Shivani Haria

Sr. Business System Analyst/ Business Analyst

adxxbv@r.postjobfree.com Bettendorf, Iowa

Professional Summary

Over 8 years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, and Joint Application Development JAD sessions with clients and referring to accessible documentation and procedure.

Experienced in conducting in-depth analysis of pharmacy benefit management operations, workflows, and data to identify areas for improvement, cost reduction, and increased operational efficiency.

Have proficiency in supply chain management to evaluate end-to-end processes related to pharmaceutical products and medical supplies.

Have proficiency in identifying gaps in the existing life insurance coverage and proposed solutions, collaborated with various stakeholders, including actuaries, underwriters, and product managers, to develop innovative and competitive life insurance products.

Good knowledge of Health Insurance Portability Accountability Act HIPAA standards, Electronic Data Interchange EDI and Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, and HL7.

Strong Understanding of Medical Claims in Process Documentation, Analysis and Implementation in 835/837/834/270/271/ (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side

Proficient in conducting feasibility studies on new digital health technologies and data management systems to determine their viability and impact on business operations.

Deep understanding of EMR/EHR systems to configure and customize the software according to the specific needs of healthcare providers and organizations.

Good Knowledge in Initiating and implementing change control activities in accordance with site procedures for GXP Compliant systems.

Experienced in designing business models using UML diagrams such as Test cases, use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio.

Proficient in creating mock-up screens, wireframes and prototyping static and UI/UX to assist UI/UX teams.

Supported and maintained Business Objects Universe overlaying Data Warehouse, Data mapping and extracted from an internal data warehouse, transformed and sent to an external entity.

Experienced in performing Data Analysis using complex SQL queries, like Data Profiling, Data Quality and Data Validation.

Experienced in producing documents like Business Requirements Documents (BRD), Functional Requirement Specifications (FRS), Software Requirement Specifications (SRS), and Creating Request for Proposals (RFP).

Facilitated User Acceptance Testing (UAT) with the stakeholders and the business users as well as trained users to use the system configured.

Have Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence).

Expertise to define key performance indicators (KPIs) for measuring the effectiveness of CRM initiatives and tracking customer engagement.

Extensively worked in various Software Development Life Cycle (SDLC) methodologies like Waterfall Model, Agile (SCRUM, User stories, Sprints) with an in depth knowledge of RUP's Iterative Software Development Life Cycle process.

Professional Experience

Johnson & Johnson, New Brunswick NJ Aug 2021 – Present Sr. Business System Analyst/ Business Analyst

Project Description: The project is aimed to enhance pharmacy workflows and optimize supply chain management processes at Johnson & Johnson's facility. By leveraging technology and process improvements, the project is streamlined operations, improved inventory management, and elevated patient care. It is dealt in optimizing workflows, enhancing supply chain efficiency, implementing technology solutions, and ensuring regulatory compliance. The project is ensured by delivering a workflow analysis, supply chain assessment report, technology implementation plan, and comprehensive compliance framework.

Responsibilities

Worked with the Scrum team to develop and implement solutions that streamlined pharmacy workflows, such as optimizing inventory management or improving prescription fulfillment processes.

Utilized analytical skills to gather, analyze, and interpret data related to pharmacy benefit management.

Involved in Medicaid and Medicare claims processing along with CMS, MITA, MMIS, Electronic Medical Health Record (EMR/EHR) and Pharmacy Benefit Management (PBM).

Coordinated and executed Request for Proposals (RFPs) for Small Employer Groups to assist in finding the appropriate Pharmacy Benefit Management (PBM) organization for their needs.

Actively participated in GxP compliance program and maintained system documentation for GxP computer systems.

Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.

Analyzed Business Requirements and developed User Stories, Activity Diagrams and State Chart Diagrams using Rational Rose according to UML methodology thereby defining the Data Process Models.

Tracked program development progress in Atlassian Jira, involved in User Acceptance Testing and supported in SDLC documentation with technical implications.

Co-ordinated with UI/UX team on designing mockup screens in order to create an best Customer Experience Portal by taking care of portal’s look and feel.

Designed documentation and reviewed of business documents like business Requirement Document (BRD), Functional Requirement Document (FRD) and System Requirement Specifications (SRS).

Understood the specifications for Data Warehouse ETL Processes and interacting with the data analysts and the end users for informational requirements.

Involved in data analysis to identify trends, perform root cause analysis, problem-solve, and deliver key recommendations based on thorough analysis.

Implemented and managed the formal SDLC implementation using the RUP/Agile Methodologies.

Performed comprehensive analysis of CRM system related business practices and drivers to increase system utilization, sales and retention while streamlining customer experience.

Involved in evaluating and assessing API requirements for healthcare systems and applications, identifying opportunities to streamline data integration and improve interoperability between different systems.

Involved in designing and implementing SSAS cubes and utilizing SQL queries for data extraction, analysis, and reporting in support of business intelligence initiatives.

Utilized MS Visio's diagramming capabilities to effectively communicate requirements to development teams and stakeholders.

State farm, Tempe AZ Jan 2019 – Jul 2021 Business Analyst/ Data Analyst

Project Description: This project was on enhancement of life and health insurance processes for State Street Farm, aiming to streamline operations, improve customer experience, and drive business growth to optimize policy enrollment, claims management, underwriting, and premium calculation. The objective of the project was to increase operational efficiency, ensuring accurate policy administration, and delivering comprehensive coverage to policyholders.

Responsibilities

Interacted with client groups to determine user requirements, Business rules and goals.

Analyzed EDI transaction (Enrollment and Maintenance) for the conversion of health insurance enrollment.

Managed different sectors for new releases successfully with life Insurance, Health Insurance division also worked on mainframe for different projects.

Managed the output requirement project for various Life insurance products.

Created and maintained the insurance coding and fee tables along with the contracts in the electronic billing system and prepared annual budget recommendations.

Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business requirement Document (BRD).

Created Business Requirement Documents (BRD), Use Cases, Functional Requirement Documents (FRD), and Use Case Narrative.

Organized JAD sessions to flush out requirements, performed Use Case and work flow analysis, outlined business rules, and developed domain object models.

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

Translated business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) using MS Visio.

Facilitated the UAT (User Acceptance Testing) effort for accounting team and other end users of the system to make sure the overall functionalities of the system and generated UAT Report for senior management.

Created reports and deployed them on server using SQL Server Reporting Services (SSRS).

Maintained boards, organized charts within JIRA and influenced best practices to team.

Involved in presenting walkthrough of requirements/user stories and implementation approach to the client.

HCA Healthcare, Nashville TN Apr 2017 – Dec 2018

Business Analyst

Project Description: The project involved optimizing Medicaid claims and Medicare processes for HCA Healthcare which was to streamline claims management, improve reimbursement accuracy, and enhance compliance with Medicaid and Medicare regulations. It was aimed to increase operational efficiency, reduce claims denials, and maximize revenue as if it could provide seamless and effective healthcare services to Medicaid and Medicare beneficiaries while ensuring regulatory compliance.

Responsibilities

Involved in gathering requirements from clients and created Business Requirement Document (BRD) and facilitated in creating System Requirement Specifications (SRS) Document.

Validated the EDI 837 claim billing professional, institutional, and dental claims 835 remittance advice or payment claims adjudications.

Implemented a modernized payment system for Medicaid claims that met regulatory requirements and industry standards, ensuring alignment with the strategic goals and objectives of HCA Healthcare.

Involved in the implementation of a Medicaid management information system, collaborating with stakeholders from multiple departments to ensure compliance with Medicaid regulations and streamline business processes.

Involved in creating requirements that comply with HIPAA and HL7 format regulations to protect the privacy of employees.

Facilitated workshops to educate providers on the advantages of healthcare interoperability using HL7 FHIR messaging.

Implemented of a cutting-edge electronic genetic record system by designing database schemas and back-end logic utilizing FHIR API's.

Demonstrated expertise in analyzing the process of medical coding and the transition from ICD9 to ICD10.

Performed Gap Analysis and created test plans for clients transitioning from data collection to EMR solutions.

Analyzed and translated business requirements into system specifications using UML and RUP methodology.

Coordinated User Acceptance Testing (UAT) with users, created test scenarios, test plans, and test cases, and provided appropriate support.

Converted various SQL statements into stored procedures, reducing the number of database accesses.

Performed Extract, Transform, and Load (ETL) operations for data cleansing, standardization, and reporting and actively involved in the Data Mapping process.

Utilized the Agile Scrum methodology in management of the team members and project deliverables.

Created and participated in JAD sessions to analyze and prioritize competing business needs.

Created Business Requirement Documents (BRD), Use Cases, Functional Requirement Documents (FRD), and Use Case Narrative.

Created UX/UI flow charts for wireframes, UI visuals, and site maps and annotated templates.

Involved in Jira testing, tracking bugs, and communicating with the vendor team for modifications and resolutions.

Utilized API specifications and documentation to analyze, validate, and map data elements, ensuring seamless communication and data exchange.

MC Kesson Corp, Irving TX Apr 2015 - Mar 2017 Business Analyst

Project Description: The project aimed to streamline healthcare data interoperability for MC Kesson Corp by integrating EHR, PBM, and leveraging HL7 standards. It was involved in enhancing Health Information Exchange capabilities, ensuring secure and standardized data exchange, and conducting thorough testing and validation. The project also provided training and support to promote seamless adoption and utilization of the integrated systems and improved HIE capabilities.

Responsibilities

Worked on identifying and analyzing the digital health management needs of the organization, understanding the goals and objectives, and translating them into technical requirements for the development team.

Used risk-based approach to determine the scope of validation for GxP systems to create documentation and verification activities with appropriate justification of the approach.

Involved in web back-office application to manage PBM Incoming and Outgoing files verification process and other aspects of accounts reconciliation.

Established relativity charts to understand PBMs role and effects on all other functional area.

Understood expected results and document failures effectively in the Epic TDR Issues List based on test script requirements.

Applied RUP methodology with its various workflows, artifacts and activities throughout the software development life cycle from Inception to Transition phase.

Applied UML notations and methodology in developing models that accurately represent the process workflows and clearly communicate them to the stakeholders.

Worked in Activity Diagrams, Use Case Diagrams, and Workflow Diagrams using Microsoft Visio.

Worked with multiple vendors, Offshore and cross functional team in various project management methodologies including Agile and Waterfall models.

Prepared the Functional Requirements Specification FRS and Business Requirements Document BRD.

Assisted in coordination and monitoring of UAT testers to ensure test plans are executed.

Worked on Agile Software Development methodology using Confluence &JIRA.

Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.

Prepared, Deployed and Modified new & preconfigured report layout templates to SSRS Report Server.

EDUCATION

Bachelor of Science, Biotech

MM PG Collage (Chaudhary Charan Singh University) Meerut, Uttar Pradesh. India - March 2009

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