SUMMARY:

• Sr. Business Systems Analyst/Data Analyst with 7+ years of diverse experience in Health Care domain with exposure to innovative business processes and working in Project Management environment.
• Strong experience with development as well asbusinessrequirement gathering and analysis.
• Developed predictive equations and models for all types of data: continuous, nominal, and ordinal.
• Experienced practitioner of data wrangling, data mining and manipulation applying R and Excel.
• Worked extensively on Erwin and ER Studio in several projects in both OLAP and OLTP applications.
• Developed a Conceptual model using Erwin based on requirements analysis.
• Created dimensional model for the reporting system by identifying required dimensions and facts using Erwin r7.1.
• Used Erwin for reverse engineering to connect to existing database and ODS to create graphical representation in the form of Entity Relationships and elicit more information
• Comprehensive experience identifying and documenting sources and flows of business data used in analytic models.
• Extensive work in ETL process consisting of data transformation, data sourcing, mapping, conversion and loading.
• Strong in data warehousing concepts, dimensional Star Schema and Snowflakes Schema methodologies.
• Used Model Mart of Erwin for effective model management of sharing, dividing and reusing model information and design for productivity improvement.
• Proficient in SDLC deliverables associated with each phase; specifically writing business requirements, use cases, test plant and scripts, with databases and Business Intelligence (BI) tools.
• Well versed in SAP CRM providing comprehensive business requirement analysis to clients. Proficient in SAP CRM analysis process design troubleshooting implementation and testing. Specialize in analyzing and mapping business processes to meet client production goals.
• Performed extensive GAP analysis in the project as there were numerous 'As - Is' and 'To-Be' conditions.
• Expertise in creating database objects like tables, views, procedures, triggers, and functions using T-SQL to provide definition, structure and to maintain data efficiently.
• Experienced working in utilization management.
• Expertise in creating process flows, diagrams and functional flows with MS Visio.
• Experienced working in managed care environment wellness and care management, case management, member incentive models.
• Experienced with TriZetto FACETS and HIPAA Gateway - supported new business requirements by extending the functionality of the core FACETS system using the FACETS extensibility architecture feature.
• Proficient in working with users and stakeholders to elicit, analyze, communicate and validate requirements using User interviews, Workshops, Observation, Existingsystems documentation/procedures, JAD, JAR, and Brainstorming sessions to identify Functional, Non-Functional, andBusinessRules, and subsequently model them.
• Proficient in using multiple software such as ECW,MedicareeServices,Medicaidweb portal
• Excellent experience of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
• Well versed with HIPAA, Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Experience with full Software Development Life-Cycle (SDLC), architecting scalable platforms, objects oriented programming, database design and agile methodologies.
• Proficient in using Power View visualization tool
• Worked extensively creating Pivot Tables, Macros and the lookup function in Excel.
• Extensive industry analytics experience using statistical analysis and predictive modeling.
• Proficient in using SQL queries either by making them from scratch or modifying existing queries to analyze information from company databases.
• Experience in writing Sub Queries, Stored Procedures, Triggers, Cursors, and Functions on MySQL and PostgreSQL database.
• Closely worked with IT experts, subject matter experts for data collection and analysis.
• Good understanding of Big Data, Hadoop, R, Hive, Pig, Python and proficient in writing advanced SQL queries.
• Expertise in relational databases DB2, Oracle and SQL and ETL processes.
• Written Hive queries for data analysis to meet the business requirements.
• Demonstrated strong analytical skills and problem solving skills with superior attention to detail.
• Effective written, communication and presentation skills.
• High capability to quickly learn new technology and adapt to a new environment.

TECHNICAL SKILLS:

Operating Systems: Windows XP, 7, 8, 10, Linux

SDLC Methodologies: Agile SCRUM, Kanban and Waterfall

Business Intelligence Tools: IBM Cognos,Tableau, SSRS, SAS, SAP, Power BI, PowerView, MicroStratergy, Crystal Reports

Databases and Tools: MS Access, MySQL, SQL,Big Data, Visual Studio, Apache Web Server, Erwin data modeler.

Project Management: MS Project, Jira, DOORS, SharePoint, MS Suite

Languages: C++, Java, Python, R, SQL, PHP, CSS, XML, XHTML, JavaScript

PROFESSIONAL EXPERIENCE:

Confidential - Franklin, TN

IT Business Analyst/ Report Analyst

Responsibilities:

• Data research, Data analysis, and Data evaluation to identify patterns and validate accuracy
• Understood business and functional needs, capture requirements, evaluate and define solutions, create scope to enterprise-wide business problems through the successful implementation of technology in the support of eviCore’s objectives.
• Proactively collaborated with business functions to analyze information needs and functional requirements and deliver artifacts to support technical implementation (e.g. User Stories, Acceptance Criteria, Data flows, Process flows, etc.)
• Communicated with business executives and users comfortably about the business areas they support and the technical solutions in place or being developed.
• Interact with business executives, vendors and technical staff members to gather artifacts for Knowledge Repository.
• Participated actively in and provide ideas on improving eviCore’s core capabilities in the industry through sharing best practices, identifying and implementing process improvements and continuously working to improve efficiency.
• Functioned as a product owner for report based projects.
• Created entity relationship diagrams for databases used in the new eviCore platform.
• Conducted meetings with business users and SMEs to identify and gather various functional and non-functional requirements.
• Tracked data lineage for data sources by analyzing ETL packages.
• Analyzed business requirements and organized high-level and low-level Use Cases.
• Conducted GAP analysis of the different reports that are being presented to clients to accommodate their requirements.
• Worked on SAS Business Data Network to initiate Data Glossary project.
• Evaluated suitability of Hadoop and its ecosystem to the above project and implementing / validating with various proof of concept (POC) applications to eventually adopt them to benefit from the Big Data Hadoop initiative.
• Involved in loading the created HFiles into HBase for faster access of large customer base without taking Performance hit.
• Created Hbase tables to store various data formats coming from different portfolios
• Experienced in managing and reviewing Hadoop log files.
• Worked on data reconciliation on reports generated from Micro Strategy to recreate the reports via SSRS.
• Reverse engineered SAS code to understand the report generation process and recreated the reports in SQL server.
• Reviewed System Test Plans, wrote test scripts and worked with business folks to validate and execute the test scripts.
• Preparation of Test Cases based on ETL Specification Document, Use Cases, Low Level Design document.
• Played role in creation and testing of designed scalable, reusable, and low maintenance ETL templates.

Environment: MS VISIO, SQL, T-SQL, Query Analyzer, IBM Cognos, SAS Business Data Network, Hadoop, Visual Studio 2010, SSMS, SSDT.

Confidential - Los Angeles, CA .

Business Data Analyst

Responsibilities:

• Designed and normalized the databases and created different objects like tables, views, Stored Procedures, UDF's, indexes rules and defaults on MS SQL server.
• Worked extensively in implementation of HIPAA EDI Transactions ( 835,837)
• Facilitated Electronic Data Interchange.
• Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Used EDI tools to verify mapping to X12 format.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Analyze HIPAA EDI transactions in X12 responses and of 837, 835, 277CA and 999 and looked for defects.
• Do data analysis for various version changes of EDI messages on different sub-systems.
• Data mining and cleaning and transformation for macroeconomic variables, internal and vender (Moody's) data using SAS and Erwin data Modeler.
• Data modeling in Erwin; design of target data models for enterprise data warehouse (Teradata).
• Used Reverse Engineering approach to redefine entities, relationships and attributes in the data model as per new specifications in Erwin after analyzing the database systems currently in use.
• Worked at conceptual/logical/physical data model level using Erwin according to requirements.
• Provided reporting requirements and ensure the successful delivery of Business Intelligence (BI) solutions and Executive / Operational dashboards.
• Extensive knowledge in GAP analysis in the project as there were numerous 'As-Is' and 'To-Be' conditions.
• Experienced in creating database objects like tables, views, procedures, triggers, and functions using T-SQL to provide definition, structure and to maintain data efficiently.
• Created complex Stored Procedures, Triggers and User Defined Functions to support the front-end application.
• Generated various List Reports, Grouped Reports, Cross tab Reports, Chart Reports, Drill-Down and Drill-Through Reports.
• Created Dashboards to present critical company data in a single report.
• Defined communications settings including email addresses and inbox settings using SAP CRM.
• Analyzed and developed applications for sales and marketing departments.
• Coordinated with end-users to evaluate business processes.
• Implemented the concepts of Incremental Data Load, Slowly Changing Dimensions for updating and maintaining the history of the records.
• Created SSIS Packages for import and export of data between MS SQL Server database and others like MS Excel and Flat Files.
• Generated Monthly and quarterly Reports are generated using different techniques like Drill down, Tabular reports, Matrix reports, List reports, Parameterized, Pie charts, Drill Through using Expressions, Global variables and Functions. DeployedSSRSreports in Share point for web based access for multiple end user.

Environment: JIRA, HP ALM, MS VISIO, SQL, T-SQL, Query Analyzer, SAS, Erwin 8, Business Intelligence (BI), FACETS, Visual Studio 2010, VB.NET, ASP.NET, SQL Server Profiler, SSMS, BIDS, Excel PowerView.

Confidential - Detroit, MI

Business Data Analyst/Reporting Analyst

Responsibilities:

• Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.
• Utilized RUP to configure and develop process, standards and procedures.
• Interfaced with business users to prepare and update Business Process Requirements for the new release of Healthcare tools.
• Prioritized outstanding defects and systems problems, ensuring accuracy and deadlines were met.
• Produced data and analysis for multiple departments to assist in decision making.
• Created functional dashboards from multiple data outlets to synthesize market share.
• Developed or enhanced several strategic models to assist in long term planning of the health.
• Created and presented information to senior leadership.
• Assigned to oversight committee of Center for Enterprise Innovation.
• Assigned to Data IT Advisory Council.
• Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI’S 271, 276 and 834, HIPAA 4010, 5010, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10, Facets.
• In depth knowledge of Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the program to vendors.
• Performed GAP analysis of business rules, business and system flows, user administration and requirements.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
• Used the Rational Unified Process (RUP) to develop the different phases of Software Development Life Cycle (SDLC).
• Prepared Business process models; used Visio to create use case diagrams.
• Designed mockup and wireframes to communicate visual data flow to the end users.
• Developed use cases, activity diagrams and sequence diagrams for a clear understanding of the vision document.
• Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
• Administered and coordinated User Acceptance Testing and obtain final system acceptance sign-off with the help of Program Manager.
• Conducted Risk Engineering to derive and execute action plans on time.
• Conducted Joint Application Development (JAD) sessions with stakeholders throughout SDLC to resolve open issues.
• Wrote SQL Queries in MS Access to sort data and analyze the large set of data during project life cycle.
• Used Rational Clear Quest for defects and bug testing.

Environment: User Acceptance Testing (UAT), Rational Unified Process (RUP), Rational Clear Quest, Joint Application Development (JAD), MS Access, Windows, Rational Test Manager, MS Office, Requirement Traceability Matrix (RTM).

Confidential - Tempe, AZ.

Business Data Analyst

Responsibilities:

• Interfaced with, and interviewed, cross-functional stakeholders to generate Leveraged Agile Scrum methodology for portal development.
• Prepared data mapping document for EDI transaction set 834 to comply health New England’s internal format.
• Gathered high level requirements from thebusiness, created user stories and prioritized the product backlog with the project manager.
• Collaborated with the development team through iteration and attended every Scrum meeting to represent product team
• Enabled product-centric testing and facilitated QA teams understanding of acceptance criteria and test scenarios.
• Developed Use Case diagrams, Activity diagrams and Workflow diagrams using MS Visio.
• Accountable for extensive User Acceptance Testing (UAT).
• Maintained documents on SharePoint, Wiki and Jive to facilitate seamless interaction with multiple teams.
• Performed a baseline assessment and related interfaces, existing service level agreements, policies, and operationalbusinessprocedures for readiness to comply with ICD-09 requirements.
• Identified risks, problems, requirements and concerns in order to comply with ICD-10 changes by conducting interviews.
• Created physical and logical models using Erwin to effectively translate conceptual model into logical and physical models conforming to the business and data requirements.
• Developed Prompt Pages, Cascaded input Prompts to display only the selected entries in the report and also worked on the customization of prompt parameters.
• Involved in extensive use of conditional formatting while developing reports in Report Studio.
• Migrated Reports from Cognos 8.2 to 8.3.
• Initiated for the users to do ad-hoc reporting using Query Studio.
• Actively worked on data analysis and report analysis with respect to ICD-09 impact.
• Collected the information related to ongoing application upgrade. Studied their impact on ICD-09 implementation.
• Prepared Test cases and used Mercury Quality center (QC) for updating the status of all the test cases that are executed during testing process.
• Facilitated User Acceptance Testing (UAT).

Environment: Erwin 8, IBM Cognos,SharePoint, Rational Enterprise Suite (RequisitePro), ClearCase, ClearQuest and Rose), and MS Office.

Confidential - Miramar, FL

Business Analyst/Business System Analyst

Responsibilities:

• Performed monthly full file reconciliation between CMS files, and system Identifies and corrects discrepancies, including submission of corrected data to CMS’ contractor, internal systems and eligibility overrides in the pharmacy claim system as needed.
• Provided summary and detail reporting to management to support the CMS monthly enrollment attestation.
• Researched and resolved escalated cases related to eligibility, enrollment and other health coverage information flags from employer groups, CMS or other sources.
• Received and prepared information related to an audit request from client or CMS, or monthly enrollment data validations from CMS’ contractor.
• Performed comprehensive research and reconciliation of out of area flags and other special status flags (ESRD, Hospice, Medicaid, LIS) to ensure accurate, CMS capitation payment and pharmacy claim payment
• Processed late enrollment penalty attestations and appeals, low income subsidy changes and overrides,
• Validated other health coverage information using Medicare Secondary Payer rules and CMS regulatory requirements, submits updates timely and accurately to CMS’ contractor, and identifies other coverage for other party liability subrogation.
• Reconciled CMS PDE rejections related to eligibility, demographics and LIS status. Promptly addressed 4RX, TBT FIR RAPS, and Encounter data exceptions.
• Provided ad hoc reporting and root cause analysis of discrepancies and errors that result in data mismatches.

Environment: SQL Server, Windows Server, SSRS, MS Office.