SUMMARY:

• Over 8+ years of comprehensive experience as a Business systems Analyst in the Healthcare/Insurance Industry including Payer, Provider, etc.
• Exposed to using ICD 9/ICD 10/ANSI/4010/5010 coding standards in the healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology, etc
• Extensively involved in Data warehousing administration and metadata management responsibilities.
• In debt understanding and experience in data mapping and ETL process.
• Experience in RDBMS including Conceptual/Logical & physical Database Design and Model using ERWIN.
• Comprehensive knowledge of Software Development Life Cycle (SDLC), having thorough understanding of various phases like Requirements, Analysis/Design, Development and Testing
• Exposure in Forward Mapping and Backward Mapping analysis of ICD 9 - ICD 10
• Have exposure to EDI, Web Portal, DSS and System documentation
• Extensive experience on Business Intelligence (and BI technologies) tools such as OLAP, data warehousing, reporting and querying tools, data mining and Spreadsheets.
• Worked extensively in data consolidation and harmonization
• Experience in data alignment and data cleansing.
• Vast experience of working in the area data management including data analysis, gap analysis and data mapping.
• Worked extensively with Dimensional Modeling and Data Migration.
• Experience in Data Transformation, Metadata, Data dictionary, Data Loading, Modeling 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.
• Adept at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary and interface requirements documents.
• Good control on MS Office suite, MS Visio and MS Project.
• Designed, developed and tested an Access database to document and track corporate audit results. The database included custom developed tables, queries, forms, reports, macros and VBA coding.
• Worked with business team to test the reports developed in Cognos.
• Extensively used Data warehouse ETL methodology for supporting data extraction, transformations and loading processing, in a corporate-wide-ETL Solution using Informatica, Data stage, etc.
• Knowledge of the following HealthCare EDI Transactions for 4010/5010 like (278) Referral Certification and Authorization, (834) Benefit and Enrollment, (835) Payment & Remittance Advice, (837 I & P) Institutional and Professional HC Claim
• Comprehensive knowledge of RUP, Agile, Scrum, FDD, Waterfall Methodologies
• Extensive experience in gathering, managing and documenting business requirements and functional requirements, communicating effectively with upper management, senior BAs, developers and QA engineers
• Excellent track record for meeting deadlines and submitting deliverables on time
• Excellent documentation, communication and interpersonal skills

TECHNICAL SKILLS:

Project Methodologies: Rational Unified Process (RUP), UML, Agile

Bug Reporting Tools: Mercury Quality Center, Test Director, Rational Clear Quest, Bugzilla

Operating Systems: Windows XP/2000/Vista, UNIX

Databases: MS Access, MS SQL Server, Oracle

Project Management: MS Office, MS Project

Methodologies: RUP-Rational Unified Process, UML, Waterfall, Incremental

Design Tools: Rational Rose, MS Visio, Rational Requisite Pro

Data Analysis: Cleansing, Data Transformations, Data Relationships, Source Systems Analysis

PROFESSIONAL EXPERIENCE:

Confidential, Virginia Beach, VA

Sr. Business Systems Analyst

Responsibilities:

• Involved in gathering, documenting and verifying business requirements.
• Organized JAD Sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
• Gathered Business Requirements from the Subject Matter Experts (SMEs) for “ICD 10 Project” and documented the requirements in the BRD.
• Performed Data Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
• Creation of a Mapping Document for ICD9 Codes to ICD 10 Clinical Modifications and Procedural Codes.
• Worked closely with stakeholders and SME’s for requirements gathering.
• Reconciled the Relation tables to ensure the dependencies does match with Health products selected.
• Worked with Operational and Implementation team to built a system where loading Providers and Eligibility checks can be made successfully which overcomes efforts of keying records through GUI.
• Did Post load Check through GUI to make sure provided updates/Demographic information is loaded accurately.
• Involve in drafting System Requirements & Data Requirements documents and getting them approved by the intent director.
• Create Source to Target (End to End) mapping documents where data requirements are mapped to entities in Logical and Physical Data Model.
• Worked on EDI transactions: 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.
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Worked on ETL design for various source systems.
• Define the ETL mapping specification and design the ETL process data from sources and load it into Data Warehouse tables.
• Designed the logical and physical schema for data marts and integrated the legacy system data into data marts.
• Integrate Data stage Metadata to Informatica Metadata and created ETL mappings and workflows.
• Designed mapping and identified and resolved performance bottlenecks in Source to Target, Mappings.
• Developed Mappings using Source Qualifier, Expression, Filter, Look up, Update Strategy, Sorter, Joiner, Normalizer and Router transformations.
• Involved in writing, testing, and implementing triggers, stored procedures and functions at database level using PL/SQL.
• Developed Stored Procedures to test ETL Load per batch and provided performance optimized solution to eliminate duplicate records.
• Involved with the team on ETL design and development best practices.
• Designed, developed, and maintained various Business unit reports by using Teradata, SQL, and Ms Excel.
• Extract data from Teradata, Excel and flat files into SAS Datasets.
• Made statistical analysis and reports using SAS.
• Designed and Developed ETL (Extract, Transformation & Load) strategy to populate the Data Warehouse from the various source systems feeds.
• Using MS-Visio analyzed business requirements and process through Use Cases, Class, Sequence, and Activity diagrams, and adapted UML standards to define modularized Data Process Models.
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
• Designed, developed and tested data mart prototype (SQL 2005), ETL process (SSIS) and OLAP cube (SSAS) for Computer Maintenance Management System (CMMS)
• Wrote Test Cases for EDW - Data ware house (Source to Target) and Cognos Standard Reports, OLAP and CUBE.
• Validated Cubes, Adhoc Reports and Standard Reports built from Cognos.
• Involved in project status meetings, QA review meeting, and System Test meeting.
• Coordinated and facilitated the execution of User Acceptance testing.
• Was involved in writing SOP’s for various projects/processes.

Environment: Agile methodology, Informatica Powermart, ETL, SAS, Cognos, Rational Suite (Requisite Pro, DDM, Clear Quest, Clear Pro), MS Office Suite, MS Visio, MS Project, SharePoint, JIRA, Rally, Soap UI, Windows 7, MS Access, Oracle

Confidential, Scottsdale, AZ

Sr. Data/Business Systems Analyst

Responsibilities:

• Gathering requirements from business users based on new market rules and Desk level procedures.
• Worked with Architects to Create Data flow model for Government owned Facilities, and for new oncoming ROSTERS.
• Created business requirements document (BRD) & functional requirements document (FRD) to map the business rules as documented.
• Wrote Use cases and test cases for testing and the processing of member enrollment and benefits.
• Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.
• ICD-9 and ICD-10 solution for parallel processing and step-up or step down processing.
• Implementing and expertise in ICD-9/ICD-10 and CPT related products (i.e. DSM IV-TR, DRG, APG, APC and HCC).
• Created Gap Analysis Document for changes of the EDI Transactions (837, 835, 276/277, 270/271)
• Created SQL queries to check the updates in Oracle database and executed SQL queries in Oracle to check the redundancy of data.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros
• Setup of batch job with parameter to process claims from HIPPA Gateway
• EDI Processing, the retrieval of Medicare/Medicaid claim files, delivery of acknowledgement reports, '835' Remittance Advice, '837' Professional and Institutional claim files
• Performed deep dive program analysis as a part of ICD 10 Project performed the modifications to existing SAS code.
• Set up runbook for Inbound and Outbound EDI transactions.
• 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
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process
• 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.
• Extensively used Informatica client tools. The objective is to extract data stored in Oracle database, flat files to load finally into a single data warehouse repository, which is in Oracle.
• Created and Configured Workflows, Work lets, and Sessions to transport the data to target using Informatica Workflow Manager.
• Created Test data and test cases in MS Excel to test numerous scenarios, for setting up Providers in FACETS.
• Worked with Facets Architects to get in-depth knowledge on Providers life cycle and how can Members and Claims get affected with Providers Network setups.
• Did Reconciliation of Data on Providers back-end table to gauge the quality and enhance quality of existing entities.
• Worked with Facilities to get the correct count on number of Members/ Eligibility and Demographic information to set Groups/Subgroups/Subscribers/Members accurately in facets
• Reconciled the Relation tables to ensure the dependencies does match with Health products selected.
• Worked with Operational and Implementation team to built a system where loading Providers and Eligibility checks can be made successfully which overcomes efforts of keying records through GUI.
• Reported Vendors about the data issues and required Data Quality.
• Created Pivot tables to show the oncoming new adds Vs Terms from new vendors.

Environment: Informatica power mart, ETL, SAS, Facets, MS Office suite, SQL Server 08, Quality center, Visio, Oracle, .Net, SQL, Quality Center, XML

Confidential, Boise, ID

Business Systems Analyst

Responsibilities:

• Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
• Wrote HLR (High Level Requirements), DBR (Detail Business Requirements), and Test Scenarios, Test Cases for the functional and non-functional aspects of both Web Application and Reporting jobs.
• Reviewed DBR with other technical team members in order to develop report.
• Did final testing/validation for data of reports developed by Vendor using Win SQL.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
• Reviewed vendor solutions designs and assist in coordinating testing between vendor and client for product enhancements.
• 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.
• Assisted in the Development of new SAS code, and modifying and updating existing SAS codes while validating results
• Successfully generated permanent and temporary SAS datasets.
• Extensive file transfers from Mainframes, and move it to centralized DB2 server repository, which serves as input to all the SAS programs.
• Extensively used ETL to load data from multiple sources to Staging area using Informatica Power Center. Worked with pre and post sessions, and extracted data from Transaction System into Staging Area. Knowledge of Identifying Facts and Dimensions tables.
• Tuned sources to targets mappings and sessions to improve the performance of data load.
• Designed Logical and Physical Modeling using ERwin Data Modeler tool.
• Did data migration of Informatica Mappings, Sessions, and Workflows to Data Integrator.
• Created data stores, project, jobs, and data flows using Data Integrator.
• Involved in the Development of Informatica mappings and mapplets and also tuned them for Optimum performance, Dependencies and Batch Design.
• Created Several Informatica Mappings to populate the data into dimensions and fact tables.
• Worked cooperatively with the team members to identify and resolve various issues relating to Informatica and other database related issues.
• Worked with Third Party Vendor to define Data Elements for the Data Extract and validated prior to loading into the Warehouse.
• Responsible for co-coordinating with different vendors during integration & end to end testing.
• Participated in the weekly team meeting to discuss the upcoming work, schedules and status.
• Heavily worked on Application Change Request(ACR) by Creating HLR, DBR for the ACR and working with developer to develop the functionality, and working with UAT team for testing within the time and budget(250 hours).
• Analyzed and Documented business processes and requirements for Share Point Development project.
• Worked on QNXT Security Rules to provide security solutions to Confidential .
• Worked on QNXT Configuration and Maintenance/QA Activities (i.e. Addition/Removal of AUTHs/CPT/HCPCS/Rev/ICD 9/Procedue codes/Custom fees/Restriction and Service Groups) in a Benefit/Contract term. Also worked on addition and updating of Contract Terms (Change in reimbursement fees like daily rates) with the state specific revised rates of fee schedules.
• Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
• Involved in evaluating the scope of application, defining relationship within and between groups of data.
• Effectively communicated user acceptance test results between users and development team and provided recommendations for Application change requests (ACR).
• Supported the business and the technical team in the product development and delivery process with successfully managing cross- departmental relationships.

Environment: MS Access, Mainframe, SQL, Business Object, Share Point, Data Stage, SAS,UNIX, Windows XP, QNXT, .NET, MS office, PowerPoint, Word, Excel

Confidential, Monroe, LA

Business Systems Analyst

Responsibilities:

• Worked with business requirements analysts/subject matter experts to identify and understand requirements. Conducted user interviews and data analysis review meetings.
• Resolved the data related issues such as: assessing data quality, data consolidation, evaluating existing data sources.
• Worked closely with Data Architect to review all the conceptual, logical and physical database design models with respect to functions, definition, maintenance review and support Data analysis, Data Quality and ETL design that feeds the logical data models.
• 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.
• Involved working on different set of layers of Business Intelligence Infrastructure.
• Dealt with Oracle Hyperion Financial Management tool for financial consolidation and reporting.
• Worked extensively in Data consolidation and harmonization.
• Worked extensively on the MS-SQL 2008 environment to run out the queries and explore the databases.
• Defined key facts and dimensions necessary to support the business requirements.
• Worked with OLAP tools such as ETL, Data warehousing and Modeling.
• Made statistical analysis and reports using SAS.
• Meeting with user groups to analyze requirements and proposed changes in design and specifications.
• Performed Detailed Data Analysis (DDA), Data Quality Analysis (DQA) and Data Profiling on source data.
• Flat file conversion from the data warehouse scenario.
• Created Fact and Dimension tables in Mart.

Environment: Windows 2008 Server, Mainframe, MS SQL Server 2008, UNIX, SAS, DB Visualizer, OLAP, MS Office, T-SQL Queries, Informatica Power Center 9.5, PL/SQL, Putty

Confidential, Fort Worth, TX

Business Systems Analyst

Responsibilities:

• Engaged in different phases of SDLC of the project executing RUP methodology of iterative software development from Inception to Transition phase.
• Performed the role of a liaison between Business Units and Technical Solution Developers.
• Understand and articulate Business Requirements from SME interviews and workshops and translate requirements into Business Requirement Specifications (BRS). Involved in conducting JAD with SMEs, Developers, Project Managers and Quality Analysts to discuss business requirements, test planning, resource utilization, and defect tracking sessions as a facilitator to gather requirements from the business area.
• Implemented Unified Modeling Language (UML) methodologies for process modeling and developing use cases. Developed Use Cases, Sequence diagram, State diagram, and Activity diagram.
• Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects.
• Analyzed EDI ANSI X12 file mapping and reported in analysis spreadsheet. Performed validation of 837 (P, I, D) & 835 format files according to the EDIFECS engine. Management of Patient Profile Transfer (PPT) reports created by data team by verifying the associated data.
• Involved in creating Test Plans and created Test Cases from the BRD, FRD and design document to cover overall quality assurance. Conducted Functionality testing, Integration testing, Regression testing, UAT, and ETE testing. Generated weekly and monthly reports and submitted to the Team Leads and Manager for reporting status report and analyzing purpose.

Environment: Windows, MS SQL Server, Rational Unified Process (RUP), UML, Rational Rose, Mercury Test Director, MS Office Tools, Lotus Notes, Java.