Business Analyst Senior

Indira Madhavi Bonda

Senior Business Analyst/Data Analyst

Email:*********@*****.*** Dallas, TX

Professional Summary

Around 9 years of experience as a Senior Business Analyst in Healthcare with good experience in capturing, analyzing, and documenting complex business requirements and expertise in the Software Development Life Cycle (SDLC).

In-depth knowledge and understanding of business requirement gathering, business process flow, and design documentation.

Well-versed analytical skills, converting stakeholder and business user needs into requirements.

Extensive experience in functional, integration, and User Acceptance (UAT) Systems.

Experience in UML to create use cases, sequences, and activity diagrams.

Extensive knowledge of Waterfall, SDLC, and AGILE (Epic, User Stories for Backlog) software development process framework.

Good Experience in preparing presentation slides in MS PowerPoint, which was extensively used in different JAD sessions and to track progress.

Expert in utilizing data visualization and reporting using SQL Queries and MS Excel (Lookup, Macros, Pivot Tables, etc.).

Good knowledge of Medicaid, Medicare, and Managed Care Products against contractual requirements.

Expert in analyzing skills in claims migration projects, due diligence, and analyzing RFPs provided by vendors and PBMs.

Knowledge of membership, billing, and claims payment processing concerning HIPAA, EDI 4010, 5010 X12, ICD-9, and ICD-10.

Worked with HEDIS and clinical data, possessing knowledge of clinical quality assurance and guidelines for patient care quality.

Good experience with writing and utilizing SQL Queries for Data verification in Databases like SQL Server.

Extensively used MS Word, Visio for documentation and diagrams, and Excel spreadsheets for reporting.

Extensive experience with SDLC and implementation of the Rational Unified Process (RUP).

Experience in writing PL/SQL Stored Procedures, Triggers, Cursor Functions, and SQL statements.

Extensive knowledge of managing the lifecycle of FACETS and surrounding applications/systems to sync with processes.

I obtained roles quickly, and my acumen enabled me to hold high-level positions and continue my career success in these areas: Financial Services, Insurance, Pharmaceuticals, Healthcare, and communications.

Expertise in facilitating the test process by using the bug-tracking tool JIRA.

Skilled in data visualization using Tableau and Power BI to generate the graphical representation of data.

Excellent conceptual and working knowledge of SDLC, including Agile (Scrum) and Waterfall methodologies.

Analyze and synthesize results from Joint Application Development (JAD) sessions and propose alternative tasks to transform those into a Business Requirement Document (BRD).

Worked on the EDI 834 file load to Facets through MMS (Membership Maintenance Sub-system).

Exhibit excellent analytical and problem-solving skills and serve as a team player with strong interpersonal and communication proficiency.

EDUCATION

MBA – Finance & Marketing Aditya Engineering College, JNTU, AP, India 2008 – 2010

Bachelor of Commerce Andhra University, Anakapalle, AP, India 2005 – 2008

WORK EXPERIENCE

Role: Senior Business Analyst/Data Analyst Dec 2023- Present

Client: McKesson Irving, TX

Project: HEDIS Data Processing and HIPAA-Compliant EDI Integration Project

Project description: It involved a successful transition from ICD-9 to ICD-10 coding standards, accompanied by comprehensive staff training that significantly improved operational efficiency and streamlined workflows. In parallel, strong HIPAA compliance protocols were implemented to reinforce patient data protection and maintain regulatory integrity.

Responsibilities:

Skilled in MySQL, PL/SQL, Data Lake, Informatica, Teradata, Epic, BI tools, Hadoop, Data Modeling, and Python for end-to-end data analysis, integration, and healthcare system solutions.

Conducted JAD sessions with PBM to gather their Current State Process and High Level Interface with their current connections and processes with their clients.

Collaborated with SAP Finance (FI/CO) and Materials Management (MM) modules to validate healthcare procurement, inventory, and billing transactions against claims data.

Designed and published Tableau dashboards to track HEDIS measure performance, compliance KPIs, and claims processing efficiency, enabling leadership to make data-driven decisions.

Collaborated with Data Governance teams to establish data stewardship practices, ensuring alignment with HIPAA, CMS, and NCQA standards while improving data lineage and metadata management.

Conducted workflow Gap Analysis for EMR/EHR integrations (Epic, HIE, HL7, FHIR), assessing data interoperability, missing segments, and clinical documentation mismatches.

Supported gap remediation by drafting requirements for data mapping, process redesign, and system enhancements, feeding into BRD and FSD deliverables.

Ensure data accuracy and timely reporting by managing HEDIS MRRV project metrics, analyzing reports, addressing findings, and collaborating with teams and HEDIS software systems.

Coordinate with technical teams to modify and translate segments of HL7 messages for seamless integration with EPIC systems.

Partnered with data engineering teams to migrate healthcare claims and HEDIS datasets from on-prem SQL/Oracle into Azure Synapse Analytics for high-performance reporting.

Designed data ingestion pipelines using Azure Data Factory (ADF) to automate ETL processes from FACETS Provider, Claims, and Member tables into the Azure environment.

Documented AS-IS and TO-BE business processes in SAP S/4 HANA migration context for financial reporting, claims settlement, and compliance auditing.

Analyze, re-architect, and re-platform on-premises SQL data warehouses to data platforms on AWS cloud using AWS or 3rd party services.

Document business and functional requirements for HIPAA 4010 and HIPAA 5010 transactions while testing ICD 9 and ICD-10 claims, troubleshooting utilizing CPT4, ICD-9 & ICD-10 codes.

Develop Use cases and activity diagrams, analyze business requirements, and work on Health Level 7 Interface (HL7).

Collaborated with internal teams and external stakeholders to design and implement EDI transaction sets (837, 835, 834, 820, 270, 271, 276, 277, and 278) for efficient data exchange and claims processing.

Conducted deep-dive data analysis using SQL queries on FACETS Provider, Claims, and Member tables to validate provider enrollment, contract details, and claim adjudication logic.

Extensive use of MS Office tools with great expertise in MS Excel and others like MS Access, MS Word, and MS PowerPoint MS Project for data migration into the CI System Knowledge Database in Microsoft SharePoint.

Experience utilizing MS Excel's data analysis tools, including Solver and Data Analysis Tool, to perform statistical analysis and optimization.

Connected Tableau to various data sources, including SQL databases, MS Excel files, and cloud-based services, to create unified data views.

Work on business process models in RUP to document existing and future business processes.

Employ UML methodology to create UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, and Activity Diagrams, and document business processes and workflows.

Conducted deep-dive data analysis using SQL queries on FACETS tables to identify root causes of system issues and support end-user reporting needs.

Create Business Requirement Documents (BRDs) and Functional Specification Documents (FSDs) to capture and communicate project requirements effectively.

Led initiatives to re-architect and migrate on-premises SQL-based data warehouses to cloud-based platforms on AWS using native and third-party services.

Conduct thorough analyses and Gap Assessments of CMS guidelines and regulatory requirements to ensure compliance and adherence to industry standards.

Conduct presentations periodically to management and end users during various phases of the Software Development Life Cycle (SDLC).

Developed Tableau Dashboards, Crystal Reports, and SSRS BI reports for data insights and to monitor the health of data load activities.

Hands-on learning with different ETL tools to get data in shape where it could be connected to Tableau through Tableau Data Extract. Worked with SQL Server and Oracle databases to get the data in Hadoop.

Conduct data mapping and logical data modeling, and create class diagrams and ER diagrams, utilizing SQL queries to filter and manipulate data, configuring the data mapping in SQL Server.

Utilized expertise in SQL, SQL Server, and SQL queries to retrieve, transform, and analyze complex pharmaceutical data, providing actionable insights to the business.

Use MS Word and Visio to document the data flow of the AS-IS and TO-BE processes.

Manage requirements using the RTM Requirements tool and agile methodology to develop a CMMI.

Create functional flow diagrams, context diagrams, and other high-level diagrams to document the functionality of separate modules using MS Visio.

Analyze business requirements and segregate them into Use Cases according to agile methodology.

Role: Business Analyst Sep 2020- Dec 2023

Client: Kaiser Permanente (KP) Denver, CO

Project: HIPAA-Compliant EDI Claims Processing and Healthcare System Integration

Project description: The project focuses on generating EDI claims from paper claims and uploading them to distributors. It enables trading partners to create and process 835 and 837 claims for Medicare, Medicaid, CHIP, and the Health Insurance Marketplace. Additionally, it involves updating EDI transactions from HIPAA 4010 to 5010 and participating in full SDLC implementations.

Responsibilities

Performed analysis of the FACETS claims processing system and gathered requirements to comply with HIPAA 5010 requirements.

Assisted in JAD sessions to identify business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set, and Identifier aspects of HIPAA.

Managed the company's EDI catalog for prospective EDI customers and gathered the Requirements for Medicare Systems.

Conducted data quality checks using Azure Databricks SQL for validation of provider enrollment, NPI mappings, and claim adjudication logic.

Partnered with reporting teams to publish Power BI reports sourced from Azure Synapse Analytics for compliance monitoring and CMS regulatory reporting.

Developed Tableau and Power BI reports sourced from Azure Synapse Analytics to monitor claims adjudication, provider performance, and CMS regulatory metrics.

Contributed to enterprise-wide Data Governance initiatives by documenting data ownership, creating business glossaries, and defining data quality rules for FACETS and provider systems.

Analyzed FACETS Provider tables to validate provider setup, specialty codes, and NPI/Taxonomy mappings for compliance with HIPAA 5010 standards.

Utilized expertise in Health Care Information, UML systems, and EMR models to create proposed workflows using MS Visio.

Creating reports and dashboards using Epic Clarity data on Ambulatory data, ED Department Data and Billing Data Using SAP Business Objects Tools

Maintained up-to-date documentation of data flows and system dependencies within the FACETS ecosystem, streamlining knowledge transfer across teams.

Worked on PBM, NCPDP, Specialty Pharmacy, COB, etc., including Mail Order Pharmacy

Obtained roles quickly, and my acumen enabled me to hold high-level positions and continue my career success in these areas: Financial Services, Insurance, Pharmaceutical, Healthcare, and Communications.

Responsible for checking member eligibility, provider enrollment, and member enrollment for Medicaid and Medicare claims.

Hands-on learning with different ETL tools to get data in shape, where it could be connected to Tableau through Tableau Data Extract. Worked with SQL Server and Oracle databases to get the data into Hadoop.

Conducted Gap Analysis to compare "AS-IS" and "TO-BE" states, collaborating closely with the data analytics team across different regions.

Worked in Agile Methodology, worked on all phases of the software development life cycle to build the different phases of the Software development life cycle.

Orchestrated conference calls and JAD sessions between developers and business SMEs to implement system design changes using various diagrams and models.

Facilitated daily scrum meetings and stand-offs–collaborated with cross-functional teams to exceed delivery targets by 20%.

I am the Liaison between departments such as Accounting, Pharmacy Operations, and Clinical Pharmacy and worked extensively on PBMS, coordination of benefits, Mail Order Pharmacy as required.

Leveraged SQL joins effectively to merge data from multiple tables, ensuring accurate retrieval by establishing necessary relationships.

Employed UML Methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, State Diagrams, Activity Diagrams, and Business Processes, and workflows.

Involved in conducting Functionality testing, Integration testing, Regression testing, and User Acceptance testing (UAT).

Managed and built relationships with clients to build the EDI Benefit enrolment file feed.

Conducted research and fact-finding to analyze business and user needs, incorporating a basic understanding of relevant business processes, systems, and industry requirements.

Gathered requirements for the facets implementation and performed solution analysis.

Facilitate Scrum Ceremonies daily stand-up, backlog grooming, and Retrospective.

Role: Business Analyst Jul 2018-Sep 2020

Client: CVS Texas City, TX

Project: Integrated Health Information Exchange and EMR System

Project description: The project develops an online Health Information Exchange (HIE) and a secure web portal for providers to access patient records. It includes EMR functions, clinical decision support, and cost-control features. The Viewer system tracks medical history and Healthcare Plans and manages Medicare and Medicaid.

Responsibilities

Involved in JAD sessions with SMEs and development teams and documented functional business requirements as product backlogs using JIRA.

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.

Worked with 834 (enrollment), 835 (medical claims payments), 837 (medical claims), 270 (Eligibility Inquiry), 271 (Eligibility Response), 276 (Claim Status), and 277 (claim status response).

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

Created interactive Tableau dashboards for clinical and claims data, improving visibility for compliance teams and healthcare providers.

Supported data governance activities by validating master data in EMR/EHR systems and ensuring accuracy in EDI transactions.

Analyzed patient Electronic Health Records (EHR) and Medical Health Records (EMR) through EPIC systems, creating smart data elements to enhance data processing and analysis.

Re-architected and migrated on-premises SQL data warehouses to AWS cloud-based platforms using AWS-native and third-party tools.

Interacted with Eligibility, Payments, and Enrolment hence analyzing and documenting related business processes.

Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.

Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare - Medicaid, HIPPA, HIX on EPIC software applications

Followed Quintiles System Life-Cycle (SLC) and Computer System Validation (CSV) procedures, as appropriate.

Wrote and maintained technical documentation to specify Electronic Data Capture (EDC) systems, Data Mining, and Data Modeling Activities.

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

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

Worked on multiple development approaches for internally and externally developed applications as well as packaged applications, including incremental, Waterfall, and Agile Scrum.

Responsible for the analysis of the Argus and Regulatory reports.

Involved in working on text mining, social media analytics, natural language processing

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

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

Conducted test 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

Extensively used tools such as Rational Rose, Rational Requisite Pro, UML, MS Visio, MS Project, MS Office, and MS Access.

Role: Business Analyst July 2017- Jul 2018

Client: Omnicell GRAPEVINE, TX

Project: HIPAA-Compliant EHR Integration and Healthcare Data Transformation

Project description: The project's core objective was to innovate Healthcare Technology Services, employing advanced solutions to elevate operational efficiency and patient care. Our emphasis is centered on integrating cutting-edge technology to streamline processes, enhance accessibility, and foster seamless collaboration among healthcare stakeholders, ultimately advancing the healthcare landscape.

Responsibilities:

Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set, and Identifier aspects of HIPAA.

Followed RUP and AGILE Development Methodology and adhered to strict quality standards in requirement gathering.

Worked with HIPAA Compliance and Healthcare Information Technology (HIT) Standards.

ICD 9 - ICD 10 Conversion Project - Worked on the analysis of the ICD 9 - 10 codes conversion Project.

Extracted and validated provider information from FACETS Provider tables for EDI transactions (270/271, 835/837).

Collaborated with clinical and data teams to analyze HEDIS measures, extract relevant patient data, and ensure compliance with NCQA quality reporting standards across Medicaid and Medicare lines of business.

Performed AS-IS and TO-BE analysis between the legacy system and EHR system to recognize the gap.

Crafted UAT Scripts and spearheaded quality assurance for both the HL7 ADT interface and the application, ensuring seamless testing and validation.

Customized EHR and EDR devices and converted the requirements into Business Requirements Documents (BRD) and Functional Requirements Documents (FRD) as per the client’s requirements.

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

Implemented new services and programs via MMIS for the Medicaid Program by directly interfacing with the customer and the system engineers regularly.

Developed business process models in Waterfall to document existing and future business processes.

Worked to implement software development projects using methodologies such as Waterfall and RUP.

Performed SQL Queries and PL/SQL stored procedures on the database to extract data.

Figured out the requirement of training in various departments of the hospital based on their daily work.

Created test schedules for the complete system testing and oversaw the implementation of the new EHR.

Acted as a liaison between Business and IT throughout all phases of SDLC.

Wrote complex SQL Queries to extract and validate the data from the Facets database.

Created the Epics, User Stories, and acceptance criteria in JIRA and uploaded them in confluence for group collaboration.

Performed Analysis on Data Mapping between different data models.

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