SUMMARY:

• 12+ years of experience in Data Modeling, Data analysis, business requirements modeling and development of Web Based, and Client/Server applications in diverse business domains of Healthcare Regulatory Reporting.
• Extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare, Insurance, Medicaid and Medicare Industry.
• Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Have considerable expertise in Metadata Management, Data Analysis, Data Profiling & Quality, Data Governance and Master Data management (MDM).
• Used DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Experience in dealing with different data sources ranging from Flat files, Oracle SQL (Toad), Sybase, MS SQL Server, COBOL (IBM z/OS TNS, MQ, CICS, Copybooks, JCL’s), Teradata, MS Access and Excel.
• Deep understanding of HEDIS Reporting, Medical Record Abstraction, Quality Improvement, and Data Analysis.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, Micro Strategy Data Warehouse Data Modeling and Design.
• Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 700, 701, 810, 820, 834, 835, 837, 997, 999 4010/5010.
• Expertise in all HIPAA transactions (837, 835, 270, 271, 276, 277, 278, 820 & 834).
• Comprehensive understanding of HIPAA Standards (4010 & 5010) and Compliance issues, Medicare, Medicaid, ICD9, ICD10 and Claims adjudication process.
• Involved in ICD10 Implementation process of ICD10 CM (Clinical Modification) and ICD10 PCS (Procedure Coding System) focusing on the integration of Treatment Suites and the AcheiveHCS systems to accommodate the ICD - 10 mandate (HIPAA) and transition from ICD-9.
• SDLC Implementation within the (“MDM”), Enterprise Warehouse (“EDW”) and Business Intelligence (“BI”)
• Involved and conversant in various SDLC activities from Business Analysis, Business Requirement gathering, Business Process flow, Business Process Modeling, Data Analysis, MDM Data Mapping & Developed.
• Strong visual modeling and business process modeling skills using Rational Unified Process (RUP) and Agile Unified Process (AUP) with tools like Rational Rose, MS Visio, and well experienced in developing Use Case Models, Entity Relationship Diagrams (ERD), Data Flow Diagrams (DFD), Activity Diagrams, Sequence Diagrams and UML CASE tools
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
• Collaborated with Department Directors to develop and write Performance Improvement Projects according to Centers for Medicare and Medicaid Services (CMS) standards
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing.
• Experienced in SQL Server Reporting Service (SSRS), Executing Queries and Running Store Procedures.
• Solid experience with SQL Server and T-SQL in constructing triggers, tables, user functions, views, indexes, user profiles, relational database models, data dictionaries, and data integrity
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Leads use case review sessions with business owner, technical lead and developers.
• Responsible for creating different sessions and workflows to load the data to Data Warehouse using Informatica Workflow Manager.
• Troubleshooted file transmission problems and assisted customers with EDI and Medicaid Insurance claim related inquiries explained and enforced guidelines in the X12 Implementation guides (837P, 837I, 837D, 270/271).
• Experience with TriZetto Facets 4.21/4.31 and TriZetto HIPAA Gateway 4.11 - supported new business requirements by extending the functionality of the core Facets system using the Facets extensibility architecture feature.
• Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
• Gathered and documented Non-functional requirements.
• Knowledge of healthcare standard Health Level Seven (HL7).
• Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
• Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
• Experience with HIPAA compliance and CFR Part II electronic exchange guidelines.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.Provide post sales software implementation, design and configuration services to fit customer requirements. Scope project requirements and provide corresponding project plans outlining work effort involved. Design Enterprise level SAS Data Management solutions for Fortune 100 companies and Federal agencies; including real time matching routines, ETL data load processes and batch processing algorithms. Develop strong working relationships with new & existing customers. Extract data from multiple systems, conduct detailed data analysis, and load data.
• Perform detailed data mining, analysis and functional interpretation of Procurement Master Data
• Create and map transactional script templates using SAP field names in Winshuttle Studio
• Extract and transform data from Excel to help with the data migrations and making mass changes in SAP from Winshuttle
• Master Data Management Telecommunications, Media & Entertainment: Consolidation of customer, product, partner entity types
• Data governance rules implementation around key metrics identified within health care space, including trending, pattern analysis, data churn & referential integrity. System integration of membership & product data into custom developed master data hub. Including matching, merging, cleansing and report generation.

TECHNICAL SKILLS:

Business Intelligence Tools: Informatica Power Mart and Power Center,SAP Business Objects (BOBJ) and SAP BI,Cognos reporting applications, IBM Cognos 7.x/8.x/10.x/11 ( Framework Manager, Report studio, Query studio, Active reports, Power play Studio, Analysis Studio, Workspace, Workspace Advanced, Transformer Cubes and Dynamic cubes),Ascential DataStage and Data Integrator, BI Report Studio, SQL Server Reporting Service SSRS, SQL SSIS

Data Visualization Tools: Tableau 8.x/9.x.

ETL Tools: Informatica Power Mart and Center 9.x

Performance Management Tools: Jira,HP AML, Cognos TM1 9.5/10.1 (Architect, Perspectives and TM1 Web), Clarity

Languages: SQL, SQL*Loader, PL/SQL, SAP FI/CO ERP Financials ECC 6.0 EHP5/6/7 Cobol and Python

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Business Analyst

Responsibilities:

• Responsibilities include fundamental analysis and accuracy of bill status inquires, claimant eligibility inquiry, and medical authorizations.
• Develop analyze and produce OIG (Officer of Inspector General) Semiannual Report to Congress that covered OIG activities related to Medicare and Medicaid.
• Performance MIS/Reporting for the operations team to ensure rating/underwriting backlog management as well as KPI tracking.
• Generated Provider revenue against duplicate redundant submission by harvesting nuggets of competitive information from data sets and creating dashboards and pictograms to spur target efforts.
• Cultivated provider and claimant data profiles by using data manipulation and analysis to discern habits and needs, then turned the intel into robust, user-friendly reports for the OIG/DOL team.
• Supported the system development Managers with editorial and layout by creating award-winning pictograms, maps, pie charts and more to illustrate key Report facts trends for future reporting requirements and developments.
• Earned kudos for supporting successful flagship business initiatives in print media relations, through data analysis and the creation of presentations and dashboards after Xerox Business brand conversion to Confidential .
• Support billing and account technical administration that includes system development managers for Pain Management services, providers bill and/or submissions for prior authorizations using the appropriate HCPCS/CPT codes applicable for the services

Confidential, Salt Lake, UT

Project Manager

Responsibilities:

• Responsibilities include fundamental analysis accuracy and effectiveness measurement, managing financial statement spread audits, benchmarking predictive model performance, MIS/Reporting for the operations team to ensure rating/underwriting backlog management as well as KPI tracking.
• Responsibilities include fundamental analysis accuracy and effectiveness measurement, managing financial statement spread audits, benchmarking predictive model performance, MIS/Reporting for the operations team to ensure rating/underwriting backlog management as well as KPI tracking.
• Manage technology budget and capability enhancements for the group's primary case-management application, enhancing user experience while expanding availability of information and relevance.
• Developed and manage Confidential reporting, attestation and technology builds associated with regulatory compliance and business efficiency/strategy for the Central Rating and Underwriting team. Provide key inputs into Economic Capital management process, while playing a key role in development to move key manually intensive processes into automation.
• Transform raw data into digestible data enabling the business users to make key operational decisions.
• Manage technology budget and capability enhancements for the group's primary case-management application, enhancing user experience while expanding availability of information and relevance.
• Developed and manage Confidential reporting, attestation and technology builds associated with regulatory compliance and business efficiency/strategy for the Central Rating and Underwriting team. Provide key inputs into Economic Capital management process, while playing a key role in development to move key manually intensive processes into automation.
• Analyze trends in credit risk and underwriting performance to address trends of large financial institutions with a high degree of granular monitoring, and surveying companies deemed high risk.

Confidential, Houston

Sr. Financial Technology Risk Analyst

Responsibilities:

• Responsible for gathering requirements and performing functional analysis for the delivery of what if trade valuation and impact on the counterparty risks and regulatory capital in the Confidential I/II/III compliance initiative.
• Analyzed CRA and business repository data furnishing quality and preform root cause analysis of those trades/loans rejected or transformed.
• Owned the compilation of Weekly, Monthly, Yearly cross line reports of business CRA data statistics for furnishing from both internal and external resources.
• Owned the design, development and maintenance of ongoing metrics, reports, analyses, dashboards, etc., to drive key business decisions and communicate key concepts to readers.
• Led the complete lifecycle of visual analytical applications, from development of mock ups and storyboards to the complete production-ready application.

Confidential, Chicago

Sr. Business Analyst

Responsibilities:

• Current state analysis of business process which involved meeting with subject matter experts and discussing various process involved and grouping them into logical process maps in the Client acquisition, Account Set up, Portfolio Construction, Investment Planning, Portfolio Management & Rebalancing, Trading, Corporate Actions, Regulatory Reporting mega processes.
• Assist the client in preparation of the Business Requirement Document and Functional Specification Document by providing recommendations on Understood Fixed Income, Bonds and Bond Trading Cycle, Equities and Equity Trade Cycle, Derivatives (Options and Futures), Portfolio Management, Wealth Management, and Sales and Marketing, which meets the regulatory guidelines.

Confidential, New York City

Business Analyst

Responsibilities:

• Participate actively in project planning and execution, with specific focus on analysis, requirement gathering and design and also managing the requirements.
• Worked closely with multiple Finance Directors and Product Leaders on Monthly/quarterly analysis of financial results and performance to targets.
• Write Detailed Business requirements documents ( Confidential ) and assessment of current Confidential derivatives instruction trade management processes for front, middle and back office, reference data, data attributes and security master database.

Confidential, New York

Business Analyst

Responsibilities:

• Designing of data flow process for calculating and reporting risk-weighted asset results for Confidential derivatives and Repo/Security Lending trading books as part of the efforts for qualifying for Advanced Internal Rating Based ( Confidential ) credit rating of the Confidential II Accord.
• Drafted the project scope, and presented the same to the management committee.
• Current state analysis of business process which involved meeting with subject matter experts and discussing various process involved and grouping them into logical buckets and designing process maps in the Client acquisition, Account Set up, Portfolio Construction, Investment Planning, Portfolio Management & Rebalancing, Trading, Corporate Actions, Regulatory Reporting mega processes.

Confidential, Trumbull, CT

Business System Analyst/Data Analyst

Responsibilities:

• Used Agile Scrum for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Performed data analysis and data profiling using complex SQL on various sources systems including Oracle and SQL Server.
• Performed in depth data analysis identifying data issues in legacy system and worked with business to develop resolutions to those issues.
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, and data dictionary and data analysis.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using Erwin data modeling tool.
• Data profiling, validating, monitoring and cleansing across the enterprise through Informatica Data Quality (IDQ).
• Strong experience in the Data Analysis, Data Profile, Data Quality, Design, Development, Implementation and Testing of Business Intelligence applications using ETL and ELT methodology.
• Worked on eligibility files with the Claims dept. ensuring all the data and enrollments were correct and updated in AMISYS Advance.
• Facilitated, documented and oversaw the provider set-up and contract configuration in AMISYS Advance.
• Experienced in large enterprise projects, leadership experience, requirements interviewing, meeting facilitation, project management, state health/public health, HEDIS, SOA.
• Worked on requirements and completely developed the new process for HEDIS data processing.
• Experienced with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Strong knowledge of managed care payer requirements and procedures.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Experienced with Medicare and Medicaid: Claims processing, Membership, and Eligibility Verification and care management.
• There are no co-pays for members as the company is a Managed Medicaid and Medicare Advantage Company With the implementation of the Affordable Care Act, CareSource entered the health insurance marketplace.
• Knowledge of EMR/EHR, Patient Protection and Affordable Care Act (PPACA).
• Involved in Utilization management, Claims adjudication, grievance and appeals, 820, 834, 835, 837/278 EDI transactions to update claims and Prior Approval (Pre authorization) process for professional and Facility claims.
• Involved in preparing Test Data based on the functionality of all the HIPAA Related Transactions (837/835, 270/271, 276/277) and AMISYS transactions.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Used Guidelines and artifacts of Agile (Kanban) SDLC.
• Used MS Visio to create business process flowcharts and workflow diagrams, Involved in detailing project mission, Data Process Flow Diagrams and timelines, prepared data interfaces using XML and JSON data formats.
• Very good understanding of Business Intelligence and Data Warehousing concepts with emphasis on ETL and Life Cycle Development including requirements analysis, design, development, testing and implementation.
• Proficient in RDBMS concepts and also in database testing using PL/SQL tools such as TOAD.
• Participated as a core team member of a Clinical Development initiative to create an architectural business end-to-end solution for clinical trials as a standard for all remote data capturing clinical trials.
• Uploaded the technical specification documents to Planview SharePoint portal.
• Maintaining SQL Script for creation of Database Objects using VSS (Visual Source Safe).
• Created .NET Reports which are used to present the data in different views and are effectively consumed using Crystal Reports.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data warehouse/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Involved in creating sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Developed straightforward DBMS queries, knowledge of HL7 and xml interface messaging.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
• Involved in testing the conversion of the application into web application using XML web services.
• In an agile environment created Use Cases / Activity Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams thus defining the Data Process Model and Business Process Model.
• Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Wrote Test Cases in Mercury Quality center that would test various Test scenarios.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Facilitated JAD sessions for Requirement Validation with HPA to gather requirements for the new MMIS.
• Created Data Flow Diagrams (DFDs), ER diagrams for database modeling and Web-page mock-ups using MS Visio for acceptance from analysts, surveyors and customers.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application in iSeries RPG environments
• Involved in generation and execution of SQL queries.

Environment: Medicare, ezclaim, Oracle, FACETS, Agile, Medicaid, HIPAA-compliant patient information management and billing system and Microsoft Office package, Metadata, Data Warehouse, SQL, Db2, RDBMS, Erwin, Oracle, Rally, Rose, MS Word, MS PowerPoint, MS Excel, MS Visio

Confidential, NY, NY

Business System Analyst

Responsibilities:

• Worked with development team during technical design to maximize test support and Involved in Test Inspection and executed the test scripts for Connectivity to backend and positive and negative testing.
• Extensive experience in conducting Market Research, Feasibility Studies, Data Analyses, Data Mapping, Data Profiling, Gap Analyses, Risk Identification, Risk Assessment, Risks Analyses, and Risk management.
• Worked with end users for BI data analysis and data validation. Responsible for Master Data Management (MDM) and Data Life Cycle process. Worked on heterogeneous data coming from multi sources including Flat Files, CSV files, XML Files, Mainframe Files and DB2UDB. Worked on data analysis and validation.
• Performed data analysis, data reconciliation, data profiling and data retrieval from various systems along with identification of data gaps and data quality.
• Good command over Logical and Physical entity relationship data modeling using Erwin, Oracle Designer and Power Designer.
• Worked on Data Mart responsible for gathering requirements, preparing functional specifications and BI Business/Data Analysis / Modeling and UAT.
• Elicited, documented, modelled, validated and prioritized functional and non-functional requirements using interviews, data analysis, and different modelling tools.
• Used Test Director to detect defects, communicate to the developers and tracking the defects.
• Participate in the assessments of various technical design sessions to provide details during the development process and assure those detailed technical specifications match the business’ functional specifications.
• Managed the report conversion project for the AMISYS implementation using Pivotal Tracker project management tool.
• Strong Functional knowledge in the core Facets modules such as Plan/Benefits, Membership, Provider, Claims, Billing, Customer Service & Utilization Management
• Experienced in configuration of claims adjudication systems, i.e., MMIS, AMISYS, and Facets.
• Tested claims adjudication and group and enrollment in AMISYS for New Medicare advantage members.
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Experienced in development methodologies like RUP, SDLC, AGILE, SCRUM and Waterfall.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data warehouse/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Wrote Business Cases for the Stakeholders to understand the functioning of the new Underwriting System.
• Preparing Confidential, Business Cases, and presentation to the clients, Business Re-engineering proposals.
• Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
• Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat Files.
• Incorporated the Informatica Velocity approach for Mapping design, development and Data Governance
• Gathered user and business requirements through interviews, surveys, prototyping and observing from portfolio managers and UI (User Interface)
• Produced UML Activity diagrams with defined swim lanes using MS Visio as part of claims process analysis
• Upgraded HMO Medicare EDI and reporting.
• Created User Acceptance Test Plan and coordinated UAT for the site redesign project
• Worked on following applications Business Objects, Enterprise Architect, Toad, PlanView (project management), Microsoft Suite (Word, Excel, PowerPoint, Visio, Access, Project)
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Developed UML Use Case model for the application using Rational Rose and assigned to prepare the detailed work flow diagram based on the proposed enhancement for the system.
• Performed claims processing and Billing is done through PBM (Health Trans) and Claims Accumulation and Adjudication is done through Diamond.
• Generated test cases in Claims Analyzer Editor Professional to ensure unification with CPT-4 and ICD-9 codes
• Prepared project plans using MS Project and coordinated timelines as guided by the Project Manager
• Used Rational Rose to designed and develop Use Cases Scenarios, Use Cases Models, Activity Diagrams, Sequence Diagrams, State chart diagrams, OOAD using UML
• Performed Business Process Mapping and performed AS IS and TO BE analysis
• Performed Unit Testing and User Acceptance testing and documented detailed results.

Environment: Windows 2000/XP, Microsoft Office SharePoint, Facets, OOAD, Rational Rose, Cognos, Rational Requisite Pro, MS Office, SQL Server, SQL, MS Project, MS FrontPage, MS Access, Oracle, Erwin.

Confidential, Cleveland, OH

Business Analyst/Data Analyst

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Experienced working with clients in the Healthcare industry. (NPI, Membership & Billing, MetaVance, EDI 837, Professional and Institutional Claim Processing, COB, NASCO).
• Complete understanding and hands on experience of Pharmacy Benefit Management System and Health Insurance in the United States, in depth knowledge of Health Care Laws and ICD Standards.
• Executed all aspects related to employee health insurance, worker's compensation, life insurance, long/short term disability, employee discount/store benefits including company events coordination.
• Writing functional and technical specifications, creating source to target mapping, designing data profiling and data validation jobs in DataStage, and creating ETL jobs in DataStage.
• Strong experience in the Data Analysis, Data Profile, Data Quality, Design, Development, Implementation and Testing of Business Intelligence applications using ETL and ELT methodology.
• Master Data Management (MDM): Initiated a cross-functional project to identify what master data to manage and defined a process to collect, aggregate, match, and consolidate, quality-assure, maintain and distribute such data throughout the company.
• Performed Gap analysis for the modules in production, conducted feasibility study and performed impact analysis for enhancements, Cost benefit analysis and ROI analysis.
• Performed data analysis and data profiling using complex SQL on various sources systems including Oracle and SQL Server.
• Performed data analysis, data reconciliation and data retrieval from various systems along with identification of data gaps and data quality.
• Worked on Data Mart responsible for gathering requirements, preparing functional specifications and BI Business/Data Analysis / Modeling and UAT.
• Involved in testing the Pharmacy Claims adjudication and Billing processing is done through PBM (Health Trans) and Claims Accumulation and Adjudication is done through Diamond.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Knowledge of 837, 835, 277, 270, 271, NCPDP, 4010, 5010 and ICD-9/ICD-10.
• Provided input to the HEDIS system that used Quality Compass to provide a selection base for various healthcare plans.
• Developed BRDs, FRDs and FSDs using corporate templates; developed Use Case Diagrams, Activity Diagrams and Sequence Diagrams using UML.
• Worked on Documentum for Version Controlling, to maintain up to date changes in the Documents.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing).
• Conduct Business Rule Definition JAD session and Requirements Gathering JAD sessions
• Define and document client requirements for installations and manage requirements with changes
• Seek flexible, globally applicable system solutions to client requirements (HIPAA compliancy)
• Completed the documentation of Claims Scenario’s for the source system.
• Presented detail walk through of Functional Specifications, Detail Design and VISIO work flow process diagrams to Business, EDI, MQSI, HIPAA project managers and HIPAA project regulators.
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Involved in project management using MS Project
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, DataStage, Data Warehousing, Websphere and Cognos.
• Generated daily, weekly, and monthly reports using MS OFFICE Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose.
• Developed UML Use Cases for the application and prepared the detailed Work flow diagram based on the proposed enhancement for the system.
• Collaborated with External Auditors and documented SOX compliance requirements
• Lead internal design meetings, create mapping and design documents (834s, 835s and 501s)
• Wrote test cases and test scripts for the User Acceptance Testing (UAT).
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Created DTS and SSIS Packages to vendors in which records were loaded Daily, also to other data resources such as Excel, Access, flat file, and XML in order to Create and maintain a centralized data warehouse.
• Was also involved in developing UNIX shell scripts to emulate mainframe JCL.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.

Environment: Windows XP Professional, Oracle, XML, SOA, MS Access, MS Excel, MS Visio, MS project, RUP, Oracle, UML, SQL, Rational Rose, Requisite Pro, Clear Case, Rational Clear Quest, MS Office suite, MS Visio.

Confidential, Cleveland, OH

Insurance Data Processing Analyst

Responsibilities:

• Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
• Developed models to project revenue and costs to support budget forecasting and strategy development. Prepared standard monthly reporting
• Worked on Documentum for Version Controlling, to maintain up to date changes in the Documents.
• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Conduct Business Rule Definition JAD session and Requirements Gathering JAD sessions
• Define and document client requirements for installations and manage requirements with changes
• Seek flexible, globally applicable system solutions to client requirements (HIPAA compliancy)
• Completed the documentation of Claims Scenario’s for the source system.
• Presented detail walk through of Functional Specifications, Detail Design and VISIO work flow process diagrams to Business, EDI, MQSI, HIPAA project managers and HIPAA project regulators.
• Experienced with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Assisted technical teams in creating ER Diagrams; wrote complex SQL Queries for Data Analysis; well versed with Data Modeling, Data Flow diagrams, System Architecture, User-Interface design, Data Warehouse, RDBMS.
• Researched data issues and identify the root cause in source systems, data warehouse and data marts using various data analysis techniques, data profiling and data mining activities.
• Experienced in data analysis with solid understanding of Business Requirements Gathering, Data warehousing, Business Intelligence, Data Mapping and Data Modeling.
• Deep understanding of HEDIS Reporting, Medical Record Abstraction, Quality Improvement, and Data Analysis.
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Involved in project management using MS Project
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, DataStage, Data Warehousing, Websphere and Cognos.
• Generated daily, weekly, and monthly reports using MS OFFICE Tools and submitted to the Team Leads and Manager for reporting, status reporting and analyzing purpose.
• Developed UML Use Cases for the application and prepared the detailed Work flow diagram based on the proposed enhancement for the system.
• Collaborated with External Auditors and documented SOX compliance requirements
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• Lead internal design meetings, create mapping and design documents (834s, 835s and 501s)
• Wrote test cases and test scripts for the User Acceptance Testing (UAT).
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Created DTS and SSIS Packages to vendors in which records were loaded Daily, also to other data resources such as Excel, Access, flat file, and XML in order to Create and maintain a centralized data warehouse.
• Was also involved in developing UNIX shell scripts to emulate mainframe JCL.
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Served as conduit for managing system requirements between the business and the software development team.

Environment: Windows XP Professional, Oracle9i, XML, SOA, MS Access, MS Excel, MS Visio, MS project, Facets, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case, Rational Clear Quest, MS Office suite, MS Visio.