Summary

Overview

Work History

Education

Skills

Certification

Timeline

SRI PRAVEEN KOGANTI

Southington,CT

Summary

• Oriented individual with over 12+ years of diversified experience in the Healthcare and IT industry.
• Dedicated Sr Business Analyst known for rapidly and effectively translating historical performance figures into actionable data. Taps into expansive Business Analysis, Requirement Gathering, User story Writing, EMR/EHR Systems, Agile, HL7 V2 Messaging.
• Certified in Immunization Data Standards (AIRA Certified) with strong expertise in HL7 standards (v2. X, v3. X, CDA), FHIR, and healthcare interoperability frameworks.
• Experienced in business process flows, business process modeling, case tools, business analysis, gap analysis, and organizational change management.
• Experienced in conducting sessions and working with executives, developers, and end-users to define the requirements.
• Knowledge of Confidential, Medicaid, MMIS, HIPAA EDI transactions 278, 820, 834, 835, 837, ICD-9, ICD-10, HL7, HMO, PPO, ANSI X12 Procedural and Diagnosis codes.
• Used Microsoft SharePoint as a web-based content management system and a document/project management tool.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrolment).
• Ability to develop business rules, context data flow diagram, entity relationship diagram, workflow diagramming, prototyping, and document current state, gaps, and future state processes.
• Experience in multi-tasking, such as managing numerous simultaneous projects with great attention to detail.
• Experience in solution assessment, validation, and applying critical thinking for problem-solving approach.
• Experience in Requirements elicitation techniques like conducting user interviews, document analysis, JAD sessions, and managing the requirements.
• Comprehensive knowledge of Software Development methodologies (SDLC) such as Waterfall, Agile, Spiral, and Scrum.
• Create various documents, such as the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), and Systems Design Specifications (SDS).
• Sound proficiency in analyzing and creating Use Case Diagrams, Sequence Diagrams, Activity Diagrams, Data Flow Diagrams, Business Flow Diagrams, Wire Frames, and Mock-ups using MS Visio and Rational Rossetto communicate business and functional requirements to clients and developers.
• Performed AS-IS and TO-BE business process flow for clear translation of Functional to system requirement specification.
• Support the Test Team and the rest of the Development Team in compliance-related issues while working with them in the development phases of the projects.
• Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow and Business Process Modelling, and Data Mapping.

Overview

years of professional experience

Certification

Work History

Senior Business Analyst

Connecticut Department of Public Health

03.2019 - 03.2025

CT WiZ is the statewide Immunization Information System (IIS) designed to meet national standard requirements for effective tracking and administration of immunizations in a public health setting
It is a web-based database that maintains complete, accurate, and secure immunization records for all Connecticut population
All personal information including immunization status and dates of immunization of individuals shall be confidential as required by Connecticut law
Provide technical support to clinics and vendors involved in the onboarding process from initial request or invitation, through NIST testing, user acceptance testing, to full implementation of bi-directional exchange of electronic health records (EHR) with CT Wiz
Implement end-to-end workflows and instructions to enable users to apply for HL7 onboarding and transition successfully from testing to production data submission
Responsibilities
Authenticating and validating the identity of entities wishing to create an interface
Creating HL7 facility codes and username credentials in CT WiZ QA and Production for the assigned clinics
Verifying the accuracy of the interface through testing and validation, testing both incoming and outgoing data quality
Identifying the point at which the interface is deemed accurate and approved for transition to production environment
Updating the status of clinics in the onboarding traceability spreadsheet
Testing of the interface post-production to authorize continued data exchange
Resolve help desk tickets assigned to the Immunization Program
Create weekly reports regarding the status of onboarding clinics and the resolution of Help Desk tickets assigned
Create and modify test scripts, test cases, and scenarios to ensure that the routes, HL7 parsing, and content validation are implemented correctly
Identify training needs and organize training interventions to meet data quality standards
Schedule, facilitate, and attend meetings both at DPH and with EHR vendors and clinics to resolve issues
Create and implement data quality analysis processes and workflows in the production environment
Use statistical methods to analyze data and generate useful business reports
Work with management team to create a prioritized list of needs for each business segment
Identify and recommend new ways to save money by streamlining business processes
Use data to create models that depict trends in the customer base and the consumer population
Documenting the types and structure of the business data (logical modeling)
Analyzing and mining business data to identify patterns and correlations among the various data points
Mapping and tracing data from system to system to solve a given business or system problem
Design and create data reports and reporting tools to help business executives in their decision making
Perform statistical analysis of business data
Interpret data, analyze results using statistical techniques and provide ongoing reports
Develop and implement databases, data collection systems, data analytics and other strategies that optimize statistical efficiency and quality
Acquire data from primary or secondary data sources and maintain databases/data systems
Identify, analyze, and interpret trends or patterns in complex data sets
Filter and “clean” data by reviewing computer reports, printouts, and performance indicators to locate and correct code problems
Work with management to prioritize business and information needs
Work with departmental managers to outline the specific data needs for each business method analysis project
Locate and define new process improvement opportunities
Proven working experience as a data analyst or business data analyst
Evaluating business processes, anticipating requirements, uncovering areas
for improvement, and developing and implementing solutions.
• Leading ongoing reviews of business processes and developing optimization
strategies.
• Staying up-to-date on the latest process and IT advancements to automate
and modernize systems.
• Conducting meetings and presentations to share ideas and findings.
• Performing requirements analysis.
• Documenting and communicating the results of your efforts.
• Effectively communicating your insights and plans to cross-functional team
members and management.
• Gathering critical information from meetings with various stakeholders and
producing useful reports.
• Working closely with clients, technicians, and managerial staff.
• Providing leadership, training, coaching, and guidance to junior staff.
• Allocating resources and maintaining cost efficiency.
• Ensuring solutions meet business needs and requirements.
• Performing user acceptance testing.
• Managing projects, developing project plans, and monitoring performance.
• Updating, implementing, and maintaining procedures.
• Prioritizing initiatives based on business needs and requirements.
• Serving as a liaison between stakeholders and users.
• Managing competing resources and priorities.
• Monitoring deliverables and ensuring timely completion of projects
Proficient in hl7 (health level standard) and its different versions.
2. Strong analytical and problem-solving skills in interpreting business requirements.
3. Excellent communication skills to effectively collaborate with cross functional teams and stakeholders.
4. Knowledge of healthcare it systems and interoperability standards.
5. Ability to work under pressure and manage multiple projects simultaneously.
6. Experience with healthcare data exchange protocols and data mapping.
7. Familiarity with ehr (electronic health records) systems and their integration with hl7 standards.
Certification in HL7 (Health Level Standard) is preferred.
Extensive experience in the Application Architecture for Healthcare domain applications
Expertise in FHIR, HL7, and CCDA standards for healthcare data interoperability.
Excellent understanding of FHIR resources, profiles and implementation guides
Strong programming skills in .Net, C#, Node JS, and Python.
Experience with Azure FHIR APIs, Azure Functions, and Azure Logic Apps.
Familiarity with Azure services including API Management (APIM), Azure Storage, and Azure Data Factory.
Knowledge of Azure Key Vault for secure key management.
Understanding of Azure networking concepts and network security groups.
Familiarity with Azure identity and access management (IAM) concepts, including Azure Active Directory (AAD) and Azure AD Connect.
Supported leadership team with reporting, analysis, and business presentations to inform divisional strategies.
Interacted with internal customers to understand business needs and translate into requirements and project scope.
Developed complex dashboard and reporting tools to track business performance metrics.
Deployed predictive analytics models to forecast future trends.
Utilized data visualization techniques to present and explain complex data sets.
Updated and developed scripts and queries to extract and analyze data from multiple sources.
Generated standard and custom reports to provide insights into business performance.
Developed and implemented data governance policies and procedures.
Implemented business intelligence solutions to increase operational efficiency.
Generated ad-hoc reports to evaluate specific business requirements.
Developed customized reports, summarizing and presenting data in visually appealing format.
Provided technical support for troubleshooting analytics and reporting issues.
Created dashboards to monitor and track key performance indicators.

Business Analyst

Excellus

07.2017 - 03.2019

Excellus has been providing quality health care plans to residents
Company implemented Facets claims management system, a new core system, with updated technology to allow for more efficient claims processing, membership enrolment and provider data maintenance
Facets was highly efficient, automated, customizable, and flexible, to help tackle new business opportunities and compete successfully in a dynamic healthcare industry
Moreover, TriZetto provided ongoing support and training
As a BA, I was involved in developing fully automated, claims processing system for complete, on-line mediation of medical, dental, vision, and disability claims and encounters as per HIPAA guidelines
Responsibilities
Worked as Facets Administrator and done lot of Provider Data Gap Analysis
Played the key role as a lead in managing the team and was responsible for all the deliverables to the Customer
Involved in Project estimation for Extraction and Analytics Project
Responsible for analyzing technical specifications, creating plans and strategy for Data Extraction and Analytics project
Coordinate meetings and facilitate communication between IT and business on testing
Performed gap analysis as pertains enrollment, membership management, Commissions, Finance and claims processing; relating for instance to Provider IDs use on plan communications; remittance advice statements; explanation of payments (EOP); and Member ID cards; and healthcare providers use of the assigned Provider ID number(s) for use in claims submission and plan inquiries
Used ETL tools such as Informatica, Data Stage and Ab Initio for performing ETL testing on Extraction, Transformation and Loading data from source files such as flat files, oracle and SAP
Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835 ERN)
Participated in all phases of the Facets Extended Enterprise (TM) administrative system implementation including the planning, designing/building/validation (DBV), testing, and Go-live support phases
Using the Curam software to improve care coordination, preventing gaps in care for people
Developed standard Business Process Models detailing the Curam Eligibility Enrollment solution process and presented the models to the State
Various aspects of the project’s needs such as the logging, tracking, and resolution of issues, current state workflow assessments, facilitating/presenting DBV sessions, and assist with integration testing
Clarified to Claims personnel the new payments and EOPs for same claim processing cycle: Unlike currently where payments for all claims received within a given cycle are lumped into a single check, there would be two separate EOPs and checks in the same cycle since the new and old systems would be used to process different types of claims, based on dates of service and product
Conducted User Acceptance Testing and user training pertaining to old and new Provider ID appearing on documents providers and some system generated letters)
Environment: Facets Extended Enterprise (TM), Oracle, MS Office Suite, Windows XP, S SQL, VB.NET

Business Analyst

ConnectiCare

11.2016 - 06.2017

The core of the Stop Loss architecture is Young Consulting’s ESL Office and CRW applications
ESL Office is a Delphi-based client-server application that will run on a Windows Virtual Machine (VM) within the CONNECTICARE IT environment
This application provides contact management, underwriting, contract administration, claims auditing, and block analysis functionality
CRW is a web-based application built on .NET that works in conjunction with ESL Office on the same Windows VM
CRW is designed to retrieve Claims and Enrolment information from the Data Warehouse, assign them to Stop Loss Policies, create Claim Submissions in the ESL Office, and generate monthly reports
This is accomplished primarily through stored procedures that run within the CRW database
CRW also provides a few screens that allow CONNECTICARE to manage account, group and Stop Loss policy relationships
Young Consulting’s xChangePointe application is an externally hosted secure communications portal for delivery of stop loss reports to accounts and brokers
When configuring a policy in CRW, users can assign it to an “Exchange” within xChangePointe, which allows CRW to upload report documents to xChangePointe through a web service call
The combination of ESL Office, CRW and xChangePointe together provides the technical platform needed support the selling, servicing and analysis of CONNECTICARE’s Stop Loss business
Responsibilities:
Responsible for Analyzing the Requirement Specifications, creating Functional and technical Requirement documents
Identifying the Test data from the Source systems satisfying all the test scenarios for the System Testing
Responsible for preparing the Weekly Status Report (WSR) for the Project and Regular Project progress to the client
Work with the test executive management in evolving methodologies and procedures in retaining skilled testing personnel
Work closely with Business Team on requirement gathering and Test Planning
Look beyond the current scope to define/identify potential risks and comes up with a suitable mitigation plan
Integrate working with the test executive team, the project management deliverables for the test component of the project activity
Acted as a liaison between clients and development departments and distinguished requests from needs
Transferred information from management into needed data
Found out defects which existed in the system, analyzed how the defects were originated, and cooperated with another department to fix them
Set up meetings with other departments, SMEs, or clients to solve problems and gathered requirements from meeting
Review and understand the ETL processes, functionality & identify test requirements and coverage
Coordinate with infrastructure and application teams to support the integration of projects approved and reviewed by stakeholders, senior management, and technical advisors
Translated business requirements into technical details
Used SAP Business Objects to complete report generation based on corresponding issues of defects
Worked closely with project lead, technical team and business analysts to investigate data and logic within the database and reporting application
Prepared BRD’s and test cases for each defect before defects moved to testing
Coordinated with project manager on regular status updates and assists the overall project management initiative
Worked extensively with MS office suite for preparing status reports
Prepare and monitor testing scope and requirement changes, assess the impact of requirement changes on test deliverables
Prepare test estimates and sizing of the test object
Plan, organize, direct and execute the test process and manage test releases
Prepare test execution metrics and use the metrics to derive “best practices” and suggest/recommend improvements to test processes and methodologies
Implement and evolve appropriate test measurements and metrics to be applied against test release and to be applied against the QA team
Environment: Informatica 9.1.0, SQL Server 2005, Win SQL, Cognos 10.2 Windows, Unix, MS Office Suite, MS Visio, UML, SQL, MS SharePoint, Agile/Scrum, Toad.

Business Analyst

Optum

11.2014 - 06.2016

The project that I was worked is to improve the Claims Reimbursement user interface of Optum for a better user experience and incorporate changes as per HIPAA guidelines
The main objective of the system was to secure the health information entered by the user at the time of submitting the claim and also ensured the integrity and confidentiality of the user information
Responsibilities:
Prepared the Functional Specification Document (FSD) and Software Requirement Specifications (SRS) as per SEI CMM standards
Gather business requirements through interviews, JAD sessions and observations and created the business requirements documentation for building UI for viewing data through Guidewire Policy Centre
Conduct quality assurance tests of the several Cognos software applications into practice and make note of the application failing quality tests
Interacted with business heads to finalize the product backlog for the Guidewire application
Mined data for the application team and design team to assist with creation of the application
Utilized SQL server for select statements needed to access data from different schemas containing data stored
Customizing and generating multiple TFS reports to serve company needs
Worked on improvement of Claims Reimbursement User Interface for a better experience and incorporate changes as per HIPAA guidelines using the gap analysis
Explained HIPAA guidelines and workers compensation, claim to the Dev team
Worked on the documentation of the screens in Billing Center
Wrote SQL scripts for creating performance evaluation reports
Used Guidewire for maintaining billing and claims of policy holders and identified gaps in the existing systems by performing GAP Analysis on the As-is business process maps
Developed test cases and test plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data
Used UML to create use case diagrams, sequence diagrams and activity diagrams
Performed Backend testing by using PL/SQL queries to test the integrity of the application
Developed flowchart and process diagram using MS Visio
Conducted interviews with clients to analyze their data and gather requirements
Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly
Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle
Identified bugs during the test phase and reported them using HP Quality Center
Maintained Traceability Matrix throughout the project
Used the Rational Unified Process (RUP) to build the different phases of Software Development Life Cycle (SDLC)
Environment: Windows, Unix, MS Office Suite, MS Visio, UML, SQL, MS SharePoint, JIRA, Agile/Scrum, Informatica, Cognos, Toad, J2EE, WebSphere.

Business Analyst

Amvik Solutions, Infotech

09.2012 - 10.2014

Amvik is a company providing customers with benefits, expertise and service that improves the health, well-being and productivity
As a BA, I was involved in developing fully automated, real-time claims processing system for complete, on-line mediation of medical, dental, vision, and Short/long term disability claims
System allowed the efficient and timely management of all relevant data clinical, financial, and administrative throughout the organization enabling the sharing of information between subsystems
Responsibilities:
Met with users to generate and review business use cases
Assessed the status of the organization to determine the scope of the validation process
Prepared requirements document for Commercial Auto, Inland Marine, Crime, Worker’s Compensation, Umbrella, Business Owners Policy, Commercial Output Policy, and Commercial Property Package
Also, responsible for managing communication and expectations of system vendor, the former parent company IT and business departments, and Allied Worlds various business units (underwriting, claims, reinsurance, actuary, accounting, and IT)
Created the configuration document for custom setup for various user groups such as HR, marketing, R&D & sales, research analyst & investigators
Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835)
Worked with the compliance group to make sure that the electronic data was CFR part 11 compliant
Gathered requirements by using interviews, requirement workshops and brainstorming sessions
Reviewed the requirements for calibration, maintenance and cleaning developed as draft procedures and finally wrote Standard Operational Procedures (SOPs)
Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns as per GLP in Lab Ware LIMS & Pre-Clinical Phases (electronic laboratory notebook) & data migration issues
Designed and developed project document templates based on SDLC methodology
Documented all aspects of the computer system validation lifecycle, in accordance with FDA regulation which includes validation plan and protocol, Installation Qualification (IQ), Operational Qualification (OQ) and specification performance
Proficient with Test Management tools such as ALM/Quality Center, Site Admin, Test Director and Test Brix (In house Test Management Tool) and Defect Management tool Jira
Worked in Healthcare HIPAA ICD 9-CM to ICD 10-CM rule set migration
Responsible for analyzing the current system and followed the development of a J2EE based application through various iterations of all phases of the Rational Unified Process (RUP)
Mentored and Knowledge transfer on how to create and implement test assets in RQM – Test Plan, Test Case, Test Scripts, Test Execution Records, Test suites, how to execute test and report on the test result using RQM Reports
Prepared Logical/Business Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements from conceptual to procedural level
Validate test plans/scripts and perform final reviews of test results
Used use case diagram during analysis to capture requirements
Conducted acceptance tests to verify that the validation effort was complete
Developed UAT Test Plan, Test Strategy, Test Cases, Test Criteria or Test Condition, Test Scripts and performed User Acceptance Testing along with the Business Users
Developed strategies with Quality Assurance group to implement Test Cases in Mercury Test Director for stress testing and UAT (User Acceptance Testing)
RUP, Windows XP, Rational RequisitePro, Microsoft Office tools, MS Project, SQL
Company: 3i

Education

Master of Computer Applications (MCA) -

Andhra University

India

04-2008

Skills

Healthcare IT & Interoperability: HL7 v251
EHR/EMR Integration
Immunization Messaging (VXU)
FHIR APIs Integration
Requirements Gathering
BRD/FSD Creation
Data Mapping
Gap Analysis
Manual & Automation Testing (HP ALM/QC/QTP)

JIRA
Confluence
Service Now
Use Case Specifications
RTM
UML Diagrams (Visio)
Change Request Coordination
HL7 Certification

Certification

HL7 v2.5.1 Immunization Update (VXU) Messages, American Immunization Registry Association (AIRA)
Provider Organization Onboarding for IIS, American Immunization Registry Association (AIRA)
Immunization Messaging Certification, American Immunization Registry Association (AIRA)
Certification in HL7 (Health Level 7 Standards), Preferred / In Progress

Timeline

Senior Business Analyst

Connecticut Department of Public Health

03.2019 - 03.2025

Business Analyst

Excellus

07.2017 - 03.2019

Business Analyst

ConnectiCare

11.2016 - 06.2017

Business Analyst

Optum

11.2014 - 06.2016

Business Analyst

Amvik Solutions, Infotech

09.2012 - 10.2014

Master of Computer Applications (MCA) -

Andhra University

SRI PRAVEEN KOGANTI

Summary

Overview

Work History

Senior Business Analyst

Business Analyst

Business Analyst

Business Analyst

Business Analyst

Education

Master of Computer Applications (MCA) -

Skills

Certification

Timeline

Senior Business Analyst

Business Analyst

Business Analyst

Business Analyst

Business Analyst

Master of Computer Applications (MCA) -

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