SUMMARY

• Almost 9years of ITexperience in Business analysis, design, development, Data Quality testing and implementation of Web Applications, reporting/dashboards and ETL components.
• Hand on experience with building data warehouses, Data marts, business intelligence reports and operational systems
• Worked in all phases of Agile, Scrum, and other Software Development Life Cycle (SDLC) methodologies
• Experience translating business requirements into a detailed system specification
• Facilitated Joint Application Design (JAD) sessions
• Experience working in an Agile environment or familiarity with Agile methodology
• Documented new APIs / Services and modify existing ones after evaluating the following: user stories, business requirements, high level design documents and database models
• Experience with Microsoft Azure Data Lake, Azure Data Factory, SQL Data Warehouse Azure Blob, Azure Storage Explorer
• Experience working in Medicare and Medicaid of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology.
• Knowledge of health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, EDI and XML.
• Strong knowledge of HIPAA, EDI 4010 and 5010 with ICD - 9 and ICD-10, analysis & compliance experience from payers, providers and exchanges perspective, with primary focus on Coordination of benefits.
• Proficient in medical terminology and coding outpatient and inpatients diagnosis Experience in building applications for ICD and CPT codes
• Experienced working with the centers for Medicare and Medicaid services (CMS), The Healthcare Common Procedure Coding System (HCPCS), Electronic Data Interchange (EDI), Medicare Part D Services, and State Pharmaceutical Assistance Program (SPAP) services.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Experience in FACETS with various applications involving Sales & Enrollment, Claims Processing (Dental, Medical/Hospital), Customer Service and Billing areas.
• Excellent Knowledge in Microsoft 365, Microsoft Visio, Microsoft Azure DevOps and TFS
• Strong analytical and quantitative skills with the ability to use data and metrics to back up assumptions, recommendations, and drive actions
• Clearly communicate design solutions, requirements, status updates and outcomes to all stakeholders and varying levels of the organization

TECHNICAL SKILLS

ETL Tool: Informatica Power Center, Informatica DVO, Microsoft SSIS, IBM Datastage, Microsoft Azure Databricks and Data Factory, Microsoft Azure data Factory (ADF), Amazon Web Services

Business Intelligence and Reporting Tools: Microsoft SSRS, Microsoft Power BI, MicroStrategy, IBM Cognos, SAP Business Objects and Crystal Reports

Database: Microsoft SQL Server, Teradata, Oracle PL/SQL, IBM DB2, Microsoft Azure database

IT Service Management: Incident Management, Change Management, Problem Management, Knowledge management, Project Management

ALM/DevOps Tools: ServiceNow, BMC Remedy, HP Service Manager, HP Quality Center, Microsoft TFS, Jira, Trello

Languages: SQL, Python, Java, Unix, XML

PROFESSIONAL EXPERIENCE

Confidential

Technical Business Analyst

Responsibilities:

• Developed technical documentations, system flowchart and requirement documentations
• Translated complicated data into useable information for executive leadership teams, including financial modeling
• Conducted research studies by collecting, analyzing, trending and presenting data and recommendations to management
• Performed project management duties including the creation of status reports, work plans, and presentations to client leadership
• Workedwith Developers, Quality Assurance Analysts, Architects, Business Partners and other Technology teams to gather and documentproject requirements and design
• Assist in quality assurance and user acceptance testing by writing test scripts, executing test cases and documenting defects
• Activelyparticipated and communicated with team through defect triaging, Application Lifecycle Management (ALM) tools
• Defined, developed and documented business requirements as a User Story in Microsoft TFS and delivered
• Performed the requirement analysis, impact analysis and documented the requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAAfor 837, 270/271, 276/277, 835, 834 EDI transactions.
• Performed Analysis on Data mapping between different data models.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Created ICD-9-CM/ICD-10-PCS comparison document and dealt with DRGsshift through CMS files.
• Worked with HEDIS, quality-based healthcare measurement programs
• Worked on Microsoft SQL Server and other data warehousetools withclinical andmedical claims data.
• Worked with ICD codes and CPT codes
• Documented ICD9 to ICD 10 mappings one to one/one to Many according to the GEM files from CMS with the functional and structural changes related to the conversion
• Interacted with Claims, Payments, Enrollment, Pharmacy teams to analyze, documentdata related questions
• Orchestrated backlog grooming, creating epics and user stories
• Created Product Backlog, Sprint Backlog and managed User stories.
• Led daily stand-up meetings.
• Tested the user stories for accuracy and compliance to ensure undisputed acceptance and validation of stories.
• Loaded raw NCPDP Pharmacy claims sent by PBM Express Script to Data Warehouse
• Created various reports such as billing payment reports, Billing Grouping Payment and discount reports
• Use HP Quality Center to house all test documentation and report/track all issues and defects
• Worked on Data migration project from Teradata to Microsoft SQL Server
• Gathered various requirements to create various data warehouses, Power BI dashboard and SSRS Reports

Environment: Informatica Power Center 10/9.6, Informatica Data Quality (IDQ) 9.6,Teradata, Microsoft SQL Server 2014, Teradata, MicroStrategy, Microsoft Power BI, Microsoft SSIS, Microsoft SSRS, Microsoft TFS, Service Now, Microsoft Azure, HDFS, Hive, HP Tidal Jobs, Agile, Microsoft Office 365, Unix

Confidential

Technical Business Analyst

Responsibilities:

• Facilitated meetings with Subject Matter Experts (SME) for Requirements Gathering and transforming them to functional specification.
• Acted as a primary liaison between business lines, operations, and technical areas throughout the project cycle.
• Conducted several Requirement Gathering Sessions for gaining detailed requirements and finalizing Business Requirement Document (BRD).
• Created User Requirement Specifications (URS) and Functional Requirement Specifications (FRS) documents.
• ConductedJAD sessions and meetings with developers, QA team, and users for communicating primary requirements, discussed different versions of requirements, queries, and clarified the issues.
• Reviewed Business Requirements Documents and the Technical Specification.
• Design UML diagrams like Use Case Diagram, Class Diagram, Sequence Diagram, and State - Diagram for project documentation using MS Visio.
• Set up definitions and process for test phases including Product test, integration test, system test and User Acceptance Test (UAT).
• Wrote SQL Queries to perform Data Validation.
• Implement business modeling using MS Visio to develop screens for the application.
• Performed backend validation testing for Oracle database using Toad (test SQL of Source and destination using latest data mapping).
• Participated in identification of data sources for the required data attributes.
• Developed data maps to document data attributes to data sources also data targets, including identification and documentation of data transformation algorithms.
• Assisted in knowledge transfer to other technical staff members on business data processes.
• Created test dashboard and Report test plans and verified counts between summary and detail reports various SAP Business objects dashboards
• Designed and coded maps, which extracted data from existing, source systems into the data warehouse.
• Used Dimensional Modeling Techniques to create Dimensions, Cubes and Fact tables.
• Worked on Power Center Tools like designer, workflow manager, workflow monitor and repository manager.
• Tested standard and Ad hoc reports and undergone data validation for the Cognos reports.
• Worked on multiple projects using Informatica developer tool IDQ of latest versions 9.1.0 and 9.5.1.
• Worked on Production support cycle to address ETL job failures and dashboard failures
• Worked to find Root Cause Analysis of a ETL job failure and data anomaly
• Participating in Technical Architecture Documents, Project Design and Implementation Discussions

Environment: Informatica Power Center 9.6.1/9.5, Informatica Data Quality (IDQ) 9.6, IBM DB2 9.7, SQL Server 2008, Business Objects XI R2, SQL, PL/SQL, XML, T-SQL, IBM Cognos, HP Quality Center, Microsoft Visio, MicroStrategy, MS Office Suite, Unix

Confidential

Technical Business Analyst

Responsibilities:

• Carried out queries from customer data base using SQL, data mapping, field mapping, data integration and sorted extracts as per insurance application status, age, gender, time services, demographics, lead aggregator sources, agent IDs, and call-center division to help design an effective, efficient and theme oriented online quoting engine.
• Understand and articulate business requirements thru user interviews, JAD Sessions and convert them into Technical Specifications. Conducted joint requirements planning sessions as a facilitator to gather requirements from the business area.
• Coordinated with the Release Manager in defining scope/ planning releases.
• Designed test design documents and QA project development design documents.
• Provided management with metrics, reports and schedules as necessary and participated in the design walkthroughs meeting using MS Office Suite
• Interacted with the Subject Matter Experts (SME) and stakeholders to get a better understanding of client business processes and gather business requirements.
• Worked on Web based applications and Data Warehouse for Supplemental Health Insurance benefits plan.
• Gathered requirements to create MicroStrategy dashboard and Cognos reports related to deductibles, co-insurance, in-patient expenses and unexpected childcare.
• Coordinated test activities with all testing resources
• Performed Regression testing on corporate and personal documents and fixed the errors.
• Testing to make sure that data is moved from source database to destination database by writing SQL queries.
• Involved in validating the claims, invoices coming as Electronic data Interchange transactions.
• Involved in testing the XML files and checked whether data is parsed and loaded to staging tables.
• Created Traceability Matrix to ensure that all the requirements are covered by the test cases
• Involved in testing Cognos reports for data quality and cosmetics according to requirements.
• Conducted status report meetings with internal team on a weekly basis and Documented and tracked status meeting minutes and activities
• Provided clear concise feedback to Development team on recurring errors both on individual and team with aim of long-term reduction of defects found in final releases
• Conducted status report meetings with internal team on a weekly basis and Documented and tracked status meeting minutes and activities
• Provide on Call Support for Prod mission-critical (24x7) or problematic databases, and own problem resolution from end-to-end
• Extensive worked on Migrating Databases residing on servers in one data center to another and Upgrading Database platforms to newer versions
• Document technical details of issues resolved and assist the team with building and maintaining technical repositories.

Environment: MS SQL Server 2005, MS SQL Server Reporting Services 2005, MS SQL Server Integration Services 2005, Microsoft SSRS, Flat Files, DB2, TOAD 9.5, MS Office, XML, Windows Server 2003, Mercury Quality Center 9.2, Lotus Notes 7.0.3, Agile Scrum, Web services, HTML and JavaScript

Confidential

ETL/BI Quality Engineer

Responsibilities:

• Work closely with business users to gather requirements, define project specifications, develop implementation and test plans for the projects & enhancements.
• Designed, created and tested reports to meet business requirements.
• Oversee ad-hoc client and operational reports developed and presented by others
• Support short and long term operational/strategic business activities through analysis
• Supported short and long term operational/strategic business activities by assisting in the development, execution, management and maintenance M&R, CMS Star ratings and coding accuracy improvement strategy and performance
• Experience in Managed Care, including STARS, Clinical Documentation/Coding Accuracy, and Reimbursement coding
• Experience with EMR systems (inpatient and/or outpatient)
• Worked with coding systems (i.e., CPT, ICD9, ICD10) and hospital billing systems (DRGs)
• Analyzed current Claim Authorization Process across all the FACETS Markets. Identified possible constrains that pends claims related to Claim Authorization Mismatch.
• Created and maintained SQL Scripts and UNIX Shell scripts to perform back-end testing on the oracle database.
• Design and Execute Regression Test Bed at the end of every phase.
• Performed Performance and Post Validation Testing.
• Performed HIPPA Validation of Clearing House application.
• Validate different Electronic Data Interchange (EDI) formats such as X-12, EMCDS, PCDS and 1500 formats.
• Validate different EDI formats and transactions under HIPPA compliance.
• Performed back-end testing by extensively using SQL commands to verify the database integrity.
• Conducted SWOT Analysis for better market understanding and fool proof project implementation
• Worked on pharmacy datasent by PBM on claims, fees, eligibility, benefits, formulary for statistical analysis
• Provide the necessary support to internal departments during CMS audits to document ongoing monitoring activities.
• Coordinate, schedule and implement database related patches, both software and security
• Experience of Reporting, Analysis and Integration Services (SSRS/SSIS/SSAS)
• Performed Data Analysis, writing SQL Queries for Testing and Troubleshooting against Data Warehouse.
• Created data mapping documents mapping Logical Data Elements to Physical Data Elements and Source Data Elements to Destination Data Elements.
• Maintained documentation related to difficulties, complexities and anomalies that may arise during the ETL process.
• Worked on migration project to migrate from IBM Data stage to Microsoft SSIS

Environment: SQL, Oracle 9i, DB2, IBM Data Stage, IBM Cognos, Crystal Reports, Manual Testing, SQL Server 2003, UNIX log files, XML, Flat Files, MS Office, MS Visio, MS Excel.