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Keerthi - Healthcare Business Analyst

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Keerthi Athyam Email: [email protected] Phone: 215-346-6358 Current location: Lutz, Florida, 33558 Summary: Senio BSA/Healthcare Business Analyst with 8+ years of experience in Healthcare, Medicare and Pharma domain helped business with the Design, Implementation and Delivery of Salesforce.com platform. Experienced in professional business settings, serving internal and external clients. CPQ, FSL (Field Service Lightning), Service Expertise in configuring and customizing Salesforce CPQ solutions to enhance care management processes, with a focus on improving member engagement and case management efficiency. Proficient in integrating diverse vendor services into Salesforce Health Cloud, ensuring seamless data flow and functionality for optimized care management. Excellent experience in highly regulated enterprise model of Clinical Trial Management System (CTMS), Inventory Management Systems and EQMS (Track wise). Strong understanding of various SDLC methodologies such as Waterfall and Agile with hands on experience in all of them. Involved in Care Management and Disease Management projects. Extensive experience in conducting Market Research, Feasibility Studies, Data Analyses, Data Mapping Gap Analyses, Risk Identification, Risk Assessment, Risks Analyses, and Risk management Knowledge about Pharmaceutical/Medical device regulations like FDA: 21 CFR Part 11, 21 CFR Part 58, 21 CFR Part 210, 21 CFR Part 211 and 21 CFR Part 820. Implemented and configured EHR systems (e.g., Epic, Cerner, Meditech) for healthcare providers. Knowledge and experience in working with GxP suites: GLP, GMP, GCP, GAMP 4 and GAMP5 Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements. Well experienced in validating Labware LIMS & SQL*LIMS Worked extensively on Requirements Gathering, Gap Analysis, Business Process Reengineering, and development of functional specification for Enterprise software development companies. Business writing skills in writing Business documents such as, Use-Case Specifications, FRS, SDS, and SRS. Experienced in Agile Methodologies, Scrum Principles and worked in Atlassian project management and testing tools (JIRA, Confluence). Experience with ICD 9 to ICD 10 upgrades, 4010 to 5010 conversions and worked on HIPAA X12 EDI transaction codes, Strong knowledge of Medicaid, Medicare (Part A, B, C, D), Procedural and Diagnostic codes and Claims Process chiefly concentrated on the Medicare & Medicaid Eligibility/Enrolment Criteria. Strong knowledge of Coordination of Benefits (COB), HL7 Standards, HIX, EHR - Electronic Health Records, EMR - Electronic Medical Records, CMS regulations, Health Care Reform, EMTALA, PPO, POS, SCHIP, SNAP, TANF, MCOs and HMO. Strong working knowledge of Medicaid Management Information Systems (MMIS) and its various subsystems like Members, Providers, Claims, Managed Care, etc. Experience in both Waterfall model and Agile Methodology (Scrum) including Behavior Driven Development (BDD). Hands on experience on configuring and administering features available on Health Cloud, Marketing Cloud (Exact Target), Pardot, Service Cloud, Sales Cloud. Experienced in performing software Requirements Traceability matrix using JIRA and Confluence. Skill Matrix Skill Experience Skill Level Sr. Business Analyst/BSA 8 Years Expert Healthcare, Medicaid & Medicare, Pharma 7+ Years Proficient Salesforce, CRM, Payers and Provider, Field Service Lightning, EDI, LIMS, CTMS, Clinical, EMR, EHR HL7, FHIR, Claims Processing, Clinical, Crae Management 5+ years Proficient Sales, Service Cloud, Health Cloud, Marketing Cloud, API, CPQ 4+ years Proficient Requirements Documentation (BRD), FRD 7 +Years Expert System Design Documentation (SRS) 6 +Years Expert Scrum, Jira, SQL, Agile, Waterfall, JAD sessions 6+ Years Expert SQL, ETL, UAT, Data Mapping 5+ Years Expert Technical Skills: Methodologies UML, SDLC, Agile, Scrum , SAFe Microsoft Tools MSOffice, MS Visio, MS (Excel, Word, PowerPoint). MS SharePoint. Rational Tools Rational Requisite Pro, Visio, Rational Clear Quest, Rational Rose, Rational Clear Case Internet Technology HTML, AOI, Apex, CSS, Visual force, SOSL, SOQL QA Tools Application life-cycle Management, Unified Functional Testing tool, SOAP UI, Bugzilla, Qtest Operating Systems Windows, UNIX, Linux Salesforce.com (Service Cloud, Sales Cloud, Marketing Cloud, Health Cloud), Non-Profit Success Pack for Salesforce (NPSP) VersionOne, Electronic Medical Records (EMR/HER), Database SQL, MS Access, Oracle Certifications: Salesforce certified Admin, Salesforce PD-1 Education: Bachelor in computer Science Jawaharlal Nehru Technological University Hyderabad - 2014 Professional Experience: Sr. Business Analyst Jun 2024 to Present Agilon Health - Westerville, OH (Remote) Project: Salesforce Health Cloud Enablement for Value-Based Care Operations Agilon health implemented Salesforce to support its value-based care model by unifying physician group acquisition, contracting, onboarding, care operations, and patient engagement on one platform. The solution used Health Cloud as the core care data layer, with Sales Cloud, Service Cloud, Marketing Cloud, CPQ, and API-led integrations to connect payer and EHR ecosystems and enable measurable improvements in operational performance. Responsibilities Gathered business and functional requirements with provider network, clinical operations, payer operations, finance, and IT stakeholders; produced BRD/FRD, workflow documentation, and functional specifications. Facilitated JAD sessions to define end-to-end processes for physician group acquisition, contracting, onboarding, care coordination, and patient engagement; documented as-is/to-be flows and performed gap analysis. Supported implementation of Sales Cloud for physician group acquisition, pipeline management, opportunity lifecycle, and partner relationship tracking. Supported implementation of Service Cloud for practice operations support, case management, task orchestration, escalations, and SLA-based workflows to improve care team productivity and response times. Defined and validated Health Cloud requirements including patient 360, care plans, program enrollment, assessments, care gaps, and longitudinal timelines to improve care coordination visibility. Captured requirements for Marketing Cloud segmentation and journey automation for provider and patient outreach; aligned messaging triggers with clinical and operational events to improve engagement effectiveness. Led requirements for CPQ to support physician group contracting, pricing models, approvals, and document generation; helped reduce contracting cycle time through standardized configurations and automated approvals. Performed data mapping and integration analysis for payer, EHR, identity, and analytics platforms; partnered with integration teams on MuleSoft/API designs, payload definitions, error handling, and reconciliation to establish a scalable integration architecture. Authored user stories with acceptance criteria and story point estimates; managed backlog grooming, sprint planning, and release readiness in an Agile SCRUM environment. Supported Salesforce configuration across standard/custom objects, fields, relationships, validation rules, flows/workflows, and security model (profiles, permission sets, sharing rules) to enforce compliant access and auditing. Collaborated with developers on Apex-based extensions and Health Cloud-specific customization where configuration was insufficient; reviewed technical design impacts against business requirements. Designed and validated operational and executive dashboards and reports for value-based care KPIs (risk, quality measures, utilization, provider productivity), enabling real-time performance tracking and decision support. Owned UAT planning and execution including test scenarios, scripts, defect triage, and stakeholder sign-off; coordinated deployments across environments and supported post-release stabilization to improve adoption and reduce production issues. Sr. Salesforce Business Systems Analyst Apr 2022 to May 2024 Aetna (CVS Health) - Hartford, CT Aetna is the leading health care insurance providers, offering traditional and consumer directed health care insurance and related services. Care Management Systems- CEC (Clinical Engagement Console) is an application utilized by CVS Aetna Clinical Operations for Omni-channel communications and Outbound Engagements. Comprised of three primary applications CEC, ATV, Med compass supporting commercial/Medicare & DSNP lines of business integrated in Salesforce. Responsibilities: Collaborated with the Product Owner and documented high level requirements to capture the end-to-end business need across all impacted systems. Created the Business Requirement Document based on the requirements for a CEC Clinical User to access on Sales Force. Assisted with Clinical Intake requests by documenting scope and assumptions and CEC cost estimates. Created VISIOs for all the Activity Types involved in the Guided workflows of CEC for Commercial, Medicare & Medicaid members using MS Visio and validated flows that were built on Sales Force Health Cloud Created an end-to-end play book on Smarty Streets which is a 3rd party vendor for validating Member addresses. In collaboration with the Product Owner and reporting team drafted reporting requirements for Service Cloud reports that needs to be migrated to Health Cloud Documented the Auto Task and cycle rules for the outbound calls of Medicare Members for CEC. Participated in the ART-Sync meetings to follow up the progress on objectives and features and to identify any impediments. Worked with the impacted cross system BAs to identify cross-system impacts and inter-dependencies. Documented cross-system business attribute and value mappings. Identify appropriate checklist to correlate to the MMIS Subsystems Scheduled and facilitated planning and SMEs to establish rapport and sense of partnership with internal business clients, involving them in project planning, and setting goals. Generated requirements from Feedback (from FA's) / Users' requirements via CRM (SFDC or Salesforce.com) Produced Salesforce reports monitoring group progress. Involved with Salesforce.com Premier Support and handled the support cases with the help salesforce.com support. Coordinated, implemented, and provided on-going support of the Quality Performer as outlined in the Specifications Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS). Excela Health - Greensburg, PA Mar 2021 to Mar 2022 Clinical Business Analyst This project supports Excela Health in improving clinical operations and patient care across its hospitals and outpatient network. The Clinical Business Analyst works with clinical, operational, and IT teams to analyze workflows, optimize EHR systems, and implement process improvements that enhance efficiency, quality, and patient outcomes. Responsibilities: Created Business Requirement Document, analyzed the business requirements to understand the business needs and produced Functional Requirement Document. Working closely with the scrum teams and larger organization on how to get the most out of Agile/Scrum practices Performed scope analysis, impact analysis and GAP analysis Plan new workflows and clinical IT solutions towards health care. Developed and maintained user stories, functional specifications, and process flows for enhancements and integrations involving Veeva systems. Performed risk analysis of the requirements to identify key business areas for the project. Involved in design and development of Clinical Trial Management System (CTMS) integrated with EMR and customized to suit protocols following CDISC, GCP and other CDA and FDA standards. Skilled in using change control and bug tracking tool JIRA for identifying, analyzing, assigning and documenting defects including version and change control. HIPAA EDI transactions of 270/271, 834, FHIR, HL7, Medicaid/MMIS 820, 276/277, 275, 835, 278 and 837 I/P/D, ACT/Obama Care, HIPAA ANSI X 12 4010/5010 , and PBM. Firm understanding of HIPAA regulations and experienced working in all phases of healthcare insurance processing like defining Membership Eligibility and Enrollment and various Medical Claims processing. Effective management of Clinical interop, clinical data using Electronic Medical Records (EMR) and Electronic Health Records (EHR) Involved in FDA regulations particularly 21 CFR part 11 and validation requirements like reporting features, password regulatory rules, password aging and session time-out for the LIMS system Utilized EHR to support population health management, quality improvement, and patient engagement. Created source to target mapping documents from staging area to Data Warehouse/Data Mart. Experience in using Quick Test Professional (QTP) testing for Client /Server, Web and Database Applications. Worked with Cognos and micro strategy reporting systems to extract the data for analysis using filters based on the analysis. Participated in designing & drafting a UAT script for an upgrade of Lab ware LIMS and reviewed the executed test scripts for approval. Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle). Teva Pharmaceuticals - Salt Lake City, UT Jul 2019 to Feb 2021 Validation / Business Analyst The project involved commissioning, qualification and execution of validation protocols for packaging line integrated equipment, including scheduling, communication, and coordination of execution between Manufacturing, Quality, R&D, Production/Operation groups to meet project goals. Effective communication of both technical and non-technical topics with all levels of the organization both verbally and in writing. Validation support activities and Risk Assessment development. Responsibilities Underwent training on user SOP s, site procedures and cGMP policies and procedures Designed testing strategy and developed methodology for the commissioning, qualification and validation of manufacturing equipment, process, cleaning, and Computerized Systems Validation within a GMP environment for equipment including: transdermal fabrication and pouching lines, secondary packaging lines, mixers, bottle and tube fillers (laminate and aluminum tubes), Micro-dose filler (single use nasal spray), label lines (bottles, cartons, cases), and various stand-alone equipment pieces Reviewed and executed validation protocols (IQ, OQ, PQ, Deviations, and Summary Reports) for serialization packaging lines (Line Master and Pharma Proof for bottle, case, carton, and pallet). Designed and authored validation protocols for validating LIMS applications and customizations including databases tables, reports, labelling and barcode systems. Led validation efforts for R&D software applications used in clinical and non-clinical studies, ensuring data integrity and system performance. Assisted with the commissioning support for various manufacturing equipment Performed GAP analysis to ensure compliance with GxP. Assisted in the validation of laboratory systems, electronic data capture (EDC), LIMS, and other R&D applications to support clinical and non-clinical research. Reviewed and drafted Standard Operating Procedures (SOPs) and User Manuals for the equipment and associated software to ensure they meet FDA requirements Involved in the validation of equipment and software associated with the Process and Cleaning Validation for manufacture of non-parenterals and automated filling Maintained Requirement Traceability Matrix (RTM) to track requirements Salesforce Admin Aug 2017 to Dec 2018 Cloudmasonry- Hyderabad Responsibilities Administered and supported Salesforce CRM platform including user management, security settings, profiles, roles, and permission sets. Configured and maintained custom objects, fields, record types, page layouts, and Lightning pages based on business requirements. Designed and implemented automation using Salesforce Flows, Workflow Rules, and Process Builder to streamline business processes. Developed validation rules and data quality controls to ensure accurate and consistent data entry across the organization. Created and maintained reports and dashboards for sales, service, and management teams to support business decision-making. Managed data imports, exports, updates, and backups using Data Loader and Data Import Wizard. Provided day-to-day system support and troubleshooting for Salesforce users across sales and service teams. Configured email templates, assignment rules, auto-response rules, and escalation rules to automate customer communication and case handling. Implemented approval processes for discounts, contracts, and business workflows in compliance with company policies. Supported sandbox management, testing activities, and production deployments for new features and enhancements. Worked closely with business stakeholders to gather requirements and translate them into Salesforce solutions. Coordinated with development teams for system enhancements, integrations, and bug fixes. Created and maintained system documentation, user guides, and training materials. Conducted end-user training sessions and provided ongoing application support. Monitored system performance, platform usage, and security compliance following Salesforce best practices. Keywords: cprogramm quality analyst user interface rlang information technology microsoft mississippi Connecticut Ohio Pennsylvania Utah