Business Analyst Sr
Resume:
Bhavani G
************@*****.***
Sr Business Systems Analyst
Email is my preferred mode of contact.
Approximately 9 years of experience as Sr Business Systems Analyst in IT field (with Financial and Healthcare clients) with good understanding of IT/ Infrastructure / Business oriented and Database oriented operations with good written and verbal communication skills and can demonstrate a high level of critical thinking to troubleshoot business centric and operational issues that are time-sensitive, and revenue bound.
In my current BSA role with ACFC in 2023-2022 with Med Management Jiva Application support; this role calls for active, frequent, and direct stakeholders’ engagements with vendor partners, business partners, project, and Tech teams on requirements elicitations sessions on different projects such as Evicore, Icario-DE, NH and OH Markets and Internal ACFC HRA outreach project by CM, CC and RROT Teams. Integrations with Jiva, Icario Eligibility file send from Jiva to external HRA vendor called as Icario and have worked on FRDs for Authorizations integration with Jiva application with Evicore vendor, have authored FRD for sending member Eligibility file from Jiva to external HRA vendor called as Icario for member outreach purpose for HRA survey and have also worked on internal project such as Internal member eligibility file generation from Jiva in alignment with business criteria to internal HRA outreach teams that are responsible for care management, care co-ordination and customer support welcome center teams etc. I have actively worked on user stories to capture the business requirements in Agile projects to drive the requirements through deployment and delivery phase. Evicore Authorization Oncology specialty vendor integration project with Jiva IS med management systems called for automated Authorization loads into JIVA PHP application via APIs to create and update Authorization in Jiva. Evicore supported IP and OP episodes so that the Authorizations from the vendor could be loaded into PHP – CM and UM platform called Jiva as IP(Inpatient) or OP (Outpatient) episodes depending on the POS – place of service codes passed by the vendor on the Auth layout. BH and LTSS episodes were out of scope for this project. These Auths from Jiva will get transferred to Facets every night for Auths to claims matching via UMI extract and load process. UMI stands for Utilization Management interface. Worked with Apigee Teams on APIs integration to check provider PAR-NON-PAR status so that the appropriate provider status as INN or OON can be passed via payloads to Jiva Auth/episode loads via create, search, retrieve and update APIs as found applicable depending on the Authorization operation indicator sent by the vendor. Have formulated SQL queries throughout the SDLC development and testing phases on the Authorization integration project with Jiva from vendors to ensure seamless integration with Jiva via APIs. Was responsible for Mapping Authorizations from Vendor layout to CDR2- Clinical data repository and in turn from CDR2 to Jiva via APIs depending on whether the Authorizations need to be created or updated with service lines for IP and OP episodes in Jiva. Since LOB indicator was not passed by the vendor on the Auth vendor layout to HP- Health plan; the LOB to Member lookup was performed using the HL7- Member master table in CDR2 DB for mapping LOBs to Members depending on the line of business associations. Though in Jiva any member can be associated with only one LOB at a given point in time. Authorizations in Jiva are loaded by unique Member ID, Procedure codes along with all the other required data passed on the Vendor Auth layout. Once Authorizations are successfully loaded in JIVA; a response file is generated from the staging DB and is sent back to the vendor so that the vendor can remediate or work on the required corrections for the failed records and accordingly process the same.
In my prior (engagement with another Health plan in 2020-2021– GHP or Gateway ) project on core administrative platform shift project coupled with enterprise-wide technology transformation/migration project (called as Gatetech) with Gateway Health I was responsible for -- Relationship Management including managing and engaging stakeholders at different layers like vendors, Business Owners, Application owners, product owners, Database teams, Project managers and building relationship networks and ticketing incidents, logging issues and tracking solutions. Have worked with API implementation partner stakeholders on Cerner integration with HRP-Health Rules payor on the request – response query for Authorizations. HRP – Health Rules Payor offered by Health Edge refers to the core administration enrollment, claims and PI-Payment integrity platform used by Health plans like Gateway to maintain member data, process claims and avail features for Payment integrity solutions.
Working with people with different functional expertise and working in a collaborative fashion targeting common goals in the project on a migration project called as Gatetech which focused on remediating Applications, Vendor extracts from the legacy on-premises to Cloud infrastructure and to shift the legacy core admin platform called GateLink to the State of the art HE vendor based enrollment, claims and provider management platform called as HRP hosted by the vendor on the clouds on the enterprise wide migration project called as Gate Tech. I was technically responsible for facilitating migrations to migrate the business applications to the latest state of the art technology on HRP (Health rules Payor) backed by Oracle Database engines and SQL servers hosted on cloud infrastructure-a shift from on-premises data centers.
The last project that I worked on was executed in efficient sprints in Agile Environment and used JIRA for ticketing and tracking issues and for reporting on Vendor Extracts remediation.
GHP/Gateway HP - In my last project in healthcare industry with Gateway health plan I worked as a Sr Business Analyst on the Gatetech technology migration project Which refers to the core administration platform shift on enrollment and claims processing along with provider end communications transitioning to the new core platform calls as HRP-or Health Rules Payer which is owned by the vendor Health Edge. I was responsible for all the Vendor portfolio interactions at the peripheral layer and Our DAAI Team at GHP coming from vendor workstream background was responsible for coordinating with all the vendors (70 plus vendor base) on all the outbound extracts or files remediation due to the technology transformation or migration project – called as Gate Tech.
GHP/ Gateway HP - As part of project Gate Tech operations have interacted with vendors who serve both Medicare and Medicaid lines of business.
GHP/ Gateway HP - On my last Gatetech project with Gateway Health Plan -GHP - I have worked actively in JIRA right from project inception to document all epics/user stories based on all the business requirements driven by appropriate vendor and business stakeholders in an Agile driven business work environment and have actively worked with project managers in alignment with Project and Business requirements as and when needed and have used SharePoint effectively for the relevant business documentation on the project of course along with the appropriate Microsoft office products as per project requirements
Have worked on core BA activities but such as:
Requirements gathering, documentation and managing stakeholder requirements to meet the business and project objectives.
Prepare and conduct meetings in support of requirements, process definition, and development of Epic and User Stories. Prepare and conduct concept visioning and development meetings. Prepare and complete all required documentation in support of project-related activities.
Good knowledge and experience in a full SDLC environment with Agile Scrum and waterfall methodologies. Have acted as an effective liaison between Technical and Business end stakeholders and have communicated effectively with project resources such as development, testing, Business and Release teams.
Have worked closely with tech leads and SMEs and have converted business requirements into Functional requirements and have created FRDs to be implemented by downstream DEV teams and to be tested be QA team post development implementation.
Participated in QA meetings such as test strategy, test methodology and test plan meetings to set up and understand the ground for UAT phase and to review User acceptance criteria (very important in getting user-sign off) to ensure UAT success and business sign-off walkthrough following UAT. Actively supported UAT scenarios owned by Business owner stakeholder groups in coordination with the Vendor Technical teams as in Project Gatetech where the vendor extracts had to be validated by the vendor groups post the new data source shift /migration to the new platform due to the enterprise-wide technology upgrade project by GHP called as Gate Tech.
Worked on the key application systems in current project : 2022-2023(Member eligibility files generation from key applications to be sent to external vendors, impact on claims processing, UMI or Utilization management interface study with respective stakeholders say by way of implementing UM SGs-UM Service groups implementation for vendors like Evicore so that procedure codes loaded via Jiva gets mapped to respective UM SGs in Facets since the Xwalk for UM SGs mapping is built at UMI interface level for append and Term functionality of UM SGs ) and business process of health insurance companies, when key changes need to be implemented in collaborative operations along with Change Advisory Boards (CAB)
Have effectively worked as a liaison between the business end and the technical end stakeholders and teams and was involved in analyzing efforts on projects end resources and estimates and have performed as an enterprise level consultant by coordinating with the Data and the Database and business end SMEs as well.
Skill set:
Skill set:
Expertise
Databases
Oracle 9i/Oracle 10g/11g, UDB (db2) 2 9.7.4, Standby Dbs.
Hardware Platforms
Sun Solaris 10, Red hat Linux 3.0, IBM AIX 5.3(p series),
Windows Platforms
Tools
Agile - JIRA, SQL*Loader, Fog light, Ignite, Toad, Informatic
end user support, db2top etc.
Languages
UNIX Shell scripts, SQL*Plus, PL/SQL,
ERP Suite
Oracle Applications 11i, 11.5.4
HA/DR
Sun clusters / Veritas and Oracle RAC, Data Guard
Replication
Share plex and Golden Gate
Others
RMAN 9i/10g, 11g, VERITAS-net backup, TSM, OEM, ASM,
dbca, data pump utility
Oracle DR Setup:
Oracle Managed Standby DB on 8i/9i, 10g, 11g, Oracle Logical
and physical Standby, (SQL*Apply), Oracle on VCS/SRDF
Scheduling:
AutoSys
Monitoring:
HP-OV, Fog light, Spectrum
Methodologies
Agile, Hybrid, Waterfall
Certifications:
Associate program in computer applications.
Feather in the cap for resolving multiple Oracle DB oriented performance tuning and admin issues on Oracle 9i versions.
Education:
Bachelors in computer sciences and Engineering
Associate program in Computer sciences and Applications
Have studied with Aviation Institute of Maintenance in Virginia
Project Details:
AmeriHealth Caritas: ACFC Feb2022 to current date
Sr Business Analyst engaged in Business requirements elicitation with Business and vendor stakeholder groups engaged in multiple projects such as Perform Rx- Auth’s integration with Jiva, Evicore- UM Clinical Subcontractor Authorizations integration with Jiva for multiple markets Medicaid and Medicare, Icario external HRA vendor on HRA member outreach for DE, NH and OH markets and Internal HRA member outreach project by internal ACFC Teams such as CM, CC and RROT teams.
Care is the heart of our work at AmeriHealth Caritas and AmeriHealth caritas is one of the leading MCO organizations offering award winning Heath plans in many communities across the country say starting from Medicaid managed care to pharmacy benefits to Behavioral health and more. So ACFC’s goal is to provide responsible managed care solutions including Medicaid and Medicare.
Responsibilities:
1.As a Sr Business analyst, I am well versed with Business Analytics techniques coupled with Analytical and Technical end database skills to effectively interact with vendor, PMO, Technical and Functional partners to effectively elicit requirements as part of the requirements gathering SDLC phase to convert the same into Functional requirements so that the DB Team can effectively configure and convert the same into system requirements to be implemented at DB end in alignment with Application functionality such as IS Med management functionality and so.. For example, in the case of Auths integration from a vendor like evicore; I captured the business requirements and converted into Functional requirements so that the Authorizations can be loaded via auto configured ETL jib into staging Clinical repository database called as CDR2 and then effectively load the data into JIVA PROD DB in an automated fashion via APIs. When new Auths are sent by the vendor; create API will be used to create IP or OP episodes in Jiva based on the POS value configured in the Authorization layout. If the vendor sends updates to the existing authorizations such as update on the Authorization operation; then update API will be used to effectively update authorizations in Jiva depending on whether it’s a IP or OP Auth and depending on whether the updates are at which service line item level. Accordingly use cases will be created to implement the testing scenarios based on the testing strategy adopted in the test environment so that the outcome of the testing phase can be presented to the UAT stakeholders for user acceptance testing and approval. To support business and UAT sign offs; testing workflow is created in VISIO for effective presentation and the appropriate use cases will be approved by UAT stakeholders so that the technical and development and testing teams can head into the deployment phase prior to the production Go-Live phase based on LOBs per rollout. I have been engaged in vendor facing and business facing roles in gathering requirements for projects like Icario HRA external vendor and Evicore – UM Subcontractor clinical vendor and in problem solving roles and I have created technical documentation of the requirements gathered into a Functional requirements document that can be effectively used by development team to develop the products along with Conceptual architecture workflows and Solution architecture diagram coupled with TDD that are technical design documents that helps develop teams to understand how APIs are used for automation and the database table configurations and workflows as such. Based on TDDs, CAD, SAD and FRD; testing team will create the testing workflow and use case scenarios and Visio diagrams that is used for testing-by-testing team. This position calls for frequent interaction with vendor partners, business partners, DEV team, Architects, operations and QA teams, SMEs and other cross-functional team members. My presentation and technical documentation skills was greatly appreciated by business managers and technical managers alike along with develop team stakeholders.
2.On the Icario external vendor HRA member outreach program I was engaged in the vendor and the business facing roles in requirements gathering/elicitation sessions, requirements finalization meets with the business stakeholders and the project teams so the Business requirements could be effectively translated to the Functional requirements for implementation by the DEV team for system level integrations so that outbound Member eligibility files from PHM – Med Management application JIVA can be sent to the vendor for different markets such as DE, NH and OH.
3.On the Evicore – UM Subcontractor vendor implementation- that I am currently engaged in; I am responsible for closely interacting with Evicore vendor stakeholders, PMO stakeholders, Business, SME and DEV teams so that requirements can be translated to Functional specifications in order to integrate Auths received from the vendor with the PHM Jiva application in alignment with Business rules and process workflows as agreed with vendor and Business stakeholders. I am also responsible to define the Authorization mappings in this project say from the Auth vendor layout to CDR2 and from CDR2 to Jiva PHM Applications so that Authorizations received from Evicore for all services supported by Evicore such as Med Onc, RT, LAB, MSK therapies, MSK services, DME and Sleep can be effectively loaded into ACFC PHM system Jiva. Jiva is the Med management application that is used for CM and UM operations and houses all Authorizations data from all vendors.
4.On the internal HRA ACFC project, I was responsible for requirements gatherings so that Jiva eligibility files for OHIO Market can be sent to internal HRA ACFC teams such as CM, Contact center and RROT teams so that internal ACFC HRA teams can effectively outreach to new members who transition from other MCOs and to High Risk stratified members to complete HRAs between 1st and 20th of every month. Internal HRA ACFC member outreach project is also closely tied with the Icario external HRA vendor as the vendor is involved in outreaching to members who have not completed HRA.
Environment : Oracle, SQL – Server, Linux Server, Appian, API – Automation loads into Jiva PHM Platforms, Navient-Provider Portal, Jiva PHM Med Management Application, Facets for claims processing and payments, CDR2 DB for intake of vendor data like Authorizations via ETL jobs, Tidal automation in place for jobs pickup, All recurring jobs are automated and scheduled may that be member eligibility extracts or Auth extracts from Jiva to be loaded into UMI to be uploaded into Facets and otherwise, In house member portal, Pharmacy integrations, Medical pharmacy integrations into Jiva from third party Med Auth record vendors except Retail pharmacy integrations ; Web based APIs integrations with other systems via REST API integrations on REST Architecture & JSON as a common message format for sending and exchanging data via REST API that follows request (URL)/ Response (sent data back) format.
Gateway Health Plan PA Jun 2020 to Oct 2021
Sr Business Analyst and Vendor stakeholders’ management on a technology transformation project at enterprise level called as Gatetech which refers to the core administration platform shift from the legacy GateLink platform to the new/current HRP -Health Rules Payer Platform owned by Health Edge-HE.
Gateway Health is a managed care organization that offers complete healthcare known as whole care to Gateway members. Gateway's mission is to care for the whole person in all communities where the need is greatest. Gateway's members have benefitted from different services such as Disease management, Health and wellness programs, Preventative care, and social determinants of health initiatives. Whole person care is delivered to nearly 340,000 members and GHP works with a large provider network of more than 30,000 providers.
This project was to support all external vendors contracted with Gateway since the organization was going through a major enrollments and claims platform shift to Health Rules Payor from GateLink and hence we had to send newer upgraded files from the new operating platform to ensure smooth operations with all the connecting outside vendors on enrollments/ member eligibility files that was being shared.
Responsibilities:
As a business analyst I was involved in supporting the vendor extracts on enrollment claims and providers on the technology upgrade project adapted by Gateway in 2021 called as Gate Tech. Was an active driver in communicating with the vendors and the tech remediation team on different aspects of the technology transformation such as the below to name some aspects of my support initiatives.
Gatetech is an operation and a technology transformation initiative that Gateway has undertaken to better care for the whole person in all communities where the need is greatest.
Gatetech technology transformation refers to the core administration platform upgrade from the current or the legacy platform to the new core administrative platform called as HRP or Health Rules Payer on the Gatetech Project that includes a new claims processing and a clinical platform as well.
Gatetech is not an external member or provider facing tool or application but is the term coined by GHP to refer to the conglomerate of internal systems and supporting applications that brings many new efficiencies to how GHP serves their members and providers in brief.
At an outline – FYI - With reference to authorizations, participating providers will continue to have the ability to enter authorization requests through Navi Net which is the provider portal. With reference to provider end transition on Gatetech updates; GHP announced to it providers that the company will be implementing a new operations platform called as Gate Tech in Q3 of 2021.
As part of Gatetech project planning efforts, FYI - Communications were sent out to the providers on the enhancements on the technology transformation process on Gatetech. The Technical transformation on Gatetech is more internal to Gateway on the technical dynamics or on the technology side of the operations to enhance effectiveness of the operating systems and to be in sync with the current state of art Technology process.
As an example, providers were informed that Gateway Health will be transitioning to PNC Bank's claims processing and Remittance (CPR) platform on Gatetech as scheduled.
Responsible for interacting with Vendor stakeholders on project Gatetech since there was a change to the data source of the files sent to vendors and hence remediation of the outbound extracts was required on project Gatetech. Responsible for setting up meetings with the entire Vendor Base on project Gatetech on remediation of the outbound files sent to vendors by GHP.
Responsible for follow through with vendor and business stakeholders related to vendor files extraction and files scheduling efforts. Responsible for communication with business and vendor stakeholders on project end. Responsible for documenting issues in JIRA and in generating reports as requested by the project management teams to report to the upper management say for example on
oVendor status reporting by SDLC Phase (Building or (design phase in some cases by tech and business teams) files, Unit testing, QA, Files delivered to Vendors, Vendor Testing phase, vendor approved Sign-off, Deployment ready at GHP Tech end, Vendors in PROD -Go Live phase on Gatetech etc)
oVendor remediation status on Gatetech by Tiers (such as TIER 1, TIER 2 and TIER 3)
oVendor reporting status by Lines of Business such as (Medicaid or Medicare or Both). Vendor Status reporting by TIERs, LOB and by Vendor Names based on Data uploads in JIRA and JIRA Reporting data management strategies put in place.
Environment: vendor interactions with Netsmart, Cotiviti, Optum, Evicore, Davis Vision, Cerner integrations for real time Auth checks to name a few..
Federal Home Loan Bank, Des Moines, IA Aug 2017 till Apr 2020
Role: Business Analysis and support as Oracle DB Administrator
FHLB DB infrastructure team was responsible for hosting databases that supported the applications which catered towards mortgage lending factored towards economic development and affordable housing in the communities. The mortgage-oriented banking databases hosted in-house supported mortgage applications that needed a more comprehensive approach to compliance risk management, one that combines regulatory analysis, identifying competing regulations, instituting operational process controls, effective data quality and document management strategies.
DB infrastructure team also hosted databases that serviced Loan origination and Loan servicing data-oriented applications. Loan origination is the process by which a borrower applies for a new loan, and a lender processes that application. So, Origination basically covered all the steps from taking a loan application up to disbursal of funds (or declining the application as the case may be). Also managed databases that hosted Loan servicing applications that covered everything after disbursing the funds until the loan is fully paid off.
Project was to take care of day-to-day operational support and to coordinate any change management requests requested by business and Tech teams to support the operational applications in alignment with business requirements. This involved coordination with DEV team on basic support requirements and to coordinate with them on any changes and to maintain the overall health of the environment.
Responsibilities:
Maintain structure, tables, access to and efficient operation of one or more databases in use for systems or applications in current use by clients, business units, or corporate offices.
Loan data is commonly stored across multiple systems, making it difficult for banks to aggregate and package the requested data in an efficient, timely and consistent manner. So effectively coordinated with business units or corporate staff and/or developers regarding current or planned applications on the databases connected in lines with their technical requirements.
Maintain, update, or document data structures or models, tables, and other objects used in the database(s) supported. Maintain client registrations for the use of specific database(s).
Coordination with tech team that are Setting up and testing the backup and recovery strategies. Worked with a 10 member of Oracle DBA team database size was half petabytes (500 Terabytes) with 100 test data instances and 15 production instances.
Worked on customer service requests for SQL and database tuning, software patches and upgrades, as well as database environment setups for testing and production issues simulation.
Major projects include upgrades from Oracle 9i database to Oracle 10g and hardware and software setup and implementation and coordination with all teams depending on the assets impacted.
Resolve database incidents to ensure database availability and stability.
Environment: Solaris 10, Linux, Oracle 9i, 10g, 11g, 12C OEM, Oracle Golden Gate, TSM
Santander Bank, Boston MA Jul 2014 to May 2017
Role: Business Systems Analyst with Oracle DB support and MS-SQL query support role
Santander Bank (SB) provides competent financial services with easy-to-use banking products and services. SB also provides Cash Management solutions that can accelerate and simplify the customers cash flow. Provides all Cash Management services for customers like Mobile Deposits, regular cash deposits for small and large volumes, sending money etc in addition to hosting basic banking services such as Checking Savings and Business Accounts.
Project was to attend to any issues reported by business on performance or to extend business hour support in case of any availability issues in non-production environments and to act as a liaison between business and technical database teams.
Responsibilities:
Install, test, and update multiple versions of RDBMS software for Oracle Servers in both single-instance and high availability methodologies.
Understand, monitor, and administer database security and perform the role of gatekeeper.
Configure, maintain, and monitor disaster recovery environments for hosted database platforms.
Contribute to the refinement of standards and best practices for database operations in a private hosted cloud setting.
Extensively worked as Team Leader in performing tasks such as Strategic Planning, Installations, and Configurations. Excellent interpersonal, analytical, and problem-solving skills. Enhance database performance, perform restores, implement recovery procedures, handle performance tuning and conduct regular system backups.
Served as DBA infrastructure facilitator in the completion of 80+ medium- to large-scale implementations, extending support in projects through different phases of SDLC from business requirements analysis to solutions delivery and support.
Environment: Oracle Apps, Oracle 11g/12c, RAC, ASM, OEM 12c, Data Guard, TOAD, Red Hat, Windows 2003/2008, SQL/PLSQL,
Freddie Mac, Reston Nov 2013 till May 2014
Role: Business Analyst with Oracle DB Support
Freddie Mac (FM) makes homeownership and rental housing more accessible and affordable. Operating in the secondary mortgage market, FM keeps mortgage capital flowing by purchasing mortgage loans from lenders so they in turn can provide more loans to qualified borrowers. FM mission is to provide liquidity, stability, and affordability to the U.S. housing market in all economic conditions extending to all communities from coast to coast.
Project was to upgrade all supporting underlying databases that support homeownership applications and to remediate the applications if impacted per requirements.
Responsibilities:
Responsible for performance, integrity, and security of databases. Involved in the planning and development of databases, as well as in troubleshooting any issues on behalf of the users.
Perform backups/restores, and archive data, perform optimization and tuning of data loads and extractions.
Plan for transition of the development and/or production environment to new technology.
Monitored and accomplished refreshing of data and installation and testing of new releases or patches of database software. Install, patch, and maintain Oracle software. Tune Oracle instance components as a teamwork including SQL and PL/SQL
Have managed and administered oracle 11.2.0.3 databases in
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