SUMMARY:

• A Sr. Business Analyst with Over 7 years of diversified experience in areas like Business / System Analysis, Project Management and Testing.
• Extensive experience Healthcare and Insurance applications.
• Knowledge and vast experience of PMBOK and BABOK.
• Well Familiar with current industry standards, such as HIPAA, SOX, ISO, Six Sigma, and Capability Maturity Model (CMM).
• Strong experience of working with Medicare and Medicaid insurance data, Medicare parts A, B, C & D, and Insurance Claims.
• Extensive experience on interaction with system users in gathering business requirements and involved in developing projects. Chaired and conducted JAD sessions with business and technical teams.
• Extensive Experience in OBIEE Administrative Tool, OBIEE Answers, OBIEE Dashboards, OBIEE Delivers and BI Publisher in designing, developing and with prebuilt
• Strong knowledge of HIPAA (EDI), ICD, OIR, CMS, Claims, Under Writing, Membership / Billing, Medicare, Medicaid, Claims and Medical management systems.
• Extensive Business Intelligence and Data warehousing experience using OBIEE 10g/Siebel Analytics 7.x,BI Publisher, Informatica7.x/6.x.
• Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC). Experience in leading the testing effort for Mainframe, COBOL, java, J2EE, .NET applications.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD - 9, ICD-10 coding and HL7.
• Knowledge of 837, 835, 277, 270, 271, NCPDP, 5010 and ICD-10.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
• Experience in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis.
• Proficient in using Agile Scrum methodologies, performed roles of Scrum Master following sprint/standup sessions and used Excel extensively to write user stories, analyzed the Iteration Burn Down charts and reviewed defects.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270, 271 for healthcare benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Worked on Facets - a product for Healthcare Insurance sector. Good working knowledge of Claims processing, HIPAA Regulations and 270, 837P, 837I, 837D EDI Transactions for health care industries.
• FACETS experience in the areas of Enrollment, Enrollment Pre-processing (834 & proprietary enrollment file mapping, Business rules design & Enrollment Keyword creation) MMS Batch processing, Provider, and Claims Strong understanding of test plans, test cases, test scripts and defects tracking/reporting.
• Hands on experience in SAS programming for extracting data from Flat files , Excel spreadsheets and external RDBMS (ORACLE) tables using LIBNAME and SQL PASSTHRU facility
• Well versed with ICD9, CPT, HIPPA, claim adjustments, claim processing claim review, identifying claims processing problems, their source and providing alternative solutions.
• Experienced in creating Data Flow Diagrams, Use Cases, Use Case Diagrams, Activity diagrams, Entity Relationship Diagrams
• Experience in Forward Mapping and Backward mapping analysis of ICD 9 - ICD 10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).
• Experience on Object Oriented Programming (OOP) like C#.NET, Java, using Eclipse and Visual studio with Back end as Oracle and SQL Server.
• Hands on experience working with SAS Enterprise Guide, Information Map Studio, Data Integration Studio and Web Report Studio
• Well versed in Process Narratives, Flow charting Techniques using UML, and Good Documentation Practices.
• Experienced in developing Object Oriented Analysis and Design Models; Use Case Model and UML.
• Good Knowledge of Unified Modeling Language (UML), Class Diagrams, Use Case Diagrams, Activity Diagrams, Sequence Diagrams.
• Experience in utilizing SAS Procedures, Macros, and other SAS applications for data extraction, data cleansing, data loading and reporting. Involved in the data analysis, DB creation, applying database constraints and make ready to load onto database

TECHNICAL SKILLS:

C++, SQL, HTML, SAS, MS-Access, Oracle PL/SQL, ASP.NET, MS SQL Server, DB2, Microsoft .NET, Frameworks, ASP.NET, SAP, Flash, JavaScript, PVCS Tracker, and SharePoint, HTML, XML, Macromedia Dream Weaver, MS-Front Page, MS Word, MS Excel, MS PowerPoint; (Lotus, HTTP, TCP/IP, FTP,MS-Visio, Rational Rose, Irise (User Experience),MS-Project, PVCS Tracker,SDLC, SDM, Agile, Waterfall, Object Oriented Analysis and Design (OOAD), Rational Unified Process (RUP), SAS (Base SAS, SAS/STAT, SAS/SQL, SAS/MACRO, SAS/GRAPH, SAS/ACCESS, SA/ODS, SAS/QC, SAS/ETS, Unified Modeling Language (UML), Rapid Application Development (RAD), Joint Application Development (JAD)

PROFESSIONAL EXPERIENCE:

Confidential, Dayton, OH

Sr. Systems Analyst

Responsibilities:

• Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
• Extensively involved in data modeling
• Provided full life cycle support for company’s Facets enhancement to Facets e2 Workflow and Network Management Suite with Pricing Modeler and Network Modeler application--including Business Requirement gathering, Functional Design, Technical Design, and Production Support documentation for multiple outgoing interfaces.
• Gathered legacy system requirements by shadowing Customer Service Representatives (CSRs), Customer Relationship Representatives (CRRs), preparing questionnaires, to identify limitations in the current system and GAPS in the proposed system.
• Created reports in SAS and exported to Excel spreadsheets, created web reports using Web Report Studio.
• Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transition from version .
• SAS Requirement Analysis, Sizing and Management.
• Performed Data analysis, statistical analysis, generated reports, listings and graphs using various SAS Tools namely SAS/Base, SAS/Macros, SAS/Graph, SAS/SQL, SAS/Connect, SAS/Access.
• Teamed up with both internal and external software development groups to provide functional requirements specifications in form of use cases, business process flows, and prototypes and management reporting requirements
• Experience in Customer Service Request handling.
• Developed Java Servlets at server side for handling requests and responses from the web page
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Executed OBIEE administrative tasks such as OBIEE server installation, migration and user maintenance.
• Responsible for generating Financial Business Reports using SAS Business Intelligence tools (SAS/BI) and also developed ad-hoc reports using SAS Enterprise Guide.
• Established Connection between Java and Database using JDBC
• Hands on experience on setting up LDAP for OBIEE.
• Worked on the MMIS (Medicaid Management Information Systems).
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Trained End Users and Pilot Users about OBIEE Tools.
• Performed Client side validations using Java script and database programming in oracl
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
• Worked extensively through Agile development methodology by dividing the application into iterations
• Worked with FDA guidelines (21CFR), HIPAA (Health Insurance Portability and Accountability Act).
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes
• Using MITA improved managing and monitoring of programs through the sharing of data.
• Used Facets 4.71 to receive, store and send HIPAA-standard transactions (835, 837, 270, 271, 276, 277) and to administer HIPAA privacy rights.
• Single-handedly developed utility programs (using Base SAS & SAS Macros) for generic IND tables & Listings along with interface (SAS Macros - window
• Mapped provider data from source to target Facets 4.71 data layout for the claims and benefit configuration.
• Participated in Facets Table data modeling; planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• Translated high level business / data requirements into Process, Workflow, and Data Flow Diagrams using Rational Rose / MS Visio / BPMN towards facilitating clear understanding of the business process.
• Supported SOA, data warehousing, data mining, and Enterprise Service model standards in designs, and developed standardization of processes like configuration management.
• Created the conceptual, Logical and Physical Model for the data warehouse with emphasis mutual funds and annuity using Erwin data modeling tool.
• Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications;
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Used the CMMI Model to guide process improvement across a project
• Experience in providing the backward compatibility from Facets 4.71 to all earlier versions.
• Identified authoritative data sources; specified business rules for data feeds utilizing HL7 protocol.
• Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
• 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.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
• Responsible for GAP analysis of ICD9-ICD10.
• Created test plans, test cases and test scripts for UAT.
• Created test scripts and plans for UAT Phase.

Environment: MS Project, SQL, RUP, Rational Requisite Pro, SAS, OBIEE 10.1.3.2, Rational Rose, Agile, Clear Quest, MS Visio, Window, 2000/XP,Mercury Test-Director, HTML, Dreamweaver, JAVA.

Confidential, Indiana

Systems Analyst

Responsibilities:

• Wrote Business Cases after conducting meetings with business users, risk team and finance team.
• Acted as IO Analyst and worked closely with IO Manager, BU Sponsor and BU Contact. Measured business opportunity, description of solution and scope. Measured and documented Labor and Material Detail, Skill Set, Budget Cost to Achieve (CTA) Summary, Inflow Summary and Economic Analysis.
• Installed OBIEE 10.1.3.4.1 on Windows Server 2003 Environment.
• Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837, 835, and 834 and ICD-10 Code sets.
• Was responsible for data mapping of HL7 messages into relational database.
• Develop, design and implement department plan to operationalize new FACETS integrated processing system, to include but not limited to workflow, management oversight and performance analysis.
• Facilitated Change Control Board and Governance Board (CCB) meetings and acted as a liaison between parties impacted by the change requests.
• Added new Tags into the OBIEE 10.1.3.4.1 instanceconfig.xml file resolve the report and dashboard issues like Graph engine is not responding, pivot table/charts display twenty five rows by default etc.
• Worked on SQL Server 2005 concepts SSIS (SQL Server Integration Services), SSAS (Analysis Services) and SSRS (Reporting Services).
• Creating, documenting and maintaining macro library. Writing SAS Macro for the creation of a Generic Treatment File.
• Developed straightforward RDBMS queries, knowledge of HL7 and xml interface messaging.
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
• Mapped all as-is business processes using BPMN standards on MS Visio.
• Conducted JAD sessions and created functional and technical requirement specification for application development based on Solution Delivery Process.
• Created a test plan and a test suite to validate the data extraction, data transformation and data load and used SQL and Microsoft Excel.
• Established Connection between Java and Database using JDBC.
• Deployed Map Viewer and Integrated Map builder with OBIEE by creating the Spatial Data in database and Created different Maps using Different Themes, Colors and Markers.
• Developed estimates, project plans (Microsoft project), training material, BI reports using Microstrategy
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• 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.
• Used the BPMN to GAP Analysis to bridge the gap between business processes.
• Coordinated end to end testing efforts of the HIPAA Compliance and EDI Transactions.
• Ran queries monthly to verify tie-outs for the business prepared by the technical resource to provide support for applications solutions supported by the Reporting and Analytic Finance team with emphasis on the Corporate Finance Cognos Planning Models.
• 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.
• Performed Impact Analysis and Gap Analysis.
• 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.
• Develop, build and manage Reporting Services (SSRS) reports using both SSAS cube and relational database sources including distribution of reports using subscription services
• Recommended changes for improvement after analyzing operational procedures and methods.
• Documented issue list and risk list pertaining to various projects.
• Creation of Gap Impact Analysis and Operational Analysis Document for Medicaid Subrogation
• Wrote use cases and verified that they match every single requirement of the application.
• Prototyped the application, provided screen shots for better visualizations.
• Coordinated and collaborated the business, operations and the technical areas throughout the project life cycle.
• Create presentation style reports with chart and graphs which can be used to access any type of data source
• Presented reports to management and provided user training and acceptance tests.
• Performed manual testing and recorded results in Clear Quest and used SQL queries for enhancements.
• Performed the user acceptance testing.

Environment: Rational Unified Process (RUP), UML, Dreamweaver, SAS, Rational Test Manager, WinRunner, Rational Clear Quest, Windows, MS Office, HTML, Windows

Confidential, DE

Business Analyst

Responsibilities:

• Conducted user interviews at both in-house and client locations, gathering and analyzing requirements using Requisite Pro and Requisite Web
• Organized Joint Application Development (JAD) sessions with ETL team while having walkthroughs for mapping documents.
• Proactively search for opportunities to increase UX efficiencies
• Extensively used Agile Methodology in the process of the project management based on SDLC.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, Object Oriented Design (OOD) using UML
• Worked extensively in Data consolidation and harmonization
• Designed and Developed the OBIEE metadata Repository using OBIEE Admin tool by importing the required objects with integrity Constraints into physical layer using connection pool
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state requirements
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Identify Member, Provider, Coverage, Medicare, and Medicaid.
• Experience with TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Integrated LDAP Server with OBIEE by creating servercert.perm, serverkey.perm and serverpwd files in Config folder and also updated Config file then created LDAP connection. Imported users and synchronized users with LDAP server.
• Developed test cases and test scripts and assisted Quality Assurance activities, with system integration testing and user acceptance testing (UAT), developing and maintaining quality procedures and ensuring that appropriate documentation is in place.
• Involved in claim adjudication process of FACETS application.
• Used Trizetto Product NetworX Pricer and the terms used in the Pricer.
• Interacted with Subject Matter Experts (SME), claimers, customers; Conducted detailed interviews with them, recorded the requirements, and reviewed the gathered requirement by both technical and business people.
• Responsible for identifying and documenting business rules and creating detailed Use Cases
• Developed ETL mappings, testing, correction and enhancement and resolved data integrity issues.
• Identified the source and target tables. Developed mapping document using MS excel.
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications.
• Determined the natural keys for the target tables.
• Created the conceptual, Logical and Physical Model for the data warehouse with emphasis on insurance (life and health), mutual funds and annuity using Erwin data modeling tool.
• Participated in the process of internal and external auditing activities and developed timelines for project delivery, and managed projects and resources to successful completion
• Mapped provider data from source to target Facets 4.71 data layout for the claims and benefit configuration.
• Responsible for executing User Interface Testing, System Testing, Data Quality Testing on the configuration design and prototypes in Facets 4.51.
• Participated in frequent Agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide UX input and guidance to an Agile product development process.
• Experience working with Health Care Client Server Product TRIZETTO FACETS
• Involved in data dictionary management, extraction, transformation and loading (ETL) of data from various sources. Participated in ETL requirements process during data transition from source systems to target systems
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting
• Established Inner Join, Outer Join and created Indexes whenever necessary
• Facilitated internal review sessions with the BI and ETL team and external review sessions.
• Writing Complex SQL queries and optimizing SQL Queries.
• Designed and developed the OBIEEMetadata Repository (.rpd) using OBIEE Server Admin tool by importing the required objects (Dimensions and Facts) with integrity constraints into Physical Layerusing connection pool, developing multiple Dimensions (Drill-Down Hierarchies) & Logical & Facts / Measures objects in Business Model Layer, and creating the Presentation catalogs inPresentation Layer
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize FACETS features not provided by the legacy systems.
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting
• Participated in creating logical and physical data models, their enhancement. Based on the data models, worked with business architect, to create the software solution models.
• Helped in creating of Data-Mapping best practices document including visual processes and trained team members on Data Mapping process and tools.

Environment: Rational Rose, Rational RequisitePro, DB2, Rational Clear Quest, Rational manager Rational Administrator, SQL, VB.Net, Oracle, IBM Business Modeler, SEI, UML

Confidential, FL

Business Analyst

Responsibilities:

• Facilitated collection of functional requirements from system users, and prepared business and technical requirement specification documents.
• Write and execute positive and negative test cases to ensure the data originating from the data warehouse (Oracle dB) is accurate through to the SQL dB in the applications.
• Senior level SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data ware house processes.
• Facilitated review of Enrollment, Claims, Commissions, and membership portlets’ designs with architects and developers to ensure that the goals of the portal requirements were satisfied
• Used UML, for gathering requirements, created Use Case Diagrams, and Use Case Specification document (USD).
• Tracking and managing requirement changes using Requisite Pro.
• Worked closely with Users, Developers and Administrators to resolve ongoing Production Problems by reviewing design changes made to production systems and made corresponding changes to theOBIEE Repository
• Assisted in building a Business Intelligence Process Model using Rational Rose and Visio.
• Extensively involved in the modeling and development of Reporting Data Warehousing System.
• Used Prototyping method to gather additional requirements from the users in order to describe the business needs in terms of the system being created.
• Responsible for the development and implementation of documentation standards, naming conventions, templates and process documents for CMMI certification.
• Prioritized project efforts, developed project plans, process flows, Use Cases and SRS using RUP.
• Experience in implementing and managing the implementation of software, hardware and hybrid solutions to enable Electronic Health Records (EHR) and Health Information Exchanges (HIE)
• Followed the RUP based methods using Rational Rose to create: Use Cases, Activity Diagrams / State Chart Diagrams, Sequence Diagrams.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Provide business intelligence analysis to decision-makers using an interactive OLAP tool
• Captured, communicated, managed system requirements and Maintained requirement tractability to keep team members up to date with the latest requirements and changes if any.
• Formatted HL7 messages for interface applications to Cloverleaf interface engine.
• Responsible for training and testing of transactions.
• Successfully implemented AGILE methodology for application development.
• Involved in creation of test plan, test scenarios, test cases for unit, system and system integration testing.
• Execution of test scripts using WINRUNNER, TESTDIRECTOR.

Environment: MS Office Suite (Word Excel, PowerPoint), MSP, MS Visio, Windows XP/2000, Caliber RM, Business Process Modeling Notation, HP Quality Center, Dot.net 2.0