Summary
Overview
Work History
Education
Skills
Personal Information
Timeline
BusinessAnalyst
Dhruv Bindra

Dhruv Bindra

Systems Analyst
San Diego,CA

Summary

Senior Business Systems Analyst and Product Manager with over 14 years of experience across all phases of the Software Development Life Cycle, including requirements elicitation, analysis, development, testing, client delivery, and project management. I have extensive experience in leading project implementations, managing client expectations and large books of business, particularly within the healthcare domain. I have a strong background working with Federal, CMS, and State healthcare regulations, ensuring end-to-end compliance in all initiatives. As a skilled Agile practitioner, I facilitate daily stand-ups, remove blockers, track sprint progress, and promote continuous improvement to drive efficient and high-quality project delivery. I have led the planning, execution, and deployment of healthcare systems, focusing on seamless systems integration, stakeholder coordination, and successful delivery within scope, budget, and timelines. My expertise spans business and technical documentation, test case development, defect and change management, user training, and post-implementation support.

Overview

15
15
years of professional experience

Work History

Sr. Business Systems Analyst

UCare
01.2023 - Current
  • Worked in a cross-functional environment with Claims, Operations, Data Engineering, Analytics and Reporting teams to identify project scopes & business requirements and opportunities.
  • Facilitate Scrum ceremonies (Sprint Planning, Daily Stand-ups, Sprint Reviews, and Retrospectives).
  • Worked extensively on EDI 837, 835 and NCPDP.
  • Worked on analyzing data using SQL for source/target mappings and created clear mapping documents with business rules.
  • Used Jira to document user stories, logging and tracking of defects, and reporting.
  • Developed project plans for all engineering changes and tracked progress to schedule and budget.
  • Collaborated with Product Owners to refine and prioritize the product backlog for health insurance projects.
  • Developed and maintained ETL (Extract, Transform, Load) processes for data migration between legacy systems and modern platforms.
  • Worked with tools like Informatica to manage data exchange and mapping.
  • Responsible for stakeholder management through executive communications on roadmap, progress, risks etc. through periodic updates and business reviews.
  • Highly familiar with pharmacy claims workflows, adjudication rules, prior authorization (PA) processes, and rejection codes based on NCPDP guidelines.
  • Played a lead role in investigating claim, accumulator, eligibility discrepancies and provided technical fix through file loads.

Client Services – Systems Analyst IV

MedImpact
San Diego
05.2014 - 11.2022
  • Company Overview: MedImpact is one of the leading Pharmacy Benefit Management System covering over 35 million members. The company provides PBM services to major private payers, Medicaid, self-insured groups and other healthcare entities.
  • Worked in a very client centric and data intensive role. Highly familiar with regulations and CMS compliances pertaining to Medicare Part D.
  • Work closely with 30+ external data vendors to manage data exchange process for member eligibility, accumulators and claims.
  • Implemented and managed 15+ MCO and SI clients for project implementation, data exchange, maintenance of book of business and system enhancements.
  • Led implementation meetings with clients for plan design, member enrollment, data loads (eligibility, claims PAs, accumulators) and benefit configuration.
  • Highly proficient in SQL for business analysis and client reporting.
  • Extensive experience with JIRA, Salesforce, and Confluence for various aspects of project management and client delivery.
  • Worked on Informatica for file/data exchange.
  • Created specifications for the development team to create custom conversion programs for data exchange.
  • Performed and improved formulary, benefit coverage, and DUR (Drug Utilization Review) workflows for healthcare clients.
  • Led meetings for gathering business and technical specifications for data exchange, file management and system integration.
  • Extensive experience in SQL reporting supports internal and external (CMS) audits. Facilitated with independent TPAs to support audits.
  • Extensively used Salesforce and QuickBase for maintenance of business purposes.
  • Facilitated File Spec meetings for file version upgrades and modifications.
  • Managed member accumulation, eligibility modification and benefit change Service Requests.
  • Gained extensive experience with Medicare Part D, commercial plans and Self-Insured groups.
  • Worked with multiple internal file formats for claims, membership, plan design and formulary.
  • Used Informatica for inbound and outbound file transfers.
  • MedImpact is one of the leading Pharmacy Benefit Management System covering over 35 million members. The company provides PBM services to major private payers, Medicaid, self-insured groups and other healthcare entities.

Sr. Applications Analyst

Sutter Health
Rancho Cordova
08.2012 - 05.2014
  • Company Overview: Sutter Health is one of the leading Health care providers in Northern California serving over 100 communities in the Bay Area, Central Valley and Sac-Sierra region.
  • The project involved implementing the EHR (Electronic Health Records) system as part of the Federal regulation. The project was mostly focused on integrating the current Revenue Cycle and other Clinical applications to the Epic system.
  • Drafted Business Requirements and Rules for the Epic Integration project.
  • Prepared diagrammatic representations such as Process Flows, Business Modeling and Swim Lanes in MS Visio.
  • Performed UAT for various Revenue cycle applications (Clinical & Non-Clinical) during regional cutovers.
  • Gained extensive experience with Inter Organizational patient transfer application Central Logic.
  • Managed MS SharePoint regarding document change control, version control and task allocation.
  • Facilitated JAD sessions and drafted high level clinical process workflows in conjunction with the nursing team.
  • Developed the Business Process Model for the clinical workflow between the new system (Epic) and other clinical applications.
  • Provided on-site support in various Sutter hospital sites of Sutter during implementations.
  • Worked closely with the medical practitioners and drafted new process model for procedure and diagnosis charging in a clinical setting.
  • Acute knowledge in performing HL7 validation, unit, integrated testing for multiple downstream applications.
  • Assisted in supporting patient payment system, by performing root cause analysis for issues and resolving interruptions of service and communicating to customer base.
  • Resolved time critical tickets for the clinical staff in the ED department using LYNX E point application.
  • Gained expertise in integration testing of LYNX applications with Epic system.
  • Sutter Health is one of the leading Health care providers in Northern California serving over 100 communities in the Bay Area, Central Valley and Sac-Sierra region.

Sr. Business Analyst/ QA Analyst

ACS-Xerox
Sacramento
07.2011 - 07.2012
  • Company Overview: ACS, A Xerox Co., is a leading software consulting firm actively developing the Healthcare mandates for the California Medicaid system.
  • The project involved working on the HIPAA 4010 to 5010 conversion, CORE certification and ICD 10 for the existing system. It included working on the major EDI transactions as per the current CA-MMIS architecture.
  • Developed the Business requirements for all the major claims transactions such as 837I/P and 835.
  • Worked closely with the development team regarding the technical and design aspects of the HIPAA 5010 project.
  • Worked extensively on MS SharePoint regarding the document change control and task allocation.
  • Gained extensive experience with various tools and platforms such as Rational Quality Manager (RQM), Clear Quest (CQ) and DOORS among others.
  • Facilitated Defect Management, Change Control and Testing update meetings daily.
  • Actively participated in Change Management of the requirements and other specifications.
  • Gained extensive experience with IBM Mainframe and all the major components of the system.
  • Worked on various new screens and reports for IBM Mainframe due to ICD 10 Enhancement.
  • Worked actively with the developers and the QAs for Defect Management during the testing phase.
  • Worked with SQL for Data Extraction during File Compare process in ICD 9 Prod VS ICD 10 test environment.
  • Worked extensively with MS Visio for Business Process Modeling.
  • Worked extensively on test data manipulation of X12 format on tools such as EDIFECS and Slick Edit.
  • ACS, A Xerox Co., is a leading software consulting firm actively developing the Healthcare mandates for the California Medicaid system.

Requirements Analyst/ Business Systems Analyst

Excellus Blue Cross Blue Shield
Rochester
06.2010 - 07.2011
  • Company Overview: Excellus BCBS is the leading healthcare insurer in upstate New York.
  • The project Health Care Reform involved making all the changes within the corporation as per the legislation to be following HCR. Other responsibilities involved working on projects such as ICD 9 to ICD 10 transition and Medicaid Third Party Health Insurance Feed projects.
  • Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
  • Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR.
  • I interacted with senior business teams and legal firms to gather and analyze requirements.
  • Worked with the Customer Care department to document the User Guides and Corporate Communications regarding policies and products.
  • Extensively used Requisite Pro and other Rational tools for Requirements Management and their traceability.
  • Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio pertaining to various provisions of HCR.
  • Gained extensive experience regarding all phases of Requirements Management and Change Control for various projects.
  • Ensured legal compliance of the corporation regarding the mandates of the Federal and State regulations.
  • Worked extensively on all the mandated first-phase provisions of Health Care Reform.
  • Gathered and documented functional requirements pertaining to Facets and other legacy systems such as LRSP, TOPPS and MABIL.
  • Gained extensive experience related to various product lines and impact on the respective products due to HCR.
  • Worked on the modification of Pricing Modeler of the various systems.
  • I gained extensive experience with medical codes and the change of benefits regarding various products.
  • Attended training sessions for the latest versions of existing Rational tools such as Rational Requisite Pro 7.1.1, Rational Quality Manager and Rational ClearQuest 7.1.1.
  • Excellus BCBS is the leading healthcare insurer in upstate New York.

Business Systems Analyst

Ingenix Connectivity Solutions, United Health Group
12.2009 - 05.2010
  • Developed Process Flows, Data Flow Diagrams and Swim lanes for various clinical areas of the project.
  • Responsible for creating and reviewing business requirements, functional specifications, project schedules, documentation and test plans for several clinical applications.
  • Responsible for requirement and design documentation review, test plans, identifying and reporting software anomalies and test results.
  • Developed test scenarios and implemented test plan. Providing key input in working with users in defining project and system requirements.
  • SCRUM principle was used in acute functionalities to design, document and manage requirements throughout the lifecycle of the project, i.e. definition, design and testing phases.
  • Performed gap analysis ‘Effect on CMS-1500 by 837P HIPAA 5010’ and recommended the user interface changes.
  • Created UAT, Integration test scenarios for various EDI transactions.
  • Performed testing of various EDI transactions related to HIPAA 5011 for future implementation.
  • Prepared structural difference report for transactions regarding the affected elements of the transactions.

Education

PG Diploma - Software Engineering

AIT
01.2008

BE - Electronics Engineering

University of Pune
01.2007

Skills

  • JIRA
  • EDI transactions (837,835, 270,271)
  • Agile
  • SQL
  • HL7
  • Requirements Elicitation
  • Informatica
  • NCPDP
  • Software Testing & Validation
  • UNIX
  • EHR
  • Client Management
  • Salesforce
  • PBM
  • Ad-hoc reporting

Personal Information

Work Permit: Eligible to work for any employer in the USA

Timeline

Sr. Business Systems Analyst

UCare
01.2023 - Current

Client Services – Systems Analyst IV

MedImpact
05.2014 - 11.2022

Sr. Applications Analyst

Sutter Health
08.2012 - 05.2014

Sr. Business Analyst/ QA Analyst

ACS-Xerox
07.2011 - 07.2012

Requirements Analyst/ Business Systems Analyst

Excellus Blue Cross Blue Shield
06.2010 - 07.2011

Business Systems Analyst

Ingenix Connectivity Solutions, United Health Group
12.2009 - 05.2010

PG Diploma - Software Engineering

AIT

BE - Electronics Engineering

University of Pune

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