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Business Report Analyst/medi-cal Fraud Analyst Resume

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CaliforniA

SUMMARY:

  • Business Analyst with 7+ years of experience in Requirements Management, Business Analysis, Data Analysis through HealthCare/Real Estate/Finance/ Telecommunications industries.
  • Excellent skills in performance management to support strategic planning (SWOT Analysis), goal setting, strengthen accountability, enhance decision making.
  • Developing Functional Specifications for business process refinement and automation, conducting feasibility studies and scope.
  • Conducted Requirement Gathering Sessions such as Joint Application Development (JAD), Rapid Application Development(RAD) interviewed Subject Matter Experts (SMEs), Stakeholders for deriving detailed functionality aspects of business process and carefully updated the requirements information in an easily understandable format.
  • Developed RACI Charts for clarifying roles and responsibilities in cross - functional/departmental projects and processes.
  • Excellent business writing skills essential for producing various business documents such as Business Requirements Document (BRD), Functional Requirements Document (FRD), and Non-Functional Requirements Document (NFRD), Business Process Documents, Business Flow Documents, User Training Manuals, User Interface Specifications.
  • Experienced in FACETS, ICD 9-ICD 10 conversion
  • Excellent knowledge of HIPPA transaction codes such as 270/271 (Inquire/Response Health Care Benefits), 276/277 (Claim Status), 835, 837 (HealthCare Claim), 834 (Benefit Enrollment)
  • Expert in EOB (Explanation of Benefits), COB (Coordination of Benefits) reporting
  • Experienced in Data Analysis techniques such as Data Flow Diagram, Data Mapping
  • Comprehensive knowledge of software development methodologies (SDLC) such as Waterfall and AGILE SCRUM.
  • Strong knowledge of Business Process Modeling assessing “As Is” & “To Be” scenarios and diagramming data & process mapping, applying Unified Modeling Language (UML).
  • Experienced in EDW, Master Data Management, Data Profiling
  • Extensive knowledge in data migration, data integration and deployment of application
  • Experienced in ETL process from source to target level process and testing along with UAT testing
  • Well versed in performing Change Management by using Impact Analysis, Gap Analysis.
  • Developed Requirement Traceability Matrix(RTM) using MS-Excel.
  • Extensive experience in analyzing and creating Use Cases, Use Case Diagrams, Data Flow Diagrams, Business Flow Diagrams, Navigational Flow diagrams, Swim Lane Diagram, and Sequence Diagrams using MS - Visio.
  • Proficient in writing SQL queries and in creating complex SQL Queries using Joins and Sub-Queries.
  • Extensively worked with the On-site and Off-shore Quality Assurance Groups by assisting the QA team for developing Test Plans, Test Cases, and Test Scripts etc., conducted User Acceptance Testing (UAT).
  • Good knowledge in usage of Quality Center, test cases.

TECHNICAL SKILLS:

Operating Systems: Windows 2000, 2007,2010, NT, VISTA, XP, MAC

Languages: UML, SQL, C Language, Java, VB Scripting, HTML, C#Databases & Tools: SQL Server 2005/2008, Oracle, Sharepoint, Citrix, Fusion Import, COGNOS - Data Manager, COGNOS- Query Studio, COGNOS- Report Stusio, OM Financial Suite, FRx, MS-Visio, MS-Project, MS-Access, BigData HADOOP Platform

Testing Tools: QTP, Quality Center

Business Intelligence Tool: IBM Cognos v8- Report & Query Studio, MicroStrategy

PROFESSIONAL EXPERIENCE:

Confidential, California

Business Report Analyst/Medi-Cal Fraud Analyst

Responsibilities:

  • Supporting Department of Health Care Services (DHCS) in creating Medi-Cal related report templates to support everyday needs. Reports are based out of Business Objects reporting tool.
  • Supporting DOJ group in building Medi-Cal fraud cases and creating fraud report templates out of Business Objects.
  • Support DHCS and DOJ in resolving their data warehouse related questions by explaining the data definitions, compatible join conditions between different datasets
  • Provides user training on “How-To” use Business Objects, SQL queries, report prompts, measures, dimensions, report filters, merged dimensions, sub-queries, variables etc.

Confidential, Dublin, CA

Business Analyst/Systems Analyst/QA Lead

Responsibilities:

  • Working with Business Stakeholders to gather requirements and complete artifacts, including solution design support and data mapping
  • Used Business Intelligence Reporting Tool to create KPIs and Scorecards to improve corporate profitability measures and comparative financial analysis
  • Interviewing business area experts and technical people to prepare Logical Data Models to analyze and document business data requirements
  • Analyzing business requirements and creating Use Cases, Sequence diagrams, Activity diagrams using MS Visio as per UML methodology
  • Participating in the system design exercise with the Application development team
  • Working closely with Operations groups to ensure accuracy of data being used
  • Providing suggestions and recommendations on Project Plan and Work Breakdown Structure
  • Collaborating with Project Stakeholders and technical teams regarding enhancements, changes, issues and defects that may impact development, data, workflow, and/or functionality.

Confidential, Woburn, MA

Business Analyst

Responsibilities:

  • Worked from Requirement gathering phase till post production validations.
  • Documented functional and Technical Requirements, Test Plan, Test Cases, Use Cases
  • Worked closely with Development team on ETL process, data infrastructure, data modeling, business intelligence reporting and dashboards
  • Implemented Analytical reporting models using EDW tables and Operational models using ODS tables from Data Warehouse
  • Created data dictionary documents, logical diagrams, summary table requirements, end-to-end data mapping documents, dashboard prototypes
  • Handled the process change management to implement changes in ETL and COGNOS
  • Creating technical summary documents for ETL team to create summary tables for Asset Count Analysis Dashboard
  • Assisted QA team in covering use cases for each business requirement
  • Provided training to internal users for using Cognos Report Studio and Cognos Query studio
  • Closely worked with testing team in documenting test plans, QC testing and UAT testing and worked independently on post-production issues.
  • Created data mapping and data dictionary documents
  • Performed extensive data analysis to document data issues and their impact
  • Created data profiling document for each data quality scenario where data clean-up is needed
  • Worked closely with the business to set business rules and standards that would help resist current issues to happen in future
  • Worked closely with technical teams to implement logics in application so that bad data will not get created
  • Involved in data governance principles to document ownership, strategy, quality and security related information

Confidential, Omaha, NE

Corporate Financial Systems

Responsibilities:

  • Gathered requirements for Business rules related to West’s expense policy from AP, TAX and CFS department. And assisted third party vendor in setting up business rules in Concur application.
  • Well versed with B2C, B2B applications, general finance and accounting principles
  • Gained hands on experience in the Waterfall methodology of Software Development Llifecycle
  • Experienced in UAT Testing - the final application for Usability testing to verify whether all the User Requirements were catered to by the application
  • Gained knowledge about creating data mapping documents
  • Handled Corporate Financial system’s several financial applications successfully
  • Assisted in generating and formatting reports from FRx, Cognos
  • Gained knowledge on using Cognos-Data Manager tool, profound knowledge of calculation scripts, load rules, business rules, forms
  • Comprehensive knowledge of relational database and SQL
  • Handled user security access rights, new user setup in production environment on day to day basis
  • Worked on ETL (Extraction. Transform and Loading) process
  • Ran GL (General Ledger) Import/Export process for global subsidiaries through FRx
  • Worked on Financial application under Citrix - EDM, Workplace, DocLink, Epicor, FRx, Fusion Import
  • Handled NET CHANGE process to clear missing GL entries in month end

Confidential

Jr. Business Analyst

Responsibilities:

  • Assisted Sr. Business Analyst in writing Business & Functional Requirement Specification(FRS)
  • Involved in preparing test plans and test cases
  • Designed and developed Business Flow Diagrams, Activity Diagrams, Sequence diagram
  • Conducted User Acceptance Testing (UAT), end to end testing
  • Conducted user interviews, Gap Analysis, attended JAD sessions and created Agendas.
  • Developed Logical Data Models with the help of Data Architect.

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