SUMMARY

• Over Seven years of Experience as a Business Data Analyst in Health Care domain on various areas like Claims Processing, Billing, Insurance and Reimbursement, Medicaid and Medicare Services, and Pharmacy Benefits Management.
• Experience in Mapping ICD 9 codes with corresponding ICD 10 Diagnosis and Procedure Codes.
• Worked with different Business Areas like Claims and Enrollment to document proposed ICD 9 - 10 Code changes.
• Having extensive domain knowledge in MMIS, EPIC, EDI X12, HL7, HIPAA, ICD 10, and system, Medicare and Medicaid, CMS Compliances/Regulations.
• Knowledge on claims process and adjudication in the Medicare Part A, B, C and D, Medicaid, Managed care, Private and TPA Insurance Sectors.
• Performed 5010 Upgrade mapping for new B2B and existing B2B clients.
• Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
• Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/XDM, HITSP, CCR (continuity of Care Record), CCD (Continuity of Care Document), NCPDP Script, ELINCS, and CDA, HHS, CMS, RHIO's, IHDN's.
• Proficient in conducting Business process modeling (BPM), feasibility studies, Impact Analysis, Cost/Benefit analysis, Gap Analysis and Risk analysis.
• Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
• Designed and developed normalized, relational databases in MySQL.
• Experience on projects related to Health Information Exchange (HIE), Interoperability, Medicare, Medicaid, EDI transactions (inbound and outbound: 837, 820, 834 etc.,) HL7, Eligibility and Benefit systems, ICD 10, HCPCS, CPT, HIPAA 4010 and 5010, Claims Adjudication and expert in Affordable Care Act (ACA), aka Healthcare Reform (HCR)
• Detailed Analysis of the HIPAA 4010, 5010 along with the 6020 versions of the 834 and 820 Companion guides.
• Experienced in gathering and documenting test Scenarios and ability to train users to translate technical requirements and translate them to a business audience
• Expert in compliance with HIPAA 4010 and 5010 standards.
• Strong knowledge of X12 format files and its structures including Loops, Segments and Data Elements.
• Strong experience with different project methodologies including Agile-Scrum Methodology, Waterfall, Modified-Waterfall, Iterative, Incremental and RUP.
• Strong Knowledge and experience of EDI transactions, ASC X12 Transaction sets: 834 (Benefit Enrollment and Maintenance), 835 (Claim Payment/Advice, 837 (Claims and Encounters), 820 (Payroll Deducted and Other Group Premium Payment for Insurance Products) 270/271 (Explanation of Benefits (EOB) /Response to EOB), 276/277 (Claim Status/Claim Status Response)
• Writing Use cases, test plans and test cases, System/Application testing and creating Business process flow diagrams.
• Excellent in designing business models using UML diagrams such as use case diagrams, class diagrams, activity diagrams, sequence diagrams and collaboration diagrams using Rational Rose and MS Visio.
• Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end-users, Subject Matter Expert (SMEs) team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
• Creative and aggressive self-starter with integrative thinking skills, capable of communicating creative ideas through graphical analysis charts and statistical data display.
• Strong Management and Communication Skills, demonstrated proficiency in leading and mentoring individuals to maximize levels of productivity, while forming cohesive team environments.
• Maintained the Traceability Matrix table to track the Business Requirements to the design to the testing keeping track of all requirements in the BRD.
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases.
• Defect Management / Bug Fixing - Fully involved in the process of defect identification and resolution using tools like QTP, Clear Quest, and Quality Center.
• Experience in Risk Management process and technology reengineering, Sarbanes Oxley implementation, valuation review process and technology, strategic sourcing, metrics and benchmarking

TECHNICAL SKILLS

Analytical Tools: Tableau (Desktop/Server/Public/Online/Reader) 9.x/8.x/7.x, Adobe Analytics, SSRS, Business Objects

ETL Tools: Alteryx, DataStage, Informatica, SSIS

Databases: Teradata, Oracle 11i/10g/9i, DB2 UDB, MS-SQL Server, Sybase

Requirements Management: Requisite Pro, Microsoft Office (Word, PowerPoint Excel)

Front End Tools: Microsoft Project, Microsoft Office, Visible Analyst, Lotus Notes

Document Management: Documentum, Visual Source Safe 6.0, Share point, Ultra Edit

Defect Management tool: HP Quality Center

Methodologies: Data Modeling - Kimball/Inmon, Logical/Physical/Dimensional, Star/Snow flake Schema, ETL, OLAP, Waterfall, Agile.

Data Modeling Tools: Power Designer, ERwin, ER Studio, MS Visio

Languages: SQL, PL/SQL and JavaScript

Operating System: Windows NT/2000, UNIX (HP UX, AIX), AS/400, OS/390.

Web Applications: HTML, Perl, XML and JavaScript

PROFESSIONAL EXPERIENCE

Confidential

Business / Data Analyst

Responsibilities:

• Involved in expansion of patient data delivery between acute care and ambulatory settings utilizing industry standard Health Information Exchange (HIE) technology tools.
• Completed implementation for more than 160 Physician Practices involving 27 different EMR systems.
• Coordinated the integration of clinical applications and electronic health record (EHR) systems to the HIE.
• Held meetings and discussions with business users and subject matter experts for detailed requirements gathering.
• Responsible for configuration and build of the Lab, Radiology & Transcription Interfaces using the Medicity HIE tools.
• Responsible for the support of existing HIE clients concurrent with the expansion to additional ambulatory offices.
• Worked with clients and peers to design and build solutions documentation.
• Responsible for analyzing and resolving data integration issues between multiple applications.
• Managed the creation and submission of various test messages associated with the HIE interface build.
• Prepared User Acceptance Testing and Integration Testing test cases for testing the interface between applications.
• Interacted with Technical team in understanding Operational and Technical functions of the existing Payment Engine.
• Participated in Facets Table data modeling; planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• Gathered requirement for the Facets implementation and performed solution analysis.
• Designed and developed Use Case Diagrams for the Facets process modules. Worked with Data Warehouse in the development and execution of data conversion, data cleaning and standardization strategies and plans as several small tables are combined into one single data repository system MDM (Master Data Management).
• Substantial report development experience utilizing SQL Server Reporting Services (SSRS), Cognos Impromptu, and Microsoft Excel
• Create and maintain data model/architecture standards, including master data management (MDM)
• Deployed Business Intelligence solution using Business Objects to ensure proper delivery of information to the users and Oracle Projects Suite for proper Project Management.
• Validated the test data in DB2 tables on Mainframes and on Teradata using SQL queries.
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data migration in to the CI System Knowledge Data Base in Microsoft SharePoint Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML.
• Created Graphical representation of reports such as Bar charts, Pie charts etc as per the End user requirements using Business Objects and Crystal reports.
• Designed, developed and tested data mart prototype (SQL 2005), ETL process (SSIS) and OLAP cube (SSAS) for Computer Maintenance Management System (CMMS)
• Created DTS and SSIS Packages to vendors in which records were loaded Daily, also to other data resources such as Excel, Access, flat file, and XML in order to Create and maintain a centralized data warehouse.
• Developed application using Visual Basic and wrote reports using Crystal Reports and MS Access.
• Prepared test Data sets and performed data testing using the PL/SQL scripts. Also, used MS excel for data mining, data cleansing, data mapping, and data dictionary and data analysis.
• Responsible to import the data from Crystal reports by using Business Objects Live office into Microsoft Excel and Word.
• Configured the Data mapping between Oracle and SQL Server 2005.
• Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835)
• Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat Files.
• Performed customer data analysis, to extract, transform and load data to the customer data Warehousing system.
• Provided technical Expertise on the use of Rational Clear Case, Rational clear quest and Requisite pro, which were used for Data archiving and Requirements Management.
• Dealt with data mapping issues between various source systems and staging area and data-marts.
• Involved in coordinating with the database design team, using SQL to Query databases and providing inputs in finalizing the data model, report layouts.
• Analyzing the ETL process created in Informatica, developed SQL queries and tables which replicated the ETL, and compared the SQL results with the Informatica tables.
• Developed the ETL Informatica Mappings for importing data from ODS into subsequent data marts.
• Develop, build and manage Reporting Services (SSRS) reports using both SSAS cube and relational database sources including distribution of reports using subscription services

Environment: Windows, Microsoft Office SharePoint 2007, JAVA/J2EE, Rational Requisite Pro, MS Office, SQL Server, Agile, WebSphere, MS Project, SSRS, Cognos, Crystal Reports, UML

Confidential - Charles, MD

Data Analyst

Responsibilities:

• Built an Information Security Risk Assessment (ISRA) for the secure exchange of health insurance data as part of the Affordable Care Act (ACA)
• Responsible for implementing payers onto the Health Care Exchange (HIX) for the Affordable Care Act.
• Strong working knowledge of the 834, 837 & 835 EDI Healthcare files and Transactions.
• Thorough knowledge of ICD 10 codes and CPT codes for both Mental and Medical Health and worked extensively with Inbound and outbound 834 Transactions processing systems.
• Compile, validate and report system-wide metrics to attest meaningful use of EHR to the Centers for Medicare and Medicaid Services.
• Created, altered and implemented T-SQL Stored Procedures for the use of processing consumer data and developing new web delivered tools.
• Collaborate with federal clients (CMS, NIH, ONC) and standards development organizations such asHL7 to develop
• Responsible for UAT project planning like creating testing scenario, test plans, and test scripts.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI x12 Transaction, Code set and Identifier aspects of HIPAA.
• Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA)
• Developed Schemas of EDI x12 Claims (837) and Eligibility forms in XML.
• Worked with multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models.
• Worked closely with the Enterprise Data Warehouse (EDW) team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Used Microsoft SharePoints to create sites to support specific Content Management, Records Management, and/or Business Intelligence Needs.
• Extracted data from disparate sources by SAS/ACCESS.
• Involved in Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Data dictionary are also considered essential components of a data warehousing system.
• Initiated multiple projects that focused on Data Warehousing and financials.
• Developed schemas for extraction, transaction, and loading (ETL) using Solonde Warehouse Workbench to expedite data integration between systems.
• Analysed the existing as-is system for Insurance Personal Lines, tracked defects, provided recommendations to make enhancements in the future to-be system.
• Developed a file of ACORD Forms used as the standards in all Property and Casualty markets, for both Personal and Commercial Lines of Business.
• Created various reports such as ad-hoc reports, drill-down, drill-through, and parameterized reports using Reporting Services (SSRS) for internal teams.
• Participated as a core team member of a Clinical Development initiative to create an architectural business end-to-end solution for clinical trials as a standard for all remote data capturing clinical trials.
• Mapped process flow; assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Analyzed the data collected and process maps to determine the root causes and identify opportunities.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Worked with the QA team in testing the upgraded system for data retrieval, using complex SQL queries.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Used Informatica to extract and transform data from various DB2 database to the data warehouse.
• Wrote test cases and test scripts for the User Acceptance Testing
• Worked on Master Data Management (MDM) for maintaining the customer information and also for the ETL rules to be applied.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.

Environment: Windows, Oracle9i, MS Access, SAS, JAVA/J2EE, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, WebSphere, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential - Baltimore, MD

Business Analyst / Data Analyst

Responsibilities:

• Elicited and gathered requirements using prototype design, interviews, document analysis, surveys, site visits, use cases, scenarios, system analysis, task analysis and workflow analysis for various maintenance and new applications.
• Develop implementation guidelines and principles for practice-based clinical applications, including various practice management and EMR systems
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS) for the Web based application.
• Used MDX for querying and manipulating the multidimensional data stored
• Built Web services hosted on a database to connect to Web application using SOAP, XML, WSDL, ASMX
• Refactored and enhanced client applications to interface with MS Exchange server 2007 Exchange Web Services using SOAP, XML, WSDL and ASMX.
• Used senior level SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data ware house processes.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate effectively with them
• We were also involved in business process reengineering (BPR) for the website and a lot of our suggestions were accepted by the management for the actual business process as well.
• Participated in an enterprise level Electronic Medical Records (EMR) system implementation.
• Collected System Requirements from the clients keeping in mind their need for the application and documented it for the developers following the HIPAA Guidelines
• Performed the Analysis & Design workflow for various processes by following the Rational Unified Process (RUP) to document Use Cases.
• Assisted others in defining technical solutions for projects utilizing the Oracle RDBMS.
• Develop, build and manage Reporting Services (SSRS) reports using both SSAS cube and relational database sources including distribution of reports using subscription services
• Substantial report development experience utilizing SQL Server Reporting Services (SSRS), Cognos Impromptu, and Microsoft Excel
• Conducted the weekly status meetings with SME & project managers.
• Designed Data Flow Diagrams (DFD’s), Entity Relationship Diagrams (ERD’s), and web page mock ups using modeling tools.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Created Requirements Traceability Matrix (RTM) by performing traceability of use cases to business goals, use cases to test artifacts, and use cases to business paths to minimize Requirements and Test Gaps using Requisite Pro.
• Worked in association with RUP mentors to ensure fidelity to the standard RUP practices of the institution.
• Executed and scheduled tasks; batch processing, metadata management and data mapping.
• Worked on data modelling and produced data mapping and data definition documentation
• Developed SQL-based data warehouse environments and created multiple custom database applications for data archiving, analysis, and reporting purposes.
• Performed technical analytics related to advanced data analysis, data mining, and source to target mapping.
• Involved in performing defect tracking activities using Rational Clear-Quest.
• Imported XML files with hierarchies are maintained under Hierarchy.

Environment: MS Office, Rational Suite (Requisite Pro, Rose, SQL Server, Clear Case, SoDA), Oracle 10g, Perl, UAT, ERwin 4.1, Informatica, MS Visio, UML, RUP, Windows 2007.

Confidential, Chicago, IL

Data Analyst

Responsibilities:

• Worked on code variance reduction project for a business rules engine that drives operations. Standardized rules while also optimizing performance to help with daily operation workflow. This defect elimination brought more than ~$2 million in lost revenue back to balance sheets for revenue cycle operations teams.
• Worked as project analysis, development and implementation of new application module; which augmented application capability while reducing redundant data feeds leveraging an existing, alternate data source within internal data warehouse.
• Managed resolution of strategic and day-to-day technology issues for clients and vendors.
• Created operational dashboard reporting to communicate enterprise ETL health; resulting in an effective means to identify and quantify enterprise opportunities to enhance data quality and ETL processing.
• Standardized HL7 ADT messaging feeds and ETL processes from client EMR/EHR host systems (EPIC/Meditec) into internal databases for processing; increased successful load percentage to ~99% (up from 70%).
• Perform Data Analysis utilizing ETL, SSIS, Visual Studio, SSMS, and SSRS
• Develop custom reports utilizing SQL Server 2008 Report Builder 2.0 (SSRS)
• Responsible for the monitoring and support of the interfaces for electronic transaction feeds, Data formats include: XML, HL7 (ADT), ANSI 836/837, Imbedded PDF through the BDI process, ASCII, Postscript, TIF, IERL, PDF, and JPG
• Performance Improvement - Researched, developed and implemented a Document Master database (utilizing MS Access) to identify, organize, document and maintain all internal forms (approximately 2500) that are contained in the EMR.
• Work as a team member on data integration development projects and evelop, test, analyze, and deploy SQL scripts for data warehouse ETL process
• Created database schemas, tables, views, and control files to load extracted data using Oracle SQL Loader utility
• Effectively implemented and used oracle sql queries and procedures to test data for gaps, format issues, record counts, and uniformity
• Communicated with client side personnel to resolve issues related to client side data.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), ETL, .NET, Oracle, Crystal reports, RUP, UML, Visual Basic, SQL, Agile, Scrum

Confidential - Boston, MA

Data Analyst

Responsibilities:

• Coordinate with client side to ensure reporting and analysis solutions and requirements.
• Business Analysis and Creation of business analysis Documents.
• Reports and Analysis verifications.
• Analysis of functional and non-functional categorized data elements for data profiling and mapping from source to target data environment. Developed working documents to support findings and assign specific tasks
• Worked with data modelers in developing database models for the operational data store, data warehouse, and federated databases to support client enterprise Information Management Strategy.
• Worked with data investigation, discovery and mapping tools to scan every single data record from many sources.
• Performed data analysis and data profiling using complex SQL on various sources systems including Oracle and Teradata.
• Written several shell scripts using UNIX Korn shell for file transfers, error logging, data archiving, checking the log files and cleanup process.
• Metrics reporting, data modeling, data mining and trends in helpdesk environment using Access
• Extensively used MS Access to pull the data from various data bases and integrate the data.
• Worked with Excel Pivot tables.
• Create and Monitor workflows using workflow designer and workflow monitor.
• Performing data management projects and fulfilling ad-hoc requests according to user specifications by utilizing data management software programs and tools like Perl, Toad, MS Access, Excel and SQL
• Written SQL scripts to test the mappings and Developed Traceability Matrix of Business Requirements mapped to Test Scripts to ensure any Change Control in requirements leads to test case update.
• Involved in extensive data validation by writing several complex SQL queries and Involved in back-end testing and worked with data quality issues.
• Identify & record defects with required information for issue to be reproduced by development team.
• Involved in Onsite & Offshore coordination to ensure the completeness of Deliverables.

Environment: Teradata Oracle, PL/SQL, SQL Server 2008, MS SQL, Informatica, MicroStrategy, Erwin, DB2, HP Open View, Lotus Notes, Windows, MS Office Suite (Excel, PowerPoint, Word, Visio).