Summary
Overview
Work History
Education
Skills
Timeline
Generic

Nitheesha B

Nutley,NJ

Summary

Senior Business Analyst with over 10 years of experience delivering impactful solutions in Business Analysis data integration, and system analysis. I specialized in using ETL tool SSIS, and Informatica, along with relational databases such as SQL Server and Oracle, Microsoft SQL Server to streamline workflows and optimize data management. My expertise includes designing data models and integration processes while implementing cloud solutions with Azure and Snowflake. I have a deep understanding of healthcare data standards, including HIPAA, HL7, and FHIR, ensuring compliance across all data processes. Skilled in API integration, real-time synchronization, and automation workflows using tools like Microsoft Power Automate, Acted as bridge between technical teams and business stakeholders. With a strong command of data visualization tools like Tableau and Power BI, along with programming expertise in SQL, Python, and R, I deliver insightful reports that drive strategic decisions. My experience spans requirements gathering, business process analysis, and user acceptance testing, with a proven ability to lead cross-functional teams to achieve business goals. I’m also proficient in Agile methodologies, using tools such as JIRA, Confluence, and MS Project to ensure timely and successful project delivery.

Overview

10
10
years of professional experience

Work History

Business Analyst

State of KY
Frankfort, Kentucky
08.2022 - Current
  • Worked on integrating provider network data to ensure accurate information flow, improve connectivity between healthcare systems, and support efficient network management
  • Collaborated with stakeholders, including provider relations teams and IT, to gather detailed requirements for data integration
  • Conducted interviews and workshops to identify pain points in the current provider network data management process
  • Documented and refined functional and non-functional requirements using user stories, process flows, and wireframes
  • Analyzed existing data workflows, formats, and structures used in different regional systems
  • Identified gaps in the current system that hindered seamless integration of provider data
  • Triaged data issues encountered during testing and worked with teams to implement fixes
  • Evaluated existing third-party systems for compatibility with the central database
  • Worked with technical teams to map data fields from external provider systems to internal systems using SSIS
  • Partnered with developers to define API requirements for real-time synchronization of provider data
  • Reviewed and tested ETL pipelines to ensure the seamless extraction, transformation, and loading of data from external systems
  • Conducted data validation using SQL to compare source and target systems, ensuring no discrepancies in the integration process
  • Created process flow diagrams using Microsoft Visio and Lucidchart to visualize current-state and future-state workflows
  • Created test plans and executed data validation tests to ensure accuracy and completeness of integrated data
  • Conducted end-to-end testing, identifying and resolving discrepancies in data integrity
  • Validated performance metrics of data pipelines, ensuring efficiency in real-time updates
  • Developed test cases for UAT to confirm that the integrated system met business needs and regulatory standards
  • Worked with (Azure) to ensure seamless integration of provider data between cloud-based and on-premise systems
  • Worked with technical teams to define the specifications for APIs, data pipelines & ETL processes
  • Ensured that all data integration processes adhered to HIPAA regulations and healthcare data standards (HL7, FHIR, X12 EDI)
  • Conducted data reconciliation and validation checks to guarantee that data mapping met business requirements
  • Verified compliance with state and federal regulations for provider network management
  • Written SQL queries to validate data mapping, ensure data consistency, and perform data transformations
  • Worked with relational databases (e.g., SQL Server, Oracle) and understanding how data is structured, stored, and queried
  • Coordinated the integration of data from external sources (insurance providers) using API tool MuleSoft and Postman
  • Implemented Informatica Data Validation (IDV) for automating the validation of large datasets during ETL processes
  • Managed project timelines and deliverables using JIRA, Confluence, and MS Project
  • Coordinated API integration between internal systems and external platforms to enable real-time data synchronization, ensuring that provider information is always up-to-date and accurate across all systems
  • Designed dashboards & reports using Tableau to track integration performance and data quality metrics
  • Tools&skills JIRA, Confluence, Microsoft Word or Google Docs, Microsoft Visio / Lucidchart, SSIS, MuleSoft, Informatica Data Validation, Postman, Azure, SQL, SQL Server / Oracle, MS Project, HL7, FHIR EDI

Sr. Business Analyst

Centene
Iselin, NJ
01.2019 - 07.2022
  • Collaborated with business stakeholders (claims processors, billing teams, insurance companies) to gather requirements for insurance verification and eligibility checking systems
  • Communicated the business requirements clearly to technical teams, ensuring they understand how the data should be handled and integrated
  • Worked on mapping patient insurance data from an external Medicare provider’s system to internal Medicare claims processing system
  • Created an interface for users to compare Medicare plans, including Part A, Part B, Part D, and Medicare Advantage
  • Identified key needs for eligibility verification, such as verifying Medicaid, Medicare, or private insurance coverage
  • Documented functional requirements for insurance verification processes, including real-time verification, batch processing, and integration with external insurance databases
  • Analyzed the data workflows between the external system (insurance provider) and the internal systems (claims management system)
  • Validated APIs for integration with payer systems
  • Used BPMN to create flow diagrams and process models, mapping out data integration workflows to identify inefficiencies and optimize processes
  • Wrote SQL queries to extract, clean, and validate insurance data & also used Excel for further analysis and reporting
  • Used Entity-Relationship (ER) Diagrams and UML to visually represent data structures and relationships between systems
  • Used SQL to validate data transformations, ensuring that external and internal systems’ data aligned correctly after mapping
  • Used Tableau to create dashboards and visualizations to provide stakeholders with insights into claims, coverage, and other critical metrics
  • Worked with X12 EDI transactions to automate and standardize the exchange of healthcare data (claims, eligibility verifications)
  • Utilized HL7 messages for exchanging electronic health information (patient demographics, lab results) between external systems (insurance providers, healthcare providers) and internal systems (claims management systems)
  • Mapped and validated EDI messages like 270/271 (eligibility inquiries) and 837 (claims submissions) to ensure accurate and compliant data flow
  • Used FHIR APIs for real-time data access and integration with external systems (insurance providers, hospitals)
  • Ensured insurance verification systems met HIPAA and CMS standards, focusing on secure data handling and compliance
  • Worked with end-users to conduct User Acceptance Testing (UAT) and ensure that the new systems meet business requirements
  • Implemented automated reporting mechanisms for compliance, tracking key metrics (eligibility status and claims approvals) ensuring reports align with (HIPAA & CMS) regulatory standards
  • Created and maintained comprehensive documentation for data mapping, transformation rules, and integration processes
  • Used SSIS and Excel to create data mapping templates, ensuring accurate transformation and integration of data between external insurance systems and internal platforms
  • Worked with IT teams to ensure that patient insurance details are consistently and accurately transferred from EHR to billing systems
  • Used data integration platforms MuleSoft and Apache NiFi, ensuring smooth and accurate data flow from external systems (insurance providers, partner databases) into internal systems
  • Worked with RDBMS (Microsoft SQL Server, Oracle) and data warehouse (Snowflake, Azure SQL) to design and implement data models
  • Developed test plans and scenarios for insurance verification systems to ensure that the systems work as expected (accurate eligibility verification, seamless integration with external insurance databases)
  • Engaged with technical teams to develop automated rules for eligibility checking (Medicaid or Medicare coverage) to reduce delays and improve accuracy
  • Used Microsoft Visio to design and visualize current and future data workflows
  • Used Microsoft Power Automate to automate repetitive tasks and data workflows
  • Worked on integrating external and internal systems using RESTful APIs
  • Used Excel to create data mapping templates, ensuring accurate alignment between external and internal data models
  • Acted as the liaison between business and technical teams, using JIRA for task management and Confluence for sharing updates, documentation, and meeting notes
  • Created detailed test cases using (TestRail & JIRA)
  • Defined business rules for data validation and collaborated with QA teams for testing
  • Worked with data engineers to map insurance data fields (policy numbers, coverage types) from external systems to internal data models
  • Designed workflows and systems for verifying insurance eligibility using (EDI) & API integrations with insurers
  • Tools JIRA, Confluence, BPMN, UML Tools, Microsoft Visio, MuleSoft, Apache NiFi, SSIS, RESTful APIs, FHIR APIs, X12 EDI Transactions, HL7, SQL, Excel, UAT, Tableau, ER Diagrams, RDBMS (Microsoft SQL Server, Oracle), Data Warehouses (Snowflake, Azure SQL, Microsoft Power Automate)

Business System Analyst

Humana KY
Louisville, KY
07.2016 - 12.2018
  • Met with stakeholders such as claims processors, customer service teams, IT staff, and business managers to understand the existing claim processing workflow and gather their pain points and needs
  • Developed Business Requirements Documents (BRD) and Functional Requirements Specifications (FRS)
  • Conducted gap analyses to identify areas where the current system does not meet business needs and recommend solutions
  • Analyzed data sources and work with technical teams to design and implement integrations between disparate systems (e.g., integrating claims data with member service data)
  • Analyzed Medicaid/Medicare data for compliance improvements and reporting
  • Designed and developed dashboards and reports using Tableau
  • Created real-time, automated reports for claims metrics (approval/rejection rates, processing times) and member data (satisfaction scores, retention rates)
  • Created process flow diagrams using BPMN to document and analyze insurance workflows (policy issuance, claims processing, and member onboarding)
  • Worked with UX/UI teams to define user-friendly dashboards and visualizations for end-users
  • Mapped current-state claims workflows and designed future-state workflows that improve operational efficiency and reduce claim errors
  • Analyzed data exchange processes using HL7 standards, ensuring accurate and compliant transmission of healthcare information
  • Monitored regulatory compliance for data reporting, ensuring adherence to standards like HIPAA and CMS requirements
  • Worked with third-party vendors for pharmacy benefit management (PBM), dental, and behavioral health services, ensuring seamless integration into reporting systems
  • Designed reports and dashboards that help track (KPIs) (claims approval rates, member satisfaction, and financial performance)
  • Created data dictionaries & performed Source to target data mapping to integrate various data
  • Coordinated with product managers and actuaries to propose plan benefits, pricing strategies, and cost-sharing models
  • Engaged with technical teams to map data elements from disparate healthcare systems and develop integration strategies using ETL
  • Translated business requirements into technical specifications for developers and data teams
  • Used database management systems such as SQL Server and Oracle to store and manipulate data
  • Loaded data from flat data files into SQL Server database tables using bulk insert and table import
  • Mapped current-state workflows, designed future-state workflows, and defined the implementation roadmap for system enhancements
  • Supported data governance efforts by implementing policies for data accuracy, consistency, and security
  • Developed and executed test cases to validate data accuracy and ensure reporting solutions meet business needs
  • Partnered with IT and operations teams to optimize data pipelines and reporting workflows
  • Engaged with data analysts and engineers to extract, clean, and analyze claims and member data
  • Developed SQL queries to extract and aggregate data for ad-hoc reporting and analysis
  • Tracked the project progress in Jira and MS Project to provide regular updates to stakeholders
  • Types of Data Handled: Claims Data, Authorization Data, Clinical Data, Financial Data, Medicare/Medicaid, HIPAA compliance, CMS regulations
  • Tools & skills: SQL, Tableau, Advanced Excel techniques (VLOOKUP, data validation, macros), Python, SSIS, PowerPoint, Jira, SQL Server, Oracle

Business Data Analyst

Evicore
06.2014 - 06.2016
  • Worked closely with teams from clinical, operational, and IT departments to gather requirements and make sure project objectives were in line with business goals
  • Used JIRA to organize tasks, track progress, and ensure that milestones were met on time
  • Reviewed incoming data requests from stakeholders and prioritize tasks based on urgency
  • Analyzed claims, authorization, and patient outcome data to identify patterns and trends
  • Familiarity with (EMR) systems and payer/provider systems
  • Utilized Microsoft Word, Excel, and PowerPoint for creating reports, spreadsheets, and presentations
  • Developed dashboards using Tableau to track KPIs across claims processing, prior authorizations
  • Pulled and analyzed large sets of healthcare data using SQL to track key metrics and support data-driven decision-making
  • Designed and dashboards in Tableau to track important metrics like turnaround time, cost savings, and service utilization
  • Partnered with healthcare providers and payers to interpret data-driven decisions
  • Communicated findings to non-technical stakeholders in a clear and actionable way
  • Evaluated the efficiency of existing processes (Prior authorization workflows) and recommend improvements
  • Supported the implementation of new initiatives to enhance healthcare quality and reduce costs
  • Ensured all analyses adhere to healthcare regulations such as HIPAA (Health Insurance Portability and Accountability Act)
  • Validated the accuracy and reliability of data used for reporting
  • Types of Data Handled: Healthcare Claims Data, Authorization Data, Clinical Data, Operational Data, Financial Data
  • Tools & skills: SQL, Python, R, Tableau, Word, ETL, PowerPoint, Excel (Advanced), Snowflake, Oracle, MySQL, Claims data, EMR systems, HIPAA compliance, utilization management, Jira, Confluence, Agile methodologies

Education

bachelors - business administration

osmania university
hyderabad
01.2013

Skills

  • JIRA
  • Confluence
  • MS Project
  • Agile Methodologies
  • SSIS
  • MuleSoft
  • Apache NiFi
  • RESTful APIs
  • FHIR APIs
  • X12 EDI
  • Informatica
  • SQL
  • Advanced Excel
  • Python
  • R
  • Tableau
  • SQL Server
  • Oracle
  • Snowflake
  • RDBMS
  • Data warehouses
  • HL7
  • FHIR
  • HIPAA compliance
  • Utilization Management
  • Power BI
  • PowerPoint
  • UAT
  • Excel
  • Microsoft Power Automate
  • Microsoft Visio
  • Lucidchart
  • Microsoft Word
  • Google Docs

Timeline

Business Analyst

State of KY
08.2022 - Current

Sr. Business Analyst

Centene
01.2019 - 07.2022

Business System Analyst

Humana KY
07.2016 - 12.2018

Business Data Analyst

Evicore
06.2014 - 06.2016

bachelors - business administration

osmania university

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Nitheesha B