SUMMARY:

• Worked as a claim analyst in life insurance death claims department for one of the major companies with UK based Customers.
• We used to validate the documents, which are received from customers, and once the requirements met then we will settle the claims to respective persons.
• Worked as quality analyst, we used to verify the documents twice before settling the claims.
• Handling a team of 10 associates for HealthEC - MneConnect/OrbiteConnect Process.
• Quality Analysis and sharing feedback with the associates.
• Handles Payer Implementation process. Responsible for making direct contacts with the different payers
• (Commercial, State/Federal etc.)
• Responsible for maintaining direct connections with Health Payers for claim transmission.
• Responsible for conducting sessions in the team for any new joiner.
• Responsible for conducting webinars and session with the clients
• Modifying and Improving the existing Product. Updating SOP's on regular basis and sharing with the team as suggested by the onshore partners.
• Handled regular nesting batches before they hit the floor.
• Handling customer complaints and taking escalation calls.
• Conducting & Development programs for associates on monthly basis for knowledge enhancement and self-grooming.
• Knowledge of medical terminology and procedures, billing standards, data analysis and law regarding medical billing.
• Complete knowledge of claims transmission process and all types of medical files (837 P/I, 835, 270, 999, 277 etc.)
• On board healthcare providers (submitters) for Batch Claims. Responsible for the entire Batch Implementation process for all formats ANSI, CSV and Image. This process includes testing as per the format submitter will chose, also as per the payer requirements.
• Helps development team to get all the new payer requirements validated in our system/portal.
• Experienced professional with strong knowledge of the medical and insurance fields, including but not limited to customer service, claims processing, medical transcription and practice management.
• Nearly 6+ years of experience leading projects across multiple verticals. I have cultivated expertise in Agile Leadership and Project Management.
• Worked in all phases of project life cycle and in different SDLC methodologies such as Waterfall and Agile.

TECHNICAL SKILLS:

Business Tools: MS Office Suite, MS Visio, MS Project, MS Access, SharePoint, UNIX

Methodologies: Waterfall, Agile, RUP

Database Tools: Oracle SQL Developer, SQL Server, UNIX, MS -Access

Test Management Tools: Quality center, QTP, JIRA,HP ALM

EDI Mapping Tools: EDIFECS, xEngineVisualization Tools

Power BI, Power: Point, Tableau

MS Access, MS: Excel (Macros), SSA,Minitab

WORK EXPERIENCE:

Confidential, Schenectady, NY

Business Data Analyst

Responsibilities:

• On board healthcare providers (submitters) for Batch Claims. Responsible for the entire Batch Implementation
• Process for all formats ANSI, CSV and Image. This process includes testing as per the format submitter will chose, also as per the payer requirements.
• Helps development team to get all the new payer requirements validated in our system/portal.
• Experienced professional with strong knowledge of the medical and insurance fields, including but not limited to customer service, claims processing, medical transcription and practice management.
• Nearly 6+ years of experience leading projects across multiple verticals. I have cultivated expertise in Agile Leadership and Project Management.
• Worked in all phases of project life cycle and in different SDLC methodologies such as Waterfall and Agile.
• Experience in analyzing requirements, design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
• Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis and working with different software methodologies like Agile, Waterfall.
• Supporting all the documents with UML Diagrams such as Use Case Diagrams, Class Diagrams, Activity Diagrams, Data Flow Diagrams, Sequence Diagrams, Process Flows (Business and System) using UML modeling tools such as MS Visio and Rational Rose.
• Experience in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
• Organized many Joint Application Development (JAD) sessions and Joint Requirement Planning sessions (JRP), walkthrough, Interviews, Workshops and Rapid Application Development (RAD) sessions with end-user/clients/stake holders and the IT group.
• Teaming with all stakeholders to build 'as-is' and 'to-be' business process flow documentation using Microsoft Visio, as well as conduct gap/deficiency identification and analysis, including cross functional members.
• Knowledge of healthcare standard Health Level Seven (HL7)
• Lead fit/gap sessions to map requirements to standard Business Application Suite features and functions and experience on SQL queries to check the integrity of data and Facilitating Project Discovery, Sprint Backlog and Sprint Planning meetings
• Extensive experience in designing of Workflow Alerts and Actions, Workflow Approval, Profiles, Role based hierarchy, Sharing Rules, Validation Rules, Case Management, Custom Reports, Report Folders, Report Extractions to various formats, Dashboards, and Email generation according to application requirements.
• Knowledge of Oracle, SharePoint, Visio, IBM Rational Clear Case, Requisite Pro., UML/XML models.
• In depth knowledge in the analysis, design, and re-engineering of system applications and business processes, using structured system analysis methodologies, placement of business controls, diagramming data and process mapping, applying Unified Modeling Language (UML), and implementation of performance measures.
• Experience in system conversions (Mapping) such as HIPAA, ICD-9 codes to ICD 10 & PCS codes and claims processing.
• Strong knowledge of Word, Excel, VLOOKUP, Pivot table generation, Pivot Reporting and Flow Charts Monitored project execution/ change control/ release management.
• Experienced in Preparation of Test plans, Test Strategy Document, Test cases, developing and maintaining Test scripts, Analyzing bugs, Test Summary Report etc.
• Very Good experience in using HP-Quality Center and testing
• Sound proficiency in analyzing and creating, Use Case Diagrams, Sequence Diagram, Activity Diagram, Data Flow Diagrams, Business Flow Diagrams, Wire Frames and Mock-ups using MS Visio and Rational Rose to communicate business and functional requirements to clients and developers
• Understood Current state and future state of the project, performed "As-Is" and "To-Be" processes/GAP analysis.
• End-to-End project management and business analysis for several modules from inception to delivery.

Confidential, Bethesda, MD

Business Data Analyst

Responsibilities:

• Involved in the acquisition process of new infrastructure, establishment of a new service model, and implementation of a new service management system (ServiceNow)
• Worked with internal and external customers to gather the business requirements and transform them into user stories on ServiceNow Agile Development module
• Used ITIL practices to implement ServiceNow applications in phase-by-phase approach, created SLAs and participated in running SLAs and responsible for closing successfully in ServiceNow.
• Developed Service catalog, which includes creating new catalog items, designing workflows and execution plans.
• Hands on experience in writing Triggers, Procedures, Functions, Cursor, XML and PL/SQL Packages, Bulk Collect, For ALL clause, REF cursor, DBMS packages, SQL Loader, Analytical functions, Dynamic SQL, Collections, Views, Materialized views, data cleansing, UQT reports and Exception handling.
• Developed Complex Database Objects like Stored Procedure, Function, Package, Triggers using SQL, PL/SQL Scripts.
• Processed Medicaid claims and worked on X12 format of EDI 837 and EDI 835 for Medicaid claims.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrolment/Dis-enrolment to a health plan)
• Experience with HIPAA EDI Transactions 837, 835, 820, 276, 277, 278 code sets testing in Health Insurance.
• Experience with EDI HIPAA Project to convert EDI X12 Healthcare HIPAA 4010 transactions into HIPAA 5010 Complaint transactions.
• Involved in EDI automated first-pass claims adjudication, requiring thorough understanding of claims processing, both front and backend operations.
• Collaborated with ServiceNow Team to align the functionality and ease of use of the ServiceNow Service Catalog by undergoing a re-design into the workflow, functionality, and overall usability of the Catalog of services.
• Actively participated in activities such as CMDB administration, system upgrade and patching, regression testing and releasing of new applications
• Worked on creating Users, roles, groups and load the data to service-now objects using import sets on daily, weekly, monthly on request basis.
• Responsible for creating homepages, including basic reporting and dashboard presentation.
• Worked on creating survey questions in ServiceNow using Survey designer.
• Provided on service-now process, operations, answer questions, resolve issues and capability to all required teams.
• Manage the user story backlog by ensuring that the backlog items are appropriately groomed, prioritized and estimated and that the team fully understand what needs to be delivered.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Used Informatica features to implement Type I & II changes in slowly changing dimension tables. Created and ran workflows using Workflow Manager to load the data into the Target Database.
• Importing the IDQ Maps let's to Informatica and using them in the Informatica mappings
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology.
• Experience in writing Informatica ETL design documents, establish ETL coding standards and perform Informatica mapping reviews
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing reporting portals.
• Performed the requirement analysis, impact analysis and documented the requirements.
• Tracking and maintaining release schedule to estimate efforts and aligning stakeholder& expectations with the availability of time and resources for development of features and functionalities promised to business-users.
• Provided thought leadership at bank-sponsored events, industry forums and regional and national treasury conferences.
• Adhered to team Agile development practices, including BDD story writing and Continuous Integration.
• Facilitated daily Scrum Stand-Ups, sprint planning, sprint review, sprint demo.
• Worked on the procurement module of ServiceNow where the primary responsibilities are to understand the procurement compliance processes for purchase requests, approvals and orders, audit compliance, general ledger coding and then gathering the requirements, BPMN.

Confidential, Louisiana

Business Data Analyst

Responsibilities:

• Worked on the implementation of Incident Management, Problem Management, Change Management, Event Management, CMDB, Reporting, and Service Catalog in ServiceNow.
• Involved in Order Management and Inventory Modules.
• Enhancement related to pl/sql and sql for Oracle Clinicals (oracle product used by client for clinical trials)
• Responsible to design, develop and test the software (Informatica, PL/SQL, UNIX shell scripts) to maintain the data marts (Load data, Analyze using OLAP tools)
• Very good knowledge of SQL, PL/SQL especially writing queries with Joins, Sub Queries, Set Operators, Psudo Columns, Analytical Functions and having knowledge on regular expressions
• HealthCare management experience in projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day-to-day business operations.
• Prepared BRD ( Business Requirements Document), FRD (Functional Requirements Document) and N-FRD (Non-Functional Requirements Document)
• Effectively managed the hardware and software assets through their lifecycle using the procurement module.
• Prepared BRD ( Business Requirements Document), FRD (Functional Requirements Document) and N-FRD (Non-Functional Requirements Document).
• Resolving the complex requirements into simpler fragments and conveying it to the technical team for faster and efficient development.
• Coordinated with Data Analyst, ETL and UI interface Developers and did tasks in construct phase.
• Created the ETL exception reports and validation reports after the data is loaded into the warehouse database.
• Involved in migrating the ETL application from development environment to testing environment.
• Extensive experience in ETL processes in extracting data from operational and legacy systems to data warehouse using Informatica.
• Coordinated with Data Analyst, ETL and UI interface Developers and did tasks in construct phase.
• Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results with the actual report against the Data mart (Oracle)
• Conducts coverage analysis of clinical research trial procedures to delineate standard of care and research procedures; reaches out to research site to assist in determining charge direction.
• Created dynamic reporting using MS Excel formulas, macros and Visual Basic for Applications (VBA)
• Created Batch files to execute the multi transaction data feed files into CTMS.
• Clinical Data Exchange Bulk Migration: EIM Imports/Updates and SQL's Procedures to load the Historical data in between Staging/Legacy and CTMS systems.
• Participating in testing process and coordinating with QA team in each test cycle.
• Create and run analytical reports as needed using tools such as Reporting Workbench, Epic Cubes, BI Portal and other reporting tools.
• Assist in the co-ordination and management of various activities associated with clinical trial planning and initiation including clinical trial budget and agreement review, third-party vendors identification, and site/study feasibility assessment; among other responsibilities.
• Involved in Project co-ordination, Onshore/Offshore Co-ordination, optimal service delivery and Knowledge management.
• Performed UAT and participated in writing test plans, and developed different testing strategies like black box testing and load testing.
• Staff Augmentation and mentor new team members
• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
• Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from inspection to transition phase.
• Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
• Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence
• Diagrams, State Diagrams, Activity Diagrams and business process and workflows.
• Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects
• Coordination / Support for HL7 Interface testing (ADT Messaging)
• Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.