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Vamsi Krishna - Business Analyst

[email protected]

Location: Rocky Hill, Connecticut, USA

Relocation: Yes

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Resume file: Krishna K BA_1767795450740.docx Please check the file(s) for viruses. Files are checked manually and then made available for download.

Krishna K Email: [email protected] Ph no: 415-286-5154 PROFESSIONAL SUMMARY Around 9 years of experience as a Business & Data Analyst in Healthcare Industry with proven expertise in EMR data migration, integration of EDI transactions and ensuring compliance with healthcare regulations. Extensively worked on gathering, defining, and analyzing requirements, creating documentation, communicating with the business team, and identifying areas for improvement and change management. Proficient in utilizing ICD-9, ICD-10, LOINC, SNOMED, HL7, CMS, Health Assessment Systems, and HL7 Standards. Well-versed in HIPAA, HITECH, HIE, and FHIR regulations. Collaborated cross-functionally to customize EMR workflows, tailoring solutions to meet departmental needs while optimizing system functionality and user experience. Analyzed Medicare and Medicaid reimbursement practices and made recommendations, which helped healthcare organizations operate more effectively and spend less money. Worked on Claims insurance experience with emphasis on personal lines and business owner s lines. Experienced working on EDI Transactions like EDI 835(Medical Claims Payment), EDI 837(Medical Claims Submission) and EDI 270(Eligibility Inquiry), EDI data mapping and migration. Maintained knowledge of diagnostic coding conventions such as ICD-9-CM and ICD-10-CM. Worked on Cerner applications for Citrix Workspace and Relay to process claims and charge for medical services under CMS (1500) and uniform billing (UB04). Involved in all phases of the Software Development Life Cycle (SDLC)and created use case diagrams, process flow diagrams, and AS-IS diagrams. Experience in gathering functional and non-functional requirements and preparing Business Requirements Documents (BRDs). Experienced in multiple SDLC models, including Waterfall and Agile methodologies, and created user stories using the JIRA tool. Proven ability to write detailed user stories and use cases that capture all necessary requirements and provide a clear vision for the development team. Developing test cases and conducting user acceptance testing to validate that the requirements are being met. Experienced in preparing, traceability matrix and technical documentation that meet the requirements of the stakeholders. Experienced in collaborating with the business team and development teams and acting as a bridge. Extensive experience in preparing Data Dictionaries, technical documentation, and source-to-target data mapping document. Experienced in conducting JAD sessions and interviews with the business team and tech team. Extensive Expertise in transforming business requirements into technical specifications to be used by the technical team. Developed data mapping strategies to identify and define relationships between data elements in different EHR systems, ensuring data consistency and interoperability. Designed and executed data migration plans, coordinating with technical teams to extract, transform, and load data while maintaining data integrity and minimizing downtime. Experienced working with Data Bricks, Informatica, SSIS for data transformation, extraction, and in-depth analysis. Optimized ETL workflows and performance by implementing Teradata specific techniques, such as partitioning, indexing, and query optimization, resulting in improved data processing speed and efficiency. Created queries, executed reports, conducted extensive manipulation, and analyzed large-scale datasets employing a diverse set of tools, including SQL Server, MySQL, SQL Server Integration Services (SSIS), Oracle SQL, Access, Excel, Tableau, and Power BI. Developed complex SQL queries, stored procedures, and triggers to automate routine data tasks, enhancing data accuracy and efficiency across the organization. Collaborated with cross-functional teams to gather requirements, design data models, and ensure seamless integration of new data systems with existing healthcare platforms. Used complex SQL queries to create UMT tables, aggregate tables and create Trend reports, Pivot, and List reports. Created and maintained reports using SQL Server Reporting Services (SSRS) to improve data visibility. Proficient in designing star and snowflake schemas for effective data modeling, and proficiently utilized the JIRA tool to formulate user stories. Worked extensively on DML, DDL, and DCL statements, and worked on complex SQL queries such as joins (inner joins, left outer joins, right outer joins, and self joins). Worked with T-SQL, Python, XML, JSON scripting to scrape data from multiple sources. Worked with Azure data bricks to speed up the preparation of high-quality data. Defined and tracked key performance indicators (KPIs) for RPM initiatives, developing interactive dashboards and reports in Power BI and Tableau to monitor patient health metrics and program effectiveness. Designed and executed ETL processes for healthcare data migration across Cloud and Traditional databases using AWS, GCP, and Azure. TECHNICAL SKILLS: SDLC methodologies: Agile, Scrum, Kanban Computer Language: SQL, Python, R. Cloud: Snowflake, Azure, AWS, Google, Databricks. Visualization tools: Tableau, Power BI, Excel, RStudio. Database: SQL server, Oracle, MS Access, MYSQL. MS Office Suite: MS Office, Outlook, Word, PowerPoint, MS Visio Tools: Jira, Azure Devops, Informatica, Knime. PROFESSIONAL EXPERIENCE: Cigna, Bloomfield CT. May 2022 - Present Role: Senior Business/Data Analyst Responsibilities: Orchestrated the integration of HL7 interfaces to facilitate seamless data exchange between the new EHR system and external healthcare systems, ensuring interoperability. Designed and developed Fast Healthcare Interoperability Resources (FHIR) APIs to enable secure and standardized data exchange between the EHR system and third-party applications. Ensured that the EHR system complied with Medicare and Medicaid regulations, including Meaningful Use requirements, to qualify for incentive programs and avoid penalties. Led the enhancement of claims processing functionalities within the EHR system, improving accuracy and efficiency in submitting and adjudicating healthcare claims. Utilized expertise in International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding systems to ensure accurate coding and billing practices within the EHR system. Ensured compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations for data privacy and security during HL7 and FHIR implementations. Documented HL7 and FHIR implementation processes, including interface specifications, mapping documents, and testing procedures. Optimized revenue cycle management processes within the EHR to streamline billing, coding, and claims processing, improving financial performance. Conducted data mapping exercises to align clinical and financial data fields for claims submission and processing within the EHR system. Monitored and analyzed patient outcomes using EHR data to identify trends, measure the impact of interventions, and improve overall care quality. Facilitated backlog grooming sessions with the Scrum team to ensure that user stories and use cases are well-defined and ready for development. Worked closely with stakeholders to understand their needs, prioritize requirements, and make changes to the project as necessary using Agile methodology. Gathered functional and non-functional requirements and managed business requirement documents (BRD). Created use case diagrams and Created user stories using JIRA in accordance with the FRD. Worked closely with IT teams to resolve technical issues and ensure successful integration with other systems using JIRA for issue tracking. Managed HHSDC network operations, ensuring high availability and security of network resources. Participated in PMO activities, contributing to project planning, execution, and monitoring. Ensured secure and reliable data transfer using industry-standard protocols and encryption methods. Developed data models in Excel to analyze and visualize pre-implementation performance metrics and project goals. Mapped existing clinical and administrative workflows using Visio to identify areas of improvement. Designed optimized workflows in Visio to ensure seamless integration with the new EHR system. Oversaw the data migration process, ensuring data integrity and accuracy using ETL (Extract, Transform, Load) tools. Wrote complex SQL queries to extract, transform, and load (ETL) data from legacy systems into the new EHR system. Created ETL pipelines using Python to automate the data migration process and reduce manual intervention. Created Python scripts to automate data validation processes, ensuring data accuracy and integrity during migration. Coached and mentored team members on Agile principles and practices, fostering a culture of continuous learning and improvement. Adapted Agile methodologies to fit the specific needs of projects, resulting in a 15% reduction in delivery time without compromising quality. Facilitated conflict resolution and problem-solving within Agile teams, promoting a collaborative and efficient working environment. Conducted Agile training sessions for new team members and stakeholders, ensuring a consistent understanding and application of Agile methodologies across the organization. Applied SQL performance tuning techniques to optimize the database for faster query execution and reporting. Managed and optimized large-scale databases in Oracle and MS SQL Server, ensuring high availability, data consistency, and efficient querying for mission-critical applications. Developed and maintained complex SQL queries, stored procedures, and triggers to support data management requirements for various systems, including those handling enrollment processes. Conducted performance tuning and optimization of Oracle and MS SQL databases, improving query execution times and system response for business-critical operations. Led the business analysis and requirements gathering for streamlining the Enrollment Life Cycle, improving the onboarding process for members, ensuring timely enrollment updates, and reducing manual processing. Collaborated with cross-functional teams to enhance the enrollment and eligibility verification processes, ensuring compliance with industry standards such as HIPAA and improving data accuracy. Designed workflows for the Enrollment Life Cycle, automating critical stages such as application submission, verification, and approval, reducing processing time and improving member experience. Utilized CI/CD pipelines to automate testing, integration, and deployment processes, significantly improving the efficiency and quality of software releases. Facilitated sprint planning, daily stand-ups, and retrospectives, ensuring continuous improvement and timely delivery of features related to the Enrollment Life Cycle and database systems. Integrated automated testing into the CI/CD pipeline, ensuring comprehensive test coverage and early identification of bugs, leading to more stable and reliable deployments. Set up and configured a Snowflake data warehouse to handle large-scale data integration and analytics for the EHR system. Designed and deployed interactive dashboards in Power BI to monitor real-time project progress and key performance indicators (KPIs). Environment: ETL, SQL, SAS, EPIC, EDI, QNXT, PHI, EMR, Teradata, Snowflake schema, Power BI, Tableau, AWS and Databricks Blue Cross Blue Shield, Detroit, MI. Jan 2020 - Feb 2022 Senior Business/Data Analyst Responsibilities: Ensured compliance with HIPAA regulations in medication reconciliation processes to protect patient privacy and security of health information. Implemented HITECH requirements in medication reconciliation initiatives to promote the adoption and meaningful use of electronic health records (EHRs). Led cross-functional teams to implement medication reconciliation initiatives, ensuring compliance with regulatory standards such as CMS requirements. Integrated HL7 standards for interoperability between healthcare systems, facilitating the exchange of medication information during reconciliation processes. Utilized FHIR standards to enable secure and efficient exchange of medication data across different healthcare IT systems and applications. Applied coding standards (like ICD-10, CPT) in medication reconciliation documentation to ensure accurate billing and reimbursement processes. Integrated medication reconciliation processes within EMR/EHR systems to enhance accuracy and accessibility of patient medication information. Data that has been verified in accordance with HITECH, EDI, PHI, and HIPAA regulations. Worked based on waterfall methodology and coordinated with other teams. Worked with Agile methodologies, such as Scrum and Sprint, to efficiently manage timelines, budgets, and resources, ensuring high-quality outcomes in the analysis of clinical trial data. Collaborated in the creation of a user interface and development of a data model by gathering comprehensive requirements within an agile software development life cycle (SDLC) framework. Leveraged Jira as a tool to log, track, and resolve data-related issues, while collaborating with the team to prioritize tasks and meet project deadlines. Experience in conducting sprint reviews with stakeholders to demonstrate completed user stories and use cases and gather feedback for continuous improvement. Created and managed business requirement documents (BRDs), functional and nonfunctional requirement documents, and worked closely with stakeholders to understand their needs and ensure that requirements were clearly defined. Created User Stories and User Acceptance criteria in Confluence to capture the requirements and expectations of stakeholders. Collaborated with the IT team to implement data management solutions, ensuring data accuracy and security. Expertly employed MS Visio to create detailed process flowcharts and diagrams, enhancing project visualization and understanding. Extensive experience in preparing data dictionary documents, data definition documents, and Source-target mapping documents. Performed data mining using SQL queries to identify patterns and trends in the data. Conducted data transformation on the extracted data and executed file processing tasks by structuring and organizing the data using MySQL. Designed and executed SQL scripts to normalize and restructure client data elements according to company standards. Utilized a Python script to load the extracted information into the database. Led Agile transformation initiatives that successfully transitioned teams from Waterfall to Agile, resulting in a 25% increase in productivity and faster time-to-market. Designed and implemented Agile training programs for teams and stakeholders, enhancing their understanding and adoption of Agile practices. Utilized Agile tools such as JIRA and Confluence to manage workflows, track progress, and ensure transparency within the team. Conducted detailed requirements gathering sessions with stakeholders to understand their needs and translate them into QNXT system specifications. Implemented system enhancements to handle complex enrollment scenarios, including multi-tier eligibility, open enrollment periods, and real-time member status updates. Monitored and maintained the integrity of enrollment data, ensuring that the systems provided real-time, accurate enrollment information across different platforms. Analyzed business processes and workflows to identify opportunities for automation and optimization using QNXT. Generated a data mapping document by establishing connections between data points across various tables, utilizing an ETL (Extract, Transform, and Load) tool to facilitate the process. Automated data extraction and Data migration from the old legacy system to the new system were accomplished using ETL tools like AWS glue. Collaborated with DBAs to design and implement data migration strategies between Oracle and MS SQL environments, ensuring data integrity and minimizing system downtime. Designed relational database schemas to support scalable and robust applications, adhering to best practices for normalization, indexing, and data storage. Played a key role in executing projects using Agile methodology, working closely with development and operations teams to deliver frequent and incremental updates for business applications. Developed an interactive dashboard leveraging Power BI visualization capabilities to effectively communicate with stakeholders. Developed interactive dashboards and reports using Power BI to effectively communicate insights and outcomes to stakeholders across all levels of the organization. Employed Power BI and Tableau to create interactive dashboards, charting trends in enrollment, costs, and utilization by various demographics, diagnosis categories, service types, and geographic regions. Environment: SQL, QNXT, HIPAA, HL7, MS AZURE, ORACLE DB, POWER BI, TABLEAU, MS ACCESS. State of New York, Albany NY. Apr 2017 Nov 2019 Role: Business Analyst Responsibilities: Created process models, and revised the business requirement document (BRD), Use Case Diagrams and flow charts to support Product Owners to identify Functional Requirement Specifications (FRS). Conducted Gap Analysis, Root Cause Analysis, and Impact Analysis to identify discrepancies, underlying issues, and assess the consequences, enabling informed decision-making. Data that has been verified in accordance with HITECH, EDI, PHI, and HIPAA regulations. Worked closely with emergency response personnel to ensure seamless integration and usability. Experienced in working and designing Clinical Decision support systems. Participated in user acceptance testing (UAT) and quality assurance (QA) testing to ensure functionality. Experience working in Agile development environments, participating in Scrum meetings, and working closely with development teams. Created use cases to describe how a user uses the system to achieve the goals from an end-user perspective. Worked on user acceptance test cases and user testing observed whether a product was right for the end users. Worked on a data mapping document by connecting data fields from one source to another. Implemented stringent data security measures to ensure patient confidentiality and compliance with healthcare regulations. Led the development and implementation of data governance frameworks and policies tailored to the healthcare industry, ensuring data accuracy, security, and compliance with regulations by HIPAA. Developed and generated regular reports showcasing the impact of the clinical support decision system on patient outcomes, workflow efficiency, and resource allocation. Conducted regular meetings to gather feedback and align technical developments with clinical needs. Utilized advanced data analytics tools Python and SQL to extract meaningful insights and trends, contributing to evidence-based decision-making for clinicians. Utilized Python to explore and analyze large datasets, identify patterns, and generate visualizations for data-driven insights. Excelled in Data manipulation and Data transformation using Microsoft Excel, developed SharePoint-based workflows. Developed and maintained automated ETL workflows using informatica for scheduling and monitoring data pipelines. Used Python on Microsoft Azure Databricks to perform advanced data analysis. And managed and maintained data lake architecture on Snowflake. Led the implementation and configuration of QNXT systems, ensuring alignment with business requirements and operational goals. Customized QNXT modules to meet specific client needs, including claims processing, member management, and provider management. Created and maintained data mappings, data dictionaries, and data definitions to ensure accurate and consistent interpretation and usage of data across business systems and processes. Utilized tools like Tableau, and Power BI in conjunction with Excel and Access to create interactive healthcare dashboards and reports for better decision-making. Analyzed patient data using tools such as SQL and Python to insight the trends and visualized reports to stakeholders using Tableau and Power BI. Environment: SQL SERVER, TABLEAU, Power BI, MS EXCEL United Health Care, MN. Sep 2015 - Feb 2017 Role: Junior Business Analyst Responsibilities: Collected and organized large amounts of pharmaceutical data and healthcare data from various sources. Responsible for claim processing in Medicare, Medicaid, and private health plans for submission for Online Transaction Processing (OLTP). Developed predictive models and algorithms to support personalized patient care. Analyzing input FHIR resource files and performed mapping FHIR resources to output data domain flat files and worked on FHIR resource validation. Extensively used Python to extract the data and did basic exploring of the data. Responsible for data mapping the diagnostic codes and treatment codes with ICD-9, ICD-10. Conducted thorough analysis of healthcare workflows, identifying inefficiencies and bottlenecks through comprehensive business process mapping. Led the implementation of the UnitedHealthcare Provider Portal, improving claims processing accuracy and speed through advanced digital tools and EDI capabilities. Extract, transform, and load large volumes of raw, complex pharmaceutical data from various sources. Ensured compliance with healthcare data standards and regulations, including HIPAA and HITECH. Analyzed the Product Benefits Management (PBM) and other systems for medication benefit quality and accuracy. Validated the accuracy of the EHR pharmacy data. Gathered and managed business requirements document for clinical and operational initiatives using a combination of interviews, workshops, and stakeholder engagement. Applied Agile Scrum methodologies to ensure iterative and collaborative approaches for enhanced project flexibility. Worked on creating a user interface and developing a data model by gathering all requirements in agile SDLC. Worked on functional and non-functional requirements of the project and documented them. Created a data mapping document by linking data points in different tables using the ETL tool. Worked on user acceptance test cases and observed whether a product was right for the end users. Coordinated and conducted UAT sessions with healthcare end-users to validate that systems and processes met their needs and expectations. Calculate and analyze vaccine data for provider incentive and supplemental benefit analysis using Microsoft Access and Oracle SQL. Developed and implemented SQL script to normalize and reformat client data elements into company standards. Used SQL joins and subqueries to simplify complex queries involving multiple tables. Created interactive dashboards and reports using Power BI to communicate insights and results to stakeholders at all levels of the organization. Worked closely with technical teams to assess data migration requirements from Oracle DB to MS Azure cloud platform following ETL processes. Environment: SQL, MS AZURE, ORACLE DB, POWER BI, AGILE SDLC, MS ACCESS. EDUCATION: BSC in computer science - 2015. 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