Professional Summary

• 9 years of experience as a Business System Analyst BSA in Information Technology industry with focus on Data Analysis, Data Mapping Data Modeling, Business Process Improvement expertise in implementation of IT projects using Project Management methodologies. Extensive experience in diversified industry sectors including Healthcare, Life Insurance, Property and Casualty Insurance, Commercial, Investment Banking and Credit Card services.
• Excellent expertise in Data Modeling for ODS and DW using Erwin which involves data analysis and data mapping.
• Excellent understanding of Reverse and Forward Engineering, Logical and Physical Model.
• Strong skills in Data Warehouse Design using Star Schema roll out for the fact and dimension tables. Design of cubes, partitions and aggregations with excellent knowledge of Type 2 Data modeling.
• Proficient with data warehousing, Business Intelligence reporting, Designing cubes Fact tables and dimension tables , Master Data Management MDM .
• Expertise in application development with Full Lifecycle implementation of large Data Warehouse including Project Scope, requirements gathering, Star Schema Design, Snowflake Schema, Data Modeling and ODS.
• Proven expertise in Object-Oriented Analysis and Design OOAD and exceptional record overseeing all facets of Software Development Life Cycle, from analysis and design to implementation and maintenance.
• Proficient in SDLCs using the iterative and incremental methodologies such as RUP, Agile Scrum, Agile XP and non-iterative methodologies like Waterfall methodologies.
• Strong knowledge in identifying and extracting System Requirements, Technical Specifications and Technical Requirements from Business Requirements and thereby documenting those requirements for the developers.
• Expertise in business modeling documentation for the AS-IS process and proposing the TO-BE business process as well as proficient in Activity Based Costing ABC for the AS-IS and TO-BE processes and finding out the IRR.
• Experience in conducting GAP analysis, SWOT analysis, Root Cause Analysis RCA , Cost benefit analysis and ROI analysis.
• Proficient in using Business Analysis tools such as MS Visio, Word, Excel including Pivot tables, Macros and Vlookup , Rational Requiste Pro, ReqTrace Web, Caliber RM, Optimal Trace, ClearCase and ClearQuest.
• Excellent knowledge of ASC ANSI EDI X12 transactions, HIPAA compliances and healthcare insurance claim life cycle, ICD-9 and ICD-10, State mandate Implementation Guides 4010A1 to 5010 and Companion Guides 4010 to 5010 for NEMIS system. Expertise in analyzing and testing EDI and HIPAA Transactions 837, 835, 834, 820, NCPDP5.1, 270, 271 276, 277, 278 code sets testing in Health Insurance.
• Strong Healthcare and Medicare/Medicaid business configuration experience with focus primarily on Claims Adjudication, EDI Transactions, Pricing, Provider, Member / Recipient Eligibility, Enrollment, Prior Authorization, Pharmacy / Point Of Service POS , TPL Third Party Liability / COB Co-Ordination of Benefits , Managed Care Care Management.
• Expertise in creating the dimensional models and creating ETL specifications.
• Expertise in writing BI report formats and templates/specs.
• Proficiency in elaborating the Use cases, writing Test cases and preparing Requirement Traceability Matrices RTM .
• Solid understanding of the third party administrator Pharmacy Benefit Management PBM Healthcare industry or health insurance experience and healthcare data standards.
• Conducting the UAT and hand holding the users during the initial usage of the software.
• Expertise in running ad-hoc queries for the requirements.
• Excellent communication, interpersonal, analytical skills and strong ability to perform as part of a team.
• Ability to work on multiple projects simultaneously and prioritize appropriately.

Technical Skills

Windows 95/98/NT/2000/XP/Vista/7, MS Visio, MS Access, Word, Excel, MS Project, Rational Rose Enterprise, Architect, Microsoft Project, Rational Requisite Pro, MS SQL Server 7.0/2000, PL/SQL, OLTP, Synon/2E, COBOL, IBM AS/400, CICS, Citrix, DB2, SAP R/3 FICO, ERWIN Data Modeler 4.2/4.1/4.0, Business Objects XI r3, r2, r1, 6.5, 6.1, 5.x, 4.x, Crystal Reports XI, Informatica, HTML, Dream Weaver, MS FrontPage, IBM COGNOS, Oracle BI Enterprise Edition OBIEE , C, C , XML, X12, Total Quality Management and Lean Six Sigma Manufacturing Methodologies.

Professional Experience

Confidential

Responsibilities:-

• Reviewed, analyzed and evaluated business processes and associated IT application requirements. Analyzed business workflow and system needs for conversions and migrations performed data mapping and data conversions.
• Conducted Stakeholder interview/analysis during MMIS Initiation Phase and identified GAPs between the Current AS-IS and Target TO-BE processes. In the course performed MITA GAP analysis, including Business Process Re-engineering efforts for process improvement.
• Created UML diagrams, run RTM Requirement Traceability Matrix Reports from ReqTrace and established RTM repository. Formulated the System Design Document SDD and developed draft System Design Document DSDD by MMIS Functional areas during the MMIS Elaboration phase.
• Prepared ER Diagrams, Data Dictionary, Legacy system's Process Flow Diagrams, facilitated and has driven various Requirement Validation RV sessions, prepared SRDs System Requirements Documents and SDDs System Design Documents for phased deliverables.
• Understood benefits packages for different state as well as for Federal funded programs like KDP Kidney Dialysis Program BCCDT Breast Cervical Cancer Treatment M-CHIP etc. Identified process components involved in Federal programs like KDP, BCCDT, ICS, M-CHIP, etc.
• Provided eCAMS's Iteration system Release demonstration to state on the Functionality of the system. Prepared Uses Stories User Story Titles etc. for the same.
• Performed MERP business requirements mapping and tied the requirements to its respective Use-Case packages in ReqTrace. Verified and validated requirements to Use-Case mappings via RTM Report.
• Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms ICD-9, ICD-10 codes , and treatment CPT .
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 P.I.D to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Understood and deciphered the Business Logic behind the Document Number Generation for KDP and BCCDT program documents. Deciphered High Level Business Logic as well as COBOL job packages/program codes to understand and discuss with its SME on CMS-64 CMS-37 CMS-416 and CMS-372 Federal mandate reports.
• Performed Scope Analysis on the Reporting Requirements by comparing the base systems' i.e. eCAMS existing reports with that to the MMIS Legacy system reports. Thus, identifying the New Buy-In reports list for MERP. Also reviewed eCAMS Standard Reports specification documents.
• Created SQL Queries, PL/SQL package, functions and stored procedures, Designed Informatica Mappings using various Transformations and PL/SQL Packages to extract, transformation and loading of data.
• Wrote Stored Procedures using PL/SQL and functions and procedure for common utilities. Used PL/SQL to validate data and to populate member billing tables.
• Reviewed and tracked Reports packages for Federal State / CMS Reports on Michigan MMIS Washington MMIS Maine MMIS systems. Analyzed different types of reports like i Scheduled Reports ii On-Demand Reports and iii List Reports that were used per Maryland MERP MMIS contracts. Produce all required Federal and State Financial reports.
• Applied thorough understanding and knowledge of Claims Processing , Eligibility, Editing and Pricing of Claims , eCAMS Healthcare Rules Engine and Life Cycle of Claim .
• Linked and De-Linked / Tied and Un-Tied Use Cases as well as Use-Cases Packages with that to the Business Requirements in ReqTrace Web based on the outcome of Requirement Validation RV sessions. Addressed issues related to cross-functional inter-dependent functional area Business requirements.
• Educated health plan representatives regarding appropriate provider data loading procedures and appropriate provider record set up. Responsible for working with plan representatives to ensure quality provider demographics are received. Analyzed trading partner specifications and created EDI mapping guidelines and worked extensively with the HIPAA EDI transaction sets 270, 820, 834 and 835
• Conducted detail oriented analysis on the current AS-IS Maryland MMIS legacy system and driving iterative GAP analysis sessions for the same to propose the effective target TO-BE MMIS system.
• Gained solid exposure on Financial Management functionalities like Accounts Payable AP and Accounts Receivable AR creation, Cash Receipts, Financials Gross Adjustment, General Ledger, Triaging, Triage Cash Receipt Refunds, Capitation Payments, GL Accounts, IRS 1099, Garnishment and Deductions, Invoices, Payments, Recoveries, etc within the system.
• Participated in CCRB Change Control Review Board meetings and provided system architectural as well as technical analysis required for evaluation of changes. In the process designed Change Management Process Workflow for CRs.
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835, 837, 270 and 271. Recommended tactics to implement HIPAA 4010 EDI X12 837,834,278,270 in the new System. Validated all the incoming/Outgoing data from EDI 837/835 interfaces.
• Developed Mapping rules, Designed specifications and Use Cases for the HIPAA 837 P.I.D 270/271, 276/277, 835, 824, 275 and others. Worked on multiple 837s and multiple Eligibility 270/271 and healthcare claim status 276/277 . Created EOB systems 835 .
• Summarized, managed and tracked the eCAMS system's ability to provide full compliance with ICD-10 transition and adjudicate the new version of ICD-10 compliant claims, and adhere to future iterations of federal standards.
• Served as an SME for multiple benefit plans including but not limited to Regular FFS Fee-For-Service Medicaid, S-CHIP State Children's Health Insurance Program , Home and Community Based Services HCBS Waiver Programs, Primary Adult Care Program, Program for All-Inclusive Care for the Elderly PACE , Breast and Cervical Cancer Screening Program BCCP / Breast, Cervical Cancer Diagnosis and Treatment BCCDT , Kidney Disease Program KDP , Specialty Mental Health Program, Dental Administrative Services Organization Program ASO , Pharmacy Benefit Package, Family Planning Program, Employed Individuals with Disabilities Program EID and Corrective Managed Care.
• Performed an initial risk assessment and identified alternatives for risk management. Defined Schedule and Cost Estimation for project work in accordance with Expert Directors and Functional Manager. Additionally maintained and updated the Risk Registry for all project risks.
• Created baseline architecture of the system with guidance from Solutions Architect, and a detailed system design to provide a stable basis for the Iterative development effort in the Construction Phase, and conduct an assessment of the risk.
• Vital role in documenting all Wire-Frames and Prototypes, Window designs, Architecture designs, Updating Project Charter, System process flows and simulations, Stakeholder Analysis, Work Plans, Requirements documents namely SDDs, SRDs, etc. , all major project draft documents, phased deliverables and key milestone artifacts.
• Timely updated the exiting, developed and used a newly created standard Risk Management Plan approved by State DHMH, thereby produced lists of identified risks during MMIS Inception Phase. Developed risk mitigation strategies to limit the impact, for each significant accepted risk.
• Conducted Cost estimation and budget for costs, thereby posting these estimates to each task in the WBS Work Breakdown Structure and assisted in determining resources necessary to complete the tasks in timely and efficient manner. Computed, evaluated and monthly reported Cost Variance at task level using the Cost estimate during the Execution Phase of the project.
• Executed PL/SQL statements/queries in ORACLE SQL Developer and Toad etc. applications to validate and test underlying tables in operational Production environment and staging Development and QA/Testing environment, thereby verifying front end BI Reports for matching results.
• Tested numerous summary view, detail view, prompt page, templates and dashboard view of reports generated by Data Warehouse BI tools.
• Have written copious User Manuals, Proof Of Concepts and gave several walkthrough sessions to end users business users on functionality and features of the Data Warehouse/BI Reports and BI tools during the UAT phase of each project.
• Applied integrated Project Management tools and COTS Commercial Off-The Shelf products to consolidate reports and updated management plans required for the project. Also executed Change Control on the project.
• Created and submitted project tracking and status report on weekly, monthly and quarterly basis as well as on a schedule basis as determined by State DHMH. Conducted Phase reviews with State DHMH within each phase.
• Created MMIS Construction Phase documents including but not limited to Software Development Document SDD that addressed all facets of the technical operation of the system.
• Developed SDD drafts by MMIS Functional areas, UAT Plan Performance Tuning Document, Integration Document, Test Analysis Report, Operations Readiness Test Plan, Operations Maintenance Plan covering plan for Post-Deployment period , System Administration Manual, User Manual, etc.
• Collaborated with Business Leaders from DHMH and CSC counterpart, to share and gather Cognos and Oracle BI Planning requirements, designing and developing system work flows, thereby implementing these process flows for Dev., Prod. and Test environments.
• Conducted Performance Tuning of Dashboards/Reports and made changes to database by implementing the materialized views, partitions, re-building of indexes, overwriting the SQL execution path by making use of hints etc.
• Assisted in building SSIS packages .dtsx involving ETL process, extracting data from various flat files, Excel files, legacy systems and loading into SQL server. Migrated data using ETL Tool in SSIS.
• Performed technical mapping and data mapping in Informatica PowerCenter and simple MS Excel files for source to target ETL mappings.
• Worked with ETL team involved in loading data to staging area. Provided all business rules for the database for loading data.
• Established Development, Testing and Review environments for System Release demos. Developed the Test and Evaluation Master plan.
• Conducted complete testing initiatives associated with the application including Unit Testing, System Testing, Integration Testing, Regression Testing and Security Testing, including test analysis approval and test problem reports.
• Designed Dashboards/Reports using the Oracle Business Intelligence Analytics platform for requirement analysis and data analytics. Enhanced performance of Reports / Dashboards by implementing the Aggregate tables, Materialized Views, Table partitions, re-building of indexes and managing Cache etc.
• Involved in designing and development of building Physical Layer, Business model and presentation layer and report development. Created Answers, Dashboards, iBots as per user requirement.
• Successfully delivered the system in Production environment, upon completion of an extensive testing effort. Thereby re-enrolled all existing Providers i.e. Physicians, Practitioners and Doctors from the current Maryland MMIS to the new system.
• Performed tasks including backup and restore by using SQL Server 2008 tools like SQL Server Management Studio, SQL Server Profiler, SQL Server Agent, and Database Engine Tuning Advisor. Tuned and Optimized SQL Queries using Execution Plan and Profiler.
• Designed Data entry, query and reports request screens and tuned the SQL queries. Used joins, indexes effectively in where clauses for Query optimization. Created and manipulated stored procedures, functions, packages and triggers using TOAD.
• Lead and facilitated developing of dimensional models using the facts and the dimensions and the Key performance indicator using ERWIN Data Modeler and participated in the logical and physical design sessions and created several design documents, UML diagrams in MS Visio.
• Prepared ER Diagrams, documented Data Dictionary, identified database schemas, its data elements/fields, and studied their nomenclatures from the identified columns, for phased deliverables.
• Tested BI Reports and documented user testing manuals for Cognos 10 Reports. Generated test data and tested database to meet the functionalities deliverables in the project documentation and specifications.
• Tested the ETL process in testing environment and created test cases. Created the test scripts and complex queries to test the application and to quality assurance of the data.
• Conducted hand holding during UAT sessions for the report owner business users during the preliminary usage of the software and gave walkthroughs on the User manuals ran ad-hoc reports to display dynamic report functionalities.
• Created ad-hoc reports using Cognos Report Studio, MS Access and MS Excel including Pivot tables, Vlookup and Macros .
• Performed fine-tuning of the eCAMS application, including re-work addressing significant defects. Conducted sample tests to verify all Service Level Metrics SLM are achievable. Also test individual elements units for usability.
• Designed, developed and produced a stable application that passed Product-Release Milestone per State DHMH standards before the application can be considered an eligible candidate for production.
• Conducted operation readiness tests and a post-implementation review and producing respective reports.
• Created the test scripts and complex queries to test the application and for quality assurance of the data.

Environment: MMIS / CMS Regulations, HIPAA Privacy, Wire Framing, UML, SCRUM, eCAMS ProviderOne CNSI owned developed Claims Administration System , iLotus Notes, IBM COGNOS 10 Report Studio, Oracle Financials, JIRA Defect Tracking Tool , ReqTrace Web 2.1, Oracle SQL Developer, J2EE, .NET, Oracle ODBC, Oracle BI Enterprise Edition 11g, MS Office Suite, MS Excel, MS Project, MS Office 365, SharePoint, Service Oriented Architecture SOA , RUP Rational Unified Process For MMIS Development , Informatica PowerCenter, Enterprise Architect 10 UML SPARX System's EA Visual Modeling Platform .