PROFESSIONAL SUMMARY:

• Over 8 years of industry wide experience with focus on Business /Data Analysis.
• A proactive problem solver with excellent planning and leadership skills.
• Thorough knowledge of Business Process Re - engineering, Requirements gathering, Process Flows, UML modeling, Content Management and related technical processes.
• Extensive experience in the preparation of Use Case, Sequence, Activity and Wireframe diagrams.
• Vast experience of working in data management including data analysis, Confidential and generating data mapping documents.
• Worked extensively with Erwin, Confidential and Confidential for Dimensional Modeling and Data Migration projects.
• Experience in Data Transformation, Data Loading, and Performance Tuning.
• Experience in writing SQL queries and reporting the results to the business team.
• Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Confidential Process (Encounter Confidential ), Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR).
• Extensively used Teradata utilities (Multi Load, Fast Load, and TPump) and Informatica for ETL operations.
• Good knowledge on different modules within healthcare (Membership, billing, enrollment, Confidential, capitation, providers).
• Experience with HIPAA compliance (4010 & 5010) and Healthcare systems.
• Experience with Medicare, Medicaid, Medigap/Medsupp & commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 270,271, 276, 277, 835, 837, 997, NPI, ICD 9,ICD 10, NDC, DRG, CPT, NCPDP codes & NSF formats for interfaces & images to clearinghouses/ trading partners applications.
• Experience in ETL and data integration experience in developing ETL mappings and scripts. Using Informatica Power Center, Power Mart, and Informatica Data Quality (IDQ) and Informatica Data Analyst (IDA) tools using Designer (Source Analyzer, Warehouse Designer, Mapping Designer, Mapplet Designer, and Transformation Developer), Repository Manager, and Workflow Manager & Workflow Monitor.
• Adequate knowledge in Health Administration - Confidential processing (auto adjudication), COB, EOB/Drafts, Confidential pricing.
• And testing, enrollment, Medicare, MMIS, Medicaid, CDHP (consumer driven health plans).
• Rich experience with various modules of Facets like membership management, premium billing, enrollment, Confidential processing & adjudication, coordination of benefits administration.
• Experience with data analysis, data mapping and dimensional modeling experience in decision support systems (data marts) using Star Schema.
• Extensive knowledge and experience of HIPAA EDI X12 834, 837,835, 270/271, 276/277, 278 transaction and ICD9/10 codes.
• Experience with health care Systems: FACETS, Medicare Part A, B, C, D, Medicaid systems.
• Experience with FACETS - Member Module and Confidential Module.
• Experience in Data Transformation, Data Loading, Migration and performance Tuning.
• Excellent Team player to work in conjunction with testers (QA), developers and other team members in validation and testing of complex project scenarios and in the maintenance of Quality Standards of projects.
• Experience in working with Microsoft Office Suite (Word, Excel, Power Point, Access, Confidential, and Project) for documentation, analysis and presentation.
• Substantial experience with different development methodologies such as Waterfall and Agile and a solid working knowledge of BI methodologies and tools.

TECHNICAL SKILLS:

Operating Systems: Windows, MS DOS, Linux, HP/UX

Languages: C++, PHP, CSS, SQL, HTML, XML, Familiar with .NET, Java, Korn Shell scripting, R

Database: SQL Server, Teradata, MySQL, Oracle, MongoDB, Hadoop, Ab Initio, MS Access

Project Methodologies: Joint Application Development (JAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Agile, AWS

Documentation Tools: MS - Office Suite (Word/Excel/Power Point).

Business Modeling Tools: Rational Rose, MS Confidential, MS Project

Reporting Tools: Crystal Reports, Cognos, SSRS

Data Visualization: R, Tableau, Python

Business Intelligence: Business Objects, SAP, Micro strategy Desktop 10

Healthcare Tools: EDI X12, HIPAA, 4010, 5010, Trizetto, FACETS, ICD 10,To ICD9 EDI X12, HIPAA, 4010, 5010, TriZetto, FACETS, ICD 10,To ICD9

PROFESSIONAL EXPERIENCE

Confidential

Business Systems Analyst

Responsibilities:

• Created report everyday for state reporting
• Creating excel pivot table reports using Cycle Time data. These reports consist of Customer level data. These reports are very useful to get a greater insight into the further plan design.
• Database management, database error corrections, database handling and maintaining database accuracy team projects
• Production support queue managing and handling tickets on critical needs basis
• Research and analysis teamwork based projects
• Medical Bill state reporting and Confidential handling
• Gathering requirements, communicating and translating among different teams
• Gathering and presenting data for yearly/quarterly/monthly/weekly and daily reports
• Conducting meetings with the stake holders/clients
• Initiating and maintaining strong team work
• Involved in Confidential - Confidential Report and Confidential - Confidential Report. Tested the SSRS reports to verify the data is accurate.
• Providing solutions for EDI file failures and procedures
• Processing Weekly medical State reporting files and logging in Pivot tables
• Error corrections for data accuracy and prevention of state penalties

Confidential, Durham, NC

Business Analyst / Technical Writer

Responsibilities:

• Created the report using Teradata SQL to retrieve data from the bank data warehouse, resolving & reporting data issues, liaising with the business team to QA the report.
• Created macro program to create Macro variables to pull data from oracle and SQL server for monthly daily data extracting.
• Performed daily weekly and monthly campaigns as per the deliverable schedules.
• Creating excel pivot table reports using Cycle Time data. These reports consist of Customer level data. These reports are very useful to get a greater insight into the further plan design.
• Extensively interacted with the stakeholders, Confidential and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
• Providing Solution to DM plans and Vendors if DM Files get rejected or Failed
• Ensure that all risks and issues are reported, monitored and escalated
• Involved in the data validation in some of DM Testing files and Production files
• Evaluated the Medicaid coverage and the rebate agreement from the Centers for Medicare and Medicaid Services.
• Involved in Confidential - Confidential Report and Confidential - Confidential Report. Tested the SSRS reports to verify the data is accurate.
• Created RWP (Requirement Work Plan) during the requirement planning session and set the time line to gathered requirements.
• Experienced in ETL (SSIS) and data validation processes and proficient in reporting services such as SSRS as well as SSAS.
• Worked extensively to create data profiles and score cards using SSIS/SSRS.
• Analyze and identify gaps/issues in Confidential, Confidential and remittance advice process flow.
• Convert X12 data to XML (using DI) and verify the data by performing schema validations including claim encounter data on EDI files.
• Executed queries using multiple aggregate and OLAP/OLTP functions and joins.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment.
• Designed ETL Process Models, Systems Diagram, Workflow, Activity Diagrams, Use Cases (UML) and Business Rules using MS Confidential .
• Wrote the SQL queries on data staging tables and data warehouse tables to validate the data results.
• Conducted different session with business owners from Claim, eligibility, enrollment.
• Created pivot tables for reporting data along different axes.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence
• Checked the data flow from front end to backend and used SQL queries to extract the data from the database.
• Writing PL/SQL Procedures & Batch Processes.
• Manage the successful submission of Medicaid Confidential for various states, support financial reconciliation, Monitoring Acceptance Rates, State Metrics, Correction Tracking and submission.
• Created dynamic Macro arrays by SQL and with data step programs.
• Developing repetitive loops for retrieving array variables for joining of datasets for ad-hoc reporting.
• Created reports using Proc Report, Proc Tabulate, ODS statements and Proc Template to generate output formats in HTML Excel and RTF.
• Documented the code and algorithms logically.
• Revised and automated daily, weekly, monthly and quarterly reports to run more efficiently and provide more meaningful information vital to the overall strategies.

Environment: TOAD, ETL, MS Confidential, ERWIN, Facets, MS-SQL Server, ER-Studio, HIPAA, Rational Requisite Pro, Rational Clear Quest, MS Confidential, MS Project, MS Access, Teradata, SQL, Microsoft Visual Studio.NET, Microsoft.NET Framework.

Confidential, Los Angeles, CA

Business Data Analyst

Responsibilities:

• Interacted with the Confidential to understand the business process and the project scope and documented the details to gather business requirements.
• Interviewed area experts, asking detailed questions and recorded the requirements which could be reviewed and understood by both business and technical people.
• Conducted JAD sessions for better understanding and refining of requirements in coordination with multiple teams.
• Analyzed existing reports and proposed reporting selection criteria and formats for financial planning and forecasting reports.
• Responsible for creating ad-hoc reports using Teradata SQL, Excel views & reporting using advanced excel functions for deep dive analysis by the operations analysis team, incentives reporting etc.
• Created excel pivot table reports using Cycle Time data. These reports consist of Customer level data. These reports are very useful to get a greater insight into the further plan design.
• Met with various groups, including business owners, Confidential (subject matter experts) and marketing team, for data requirements gathering in definition Stage.
• Performed Document Analysis to create Confidential for client requirements, generated workflow process, flow charts and relevant artifacts.
• Defined and documented the vision and scope of the project in Data Requirement Documents and Requirement Specification Document.
• Performed Data Mappings based on the specified data requirements and to check for data uniformity and to modify /update the data fields.
• Conducted data cleaning, manipulation, modification and combination using variety of SAS steps and functions.
• Verified Source to Target mapping and data validation.
• Worked on Medicare and Medicaid clams for PBM. Identified different Medicare and Medicaid plans and procedures for claim adjudication
• Involved in testing the Pharmacy Confidential adjudication and Billing processing is done through PBM (Health Trans) and Confidential Accumulation and Adjudication is done through Diamond.
• Helped design and implement processes for deploying, upgrading, managing, archiving and extracting data for reporting.
• Obtained, organized, and defined subject area Meta Data in applicable repositories (Teradata, SQL Server, and Oracle).
• Documented Business Requirement Documents (BRD), Functional Specification Documents (FSD), Meeting Minutes, application Documents, FAQs & Training Manuals.
• Performed GAP Analysis and analyzed the current and target system architectures and created gaps/differences document listing impacted audience and processes.
• Analyzed the source data coming from various data sources like Mainframe & Oracle.
• Created data mapping documents mapping Logical Data Elements to Physical Data Elements and Source Data Elements to Destination Data Elements.
• Worked extensively on the MS-SQL environment to run out the queries and explore the Databases.
• Worked with the UI team to create the User Interface screenshots to be presented to the Business.
• Examined, analyzed and modeled Test plans, & Test procedures and conducted regression testing and UAT.
• Performed testing on a data warehouse platform, including data integrity and data validation.
• Assisted in the designing and development Quality Assurance standard and processes to all levels of project team.
• Verified the functional aspect as per the Business Process and validated the interfaces with the systems and data conversion from the legacy system.

Environment: Agile, MS SQL Server,MMIS, UAT, ORACLE, MS SQL Server, Teradata, MS office, MS Confidential, Quality Center, Water Fall, Facets IBM-Rational Requisite Pro, UML, MS Confidential, MS Excel, Teradata, Korn Shell, Java.

Confidential

Business Analyst

Responsibilities:

• Interacted with business users, business analysts and translated business requirements into technical specifications.
• Responsible for writing SAS programs using Base SAS and SAS/Macros to create SAS Datasets.
• Extensive study, design, development and testing were carried out in the UAT Environment.
• Planned and executed detailed data analysis and simulation in Python.
• Conducted user interviews at both in-house and client locations, gathering and analyzing requirements using Requisite Pro and Requisite Web
• 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
• Gathered and documented Business Requirements, created Functional specifications and translated them into Software Requirement Specifications.
• Performed Confidential by identifying existing technologies, documenting the enhancements to meet the end state requirements
• Validated the following: 837 (Health Care Confidential or Confidential ), 835 (Health Care Confidential payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare Confidential .
• Written SQL queries for validation of ETL Reports from Source to Target system.
• Extracted Data from Teradata using Informatica Power Center ETL and DTS Packages to the target database including SQL Server and used the data for reporting purposes
• Developed ER diagrams and Physical Data-model along with the testing team so as to provide a clear understanding of the system under development and for reference of the testing tem
• Extracted data by running SQL queries, and analyzed financial and customer metadata that gets populated on the web application.
• Involved in data warehouse testing by checking ETL procedures/data mappings.
• Extensively involved in getting data from oracle database using SQL pass-through.
• Performed data cleansing to eliminate duplicate and inaccurate data.
• Generated high quality reports and listings in HTML, EXCEL and PDF formats using SAS /ODS.
• SAS/Enterprise Guide software was used for file and program management purposes.
• Using the Enterprise Guide Stored Processes, updating and developing macro programs code.
• Design of ETL process to meet the requirement of data demand.

Environment: Project, MS Office, Quality Center, UML, Teradata, JAD, SQL, SDLC, Agile, Scrum, HIPAA, Facets, HTML