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Sr. Data/business Analyst Resume

Cypress, CA

SUMMARY:

  • Qualified professional with over six years of extensive experience in the field of Business/Data Analysis, working with the technical staff to implement management and staff's business requirements into the software application in Finance industry and Healthcare Industry.
  • Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
  • Experience in B2B, B2C and Ecommerce portals web application developments.
  • Experienced as a Business Analyst in using the iterative software development life cycle principles of Rational Unified Process to manage, develop and test distributed client/server, internet and intranet applications on heterogeneous environments.
  • Highly proficient in working with users to gather requirements, analyze them and subsequently use the Rational project and design tools to model the requirements.
  • In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
  • Extensive experience with the SAS programming and in data step and with various SAS Procedures in Base SAS and SAS/Stat, including thorough knowledge of SAS Macro.
  • Used Query Analyzer, Execution Plan to optimize SQL Queries.
  • Good knowledge of Health Plans managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and Disability claims in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile
  • Experience with SOX, Regulatory Compliance and Controls.
  • Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
  • Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather business requirements.
  • Conducted JAD sessions, created Use Cases, work flows, screen shots and Power Point presentations for the Web Applications
  • Gathered and documented Non-functional requirements.
  • Experienced in preparing Business Process Re-engineering Models
  • Familiar with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
  • Extensive knowledge of IBM and Tandem Mainframe, AS400, and ASP/Client Server
  • Designed changes for Mainframe Systems and Web Based System.
  • In depth knowledge of SDLC and implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition.
  • Utilized a fusion of industry knowledge and technical programming to provide executive management the development and implementation of interactive busines1s tools, and strategic analysis, vital for use in mission-critical decision-making
  • Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the software requirements in a structured way using Rational RequisitePro to track development.
  • Interacting regularly with the development team, creative services, database designer, system administrator and the higher management to meet the deadlines of Project milestones.
  • Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
  • Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT)
  • Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
  • Used Rational ClearQuest for tracking and prioritizing defects and for enhancements after base lining the requirements.
  • Used Rational ClearCase for Version Control of requirement documents.
  • Well versed in writing queries/Scripts for Data Analysis and QA reporting and testing.
  • Good knowledge of Workflows and Content Management Tools.
  • Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and Close).
  • Expertise in Procurement and Management Services
  • Excellent skills in Project and Performance Management to support Strategic Planning, Goal Setting, Strengthen Accountability, Enhance Decision Making, and Improve Customer Service.
  • Experience in implementing Microsoft Office SharePoint 2007.

TECHNICAL SKILLS:

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: MS Access, Oracle (SQL Series), DB2

Reporting Tools: Crystal Reports 8.0

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Mainframe: COBOL, DB2, JCL, CICS, MVS

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint 2007

Automation Tools: Requisite Pro, Win runner, QTP, Test Director, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, Cypress, CA

Sr. Data/Business Analyst

Responsibilities:

  • Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
  • Verifying and updating the technical requirements for Facets products feature enhancements & new/existing table changes
  • 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.
  • Facets Conversion files development. Development of the database objects required for the product for each table change in Facets.
  • Experience with Medicare, Medicaid and commercial insurances in HIPAA, ANSI, X12 formats including 270/271, 276,277, 278, 835, 837, 997.
  • Expertise in implementing the agile, Rational Unified Process and Waterfall Methodologies throughout the Software Development Life Cycle of the project.
  • Development of automated C# dot net applications for Facets database deployment process & upgrade process.
  • Development & Maintenance of Facets Data Dictionary and Facets reporting modules.
  • Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
  • Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Medicare and Medicaid Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
  • Experienced in gathering requirements for HIPPA (Health Insurance Portability and Accountability Act) EDI (Electronic Data Interchange) Transactions 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277, 278, 997 and 999 in various phases of implementation.
  • Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
  • Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
  • Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas
  • Worked on billing system a cash management module and enhanced the encrypting standards that are required for the application.
  • Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
  • Worked in mainframe environment and used SQL to query various reporting databases
  • Worked with COBOL, JCL, VSAM.
  • Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
  • Provide technical, business, management expertise, and support the Department of Health and Human Services and Centers for Medicare and Medicaid Services \(CMS\) in building and maintaining a comprehensive enterprise architecture program
  • Responsible for creating Webservice based Interface for FACETS-MLM.
  • Followed a systematic approach to eliciting, organizing, and documenting requirements of the system.
  • Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High Level Requirements.
  • Been a part of Architecture and modeling team and have used SOA (Service Oriented Architecture)
  • Extracted data from disparate sources by SAS/ACCESS.
  • Used Query Analyzer, Execution Plan to optimize SQL Queries.
  • Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
  • Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
  • Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
  • Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
  • Planned and documented procedures for data processing and prepared data flow diagrams for the application.
  • Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros.
  • Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
  • Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
  • Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
  • Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.
  • Used JIRA to perform test management activities.
  • Analyzed trading partner specifications and created EDI mapping guidelines
  • Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
  • Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
  • Designed and developed project document templates based on SDLC methodology
  • Prepared Demo on SharePoint for various Business to get new approvals like the Therapist and Nursing divisions.
  • Designed workflows and allocated permissions within SharePoint.
  • Performed Unit Testing and User Acceptance testing and documented detailed results.
  • Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and control.

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, Rational Requisite Pro, MS Office, SQL Server, Agile, MS Project, MS FrontPage 2003, MS Access, EDI, Documentum 2.0.,UML.

Confidential, Nashville, TN

Sr. Business Analyst/Data Analyst

Responsibilities:

  • Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
  • Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
  • Led the development of a training program to train users on a custom web application and a Cognos ad-hoc reporting environment.
  • Trained the team on JIRA tool for Agile/ Scrum Methodologies.
  • Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like EDI X12 transactions (834, 835, 837, 270/271, and 276/277) and NCPDP formatted Encounter claims.
  • Involved in Service Oriented Architecture (SOA) of the claims processing system
  • Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
  • Gained in-depth knowledge and experience in pricing, inventory, procurement, time & attendance, barcode, EFT, credit cards, and handheld wireless technology in mainframe, client/server and web based environments.
  • Used SoftTest software with pseudo code to ensure test cases covered all branches of project's code impacting the system. (The system is an IBM mainframe based system that contains the master set of customer information used to bill customers.)
  • Defined Functional Test Cases, documented, Executed test script in Facets system.
  • Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Analyzed trading partner specifications and created EDI mapping guidelines.
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations
  • Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
  • Coordinating and Developing QA activities.
  • Designed and implemented basic SQL queries for testing and report/data validation
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
  • Created Process Flow diagrams, Use Case Diagrams, Class Diagrams and Interaction Diagrams using Microsoft Visio and Rational Rose.
  • Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session
  • Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
  • Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest
  • Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
  • Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.

Confidential, Washington, DC

Business/Data Analyst

Responsibilities:

  • Gathered, analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
  • Performed Cost benefit, ROI and ROM studies
  • Conducted user interviews and documented business and functional requirements.
  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
  • Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
  • Handled Medicaid Claims Resolution/Reimbursement for state health plan using MMIS.
  • Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes EDI 837, 835, 270/271 and others.
  • Defined, developed specs for federal reporting specific to Medicare Advantage
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
  • EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
  • Prepared and maintained EDI maps for different EDI transactions
  • Experience in Healthcare/Claims adjudication with knowledge of industry compliance standards like EDI X12 transactions (834, 835, 837, 270/271, and 276/277) and NCPDP formatted Encounter claims.
  • Worked with Cognos and micro strategy reporting systems to extract the data for analysis using filters based on the analysis.
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Wrote detailed specifications for various reports generated using Cognos
  • Upgraded HMO Medicare EDI and reporting.
  • Maintained on-going technical assistance and provided help desk support to customer’s mainframe systems software that included problem determination and resolution.
  • Completed the documentation of Claims Scenario’s for the source system
  • Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
  • Documented Medicare claims processing.
  • Designed High level design, for New process, integrating with legacy and Facets
  • Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
  • Exposed to Agile methodology.
  • Involved in Service Oriented Architecture (SOA) of the claims processing system
  • Created use case scenarios and documented work flow and business process using Rational Rose
  • Involved in project management using MS Project
  • Collaborated with External Auditors and documented SOX compliance requirements
  • Documented requirements, associated change requests with requirements and connected requirements with Use cases.
  • Wrote test cases and test scripts for the User Acceptance Testing
  • Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
  • Instructed and modeled core Agile principles of collaboration, prioritization, team accountability and visibility, ensured consistent application of SCRUM methodologies across the enterprise
  • Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
  • Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
  • 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.
  • Used Rational Clear case for version control
  • Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
  • Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
  • Served as conduit for managing system requirements between the business and the software development team.
  • Queried database using SQL for backend testing
  • Used Rational clear quest for defect management

Environment: Windows XP Professional, Oracle9i, MS Access 2000, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential, Philadelphia, PA

Business/Data Analyst

Responsibilities:

  • Interacted with business heads to finalize the Business Requirements for the application.
  • Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
  • Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
  • Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
  • Was responsible for Medicaid Claims Resolution/Reimbursement for state healthcare plan using MMIS.
  • Used Facets support systems to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.
  • Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
  • Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
  • Understand the As Is system and develop the To Be system concept and also prepare the System Process Maps.
  • Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.
  • Prepared and documented System Requirements and workflows for the Content Management Application tool.
  • Responsible for the management of two Application portfolios, both central to client business, involving the maintenance and production support within a mainframe environment.
  • Responsible for integrating with Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
  • Gained Knowledge of EDI transaction code sets including 270 /271, 276/277, 834, 835, 837.
  • Tested EDI transactions 270/271, 837, 835, 834(X12) according to the test scenarios.
  • Verified and validated HIPAA compliant X12 format for both inbound and out bound healthcare EDI 834 transactions as per ICD10
  • Checked Business Readiness and determined activities of flow.
  • Developed & executed several Optimized queries in SQL on this data.
  • Designed and implemented basic SQL queries for testing and report/data validation
  • Performed Unit Testing and User Acceptance Testing and documented detailed defects.
  • Wrote Procedure Manuals and was responsible for continuity preparedness.
  • Managed various tests, stored test information, reviewed and analyzed test results.
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Helped in writing Training manuals and helped business with the Training on a one to one sessions.
  • Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.

Environment: Rational Rose and Requisite Pro, MS Visio, MS Project, MS Excel, UML, XML, Windows XP, NT/2000, HTML, Vignette Content management Tool, J2EE (JSP1.2), XML, XSL, XSLT, HTML, Oracle 9i.

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