Priyanka Ranu

ad3bmz@r.postjobfree.com

469-***-****

Sr. Business Analyst/Product Owner

Professional Summary:

IT professional with over 10 years of experience working as a Senior Business Analyst and Product Owner in Health care, Pharma and Banking domains. Possess effective Communication, analytical and problem-solving skills with Creative Implementation Techniques.

Expertise in Software Development Life Cycle methodologies (SDLC) and Business Process Re-engineering in Health Care Sector with focusing mainly on Requirements gathering, Documentation, Statistical and Data Analysis, and Test Planning and Execution.

Hands on experience of delivery using the Scrum Methodology with Agile.

Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Business document, Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents

Created and maintained data mapping document(s) in reference to the HIPAA mandated transactions 837I, 837P, and 835.

Well versed with the conversion standards of HIPAA 4010 to 5010 and ICD-9 to ICD-10Codes.

Exposure to HIPAA Compliance requirements and HL 7 standards. HIPAA Transaction and Code Sets (EDI 834, 835, 837, 270, 271, 276, 277, ICD-9, ICD-10), Electronic Health Record (EHR)/Electronic Medical Record (EMR).

Tested various functionalities with the help of FACETs.

Strong project management skills from requirement analysis, process mapping and documentation. Hands-on experience on tools like Rally, JIRA, MS-Project, Confluence for collaboration and tracking.

Having extensive domain knowledge in MMIS, EPIC, EDI X12, HL7, HIPAA, System, Medicare and Medicaid, CMS Compliances/Regulations.

Excellent facilitation skills in conducting walkthroughs, surveys, questionnaires, one-on-one interview sessions, groups' sessions, proto typing brainstorming, JAD and JAR sessions.

Certified Scrum Master dealt with scrum ceremonies like Product backlog grooming, Sprint planning meeting, Daily scrum, Sprint review, Sprint retrospective meetings.

Experienced on monitoring of EDI transaction flows and ensuring error conditions are resolves it.

Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.

Thorough understanding of preparation and use of Business Process Modeling Notation (BPMN) to Unified Modeling Language (UML) diagrams including Process Diagram, Activity Chart, Use Case Diagram, Sequence Diagram, Data Flow Diagram and ER Diagram.

Excellent in analyzing and cresting Use-cases, various UML diagrams like Use case diagram, Activity diagram, E-R diagrams, Data flow diagram (DFD's) using MS-Visio, Balsamiq, mock-ups.

Experience working in a large corporate environment in accordance to an agile project framework.

Performed ETL using Informatica to load the data into the data warehouse from disparate sources, designing and deploying various reports through Tableau, and IBM Cognos.

Recommend tactic to implement HIPAA 4010 (EDI X12 837,834,278,270) in the new System.

In-depth knowledge of EDI transaction sets, 856 ASN hierarchal structures and EDI systems.

Facets Product Configuration of new products and components including research, testing and trouble shooting in FACETs

Worked closely with the QA team to conduct functional testing, compliance tensing, performance testing and develop the test plan, test conditions, test cases, ensured adequate testing of software both before and after completion, and conducted UAT.

Excellent Verbal and Written communication skills with the capability of maintaining effective

Technical Skills:

Methodologies

Agile, Waterfall, Rational Unified Process (RUP), UML

Business Modeling Tools

MS Visio, Rational Rose, UML.

IDE Tools

Rational Rose, Rational ClearQuest, Rational Clear Case, MS Visio, UML.

Requirement Management Tools

TFS, Rational RequisitePro, Doors, MS Share point, HP ALM, FHIR,EPIC,HP QC

Project Management

MS Project, JIRA, Confluence

Business Applications

MS Office Suite –MS Word, Excel, PowerPoint, MS Outlook

Testing Tools

Software Application Testing Life Cycle, QTP, QC, HP ALM, Selenium, HP QTP, Load Runner

Programming Languages

Python, R.

Reporting Tools

Business Objects

Databases

MY SQL, SQL Server, Oracle, MS Access

Operating Systems

Windows, LINUX/ UNIX

Domain Knowledge

HIPAA, Claims Processing, EDI, HL7, HIX, EMR/HER, PPACA, FACETS, Medicaid, Medicare PPO, HMO, Dental claim and POS.

Professional Experience:

Evolved Identity, Remote Oct 2022 – Present

Sr. Product Owner/ Business Analyst

Responsibilities:

Actively involved with Product Line Team to negotiate feature scope and contribute for creating and updating roadmaps (using Mural), features and release plans (Jira and Confluence).

Influence decisions related to back-end deployments with a cross-functional and multi-disciplinary teams giving inputs into prioritized features and existing functionality, user experience, dependencies and risks.

Proficient in building workflows, writing user stories and acceptance criteria to get stories to ‘Ready State’ along with continuous grooming and prioritizing Product and Sprint backlogs.

Working closely with agile dev. team providing input, advice and clarifications, strategy and solution when required.

Iteration planning: Reviewing and prioritizing the backlog for iteration planning including coordination efforts of planning dependencies with other related Product Owners.

Experience in Agile System Engineering development lifecycle and managing complex projects as Agile Product Owner

Experience concurrently working on multiple project teams.

Experience working within a Lean-agile software product development method, such as Scrum and Kanban.

Coordinate with end-users, QA and Development during UAT and end-to-end testing to verify that application functionality adheres to requirements.

Review sprint performance metrics of the Agile teams with sponsors and stakeholders. Responsible for Feature and Sprint Demo’s keeping them apprised of status and gathering feedback for the agile team.

Accept user stories during a sprint reviews and demos, confirming implementation meets acceptance criteria

Develop innovative customer facing application journeys which leveraging new technology infrastructure with the goal of increasing application complete and approval rates (UX/UI)

Planned and estimated with Product Line Team and Product Teams for 2-week sprints and PI of 4 sprints in a realistic yet time-efficient manner that allowed the teams to deliver 94% of the MVP according to the company roadmap.

Responsible for Feature work for Data visualization teams to build various reports and visual dashboards to analyze Sales, Forecast and Operational chart using Qlik sense.

Created Experimental Features to build POC with Advance analytical teams (using R and Python).

Business Analyst for integration of in-house projects between different Appian systems and embedding analytical dashboards.

Responsible for creation of Epic and Feature for Mash up projects using (Qlik sense)

Care first, Remote Oct 2021 – Sep 2022

Sr. Business Analyst / Product Owner

Responsibilities:

Develop business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation and enterprise architecture.

Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.

Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery.

Manage company's EDI catalog for prospective EDI customers.

Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.

Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).

Implement new services and programs via MMIS for the Medicaid program by directly interfacing with the customer and the system engineers on a regular basis.

Wrote user acceptance testing (UAT) scripts and led testing/ quality assurance for both HL7 ADT interface and the application.

Designed, developed, tested, and maintained Tableau functional reports based on business requirements.

Developed a work plan that ensured RFP would meet federal prior approval requirements including use of modular project development, compliance with MECT, MITA, HIPAA and other federal guidelines

Creating documentation such as BRDs and FSDs (Business and Functional design specs) with elaborate Use Cases and process flows

Worked on FACET claim processing system and gathered and documented functional requirements in the Functional Requirements Document (FRD).

Performed GAP analysis by performing the system analysis between the scheduling systems and documented the gap items.

Analyze and document Medicaid EDI transactions issues related to implementation of HIPAA 5010 and ensure these issues are documented and addressed in the approach to the HIPAA 5010 version.

Conducted JAD sessions, meetings, workshops to gather requirements from various stakeholders and SMEs.

Prepared Business Requirements Documents, Functional Requirement Documents.

Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA 5010 requirements.

Helped in initiatives such as HL7 integration data mappings, web service mapping, API data exchanges.

Facilitated all Aspects of scrum framework, including product backlog, release backlog, sprint planning session, daily scrum meeting, sprint reviews and sprint retrospectives.

Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.

Maintained a close and strong working relationship with teammates and management staff to achieve an expected QA result for the project team.

Conducted project related Presentations periodically to the management and end users during various phases of Software Development Life Cycle SDLC.

CVS Health (Remote) Hartford, CT Oct 2020 – Sep 2021

Business Analyst

Responsibilities:

Performed SWOT and Gap analysis for the new functionality requirements

Worked with HIPPA rules and regulations to draft business rules and claim processes.

Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications.

Tested different functionality of the application like Medicaid eligibility data, state available funds program, Medicaid claim processing etc.

Identified and documented the dependencies between the business processes.

Responsible for testing Medicaid Claims for peach state health plan using MMIS.

Tested all internal and external file transfer outputs manually and automatically.

Extensively involved in mapping data from various sources to the target database tables.

Helped improve the loading process for various external data into Oracle database.

Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.

Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology).

Responsible for teaching sessions for end user to tell how to use tools.

Used MS Project for various planning and budgeting activities.

Conducted Impact Analysis when there is any change in requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).

Make data-driven decisions - Integrates data from multiple sources into a logic framework that supports decision-making through various reports/ SAS programs.

Met with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.

Created BDDs (Behavior Driven Development) to create test driven development.

Worked with Architect and IT dev teams to explain requirements and extend support in designing.

Presented Mockup, gathered requirements, created stories, and groomed stories.

Worked with AD/QA team to explain the requirements.

Organized meetings and led JAD sessions to ensure legal and compliance deadlines.

Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.

Managed changes to the project scope, project schedule, and project costs using PMO change management processes and executed change control process activities for the project.

Accurately processed a high volume of claims for multiple health plans according to guidelines in summary plan document.

Uses data to make convincing business arguments by presenting the logical flow of data, interpretations, conclusions and resulting recommendations.

Devon Bank, Chicago, IL May 2019 to Sep 2020

Business Technical Analyst

Responsibilities:

Worked with the business community to define business requirements and analyze the possible technical solutions.

Requirement gathering, Business Process flow, Business Process Modeling and Business Analysis.

Worked with the Business community, Tech Lead and 3rd party vendors in gathering their requirements and data transaction information related to OLTP, OLAP and ASP.

Extensive work experience with Portfolio Managers, Experienced Traders, and Compliance Manager to configure the rule-based scenarios for capturing market and credit risk, general multi-factor sensitivity analyses, and PnL.

Co-authored business requirements document with project teams. Extract, discuss, and refine business requirements from business users and team members.

Facilitated and managed meeting sessions with committee of SME from various business areas including Mortgage Servicing, Loan Monitoring and Asset Management.

Involved in modules which provides robust monitoring and validation to ensure regulatory and NACHA processing compliance

Extensively involved with the trading activities of Credit Derivatives, Interest Rate Derivatives, FX Derivatives, Equity Derivatives and Commodity Derivatives; and Futures including Commodity Futures Contracts and Financial Futures

Developed and implemented processes and tools for requirements gathering, analysis, planning, tracking and delivery using Rational Rose requisite pro – RUP

Performed Gap Analysis for new functionality requirements, as well as prioritized them based on actual business needs so as to align them with the product release roadmap.

Designed and developed Use Cases and UML models using Microsoft Visio.

Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.

Assisted project managers with the development of project schedules.

Develop requirements and preliminary design for client applications. Perform analysis and design projects using a systems development methodology.

Work with all levels of client staff in solution definition.

Coordinated activities between business unit and technical staff, developing new methods, policies, and procedures to meet the business needs, and will acted as primary trainer in education of the business unit as it relates to business applications.

To organize meeting and send agenda of the meeting, draft minutes to keep all invitees of the meeting on a same page.

Organize weekly status meetings with the team to promote open discussion of business requirements and other system functionalities.

Enhancing supporting documentation (policies, frameworks, standards, methodologies, and modeling documents) to demonstrate compliance with the Basel II Accord.

Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.

Worked on Master Data Management (MDM) for maintaining the customer information and also for the ETL rules to be applied.

Collaborated with the business community to define and analyze business requirements, emphasizing Measurement Data Management needs.

Played a key role in gathering requirements related to OLTP, OLAP, and ASP, ensuring effective Measurement Data capture and analysis.

Worked closely with Portfolio Managers, Experienced Traders, and Compliance Managers to configure rule-based scenarios for capturing market and credit risk, conducting sensitivity analyses, and managing PnL.

Co-authored business requirements documents with project teams, extracting, discussing, and refining Measurement Data Management requirements from business users and team members.

Facilitated and managed meetings with SMEs from various business areas, including Mortgage Servicing, Loan Monitoring, and Asset Management, to ensure alignment with Measurement Data Management goals.

Utilized tools such as Erwin for developing Logical and Physical data models, ensuring accurate representation of current state/future state data elements and flows related to Measurement Data.

Conducted Gap Analysis for new functionality requirements, prioritizing them based on business needs to align with the product release roadmap, specifically focusing on Measurement Data Management improvements.

Develop Logical and Physical data models that capture current state/future state data elements and data flows using Erwin. Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.

USAA, India Remote Dec 2013 – Dec 2018

Product Owner

Responsibilities:

Gathered requirements from stakeholders at various phases to leverage Data within the organization using various techniques like JIT, Questioners, Document Analysis, Brainstorming and Prototyping.

With inputs of the technical architect will be responsible to effectively convert the functional requirements into technical User stories using Agile management tools Like Jira, Rally, and Clarity. Map these requirements in Mural for effective Scrum Quarterly planning.

Act as a lead to Own the project and establish the timelines in developing the services needed for Data Management for USAA.

Act as a liaison with the QA team in verifying/writing the test cases and documenting any bugs as a part of validation.

Show Ownership of the release plan and the creation of the Manual (user guide) so that USAA customers (Cosa Members) can understand the solution developed for ROT data using he manual as expected.

Act as a key functional resource for the technology team during grooming sessions that are part of each agile sprint and help ensure that the Business requirement is clearly understood.

Collaborate with other IT teams to estimate, implement, test and obtain approval to deploy changes into production for various change requests.

Responsible in defining the Acceptance criteria leveraging different artifacts such as architectural diagrams, use cases.

Documents data Mapping while adhering to Agile scrum while creating the User stories also ensuring that these artifacts are understood and communicated these artifacts to the team which talks about the solution to be developed for ROT data.

Leading the development team in different phases of the development of the solution like, planning, grooming,

Environment: JIT, technical User stories, ROT, user guide, JIRA, CONFLUENCE, CLARITY, RALLY.

Evolent Health, India Oct 2012 – Nov 2013

Business Analyst

Responsibilities:

Conducted meetings and Brainstorming Sessions involving User community to Identify, Analyze and Formalize Requirements and establish working relationships with business users and other stakeholders.

Involved actively throughout the Software Development Life Cycle (SDLC). Conducted meetings with the business users and SME’s in eliciting the information and gathering the requirements and documenting the requirements

Prepared Business Requirement Document (BRD) and Functional Requirement Document (FRD), to access all the needs of the software and solutions that are going to be needed by the new program

Gathered requirements for new templates from doctors and nurses through interviews. Was responsible for the creation and implementation of business requirements

Created artifacts such as Use Cases, Activity Diagrams, and Sequence Diagrams using MS Visio. Played a key role in Planning, Testing, and Implementing system enhancement requests that were generated

Identified and documented Business Rules and defined Functional Definitions, Responsible for coordinating, tracking and updating project issues, risks and change controls that impacted the BA Team

Worked with Data Analyst in Data Mapping of feeds from reference data systems to in-house applications.

Involved in updating system Test Plans and guided Software Quality Team in Developing Test Strategies during various Test Cycles. Assisted in Developing Test Scenarios and Deriving Test Cases based on Business Requirements, Technical Specifications in Test Director

I made sure HIPAA norms were addressed along with specific transaction sets.

Performed GAP analysis and analyzed EDI 837 (Health Care Claim) transaction and benefit structures in claims transactions from HIPAA 4010 to 5010.

Worked on claim processing receipt and verification of the claim forms (837) and claims attachments (275), claim Enquiry and Response (276/ 277).

Served as a liaison between Clients and Technical Staff to resolve any conflicts.

Worked on development of complete Use Case Diagrams, Data Flow Models and BRDs for a Web based patient management systems based on web services.

Experience with HIPAA 4010 and 5010 EDI healthcare transactions and transition of ICD 9 to ICD 10 codes. · Worked to bridge the gaps between IT and Business Client.

Launched the business requirement collection approach based on the project scope and SDLC Methodology.

Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).

Managed Defect Management process and Conducted Defect Review Meetings from daily defect report with PM

Coordinated with the UAT testing group and provided technical assistance in planning and implementing the Test Schedule for UAT. Worked with Application Development Team on Test Issues and conducted daily status meetings with Development and User Team during UAT.

Education Details:

BCA - Sikkim Manipal University - 2010

MBA - Uttarakhand Technical University - 2012

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