Karthik Potlapally

Healthcare IT professional with 10+ years of experience in business analysis, health informatics, and strategic healthcare systems. BDS, MHA, MPH (Health Informatics, USA) with AI Product Owner expertise. Currently serving as Lead Senior Business Analyst with deep expertise in requirements elicitation, data migration, system integration, and cross-functional stakeholder coordination across payer platforms, provider systems, and healthcare operations.

Proven ability to translate complex business needs into detailed specifications and executable roadmaps across HealthRules Payor, GuidingCare, Reveleer, RightFax, OnBase, and other healthcare platforms. Skilled in Agile/SDLC methodologies, HL7/FHIR standards, revenue cycle management, RPA, and AI/ML concepts including LLM fundamentals and prompt engineering.

EMIDS Medical Technologies | Team Lead Business Analyst | Client: FirstSource (TSS – Triple-S Salud) | Oct 2024 – Present

• Serving as Sr. Business Analyst on the TSS System Integration & Data Migration project spanning multiple payer platform modernization workstreams including data migration, claims integration, provider data, and premium billing.
• Led data migration requirements for Medicare member data to Reveleer and member data to HealthRules Payor, including field-level crosswalk mapping and error logging specifications.
• Authored 8+ comprehensive BRS documents for critical healthcare integrations including claims processing (ClaimX/HRP), RightFax integration, Reveleer, provider data management, and premium billing QA.
• Designed detailed integration specifications across 6+ healthcare platforms; resolved 15+ integration blockers through requirements refinement and stakeholder alignment.
• Facilitated 20+ cross-functional JAD and requirements-gathering sessions with vendor stakeholders; resolved 25+ integration blockers.

EMIDS Medical Technologies | Sr. Business Analyst | Client: Loyal Health | Oct 2024 – Mar 2025

• Led requirements gathering for a multi-system campaign engine for healthcare data management and patient outreach workflows.
• Designed data integration specifications for EHR systems (Epic, Athena) into a centralized patient repository; ensured FHIR/HL7 and HIPAA compliance.

PrimEra Medical Technologies – Business Analyst | Prime Healthcare Group | June 2022 – Aug 2024

• Reviewed, analyzed, and evaluated data/systems business requirements for US healthcare systems.
• Developed workflow, systems requirements, system impact analysis, and process analysis using SDLC methodologies.
• Created and maintained project plans; mentored junior analysts.

ICRIYA DIGITAL TECHNOLOGIES | Product Owner / Healthcare BA / Product Sales Lead | Hyderabad | Aug 2018 – May 2022

• Developed and implemented digital innovation solutions addressing customer needs in healthcare.
• Documented requirements for national & international healthcare accreditation quality bodies (NABH, NABD, JCI).
• Exercised data analytics and visualization techniques; worked with EHR systems (Epic, Cerner, Meditech).

ST. CHARLES HOSPITAL | Assistant Healthcare Administrator / Project Manager | New York | March 2017 – July 2018

• Directed day-to-day facility functions; managed business operations and strategic planning.
• Prepared annual budgets and P&L statements; coordinated HR activities; maintained medical records compliance.

OPTUM – A UNITED HEALTHCARE COMPANY | Quality Analyst | Basking Ridge, NJ | August 2016 – January 2017

• Managed Real-World Evidence (RWE) project lifecycle; established best practices for business analytics and data warehousing.
• Led JAD sessions; conducted sprint execution for enterprise healthcare analytics applications; ensured NCQA/HEDIS compliance.

IPRO – NGO | Quality Analyst / Research Analyst | NY | January 2016 – July 2016

• Re-engineered intranet communication system; conducted performance analysis for ESRD hospital network per CMS requirements.

SRIKARA HOSPITALS | Hospital Administrator / Clinical Administrator / Head Quality | Hyderabad | June 2014 – August 2015

• Led EHR implementation; achieved NABH accreditation; managed clinical and non-clinical audits and ICU operations.

MS. RAMAIAH MEMORIAL HOSPITAL | Resident, JCI/NABH/NABL | Bangalore | May 2012 – May 2014

• Improved healthcare operations by implementing HIS; involved in external audits and interdepartmental coordination.

Master of Public Health (MPH) – Health Informatics | Adelphi University, Long Island City, NY, USA

Master's in Healthcare Administration (MHA) | Bangalore, India

Bachelor of Dental Surgery (BDS) | Hyderabad, India