SUMMARY:

• Having 7+ Years of experiences as Business Analyst wif Healthcare and Financial Clients for business analysis, documentation, software configuration, testing and Software Deployment Life Cycle (SDLC).
• Experience in Business Analysis, Data Analysis, Data Profiling, Data Migration and Data Integration.
• Expertise in EDI Benefit Enrollment and Maintenance Set (834) and EDI Health Care Eligibility/Benefit Inquiry (270) and EDI Health Care Claim Transaction set (837).
• Working knowledge of Market Risk and Credit Risk. Strong knowledge of database marketing, risk and credit criteria, segmentation and targeting, Loan Servicing methodologies and web analytics.
• Proficient in Medicaid, Medicare (Part A, B, C, D), Procedural & Diagnostic codes, & Claims Process.
• Broad knowledge in Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
• Hands on experience wif daily claims processing and uploading 834/835/837 files into Database.
• Understanding of Business Intelligence and Data Warehousing concepts wif emphasis on ETL and life cycle development including requirements analysis, design, development, testing and implementation.
• Strong knowledge and experienced on Health Insurance Portability & Accountability Act (HIPAA 4010 and HIPAA 5010), Affordable Care Act (ACA), Six Sigma Standard, International Statistical Classification of Diseases and Related Health Problems, 9th Revision and 10th Revision (ICD - 9 and ICD-10), Current Procedural Terminology (CPT).
• Experienced working wif EHR (Electronic health record) and EMR (electronic medical record) team for data requirement.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834(X12 Standards) processes of Medical Claims Industry from teh Provider/Payer side.
• High level of expertise working wif Data Warehouse, Data Mining, and ETL tools for loading high volumes of data and a smooth structural flow of teh data.
• Extensive knowledge in Data Mapping, Data Modeling, Star/Snowflake Schemas, OLTP/OLAP, and designing E-R Models. Worked wif Erwin for Conceptual, Logical, and Physical designs.
• Knowledge of cloud computing platforms (SaaS / PaaS).
• Working knowledge of HL7 standards, LOINC / SNOMED / ICD9 Codes Mapping and HL7 Message Validation.
• Formulate system design, methods, procedures, policies and workflows affecting Medicare/ Medicaid claims processing in compliance wif government compliant processes like HIPAA/ EDI formats and accredited standards like ANSI.
• Conducted working sessions wif business partners, UX designers, Development and QA resources to ensure requirements are vetted and understood for developers and QA testers.
• Worked wif multiple clearinghouses to ensure smooth transition to 5010 standard for their day-to-day EDI X12 transactions.
• Ability to manage workload wifin time sensitive deadlines in addition to handling multiple projects or tasks under minimal supervision.
• Worked closely wif primary care physicians (PCP), clinical support staff like nurses, clinical assistants and wif specialist physicians to gather requirements information for RMS.
• Experience in extracting, transforming and loading (ETL) data from spreadsheets, database tables and other sources using Microsoft SSIS and Informatica.
• Extensive experience in using SQL Server Profiler to monitor teh SQL server for deadlocks, long running queries and fine tune teh same to improve performance.
• Highly experienced in Designing process modeling (UML) using Use Cases, Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams and Data Modeling.
• Extensive knowledge of Agile Scrum, Waterfall, and RUP Methodologies wif expertise working wif tools such as Rational Rose, Microsoft Visio, Microsoft Project, Microsoft Office Suite, Erwin Data Modeler, and Mercury Quality Center.
• Extensive experience in developing BRD, FRD and SRS wif detailed knowledge of functional and nonfunctional requirements.
• Proficient in Requirements Analysis working wif techniques such as User Stories, Use Cases, Prototypes, Interviews, and Storyboards wif a Strong Ability to facilitate JAD sessions.
• Delivered high quality functional and non-functional requirements using Business requirements documents, process flows, user stories, Acceptance Criteria, data flow diagrams.
• Worked extensively on Business Analysis (Enterprise Analysis, Requirements Elicitation, Requirements Analysis & Documentation, Communications, Solution Assessment and Validation).

WORK EXPERIENCE:

Confidential - Nashville, TN

Sr. Business Analyst

Responsibilities:

• Implemented underlying application following Agile Scrum methodology guidelines to build artifacts in different sprints and phases of teh application development process.
• Lead multiple project teams of technical professionals through all phases of teh SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Data Mapping, Data Profiling, Data Modelling, WebSphere and Cognos.
• Regularly interacted wif multiple health and welfare benefit vendors, carriers and administrators to ensure accurate enrollment and premium payment.
• Assisted in Implementation of Electronic Medical Record interfaces for revenue cycle management systems and ETL projects. Perform data integration tasks.
• Gatheird business requirements from teh compliance department and worked on data analysis and reporting for those compliances. Understood teh Basel Agreement, Bank Secrecy Act, Dodd Frank Act and US Patriot Act wif teh halp of SMEs.
• Assisted in Performing Data Profiling, Cleansing, Integration and extraction tools (Informatica).
• Provided support and interface development using Pervasive Data integration tool. Data interfaces include HL7.
• Created, documented and maintained logical and physical database models in compliance wif enterprise standards and maintained corporate metadata definitions for enterprise datastores wifin a metadata repository.
• Involved wif ETL test data creation for all teh ETL mapping rules. Project included Meditech (Magic and Client/Server) wif flat file and HL7 message types.
• Develop sustainable processes to support teh management of teh organizational warehouse (data & reporting).
• Upgraded and managed teh generation of teh data for teh Get Better Maine web site and Automated processes in support of Maine's State Innovations Model Grant (SIM).
• Developed QA processes for teh incorporation of data (HL7) into organization data warehouses, CDC documents into teh Clinical Informatics data, and EMR client demographics, admissions/enrollments, and service data
• Created data files for external reporting requirement, including HEDIS (Healthcare Effectiveness Data and Information)
• Reporting subject areas included care delivery (Electronic Medical Records), practice billing system, and Health Plan Data Committees.
• Develop and maintaining internal reporting for Medical Management Department.
• Complete in-depth multifaceted analysis for internal and external customers combining a multitude of healthcare data types and sources.
• Performed gap analysis (SQL) dat identified data inconsistencies resulting from teh migration from a legacy system and teh introduction of EMR data into a data warehouse.
• Help conducting release backlog, attended scrum meetings, conducted sprints and UAT in Agile methodology.
• Used MS Visio to create wire frames and mock up screens to present to teh stakeholders and elicit feedback early in teh development phase. Groomed product backlog and release backlog when their is a change, feedback or technical debt.

Confidential -Cherry Hill, NJ

Sr. Business Analyst

Responsibilities:

• Serves as Data analyst to work wif business teams to define reporting requirements, writes functional and data mapping specifications for ETL processes, ad-hoc frameworks and reports.
• Involved in requirements analysis, design and testing phases of Software Development Life Cycle (SDLC) and in agile methodology.
• Authored teh Business Requirements Document (BRD) and Functional Requirements Document (FRD) creating design documents through client discussion, User Interface documents conducting Requirement Walkthroughs.
• Created Logical/physical Data Model in Erwin and has worked on loading teh tables in teh Data Warehouse.
• Created teh data-mapping document, identifying and noting teh location of teh tables, business rules and teh transformation logics.
• Prepared teh mapping documents, and process flow diagrams required for teh Informatica development process.
• Worked on data modelling and produced data mapping and data definition documentation
• Worked on creating Star & Snow-Flake Schemas, FACT and Dimensions Tables, Physical and Logical Data Modeling using Erwin.
• Wrote SQL queries to validate source data versus data in teh data warehouse including identification of duplicate records.
• Worked wif developer to write programs in SAS to generate reports, created RTF, HTML listings, tables and reports using SAS/ODS for Ad-Hoc report generation.
• Involved wif ETL test data creation for all teh ETL mapping rules.
• Identify business rules for data migration and Perform data administration through data models and metadata.
• Used data step programming and advanced SAS programming techniques like SAS/SQL and SAS/Macros, in increasing efficiency and automation ability of teh reports.
• Responsible for teh collection of functional requirements, non-functional requirements, data mapping, and light data modeling.
• Responsible for doing Create and maintain requirements, test cases and defects in Mercury Quality Center.
• Wrote Test cases for Enterprise Data Warehousing (EDW) Tables and Data Mart Staging Tables.
• Responsible for indexing of teh tables in dat data warehouse.
• Used T-SQL for Querying teh SQL Server 2014 database for data validation
• Prepared teh logical and physical models for teh new database dat is being built.
• Responsible Database table review and data mapping for large scale data conversion project Oracle database to Mainframe.
• Worked wif project team representatives to ensure dat logical and physical ER/Studio data models were developed in line wif corporate standards and guidelines.
• Analyzed teh existing data model and incorporated new additions for teh advancement data into teh data model identifying teh cardinality of teh new tables to teh existing tables and ensure proper referential integrity of teh system.
• Used teh guidelines and artifacts of teh Rational Unified Process (RUP) to strategize teh implementation of Rational Unified Process efforts in different iterations and phases of teh Software Development Life Cycle.

Confidential - Tampa, FL

Business Analyst

Responsibilities:

• Involved in Data Analysis & Mapping to track all data elements used in teh application from teh user interface through different interfaces to teh target databases in which they are stored.
• Develop crucial functional requirement specifications, creating detailed use cases and process flow diagrams to support functional specifications and put in Version One tool.
• Facilitated teh implementation of EMR/EHR systems for teh exchange of patient related medical information between different medical organizations.
• Provided DBA functions in SQL server 2008R2 including adding permissions, importing and exporting data, scheduling jobs, and writing stored procedures.
• Used HL7 level standards for developing EHR for healthcare facilities to store, access and update patient's health record electronically.
• Helped in creating of Data-Mapping best practices document including visual processes and trained team members on Data Mapping process and tools.
• Involved in Developing software to assist CMS' Innovation Center (CMMI) wif capturing, analyzing, standardizing and reporting data used for creating new federal health Care payment and service delivery models.
• Implement new services and programs via MMIS for teh Medicaid program by directly interfacing wif teh customer.
• Analyzed and worked wif HIPAA specific EDI transactions for claims, member enrollment, billing transactions.
• Involved in teh reconfiguration of FACETS in functional areas, including Membership, Claims, Provider, Enrollment, and Service Modules.
• Developed a Requirements Traceability Matrix recording teh requirements through each stage of requirements gathering process.
• As part of teh data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.
• Generate reports regarding teh claims dat fell to maintain teh HIPAA validation standard (Rejects).
• Incorporated HIPAA standards, EDI (Electronic data interchange)834/837, transaction syntax like ANSI X12, Implementation.
• Used MS Share point for sharing documents, calendars and other data between users in different locations.
• Assisted JAD sessions to identify teh business flows and determine whether any current or proposed systems are impacted by teh EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Connect wif Business stakeholders for Requirements elicitation and Design Impact Analysis.

Confidential - Dallas, TX

Business Analyst

Responsibilities:

• Facilitated and gatheird requirements and created Use Cases by extensive requirementgathering sessions and JAD sessions.
• Involved in all stages of SDLC (Software Development Life Cycle) through broad knowledge of business requirements analysis, use case modeling, and use case specification.
• Prepared BRD (Business Requirement Document), FRD (Functional Requirement Document), SRS (Software Requirement Specification), Use Cases, and User Manuals.
• Performed JAD (Joint Application Development) sessions among end-users, SMEs and development team for project meetings and walkthroughs.
• Utilized RUP (Rational Unified Process) methodology and performed data modeling and mapping design wif halp of UML and Rational tools during all phases of RUP: Inception, Elaboration, Construction and Transition.
• Medical Claims experience in Process Documentation, Analysis and Implementation in EDI
• transactions (X12 Standards) processes of Medical Claims Industry from teh Provider/ Payer side
• Developing teh following artifacts: project plans, Use Cases, Functional Design Documents, Vision and Business Requirements Documents.
• Worked wif Medicare operational management to monitor, trend and report on operational metrics such as timeliness, workload, staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Interacted wif healthcare clients to gather requirements, objectives, and input and output requirements.
• Creating Data flows and Query Flows to transform teh data from source to destination and communicating Communicate wif developers through all phases of testing to prioritize bug resolution.
• Conducted one-to-one meeting wif teh business to gather teh all requirements and convert them into technical requirement for development perspective.
• Involved throughout teh System Development Life Cycle (SDLC) and performed a primary liaison between teh business and teh technical areas.
• Conducted Joint Application Development (JAD) sessions wif teh development team, end users, QA team, and stakeholders for project related meetings.
• Co-ordinated wif enhancement of AMISYS (Accounting and Management Systems) responsible for Billing of Claims.
• Documented and maintained all teh Project Changes Request (PCR) documents and updated them accordingly.
• Partnered wif multiple business units to identify and document business and technical enhancement requests, prioritizing these requests and coordinating/implementing all necessary tasks.
• Worked in SQL and Oracle dealing wif extraction, analysis and processing of SQL Queries.