Kapil Agarwal
Summary
Results-driven healthcare analyst with 14+ years of experience leading product development teams. Successfully translated complex user requirements into actionable solutions, ensuring stakeholder satisfaction and timely delivery of product features. Adept at fostering collaboration among cross-functional teams to enhance efficiency in the software development lifecycle.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Lead System Analyst/ Acting Product Owner
FEPOC
07.2022 - Current
- Led 12-15 people product development team collaboration and vision toward launching product solutions that are simple, delightful, and impacting.
- Acted as the liaison between product and IT team to understand the customers demand and prioritize the product roadmap.
- Building the Product Backlog and prioritizing the Product Backlog Items (PBI) to reflect Product Vision and deliver Minimum Viable Product (MVP)
- Owned the product roadmap and met 96% of all feature deadlines by identifying and mitigating any roadblocks.
- Fostered open communication between stakeholders and engineering team, enhancing speed and efficiency of feature development lifecycle.
- Promoted product vision, empowered customer value, and ensured end user voice was integral to development process.
- Architected and delivered enterprise-level Cognos reporting solutions for clinical, financial, and operational needs, ensuring HIPAA and data governance compliance.
- Analyzed and documented requirements as user stories and managed the product backlog.
- Creating UML diagrams like Use Case Diagrams and Sequence Flow Diagrams for clear understanding of E2E business flow
- Plan, rationalize and prioritize all product features within Agile environment, provide product specialization.
- Owned and prioritized Cognos BI product backlog, aligning with stakeholders to deliver high-impact, value-driven healthcare reporting features.
- Defined data standards, naming conventions, and data dictionaries, ensuring consistency and quality across all data management processes.
- Conducted Data Analysis and profiling to identify data quality issues and facilitate data cleaning initiatives.
- Ensure compliance with Data Governance policies and procedures during Database Design and Solution.
- Presenting project status to the executives and stakeholders on bi-weekly basis.
- Provided training and guidance to junior/mid-level analysts to enhance their proficiency in utilizing tools, applications. And understanding business process effectively.
- Performed Interface Testing and verified integration behaviors across file transfers and system handoffs for reliable data exchange.
- Prepared and delivered test results, execution metrics, and summary reports to Leadership, facilitating informed decision-making.
- Applied solid knowledge of EDI transactions to support accurate testing and validation of healthcare data exchanges.
- Monitored project schedules, tracked testing progress, communicated risks promptly, and managed deadlines independently with minimal supervision.
- Environment: Windows 7, MS Office, UML, MS Visio, FEPDirect Application, SQL, Cognos.
Lead System Analyst
Adventist Healthcare
02.2018 - 06.2022
- Led the team as the Lead Business System Analyst and Acting Product Owner for the Cerner Application, facilitating project alignment and decision-making.
- Led requirement gathering and stakeholder alignment for multiple enterprise projects, delivering solutions on time and within Budget.
- Utilized various reporting tools, including SSRS Reports, Explorer Menu Reports, and Discern Analytics Reports, to generate insights.
- Conducted process mapping and gap analysis, identifying opportunities to streamline workflows and increased efficiency.
- Conducted JAD sessions with representatives from different departments and gathered all the requirements for the purpose of building: One-Time Report, Recurring Reports, Tableau Dashboards.
- Worked on different projects with the most important ones- Quality Based Reimbursement (QBR), Total Hip/Knee Patients Dashboard, OP Radiology Dashboard and Facility Dashboard.
- Designed and optimized Cognos Framework Manager models, ensuring semantic accuracy, dimensional best practices, and performance tuning for large-scale healthcare data.
- Facilitated meetings with representatives from home health, urgent care, hospitals, and behavioral health to gather requirements for Facility Dashboard, Managed Care Contract Negotiation, and ED Dashboard projects, ensuring comprehensive stakeholder input.
- Worked with the developers and assisted them in building the Tableau Dashboard for different projects to assure the visualization is as per the need of the business users.
- Worked with testing team in developing test cases, test plans and test scenarios.
- Written complex SQL queries for querying data against different databases for data verification process.
- Oversaw daily operations to troubleshoot and resolve issues with reports and dashboards, ensuring consistent availability and reliability of critical data insights.
- Environment: Windows 7, MS Office, UML, MS Visio, MS Project, Rational RequisitePro, Quality Center, SQL, Cognos.
Lead Business System / Acting Product Owner
Blue Cross Blue Shield
01.2016 - 01.2018
- Managed intake of requirements and enhancements for Provider Directory Application, analyzing impacts, defining timelines, estimating efforts, and delivering end-to-end. Enhanced CareFirst digital applications by improving user features for Members, Brokers, and Employers, providing a real-time 360-degree dashboard snapshot and managing content from various upstream systems while ensuring compliance with ACA and federal mandates.
- Worked on external projects impacting My Account (Member Portal), Find a Doctor Application, and Security.
- Worked as a lead Business Analyst on the implementation of bringing BCBSA (National Providers) in house under CareFirst My Account Secure/Unsecure FAD application.
- Worked on implementation of bringing CVS providers in house under CareFirst My Account Secure/Unsecure FAD application.
- Pharmacy Locator Project Gathered Business Requirements from all the stakeholders and interacting with the providers, managers, developers to develop the business Processes.
- Worked on consuming Facets data from FXI services to be integrated with My Account to show eligibility, benefits and claims.
- Worked on automating the requests such as PCP, COB, Add a member in Facets systems through My Account.
- Worked on Angular JS code logic on UI side to interpret business rules.
- Acted as escalation point for Cognos production support incidents, managing SLAs, documenting root causes, and communicating with stakeholders on high-priority reporting failures.
- Worked with UI team on mock ups and angular js development of those mock ups.
- Developed various documents for the projects – Project Requirement Document (PRD), Business Requirement Documents (BRD), Change Requirement Documents, Minutes of Meetings (MOM) and other project related documents.
- Assisted UI team in the process of designing UI, Process flow Diagrams, HTML and other user experience related documents.
- Conducted risk analysis and impact analysis for changes in business requirements, maintaining the latest version of the business requirement document.
- Executed data modeling of raw fields from data sources to target fields in local data store, ensuring accuracy and alignment with project requirements.
- Contributed to team conducting logical data analysis and data modeling JAD sessions, communicating data-related standards.
- Created source to target mappings and business rules implementation.
- Conducted Joint Application Development (JAD) sessions to develop and agree upon a system that focuses on the business requirements.
- Involved in the design and development meetings with the technical team.
- Conducted the gap analysis and propose solutions for resolving them.
- Develop UI prototypes for capturing the requirements.
- Worked with Testing team in developing test cases, test plans and test scenarios.
- Worked with the architect to aid in data modeling and defining the conceptual and logical model of the data warehouse.
- Used process models to capture business requirements.
- Conducted Knowledge transfer sessions, Train the Trainer sessions with the Clients, offshore team and other teams.
- Determined the impact of program changes on the business case and reforecast value creation and document in monthly program performance review.
- Conducted meetings with the business for the requirement walkthrough sessions and seek approvals.
- Captured current process flow of system through use case documentation and flow charts using Microsoft tools.
- Generated Requirement Tractability Matrix (RTM) to track and maintain stakeholders' requested requirements and changes.
- Instrumental in capturing the requirements from the clients and publishing them into a requirements document.
- Owings Mills, MD
- Environment: Windows 7, MS Office, UML, MS Visio, MS Project, Rational RequisitePro, Rational Clear Quest,TFS, Quality Center, SQL, Cognos.
Senior Business System Analyst / Requirement Analyst
Department of Health and Human Services
08.2014 - 01.2016
- State of North Carolina provides Medicaid to the residents to eligible low-income families and to eligible aged, blind, and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Medicaid pays for: doctor visits, hospital care, labs, prescription drugs, transportation, routine shots for children, mental health, and substance abuse services. The Project is about converting the codes from ICD9 to ICD10 to provide better Health Care to the Recipients. The codes will also help all the providers to validate the correct diagnosis and procedure codes for all their patients and get the claims processed faster with least ambiguity.
- Coordinated testing phase of project to ensure quality standards and compliance with regulations.
- Participated in JAD session with DPH, DMH, and DMA to collect testing data, including billing taxonomy, rendering taxonomy, and recipients eligibility criteria.
- Created requirements analysis and design phase artifacts using, Rational Software Modeler and MS Visio to create DFDs, ER diagrams, Use Case, Activity/State chart, Sequence, Collaboration and Deployment Diagrams.
- As per the collected Data- documented all the Test Scenarios (Professional, Institutional, Dental and Pharmaceuticals).
- Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
- Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
- Analyzed HIPAA 4010/5010 & ICD10 mapping document of Medicaid claims compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
- Created RTM (Requirement Traceability Matrix) for each of the Departments in order to ensure all the important Test Scenarios are covered before the beginning of UAT phase.
- Performed and coordinated user acceptance testing with internal business and external partners.
- Used MS Visio for Process modeling and Business Process flow diagrams.
- Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
- Developed Requirements Specification Document that translated business requirements into technical specifications, enhancing clarity for the development team.
- Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
- Conducted GAP Analysis& Data mapping for ICD-9 to ICD 10 implementation as well as also developed RFP for vendor analysis.
- Conducted workflow, process diagram and gap analyses to derive requirements for existing systems enhancements using UML.
- Created relationships in Requirement Traceability Matrix linking Business Requirements to Functional requirements and Functional Requirements to Systems Requirements.
- Provide various strategies to implement HIPAA 4010 in the new MMIS system and ultimately move to HIPAA 5010.
- Actively involved in designing EDI transactions using the new HIPAA 5010 version and ICD -10 codes and analyzing HIPAA compliance and EDI transaction.
- Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
- Create SQL scripts to query, cleanse, and prep data for conversion.
- Worked in the Testing Lab (CSC) and started working on Test Execution Process.
- With the help of XQMF did Data Mining to validate appropriate Providers, Recipients and other related information.
- Conducted edits and audits to analyze logic behind claim denials and payments.
- Worked on X12, Operations Portal (UAT1, UAT2), Providers Portal, Share Point and other related tools in order to execute the test cases by validating the correct information.
- Documented defects related to production and environment for test cases with invalid claim outcomes.
- Collaborated with vendor (CSC) to resolve defects and ensure UAT testing phase aligned with designed flight plan.
- Currently working on Post Implementation Activities and part of State War room to address any concerns from Medicaid Providers.
- Collaborated closely with Business and Technical teams to analyze requirements, design elements, and changes impacting MMIS and MES modules.
- Analyzed complex data structures and provided expert guidance on data mapping to ensure seamless integration across systems.
- Reviewed configurations and coding for managing data exchanges between MES modules and Trading Partners, ensuring compliance and accuracy.
- Demonstrated strong understanding of interface workflows, file transfers (SFTP/HTTPS), and system integration points to optimize connectivity.
- Developed comprehensive test plans, test cases, and test data to validate software changes in MMIS and MES environments.
- Raleigh, NC
- Environment: Share Point, Operations Portal (UAT1, UAT2), SILK, XQMF, X12, Provider Portal, Visio, Quality Center.
Business System Analyst
HP/St. of DE
09.2013 - 06.2014
- State of Delaware provides Medicaid to the residents to eligible low-income families and to eligible aged, blind, and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Medicaid pays for: doctor visits, hospital care, labs, prescription drugs, transportation, and routine shots for children, mental health, and substance abuse services. Hewlett Packard Is the leading company in the field of Healthcare for Medicaid services. The company provides services to State government by maintaining records of Claims, encounter claims, providers, pharmacy, and beneficiaries that are enrolled in the Medicaid program. The company provides MMIS that ensures that the services provided to the beneficiaries are on time and works closely with MCO's (Managed care Organizations) to ensure that all the claims are paid on time. As a Business Analyst, I was involved with Provider Enrollment system for the new MMIS system. The project also involved updating the existing MMIS system and providing with new enrollment systems to the providers enrolled in Medicaid.
- Analyzed HIPAA claims for compliance with processing regulations, ensuring adherence to industry standards.
- Process health-care data using advanced systems and technology to produce written reports, recommendations, and system modifications.
- Processed Medicare and Medicaid claims for 5010 X12 transactions, contributing to accurate claims management.
- Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
- Documented AS-IS business workflows using UML standards to support system enhancements.
- Created As-Is Business Process Models using MS Visio.
- Newark, DE
Education
MBA - Master of Business Administration
Tarleton State University
Stephenville, TXBBA - Bachelor of Business Administration
Ansal Institute of Technology
Gurgaon, HaryanaSkills
- Business analysis
- User requirements gathering
- Data analysis
- User acceptance testing (UAT)
- Stakeholder engagement
- JIRA and Agile methodology
- Process mapping techniques
- Risk analysis and mitigation
- SQL and database management
- Microsoft Project and SharePoint
- Microsoft Office applications
- Team leadership and collaboration
- Problem solving
Certification
Safe Product Owner/Product Manager
Timeline
Lead System Analyst/ Acting Product Owner
FEPOC
07.2022 - Current
Lead System Analyst
Adventist Healthcare
02.2018 - 06.2022
Lead Business System / Acting Product Owner
Blue Cross Blue Shield
01.2016 - 01.2018
Senior Business System Analyst / Requirement Analyst
Department of Health and Human Services
08.2014 - 01.2016
Business System Analyst
HP/St. of DE
09.2013 - 06.2014
MBA - Master of Business Administration
Tarleton State University
BBA - Bachelor of Business Administration
Ansal Institute of Technology