SUMMARY:

• 6+ years of diverse experience as Business Systems Analyst in developing, innovating and improving business solutions in Healthcare/Pharma
• Liaised with Business Analysts, Quality Analysts and Development teams to identify and trouble - shoot bugs in various stages of the SLDC cycle
• Proficient in developing Business Requirement Documents(BRD) and Functional Requirement Documents (FRD)
• Experience in Business Intelligence reporting and ETL tools.
• Strong experience in Software Development Life Cycle (SDLC) RUP - Waterfall, Spiral and Agile Methodologies, Rational Unified Process (RUP), Business Modeling Process (BMP) and Requirement Traceability Matrix (RTM).
• Conducted Joint Application Development (JAD), Rapid Application Development (RAD), Disaster Recovery Planning (DRP), Fast Track Decision (FTD), Surveys, questionnaire and User Stories in requirement gathering.
• Experience with Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
• Capable to load, extract and validate client data via Extract Transfer Load (ETL)
• Strong experience in Business and Data Analysis, Data Profiling, Data Migration, Data Conversion, Data Quality, Data Governance, Data Integration, and Metadata Management Services, and Configuration Management.
• Expert in Extraction, Transforming and Loading ETL data using SSIS/DTS creating mappings/workflows to extract data from SQL Server, Excel file, other databases and Flat File sources and load into various Business Entities.
• Thorough knowledge of Eligibility and membership Affairs for Medicare and Medicaid. Also knowledge of HIPAA, ANSI (ASC) - X12, and HL7 standards, and Medicaid provider best practices.
• Strong experience in Data Analysis, Data Migration, Data Cleansing, Transformation, Integration, Data Import, and Data Export .Experience in testing and writing SQL Queries, Stored Procedures, Functions, Triggers and packages.
• Develop reports using SSRS Business Intelligence (BI) tools, and Ad-hoc reports using Report Builder. Also, managed security of reports and Report Server.
• Highly experience in creating Tabular Reports, Matrix Reports, Drill-down reports, Drill-through reports using SSRS.
• Executed database testing by composing SQL and PL/SQL scripts to validate data integrity
• Excellent Knowledge of HIPAA Regulations and Claims Processing with good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare), billing experience with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
• Competence in Electronic Data Interchange (EDI)837 (claim request), 835 (payment), 834 (enrollment and benefit), 820 (premium payment), 270/271 (eligibility status), 276/277 (claim status)
• Successfully implemented HIPAA 4010 and HIPAA 5010 transaction set rules, ICD9 and ICD 10, General equivalence mapping (GEMS) Excellent working experience with XML and ANSI X12 data files
• Strong expertise in Unified Modeling Language (UML) and Object-oriented Analysis (OOA).
• Created test plans, scenarios, test cases and test execution using ALM platform
• Strong in-depth knowledge in conducting User Acceptance Testing (UAT), data quality checks using SQL, GAP analysis and RTM.SWOT analysis, Cost benefit analysis and ROI analysis.
• Experience in Functionality Testing (QTP, Selenium), UAT, Database Testing, Regression testing, Black box testing, system integration testing and Risk Based Testing.
• Successfully managed multiple projects with Strong communication and Leadership skills.
• Exceptionally good interpersonal skills, good team player with outstanding written and oral communication skills.

TECHNICAL SKILLS:

Operating Systems: Microsoft Windows, UNIX

Languages: SQL, Java, Java Script, HTML, XML, X12 (EDI) and UML

Databases & Tools: SQL, Access, MYSQL, Oracle 9i/10g

Quality Management: Cerner PowerChart, HEDIS, HP ALM-Quality Center, Rational Test Manager, QTP/UFT, Rally, MS Test Manager (MTM), Team Foundation Server (TFS)

Business Modeling Tools: Rational Rose, Microsoft Visio, MS Excel, MS PowerPoint

Change Management Tools: Rational Clear Quest, Requisite Pro

Reporting Tools: Crystal Reports, Business Objects

Project Management: Microsoft Project Professional

SDLC Methodologies: Agile, RUP, Waterfall, Spiral, Iterative, UML, Six Sigma, CMM

Others: MS (Visio, Outlook, Access, Word, Excel, PowerPoint) Share point

PROFESSIONAL EXPERIENCE:

Confidential, Irvine, CA

Systems Analyst

Responsibilities:

• Identified and implemented the processes for developing and documenting detailed business requirements. Collected from end-users and analysts.
• Elicited business requirements through interviews, document analysis, design workshops, surveys, use cases, and workflow analysis.
• Performed Requirements Gathering and Analysis, interacted with the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
• Participated and facilitated Joint Application Development (JAD) Sessions for communicating and managing functional requirements and project expectations.
• Coordinated with the Project Manager to set project activities like keeping track of Project Status reports, Deadlines, and Compliance Issues.
• Managing and Billing Medicare, Commercial HMO/PPO claims on a daily basis.
• Worked on ICD conversion from 9 to 10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D).
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions.
• Performed Claims Unit and Regression testing.
• Interfaced with application architects, subject matter experts (SME’S), healthcare provider information specialists, managers, quality review specialists, and service team supervisors.
• Involved in Data modeling using Informatica IDQ and MS Visio.
• Designing test scripts for testing of Claims in Development, Integration and production environment.
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Establish / capture new data feeds, perform data integration, Analysis for several initiatives supporting multiple Pharmacy Insurance products
• Worked with Claims, enrollment, eligibility, benefits verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Successfully designed logical and physical database models using Informatica IDQ, data modeler; designed initial database migration plans and procedures for migrating data.
• Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios.
• Created Process Work Flows, Functional Specifications, and was responsible for preparing Software Requirement Specifications (SRS) and the Functional Specification Document (FSD).
• Developed data quality test plans and manually executed ETL and BI test cases.
• Created action filters, parameters and calculated sets for preparing dashboards and worksheets in Tableau. Created requirement for user, user groups, and scheduled instances for reports in Tableau.
• Executed and tested required queries and reports before publishing. Converted metric insight reports to tableau reports.
• Imported preexisting Microsoft Word and Excel-based requirements and tests for analysis in Quality Center.
• Responsible for creating reports based on the requirements using SSRS 2012.
• Developed and wrote test cases for the testing efforts in compliance with Pharmaceuticals Policy, which were written to comply with the rules and regulations of FDA 21 CFR Part 11.
• Performed Security Testing on the application. Selected test cases based on an analysis of the specification, for functional and non-functional requirement of a component or system without reference to its internal structure for black box testing.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Executed test cases, found errors, reported defects, determined repair priorities, did regression testing
• Tested the validity of the data cleaning done by the ETL by writing SQL and by using Informatica.
• Monitored the Defect Tracking Process and generated customized graphs and reports for the client using Jira
• Followed the Agile Methodology Process throughout the project and all artifacts are generated for each discipline.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.

Confidential, Dallas

Business/System Analyst

Responsibilities:

• Provided support for planned Cerner PowerChart Cardiology(TM) implementation
• Worked with Customer staff, SMEs to identify bugs and areas of improvement on the Cerner PowerChart Cardiology implementation
• Extensive knowledge and experience with PowerNotes, PowerForms, Iview and other Cerner applications
• Gathered Business Requirement through interviews with SMEs (subject matter expert) like medical transcripts, collection agency, insurance agency and typical patients, etc and captured requirement using Rational Requisite Pro
• Followed the UML based methods to create Use case Activity Diagrams/ State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams
• Created and maintained functional Requirement documents for MMIS Application for Medicare and Medicaid Claims
• Created Data Flow/data Lineage Diagrams (DFD/DLD) to depict the Source-to-Target Mapping and Data Lineage Analysis
• Worked on conversion from ICD-9 to ICD-10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D)
• Assisted in writing test case scenarios and performed Claims Unit testing, Regression testing, Integration testing and Compliance testing.
• Extensively worked on Facets, the claim processing tool used in the project.
• Analyzed the member/eligibility information on claim to that in Facets.
• Worked on Facets to efficiently execute core administrative functions, including claims processing, premium billing and customer service
• Worked with SME close to analyze the Claim Adjudication Process setup in Facets.
• Implemented automated COB (Coordination of Benefits) processing of Medicare claims into Facets.
• Worked with Claims, enrollment, eligibility, benefits verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
• Set up Provider's Access to the System. (Security Setup).
• Helped creating Provider Reports i.e. Financial, Claims processing.
• Performed Data Analysis, created gap analysis document, and performed data quality Checking.
• Extracted data from existing data stores, Developing and executing departmental reports for performance and response purposes by using oracle SQL, SAS, procedures, packages, functions, database triggers.
• Executed the Performance testing cases developed for the claims engine, EDI servers and T1 line.
• Used SQL in MS Access for data manipulations and data search of the claims.
• Monitored claims data is available in data warehouse for reporting purposes in Business Objects XI using MS Access.
• Involved in capturing data lineage, table and column data definitions, valid values and others necessary information in the data models. Created pivot tables in Excel by getting data from Teradata and Oracle.
• Designed and developed UNIX shell scripts as part of the ETL process to automate the process of loading, pulling the data for testing ETL loads.
• Tuned ETL jobs/procedures/scripts, SQL queries, PL/SQL procedures to improve the system performance.
• Created Transformations and Mappings using SSIS and processing tasks using Workflow Manager to move data from multiple sources into targets
• Maintained data consistency, database integrity and reported instances of data corruption.
• Interacted with end-users and business analysts to identify and develop business requirements and transform it into technical requirements and ultimately responsible for delivering the solution.
• Created SSRS report in BI studio, prepared prompt generated/ parameterized report using SSRS 2008
• Created reports from OLAP, sub reports, bar charts and matrix reports using SSRS
• Involved in gathering, analyzing, and documenting business requirements, functional requirements and data specifications for Business Objects reports
• Responsible for the definition and the scope of the business requirements for the application developed
• Responsible for the documentation of the various modules that were involved in the business process
• Gathering of business requirement and converting them into Functional Requirement Specification and User Requirement Specification
• Interacted with the Business Users to convert requirements document into Business System Design documents and Technical Specification for the Development Team
• Involved in creating queries, stored procedures and views in SQL
• Conducted regular walk through with the developers and testers
• Heavily involved in creating Test plan and test cases
• Used the Rational Unified Process (RUP) to build the different phases of Software Development Life Cycle (SDLC)
• Performed the analysis for making system compliant with Health Insurance Portability and Accountability Act (HIPAA).

Confidential, Thousand Oaks, CA

Systems Analyst/Data Analyst

Responsibilities:

• Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010 and ICD-9-CM to ICD-10 and Tested conversion of ICD-9 to ICD-10.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 EDI transactions.
• Generated monthly and quarterly reports as bar charts for the management using SSRS.
• Checked the data flow through the frontend to backend and used SQL Queries and UNIX commands to extract the data from the database.
• Trained the designers and developers on logic operations for credit insurance and other type of policies
• Worked as a member of the Data lineage Team to support the financial systems and Controls Manager on Data Mapping and documenting the end-to-end finance process
• Created database objects such as tables, views, triggers and indexes
• Responsible for data lineage, maintaining data dictionary, naming standards and data quality
• Created complex Stored Procedures, Functions, Views, Indexes, SQL joins and Sub queries for applications.
• Perform a baseline assessment of Hospital-Provider systems and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements
• Worked on Data Mapping to map Facets data to outbound eligibility extracts
• Wrote complex SQL queries to extract and validate the data from the Facets database for member and claims data.
• Involved in creating the constraints, rules, defaults and triggers to maintain the data and referential integrity and created ER diagrams.
• Involved in Physical modeling on Teradata such as creation of tables, indexes and views
• Maintained data consistency, database integrity and reported instances of data corruption.
• Interacted with end-users and business analysts to identify and develop business requirements and transform it into technical requirements and ultimately responsible for delivering the solution.
• Used SAS & SQL Server Reporting Studio SSRS for reporting.
• Involved in gathering, analyzing, and documenting business requirements, functional requirements and data specifications for Business Objects reports
• Designed and developed a database for capturing and reporting of provider and billing data and developed SQL queries for successful monthly arrangement of billing files.
• Successfully worked with Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.