMEs), and IT teams to gather requirements and define data elements and transactional workflows compliant with HIPAA 5010 and ICD-10.

•Coordinate with stakeholders and project managers to gather functional and non-functional requirements during JAD sessions.

•Performed GAP analysis to assess "AS IS" and "TO BE" scenarios between HIPAA 4010 and HIPAA 5010 and conversions of codes from ICD 9 to ICD 10.

•Worked on HIPAA 5010 (includes 999, 277, TA1 responses), HL7 compliance, ICD-9/ICD-10 Codes, and EDI transactions: 270, 271, 834, 835, and 837 to identify critical data set elements. Designed and developed project document templates based on SDLC methodology.

•Create comprehensive documentation such as Functional Requirements Documents (FRDs), Business Requirements Documents (BRDs), and System Requirements Specifications (SRS) that outline the scope, objectives, and specifications of the proposed solutions.

•Utilize various modeling techniques such as UML (Unified Modeling Language), visual models, workflow diagrams, and UML diagrams to represent system components and interactions.

•Facilitated daily stand-ups as Scrum Master; ensuring the team addressed remaining points on the story assigned to update burn down chart and determine velocity to plan upcoming sprints.

•Involved in Facets System implementation, electronic claims and benefits configuration set-up testing, inbound/outbound interfaces and extensions, Load and Extraction programs involving HIPPA 835, and proprietary format files and reports development.

•Performed data analysis and data profiling using complex SQL queries on various source systems including Oracle and SQL Server.

•Work within Agile methodologies like Scrum, using tools such as Jira, to manage projects, tasks, and sprints effectively.

•Lead Business Intelligence reports development efforts by working closely with MicroStrategy, Teradata, and ETL teams. Developed business process models in RUP to document existing and future business processes.

•Preparing System Test Cases from functional and technical requirements and Use case documents and performing System Testing. Data mapping, logical data Modelling, created class diagrams and ER diagrams, and used SQL queries to filter data within the Oracle database.

•Work within Agile methodologies like Scrum, using tools such as Jira, to manage projects, tasks, and sprints effectively.

Merck Human Health New York, NY

Business Analyst Jan 2017 to Feb 2019

Project Description: The project was based on enhancing the efficiency of Merck Human Health's clinical trials through the integration and optimization of Electronic Data Capture (EDC) and Clinical Trial Management System (CTMS). The primary focus of the project was on streamlining data collection, analysis, and reporting processes, ultimately facilitating faster and more informed decision-making. Collaborating with cross-functional teams, the aim was to deliver a seamless and user-friendly platform to support the organization's mission of advancing healthcare breakthroughs.

Responsibilities:

•Conducted in-depth interviews with stakeholders from many departments to gather and document detailed functional and non-functional requirements.

•Responsible for devising a comprehensive strategy for the seamless integration of Electronic Data Capture (EDC) and Clinical Trial Management System (CTMS).

•Deployed a web-based Clinical Trial Management system (CTMS) to internal and external users.

•Writes and maintains technical documentation to specify electronic data capture (EDC) systems, Data Mining, and Data Modeling Activities.

•Incorporated and implemented all the HIPAA standards, Electronic Data Interchange EDI, and transaction syntaxes like ANSI X12, ICD-9, and ICD-10 coding.

•Worked on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record sets.

•Deployed, and maintained core server-side infrastructure components for a high-performance, HL7 FHIR-based clinical decision support engine.

•Analyzing patient electronic health records (EHR) and medical health records (EMR) through EPIC systems, creating smart data elements to enhance data processing and analysis.

•Working closely with external subject matter experts (SMEs) to ensure the accuracy and completeness of product specifications, fostering effective collaboration and information exchange.

•Created BRD, and FRD Documents and Followed the UML-based methods using Rational Rose to create Use Cases and activity diagrams, that include Functional and Non-Functional specifications to hand off to development teams.

•Facilitated design and modeling sessions to drive solutions for new phases of the EDW including the Extraction, Transformation, and Load ETL processes

•Utilizing PL/SQL statements and stored procedures in Oracle to extract and write data, ensuring data manipulation tasks are executed efficiently and accurately.

•Involved with reviewing defects reported from UAT efforts analyzed for root cause and took actions based on the findings.

•Conducting testing efforts at all stages of the Software Development Life Cycle (SDLC) using HP Quality Center, validating the functionality, performance, and reliability of GXP systems and associated components.

Johnson & Johnson Cincinnati, OH

Business Analyst Aug 2015 to Dec 2016

Project Description: The project's primary goal was to optimize Johnson & Johnson's business processes by implementing advanced software systems, including RIMS, MPDsmart, smpXtract, and cmcXtract. This initiative focused on improving data extraction, analysis, and management capabilities to enhance decision-making and resource allocation across departments. Utilizing these sophisticated tools, the project fostered a culture of continuous improvement and significantly boosted operational efficiency throughout the organization.

Responsibilities:

•Analyze the RIMS, MPDsmart, smpXtract, and cmcXtract systems and their functionalities to understand how they are currently being used and how they can be optimized to meet business goals. Identify areas for improvement and work with senior analysts or project managers to devise solutions.

•Monitor and analyze key performance indicators (KPIs) related to PBM claims processing to identify areas of improvement and track progress over time.

•Carried out Risk Assessment, GAP analysis, and Impact Analysis, and experience in determining and writing functional specs for the 4010-5010-conversion project.

•Translated business requirements into user stories and tasks for agile BI projects.

•Interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.

•Evaluated and recommended improvements to existing HL7 interfaces and workflows to ensure alignment with industry standards and best practices.

•Involved in preparing the Methodology document for the HIPAA implementation.

•Worked closely with team leads in the process of standardizing job parameters, job flows, audit process, and rollback strategies that hold major attention for the successful implementation of EDW Incremental.

•Involved in the up-gradation of 4010 transactions to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks. Successfully worked with Oracle database and related tools like TOAD, and SQL/PL SQL.

•Involved with reviewing defects reported from UAT efforts analyzed for root cause and took actions based on the findings.

•Conducted Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.

•Utilized Agile/ SCRUM and PMI methodologies to monitor steer and develop project objectives.

Contact this candidate