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Sr. Business Analyst/ Data Analyst Resume

Dayton, OH

PROFESSIONAL SUMMARY:

  • An astute professional with 6+ years of enhanced Techno functional experience in system and Business Analyst in Healthcare with FACETS and extensive interaction with client.
  • Insightful knowledge of business process analysis and design, domain & technology expertise with strong integration skills.
  • Hands on experience in Design, Development, Enhancement and Maintaining applications in Oracle using SQL in Windows and UNIX/Linux environments
  • Expertise in scripting the Test Plan, Release Plan, Test Cases and Defect Tracking and Reporting.
  • Immense knowledge in Health care payer operations, Interfaces, Reports, Letters and system Migrations, Health Administration - Claims processing (auto adjudication), Claims pricing and testing, HIPAA, enrollment, Medicare, Medicaid, CDHP.
  • Expertise in Healthcare Administration/Managed Care Systems working with various Claims Systems/Applications with multiple healthcare client systems, with prime focus on Claims adjudication, provider, eligibility.
  • Functional experience with concentration on Use Case modeling using UML, Business Process Modeling, Data Modeling, Change Management, Technical Training, Software Development methodologies, QA testing, and Systems Testing interfaces, Reports, Letters.
  • Involved in developing database objects using Trizetto FACETS database in both SQL Server and Sybase environments.
  • Good expertise in creating Test Cases on the basis of product features, client requirements and technical documents.
  • Substantial development experience in creating stored procedures, PL/SQL Packages, Triggers and Functions.

TECHNICAL SKILLS:

Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML, Rally, RAD, JAD/JAR

Business Modeling Tools: MS Visio, UML, BPMN

Operating Systems: Windows, UNIX

Database: SQL server, DB2, Oracle

Reporting Tools: Cognos, Business Objects and Crystal Reports

Quality Assurance: Quality Center, Software Application Testing Life Cycle

Business Applications: Microsoft Office Suite, BPEL, MS VISIO, MS Share Point, Outlook, Clear Quest, Lotus Notes.

PROFESSIONAL WORK EXPERIENCE:

Confidential, Dayton, OH

Sr. Business Analyst/ Data Analyst

Responsibilities:

  • Studied existing business application and processes, collected end user requirements and suggested the improvised business process model.
  • Participated in project review meetings and gathering Business Requirement Documents (BRD)
  • Develop and implement strategies related to data governance, data quality, metadata management, data security and master data management (MDM).
  • Involved in gathering, documenting and verifying business requirements
  • Conducted user interviews, gathered requirements, analyzed the requirements using Rational Rose requisite pro - RUP
  • Generated reports for Business Owners and Operations teams on the rejected encounters data based on types of service, claim types, payer types (Medicare vs Medicaid) etc.
  • Collaborate with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members.
  • Implemented Master Data Management MDM for all entities in the project by maintaining a master hub for improving the data quality by following various data governance techniques and data dictionary standards.
  • 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.
  • Created & updated Epics, Tasks and User Stories in JIRA.
  • Worked in a RUP environment using Rational Requisite Pro for requirement management
  • Work in Agile, scrum, and sprint environment in order to change the requirements and features set.
  • Documented and tracked all product defects with use of SQL (reporting).
  • Developed tables, Views, Stored Procedures and Triggers using SQL Scripting
  • Prepare required regulatory reports which show the progress on the collection reporting and analysis on HEDIS. Involved in 835/837(P/I/D)/834 (ANSI X12) transaction with implementation guides.
  • Worked closely with stakeholders and SME’s for requirements gathering.
  • Coordinated data profiling/data mapping with business subject matter experts, data stewards, data architects, ETL developers, and data modelers, Identified opportunities for business process improvement and initiate efforts to make improvements.
  • Excellent Understanding of Data warehousing concepts - Data marts, Star, Snowflake, Fact, fact less, Dimensions, Hierarchy, Measures, cubes Etc
  • Was responsible for developing and managing project plans: system requirements, change management policy standard and procedures by utilizing Rational Unified Process (RUP)
  • Worked on developing the business requirements and use cases for FACETS batch processes; automating the billing entity and commission process.
  • Successfully worked with Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important dimensions of care and service.
  • Tracked and monitored project team using JIRA Agile Scrum Board.
  • Translating client requirements and aligning them with IT capabilities. Designing solutions for customers to achieve their goals within specified timelines based on Agile Methodology of Software Development.
  • Developed UML Use Case model for the application using MS Visio and assigned to prepare the detailed Work flow diagram based on the proposed enhancement for the system.
  • Review detailed claims data in order to verify HEDIS rates as necessary with SQL Server database.
  • Breakdown concepts into User Stories and generated acceptance criteria in JIRA, Discuss & assign those stories to the developers.
  • Assist in the transitioning from the current development approach to an Agile / Scrum methodologies
  • Identify the business requirements, functional requirements, non-functional using Rational Requisite Pro.
  • Performed Data Analysis and Data validation by writing SQL queries using SQL assistant on Teradata.
  • Followed the RUP methodology for the entire SDLC.

Environment: Windows, MS Office, MS Visio, Teradata, Quality Center, SSIS, ETL, Data Warehouse, Agile, JIRA, PL/SQL, Rally, MS Project, SharePoint, SQL, SQL Server, Clear Case, UML, Informatica, Etc

Confidential, Walnut Creek, CA

Business Systems Analyst

Responsibilities:

  • Involved in Inception Phase and prepared vision statement and initial data models that contain Business Requirement Documents and supporting a document that contains the essential business elements and detailed definitions.
  • Gathered and understood business requirements and transformed them into data warehousing solutions for Group Health Insurance Customer data.
  • Collaborated with Business and Data Governance to translate governance and business team needs into MDM Functional and Technical requirements.
  • Worked alongside Users/SMEs (Subject Matter Experts) to recommend and gather low-level business processes and convert them into technical requirements for the development team, at various stages of the SDLC (System Development Life Cycle).
  • Development of SQL queries as per the request from the business team in SQL server.
  • Developed test scripts in SQL to check the data integrity from the databases
  • Responsible for the design, development, testing and implementation of systems to load source data into Target databases using Informatica.
  • Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
  • Act as primary communication channel between business areas and Data Warehouse group. Provide support to Data Warehouse users to ensure that their needs/business requirements are being met
  • Create or providing input to project plans
  • Deliver requirements under the Agile Scrum SDLC methodology to meet a very fast release schedule.
  • Prepare requirement specifications such as Use cases and System requirement specifications and Supplementary specifications; Tag and trace system requirements to business requirements
  • Followed Agile Methodologies and Attended daily defect status meetings and weekly team status meetings for reporting testing status and shared ideas for improved testing efforts
  • I was responsible to analysis of the proposed system and prepare the gap analysis document and functional design documents.
  • Gathered requirements and modeled the Data Warehouse and the underlying transactional database.
  • Collaborated with Quality Assurance Analyst in Automated and Manual Black box testing.
  • Responsible for architecting integrated HIPAA, Medicare solutions, and having sound Knowledge of data architecture concepts, data warehouse and datamarts and having strong experience in Strong skills at SPSS, Microsoft SQL server and Excel.
  • Coordinated data mapping, testing and validation strategies of 837 and 277 transactions to ensure adherence to HIPPA and State regulations.
  • High level SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data ware house processes.
  • Created/Reviewed data flow diagram to illustrate where data originates and how data flows within the Enterprise Data warehouse (EDW).
  • Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.
  • Worked on HIPAA compliance, Electronic Data Interchange (EDI), Medicare, ANSI x12 formats and implementation of HIPAA code sets, ICD-9, ICD 10.
  • Wrote Test cases for Enterprise Data Warehousing (EDW) Tables and Data Mart Staging Tables.
  • Involved in Data mapping specifications to create and execute detailed system test plans. The data mapping specifies what data will be extracted from an internal data warehouse, transformed and sent to an external entity.

Environment: EDI, User Acceptance Testing (UAT), Data Warehouse, Claims, MS Access, Windows, Rational Test Manager, Agile, MS Office

Confidential, Boston, MA

Business Systems Analyst

Responsibilities:

  • Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team
  • Followed Workgroup for FACETS Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
  • Conducted Joint Requirements planning sessions (JRP) as a facilitator to gather requirements from the Business User and conducted many Joint Application Development (JAD) and Joint Application Management (JAM) and conducted many Rapid application development (RAD) sessions.
  • Deliver requirements under the Agile Scrum SDLC methodology to meet a very fast release schedule.
  • Prepare requirement specifications such as Use cases and System requirement specifications and Supplementary specifications; Tag and trace system requirements to business requirements
  • Develop functional design details and specifications through collaboration with development teams and using system architecture and other technical considerations
  • Actively analyzed current business processes (Claims, Billing, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance
  • Designed and implemented basic SQL queries for QA Testing and Report / Data Validation
  • Responsible to perform the quotes and purchases operations from the database by running the SQL queries
  • Extensively involved in data analysis, data modeling, Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database

Environment: Windows, XML, SQL, MS Office (MS Word, MS Excel, FACETS, MS PowerPoint, MS Visio), RUP, RequisitePro, Crystal Reports, Clear Case, Clear Quest

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