Venkatesh Kodavati

Healthcare Product Owner/Senior Business Analyst with 12+ years of experience delivering enterprise healthcare platforms across Payer, Provider, and PBM domains. Comprehensive end-to-end experience in Provider Systems, spanning patient registration, clinical workflows, order management, billing for services(RCM), and discharge processes. Deep expertise in Payer-side operations including claims adjudication, provider network management, eligibility verification, prior authorization, and denial management.

Adept at translating complex business needs into scalable solutions using Agile (Scrum/SAFe), Waterfall methodologies. Proven ability to author end-to-end project documentation including Business Requirements Documents (BRDs), Functional Requirements Documents (FRDs), scope documents, impact/initial assessments, and conceptual decks. Skilled in stakeholder management, backlog prioritization, process modeling, and regulatory compliance (HIPAA, HRSA).

Experienced in collaborating with cross-functional teams including engineering, architecture, and operations to deliver data-driven healthcare solutions at scale.

Product Owner at COFORGE (formerly ENCORA) (2022-08 – Present)

• Analyzed high-volume claims data to identify trends, reducing processing errors by 20%.
• Developed pricing logic for dispensing and administrative fees, ensuring accurate reconciliation between covered entities and contract pharmacies.
• Monitored daily claims flow for eligibility and HRSA compliance, preventing duplicate discounts and diversion risks.
• Managed product backlog of 120+ user stories, collaborating with cross-functional teams to ensure on-time release delivery across 3 quarterly releases.
• Provided solution options and cost estimates to support business decision-making.
• Delivered end-user training to 40+ operations staff on pharmacy claims processing workflows, improving system adoption and reducing processing errors.

Sr. Business Analyst at HCL (2021-06 – 2022-04)

• Created project plans, scope documents, schedules, and forecasts.
• Served as process owner for platform-level artifacts including domain models and capability matrices across six business units.
• Collaborated with leadership to define product vision and roadmap.
• Partnered with architects to evaluate trade-offs between usability and performance.
• Ensured compliance with federal and state healthcare regulations.

Functional Consultant at IQVIA CONSULTATION PVT. LTD. (2019-12 – 2021-06)

• Delivered RCM solutions supporting billing and reimbursement workflows.
• Interpreted ICD-10, CPT, and HCPCS coding requirements for system implementation.
• Authored detailed FRDs for EDI 837 transaction processing.
• Optimized 270/271 eligibility workflows enabling real-time verification.
• Led integration of 10+ external healthcare systems using HL7 interfaces, reducing manual data entry by 90% and improving data exchange accuracy.

Business Analyst at NAPIER HEALTHCARE SOLUTIONS (2019-03 – 2019-12)

Client Engagement at GGK TECH (2018-09 – 2019-03)

• Conducted root cause analysis for defects, reducing client-reported issues.
• Collaborated with multiple payers to capture regulatory requirements.
• Built predictive models to forecast operational outcomes.
• Created wireframes using Axure and Balsamiq.

Implementation Consultant at KRANIUM HEALTH CARE SYSTEM PVT. LTD. (2013-07 – 2018-08)

• Gathered requirements across hospital departments for HIS implementation.
• Prepared system design documentation and master data.
• Supported go-live planning and post-implementation operations.
• Presented insights to stakeholders through reports and presentations.

MCA in Master in Computer Application – Andhra University

BSc in Computers – Andhra University