SUMMARY

• 10+ years of experience as a Business Analyst, Business Systems Analyst and Data Analyst in Healthcare Industry.
• Strong working experience in Business requirements elicitation, Data analysis, Data validation, Data modeling, Data mining, Data extracting, Data mapping, Data migration, Data configuration, Integration specifications, Web service specifications, System Enhancement, User Interface, Risk Analysis, Reporting, MMIS, Utilization Management, Care Management and Disease management.
• Strong knowledge of the (SDLC) Software Development Life Cycle methodologies such as Agile and Waterfall models.
• Experience in defining vision statement, managing product backlog, product backlog grooming, user story development and prioritization, sprint planning, sprint retrospective and daily scrum meetings, service levels and change control methodology.
• Worked with stakeholders and end users to facilitate business requirements elicitation sessions and workshops.
• Documented business requirements (BRD), technical/functional requirements (FRD and FRS), use cases, user stories, traceability matrix, re - engineering business processes, designing, Gap Analysis and Process Improvement.
• Created business process flows, primary flows, alternate flows, activity diagram and data flow diagram.
• Maintained proper communication with the clients and developers ensuring that the modifications and requirements were addressed and monitored.
• Strong experience on HIPAA compliance and worked on HIPAA EDI X12 inbound/outbound transactions: 270, 271, 278, 834, 837, 835 4010, 5010, ICD-9, ICD-10 to identify key data set elements for designated record set.
• Experience writing SQL queries, extract, transform and load data using SSIS and generated reports using SSRS.
• Extensive experience in writing SQL/PL-SQL queries in Oracle developer, SQL Server,Toad, SAS, Teradata and data warehouse.
• Strong understanding of Facets Data Model, Data mining, Data extraction and Data profiling.
• Worked on analytical and Ad-hoc reports for member, provider, enrollment/eligibility, claims and benefits for analysis.
• Performed testing activities and write numerous test cases, test scenarios and performed smoke testing and user acceptance testing.
• Experience working on various facets of healthcare insurance domain Membership, Enrollment, Providers, Claims Payments, Billing, Authorizations and Referrals.
• Experience with FACETS and NASCO NPS Claims Processing, Guided Benefit Configuration, Medical Plan, Provider and Subscriber/Member data.
• Experience in HRIS and Payroll in employee healthcare benefits and administration system.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, MS Access, MS Visio, Share Point, technical assessment tools, Data Warehousing concepts and web design and development.

TECHNICAL SKILLS

SDLC Methodologies: RUP, AGILE, Waterfall

Databases: MS-Access, MySQL, SQL Server, Oracle, Teradata, DB2

Programming Languages: C, VB, VB.NET, .NET, SQL HTML, XML, VBScript, ASP, Java, J2EE, Python

Automation Tools: MS Visio, Rational Rose, SixSigma, Rational ClearCase, Rational Requisite Pro

Requirement Tracking Tools: Mercury Test Director, Rational ClearQuest, Share Point

Utility Tools: MS Office Suite, MS Project, TOAD

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS), Tableau

Data warehousing Tools: Informatica, Business Objects, Cognos, Erwin

PROFESSIONAL EXPERIENCE

Confidential, Norwood, MA

Sr. Business Analyst/System Analyst

Responsibilities:

• Analyzed client’s HRIS requirements and created demographic file mapping document to transform the data according to existing third party system.
• Analyzed and aligned the data for HRIS inbound files and uploaded to the MMC 365+ Portal.
• Worked on employees benefits such as (Medical, Dental, Vision, HSA, FSA, STD, LTD) and extracted the employee’s data population and reviewed with service delivery team for mapping document.
• Worked on PRD (Project Requirement document) to define business needs and assist design and development teams in terms of expected data population of benefits, deductions on client’s inbound and outbound files.
• Created and Reviewed HRIS and payroll mapping document with clients and updated the document with changes.
• Updated back end tables using SQL Developer for deduction codes, benefits ids and Plan ids.
• Fixed data in backend data tables for HRIS demographic files and payroll files using SQL queries.
• Worked on MMC 365+ portal and compared the backend data with outbound files generated for employee benefits and deductions.
• Worked on Employees enrollment/eligibility and developed business logics in the mapping document.
• Researched and coordinated efforts to implement improvements to existing processes.
• Assist in the development of performance metrics to establish process success.

Environment: Oracle Developer, MS office, Windows, BW(Benefits Workgroup), MMC365+ Configuration Portal, Share Point

Confidential

Sr. Business System/Data Analyst

Responsibilities:

• Conducted meetings with project stakeholder, business users to gather business requirements.
• Documented business requirement and created EPICs and User Stories.
• Assist product owner on all elaboration meetings, PI Planning to pull the user stories in each sprint with capacity and load and defined dependencies.
• Worked on product backlog, product backlog grooming, sprint planning, sprint retrospective and daily scrum meetings.
• Worked with developers and testers and demonstrated each user story with build functionalities in the application and process flows.
• Extensively use SQL Server/Oracle queries for backend Data analysis, Data Validation and Data Integrity, Data Reporting.
• Worked on FACETS Data tables, monitored and analyzed daily and weekly Provider outbound data files extract and resolve the issues when receiving the email notifications upon the unsuccessful delivery of file to the target system.
• Using SQL/Oracle queries to retrieve the data from FACETS for testing and validation purpose.
• Manually loaded provider data using internal resource (EPDS) into Development environment for testing and validation purpose.
• Created stored procedures for data extraction, transformation and load (ETL) for Claims and Provider data.
• Analyzed the mainframe reports for member, enrollment, provider, claims and executed batch jobs and reports.
• Develop Provider specific weekly, monthly and ad hoc reports and analyzed data based on current and future provider terminations and re-enrollment.
• Performs data analysis with line of business units to understand business needs, identify improvements and provide support of existing business reports and functions.
• Worked on Provider portal (AIM) to identify the provider data issues, extracted the provider data to validate the provider’s Service location, Date of service, Member identification, Test/treatment and Diagnosis request.
• Worked on State Assigned Provider Identity (SAPI) project with external team to fix and update the provider data issues provided in the requirements document and developed the data mapping document accordingly.
• Performed smoke testing on each story after development and identified errors in functionalities.
• Participated in Code Reviews, System Testing, data validation and UAT followed by production verification, post production testing and support.
• Testing members and providers data in lower environments and validate in production after go live.
• Worked on Compass customer care application on Service items such as Authorization Request, Correspondence, Billing, Claims search, Membership, Provider Search, Update Authorization, Complaints and Grievance.
• Co-ordinate with End users, Web-service, Facet architecture, Enrollment, Nexgen, Claims, Billing and other internal and external teams for integration and impacts.
• Provided Member/Provider test data to developers to verify in Compass application developed in Pega PRPC.
• Worked on Avaya to Genesis call data project and successfully implemented and migrated data into Compass application for customer care representatives.
• Developed the single document for Compass application which includes all web service integrations, impacts and business rules based on markets and line of business for better visibility.

Environment: SQL Server, DB2, Facets, PEGA PRPC, Windows, Batch Job Scheduler, ServiceNow, Web Services, SSRS, SSIS, MS Office, MS Visio, JIRA, Confluence, Share Point