SUMMARY:

• 7+ years of experience in the Information Technology (IT) Industry serving as a Business/System Analyst in a Data warehousing environment in Health care.
• Excellent knowledge of industry standard methodologies like Software Development Life Cycle (SDLC), Iterative Software Development Life Cycle Process as per Rational Unified Process (RUP), CMM (Capability Maturity Models), Rational Tools used during various phases of RUP and BPM Tools.
• Experience in gathering user requirements, preparing and analyzing both Business Requirement Documents (BRD) and Functional Spec Documents (FSD), and proposing changes for process improvement with use of the various internal and external requirements gathered.
• Proficient in creating Use Cases, UML, Sequence diagrams, and Activity diagram.
• Deep knowledge of Medicare - Medicaid Rules, NCPDP, HIPAA, ICD-9/ICD-10 codes, CPT, HCPCS, EMR, EHR, PHR, HL7, X12 EDI transactions’ (270/271, 276/277,834,837/835).
• Extensive experience on business intelligence (and BI technologies) tools such as OLAP, Data warehousing, reporting and querying tools, Data mining and Spreadsheets.
• Comprehensive understanding of the Organizational Framework that help to map the AS-IS and TO-BE model using the GAP Analysis and plan and monitor effective approach to build/buy solutions to the business problems/needs/opportunities.
• Deep understanding of enterprise data warehouses (EDW)
• Extensive experience in enterprise data modeling and analytics (SSRS, SSAS, SSIS, ETL, MDM, Entity Data Models and data warehousing) incorporating transaction oriented business/service level data processes and metadata collection techniques to enhance informatics strategies.
• Experience with Medicare Advantage programs and associated federal regulations
• Worked extensively with Dimensional Modelling and Data Migration.
• Experience in Data Transformation, Metadata, and Data dictionary, Data Loading, Modelling and Performance Tuning.
• Experience in DBMS/RDBMS implementation using object-oriented concept and database toolkit.
• Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
• Developed the business crosswalks for 837(P, I, D), 835, 834, 820 and 276/277 according to HIPAA implementation rules
• Documented the process flow & Business Use Case for the EDI transaction 835, 837 & tagged them in RequsitePro
• Adept at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary and Interface requirements documents.
• Worked on integration and implementation of projects and products, database creations, modelling, calculation of object sizes, table spaces and database sizes.
• Created and executed Test Plan, Test Scripts, and Test Cases based on Design document and User Requirement document for testing purposes.
• Extensive experience in the testing environment, which included User Acceptance Testing (UAT), functional testing and system testing and defect tracking using ClearQuest.
• Competent in Creating Unified Modelling Language (UML) diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams
• Involved in Test Planning, Test Preparation, Test Execution, Issue Resolution and Reports.
• Active involvement in User Acceptance Testing (UAT) and training of end-users.

TECHNICAL SKILLS:

Methodologies: SDLC, RUP, UML, Agile/SCRUM, Waterfall

Change Management: Clear Quest, BMC Remedy, HP SM

Business Modelling Tools: MS Visio, Rational Rose, Rational Requisite Pro

Operating Systems: Windows XP/ 7/2003/2008/2012, Unix

Databases: Oracle 11/10G/9i/8i, MS Access, SQL Server 2012/2008

Languages/Platforms: SQL,.NET, Java/J2EE, HTML, CSS, Xml, Shell, C, PL/SQL,SQL

BA Tools: Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook, SharePoint 2010), Visual Source Safe (VSS), Microsoft Project, Microsoft Visio

QA Tools: HP Quality Centre, Rational Quality Manager, HP Load Runner, HP Quick Test Pro, JIRA

Testing Strategies: Integration, Unit, System, Black Box, White Box, UAT

PROFESSIONAL EXPERIENCE:

Confidential, NC

Sr Business Analyst

Responsibilities:

• Developed research and investigation plans in order to: understand existing and predict future healthcare fraudulent trends and patterns in overpayments, detect double charges, and document reports containing performance measures that led to the development of new and more effective models for post-payment audits and recoveries.
• Utilized statistical analysis software such as SAS and SQL for analyzing large relational datasets.
• Sound knowledge of Medicaid, Medicare Healthcare policies, benefits, plans and medical products and well-versed in EDI - HIPAA transaction code implementation - 834, 820, 837, 835, 276, 277, HL7 and experience working with member eligibility and enrollment modules and claims processing applications
• Involved in Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Statistical comparison and analysis in order to oversight claims and identify suspicious patterns that can scrutinize for further investigation.
• Created System Use Cases and System Requirements documentation for Medicare project
• Provided mapping, and gap analysis for HIPAA codes sets and EDI transaction processing between Trading Partners and Regence
• Currently leading, coordinating EMR/EHR (iHelix Suite) implementation to achieve meaningful use stage 1.
• Performed link analysis and pattern analysis which provide the lead in identifying/connecting unrelated data in order to identify patterns and relations among apparently unrelated data points.
• Responsible for conducting gap analysis as is to be for ICD9 and ICD10. Prepared Data Flow Models for code sets validating in Facets and Claim Process Engine.
• Involved in creating sample mappings for the conversion of EDI X12transactions code sets version4010to5010and translation ofI CD 9codes into ICD 10codes.
• Developed and maintained programs in SAS for UNIX in a user support environment.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Responsible for creating mapping documents required for the ETL team.
• This task has been accomplished by analyzing data such as private commercial records, property tax records, and multi-level drill-down assessment of financial performance measures by business region, provider network, and risk assessment factors.
• Data Visualization presenting data in charts, graphs, tables, designing and developing relational databases for collecting data, designing data input and data collection screens
• Write SQL commands to query, map, join, delete, and merge tables, columns, rows of data, manipulate, filtering, aggregating and analyzing large data sets. SSRS, SSIS create reports, import and export data
• Provided configuration expertise for global configuration strategy and development and worked with multiple conversion and implementation teams.
• Managed several different teams of configuration analysts responsible for system configuration, including product design and loading, benefit conversions and reporting.
• Re-engineering and capturing of EDI transactions with legacy systems Enrollment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
• Gathered downstream systems flat files that needed to be mapped into the TriZetto Facets proprietary keyword file format in order to be committed to the Facets database through batch processing.
• Excel: Data modeling, Power Query, Power Pivot, Power View, and Power Map, VLOOKUP, HLOOKUP, conditional formatting, aggregations, formulas, functions, import large datasets, analyze data and report findings, query large data, print reports, publish reports to web, SharePoint and intranet.
• Performed felid-by-field mapping of interface between parent EMR system and downstream system.
• Map to data sources: Hadoop, on premise data sources, streaming data, cloud services, Excel, Access and SAS, SharePoint and SQL.
• EMR: Canopy, Epic, Cerner rollouts, EMR installation, troubleshooting and training medical staff
• Worked on ETL design for various source systems.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Reported and analyzed all application defects, user issues and resolution status to the higher manager using Mercury Test Director.
• Worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Developed business process models in RUP to document existing and future business processes.

Environment: Ascential, DataStage (Designer, Director, Manager, Parallel Extender) Debugger, DataStage BASIC language Expressions, SAP SD, SQL Server, Rational Test Manager, Cognos, Data Stage, ETL, Facets, Rational Requisite Pro, Rational Clear Case, Clear Quest, Rational Rose, Erwin, Mercury TestDirector, Agile, Waterfall, MS Access, SDLC, RUP, UML, UAT, XML Files, MVS, IMS.

Confidential, PA

System Analyst

Responsibilities:

• Gathered user requirements and directed developers for practical deliverables.
• Work with the full SDLC, elicit, analyze and define requirements.
• Prepared Business Object / Business Process Models that included modelling of all the activities of business from conceptual to procedural level.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Gathered requirements from the clients and developed crosswalks for 820, 834, 835, 837 P/I claims.
• Understood EMEVS, the NY state's electronic Medicaid eligibility verification system & the Medicaid & Medicare intermediary along with their roles in claim processing
• Closely worked with the ETL team to load the data from the OLAP system to the Ratings data warehouse by creating a source to target mapping documents with the data transformation logic and if any roadblocks working thoroughly to overcome the issues.
• Used Rational Unified Process (RUP) for streamlining the team’s development activities.
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 278/278, 820, 834, 271U, 835, 837-(I,P, & D), 835 Remittances and others. Resource for UB04 and CMS1500 billing formats, transaction sets requirements, EDI development and Design, X12 protocols through Version 5010 and Errata; conversion needs and understanding of legacy EDI formats.
• Prepared documents to conduct user acceptance testing.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Worked on configuration of Facets with Enrollment and Claim processing.
• Proposed solutions to reporting needs and develop prototypes using SQL and Business Objects that address these needs.
• Healthcare system implementation including enterprise Electronic Medical Records (EMR) software.
• Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
• Followed the UML based methods using Rational Rose to create: Use Cases, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Participated Testing and Evaluation of projects at established integration points to assess progress and identify key functionality issues.
• Followed the business rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions
• Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPPA 837 and proprietary format files and Reports development.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros
• Used SAS ODS to create output files in different formats including PDF and RTF
• Identify customer marketing opportunities by applying data mining models and writing advanced T-SQL stored procedures and queries.
• Prepared and analysed AS IS and TO BE in the existing architecture and performed Gap Analysis.
• Created help files for EHR incentive program for Meaningful use for Eligible Professionals to get the stimulus money.
• Led client discussions related to the Facets configuration of a standard Medicare Advantage plan.
• Worked extensively with Members, Providers, Claims, Configuration, and Payment Modules of Facets.
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment
• Tracked UAT issues/bugs and prepared reports.
• Took approvals from business owners for business requirements

Environment: Unix,ETL, DB2 UDB, SQL, MS Power Point, MS Excel, COGNOS, RUP, UML, SAS, Rational Rose, Oracle 10g,facets, Testing Strategies.

Confidential, Washington DC

System Analyst

Responsibilities:

• Involved in development phase meetings for Business Analysis and Requirements Gathering.
• Created the logical models and generated the physical models in the databases using Erwin.
• Coordinated various kinds of User Acceptance Testing (UAT) including regression testing, system testing, integration testing, functional testing, alpha & beta testing.
• Supported SOA, data warehousing, data mining, and Enterprise Service model standards in designs, and developed standardization of processes like configuration management.
• Developed test cases based on the crosswalks and compliance guidelines for 270/271, 276/277, 820, 834, 835, 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatica was used for ETL process and Business Objects are used for Reporting duties.
• Wrote Test scenarios and test cases for testing the migration of EDI 4010 to 5010 and the processing of member
• Designed and developed Project document templates based on SDLC methodology
• Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Tested Performance & Accuracy related queries under SQL Server.
• Created Graphical representation of reports such as Bar charts, Pie charts etc as per the End user requirements using Business Objects and Crystal reports.
• Analyzed Business Requirements performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Tested the ANSI X12 Version 4010 / EDI transactions (HIPAA) like 270, 271, 276, 277, 278 837P, 837I, 837D, 835 remittances)
• Responsible to import the data from Crystal reports by using Business Objects Live office into Microsoft Excel and Word.
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
• Working with and utilized a growing knowledge of X12 F4010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, and Medicare
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Analyzed the given source Dimensions and target Fact table structures to develop Surrogate Key tables referencing required dimensions.
• Worked on configuration of Facets with Enrollment and Claim processing.
• Use Cases and other Process Flow Models were designed using Visio and Rational Rose.
• Analyzed data with discrepancies through Error files and Log files further data processing and cleansing.
• Created help files for EHR incentive program for Meaningful use for Eligible Professionals to get the stimulus money.
• Experience with Teradata SQL and Teradata Utilities (ETL Data Migration Tools).
• Involved in writing the detailed Test Plan using Mercury Quality Center, after analyzing business requirements and software/functional requirement artifacts.
• Completed GAP analysis in detail on all entities in CCL for a source system.
• Wrote Test Cases in Mercury Quality center that would test various Test scenarios.
• Created and managed project templates, use case templates, requirement types and tractability matrix in Requisite Pro.
• Worked on FACETS to terminate or reinstate health coverage for the subscriber.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.

Environment: RUP, UML, SDLC, UAT, Use Case, Rational Test Manager, XML Spy, Data Stage, Rational Requisite Pro, ETL, facets, Rational Clear Case, Clear Quest, Rational Rose, Visio, Agile, DB2/UDB Universal Database Oracle 8/9i, MS SQL Server 7.0, HTML, XML, UNIX, Windows NT, Sybase.

Confidential, Lexington MA

Business Analyst

Responsibilities:

• Gathered system requirements from clients, classified and documented them into functional and non functional requirements.
• Mapping the data provided with the database that was available under Confidential with the help of SQL Queries.
• Attended meetings with Japanese Customers to gather requirements.
• Highly detail oriented towards the client requirements, proficient in collecting and organizing information and taking lead in informing project members with project update report.
• Scheduled meetings to collect more information in regards to Asia Pacific Customers.
• Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of HIPAA key EDI (ANSI X12) transactions.
• Participated in weekly meetings to discuss the status of the project
• Extensively used UML in developing modeling diagrams from the SRS like Use case Diagrams, Activity diagrams and Sequence Diagrams using Rational Rose
• Created use cases to define and identify normal flow as well as alternate flow of the system.
• Generated Reports using MS Word.
• Well versed experience in all EDI transactions like 834, 837 P, 835, 27x and conversion of 4010 to 5010.
• Analyzed data and created reports using SQL queries for all issued Action Items. Performed the Gap Analysis to find the existing gap between the HIPAA 4010 and HIPAA 5010 EDI transactions.
• Study of client requirements, to gather and manage them and finally make sure that the requirements are met in collaboration with the project manager.
• In the process of gathering Requirement had to get involved in the process of asking more and more questions, pondering answers, asking follow up questions and bringing divergent opinions to consensus.
• Clearly differentiate between the business needs and software functionality.
• Gather business requirements and completely understand the business needs before defining a software solution.
• Some business requirements needed to be documented with the help of diagrams or graphical displays.
• Knowledge to clearly document and report defects and variances from the requirements, and also assisting the development team with identifying the defects and correcting them.

Environment: MS office (Excel), SQL, HTML, Microsoft Visio and Rational Rose