SUMMARY

• Over 7 years of extensive experience as Sr. Business Analysis/Business Intelligence with hands on experience in integrating business needs into IT solutions with core activities like: Requirement Gathering &Analysis, GAP Analysis, Designing, Software Development, Implementing, Software Validation/Testing, Project Cycle Management (PCM) in industries like Healthcare, Insurance, Property & Casualty and Pharmaceuticals and extensively worked on Insurance Claims, Medicare/Medicaid Claims.
• Experienced in data analysis, data modeling, Conceptual logical modeling and physical database design for Online Transactional processing (OLTP) and Online Analytical Processing (OLAP) systems.
• Extensive experience in the field of Business Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Healthcare, Insurance, Medicaid and Medicare Industry.
• Experienced in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
• Worked on various healthcare application areas like Billing, Membership Enrollment, Benefits, Claims processing, Subscriber/member and Medicare, Medicaid etc.
• Used the DataStage Designer to develop processes for extracting, cleansing, transforms, integrating and loading data into data warehouse database.
• Experience in Healthcare Membership Enrollment and Maintenance of Member Data Or Experience in Reconciliation of Enrollment and/or Premium Payment Transactions
• Analyzed and processed all related claims data utilizing SQL, AMISYS and Microsoft Office Suite.
• Deep understanding of HEDIS Reporting, Medical Record Abstraction, Quality Improvement, and Data Analysis.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, MicroStrategy Data Warehouse Data Modeling and Design.
• Developed Logical and Physical data models that capture current state/future state data elements and data flows using Erwin.
• Collaborated with Department Directors to develop and writePerformance ImprovementProjects according to Centers for Medicare and Medicaid Services(CMS) standards
• Experienced in SQL Server Reporting Service (SSRS), Executing Queries and Running Store Procedures.
• Solid experience with SQL Server and T - SQL in constructing triggers, tables, user functions, views, indexes, user profiles, relational database models, data dictionaries, and data integrity
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Responsible for creating different sessions and workflows to load the data to Data Warehouse using Informatica Workflow Manager.
• Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.

TECHNICAL SKILLS

EDI Transactions: 270, 810, 812, 820,837I, 837P,837D 850, 852, 855, 856, 860, and 864 transaction sets

Operating Systems: Windows NT/98, XP, 2000, Unix, Linux

Application Software: MS Office suite, Rational Suite, MS Project

Databases: SQL Server, Oracle, MS Access, SPSS, DB2, Mainframe

Web Technologies: HTML, XML

Methodologies: RUP, OOAD, UML & Business/Data Modeling, ER modeling

Requirements Management Tools: Requisite Pro, MS Visio, JIRA

Testing Tools: Test Director, Quality Center, Quick Test Pro, Load Runner

Process Modelling: MS Visio, Rational Rose, Virtual User Generator

Programming Languages: Java, J2EE, SQL, PL/SQL, ASP.NET, UML, Visual Basic, C, C++, Python

Documents & Processes: SRS, Use Cases, UML diagrams, FRS, UAT, Test plans & cases, Business Process Modelling,Net Project Planning & tracking

PROFESSIONAL EXPERIENCE

Confidential - Atlanta, GA

Sr. Business Data Analyst

Responsibilities:

• Assisted Project Manager with development of the Business Case and Requirements Management Plan.
• Gathered requirements for the set-up of four new Medicare/Medicaid plans available for open enrollment.
• Performed final walkthrough of the same with both business and technical SME’s.
• Performed risk analysis at high level to assess risks and establish a response strategy tomanage and mitigate risks, impediments, and dependencies.
• Conducted user interviews, gathered and analyzed the requirements and designed the functional specification document.
• Analyzed set behavior and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
• Experienced in data analysis with solid understanding of Business Requirements Gathering, Data warehousing, Business Intelligence, Data Mapping, Data Profiling and Data Modeling.
• Performed data analysis and data profiling using complex SQL on various sources systems including Oracle and SQL Server.
• Applied business rules for “In” and “Out of Network” components of the medical plans.
• Reviewed existing products namely various insurance plans and conducted 6 JAD Sessions with a total of 40 members per session some joining in person and others through Webex, for buy-in and after draft approval. A total of 9 Departments involved.
• Worked on Facets Data Models and their relationship between Incorporated HIPAA standards
• Reviewed test plan to ensure it being comprehensive and accurate in testing updates to the system.
• Prioritized defects by identifying their overall project impact and suggested possible fixes prior to resolution efforts.
• Prepared and distributed Release Notes to accompany delivery package.
• Created SIPOC diagram - (suppliers, inputs, process, outputs, and consumers) to determine high level scope for enhancement/new functionality needed for legacy system application in Lotus Notes used by Medical Policy Department (Medicare focused).
• Analyzed and Documented Business Requirement Document (BRD), Functional Specification Documentation, and System Requirement Documentation, using UML methodologies.
• Assisted transition into Agile by facilitating various ceremonies namely: backlog grooming, daily stand up, sprint planning, the release planning, sprint demo and sprint retrospective.
• Agile methodology mentor for new team members.

Confidential - Alpharetta, GA

BA/DA

Responsibilities:

• Reviewing all documentation to ensure solution meets business requirement. Providing consultation assistance to the Project Manager, Project Planner and the Sponsor for daily touch points, problem resolution and lessons learned.
• Extensively work with the implementation team and to participate in system testing documentation, including the requirements for the Release 1 deployment covering the integration with Score Cards rating system.
• Involve in filling the defects while testing PAS-Policy Administration System by Duck Creek.
• Document use cases as part of functional design and developed RTM-Requirement Traceability Matrix.
• Analyze the graphs and reports to track defects.
• Create user guide for Business owners, Worker compensation and Commercial auto line of businesses considering agent’s and internal user’s prospective.
• Designed and documented test cases according to the application requirements.
• Coordinated and attended meetings to review the requirement specifications with the Quality Assurance manager and other team members.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Organize requirements into high level Use Cases and low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
• Worked as a Personal line of Property and Casualty Expert for interface to Insurer Business Partner on all facets of system design.
• Interacted with users for verifying User Requirements, managing Change Control Process, updating existing Documentation
• Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams so that developers and other stake holders can understand the business process by using UML.
• Developed Conceptual Data Model & Logical Data Model in alignment with MITA Information Architecture.
• Created SQL-Loader scripts to load legacy data into Oracle staging tables and wrote SQL queries to perform Data Validation and Data Integrity testing.
• Produced UML Activity diagrams with defined swim lanes using MS Visio as part of claims process analysis

Confidential - Waukegan, IL

Business Process Manager

Responsibilities:

• Analyzed trading partner specifications and created EDI mapping guidelines
• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Co-ordination with Advertising and Administration Departments.Customer service
• Report elaboration for Management and Directory Levels. Sale and marketing outlines for the country
• Assist in improving healthcare delivery by focusing on market analysis, enrollment strategies, capacity analysis and management, care management, utilization management, and referral management processes, process variation, best business and customer service strategies, and outcomes measurement.
• Analyzed and documented internal data reporting requirements forActuarial/Financial/Management purposes.
• Experienced working in the area data management including Data Modeling, Metadata, Data Analysis, Data Mapping, Data Profiling and Data Dictionaries.
• Collaborate with data modelers, ETL developers in the creating the Data Functional Design documents.
• Merged different data files and cleansed client database, built up segmentation models for provider and payer markets to bette.
• Researched data issues and identify the root cause in source systems, data warehouse and data marts using various data analysis techniques, data profiling and data mining activities.
• Implemented automated COBOL processing of Medicare claims
• Worked with care management for patients to systematically monitor their progress and coordinate with experts to identify and solve any problems they encounter in their treatment.
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Experienced in dealing with different data sources ranging from Flat files, Oracle, Sybase, SQL server, Teradata, MS Access and Excel.
• Performed data analysis, data reconciliation and data retrieval from various systems along with identification of data gaps and data quality.
• Experienced in manual and automated testing for both front-end and backend.
• Implementation of SQL Logins, Roles and Authentication Modes as a part of Security Policies for various categories of users.
• Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.

Confidential - Columbia, SC

Business Analyst

Responsibilities:

• Highly involved in understanding of department workflows and process flows with respect to applications. Developed business process models in RUP to document existing and future business processes. Improved process for payment of Medicare Secondary Payer claims through revised workflows.
• Involved in requirement gathering phase (Provider, Claim components and HIPAA).
• Performed Risk Assessment on processes within laboratory Information systems to determine the associated risk in each process and conduct Risk Analysis to determine level of control and testing over regulated activities.
• Extensive experience on RDBMS, Web and SQL along with MS SQL administration, SQL Enterprise Manager, Data analysis and reporting.
• Involved in member enrollment process by creating the membership enrollment files for different vendors.
• Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.
• Created reports using Microsoft SQL Server Reporting Services and QNXT tables
• Write SQL scripts for adding, changing or deleting various benefit or contract data to or from QNXT that would take several man hours to complete via the front end software.
• Write SQL scripts for adding, changing or deleting various benefit or contract data to or from QNXT that would take several man hours to complete via the front end software.
• Maintained benchmark controls to policies, company standards and contracts, performed vendor sourcing, pricing and contract negotiation, performed procurement, ensured compliance with service/joint interest contracts.
• Followed Unified Modeling Language (UML) methodology using ReqisitePro and Rational Rose to create/maintain: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
• Conducted User Acceptance Testing (UAT) and also assisted the QA team in testing, using HP Quality Center.
• Led the testing efforts of the datamarts in development, coordinated moving/setting up of processes in dev/qa/production. Worked with QA team and UAT team to go over the various test scenarios for different types of loads in the datamarts.

Confidential - Southfield, MI

Business Analyst

Responsibilities:

• Used Agile Scrum for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
• Resolved many issues brought up by the Care Management Organization including problems with undeliverable mail, service type validation issues, multiple unit type errors, and member address issues.
• 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.
• Analyzed the business capabilities and IT applications for retail - Commercial pharma sales, Space-Range & Display, Vendor purchasing, Store Ordering, Distribution and Store Operations
• Provided test data to all the testers including UAT Business Edge team and UI testing team
• Incorporated the Informatica Velocity approach for Mapping design, development and Data Governance.
• Very good understanding of Business Intelligence and Data Warehousing concepts with emphasis on ETL and Life Cycle Development including requirements analysis, design, development, testing and implementation.
• Proficient in RDBMS concepts and also in database testing using PL/SQL tools such as TOAD.
• 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.
• Succeeded in implementing a Pharmacy Benefits management (PBM) program using encrypted FTP data feeds.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Core responsibility involved complete manually testing of the User Acceptance Test (UAT).
• In an agile environment created Use Cases / Activity Diagrams / State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams thus defining the Data Process Model and Business Process Model.
• Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Created Data Flow Diagrams (DFDs), ER diagrams for database modeling and Web-page mock-ups using MS Visio for acceptance from analysts, surveyors and customers.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application in iSeries RPG environments
• Involved in generation and execution of SQL queries.