SUMMARY

• Over 6 years of experience working in roles like ETL Dev, BA and BSA in Healthcare IT domain.
• Proficient using SQL to implement complex queries for data extraction, manipulation, analysis, and validation and generating user reports.
• Adept in SQL for querying different kind of databases, Data Mapping, Extraction Transformation and Load (ETL) process from multiple sources.
• Strong knowledge of ETL tools and techniques for database migration and data reports generation.
• Extensively used ETL tools like Informatica PowerCenter for performing Data Analysis and design data conversions from many sources.
• Experienced working on Apache Hadoop Big Data platform.
• Experienced working on various databases like MS SQL, My SQL, Oracle, Teradata and Hive.
• Experienced working with Unix servers and shell scripting.
• Certified with the designation of Professional from the Academy for Healthcare Management (AHIP).
• Strong experience working in GBD (Government Business Division) operations especially Medicaid Operations.
• Extensive experience and solid understanding of all types of EDI 837 transactions and their loops and segments.
• Experience working on Claims Processing Systems, Member/Provider Enrollment Systems, Member/Provider Information Systems, Benefits Administration System (BAS), Code Administration System (CAS) and EDIs (837, 834, 835, 270, 271, 276, 277).
• Strong understanding of health care products such as Medicare, Medicaid and Managed Care Organization (MCO) products such as HMO, PPO etc.
• Solid understanding of Facets modules and database tables.
• Highly experienced working on Trizetto Facets and in - depth knowledge of Facets front-end modules and processes.
• Experienced working in SDLC methodologies like Waterfall, Agile (SCRUM) and Hybrid SDLC.
• Highly experienced in elicitation, management, analysis and design, and validation of requirements.
• Proficient in documenting User Stories in SCRUM methodology and participating in its various ceremonies.
• In-depth knowledge and strong experience in healthcare domain and its products.
• Solid understanding and experience of working in migration, implementation and stabilization of pilot project.
• Specialized in conducting Gap Analysis of the As-Is and To-Be processes to identify and validate requirements, SWOT analysis, MOSCOW analysis and other related analysis.
• Experienced conducting QA and User Acceptance Testing (UAT) and writing test cases for the same.
• Solid understanding and experience of requirement management tools like JIRA, HP-ALM, HP QC, etc.

TECHNICAL SKILLS

Database, Tools & Technologies: MS SQL, Hive, PL/SQL, My SQL, PostgreSQL, MS Access, Power BI, Tableau, Informatica, ETL, SQL, Shell, Dbeaver

Software Development Methodologies: Waterfall, Agile, Hybrid SDLC, Unified Modeling Language (UML)

Requirement Management Tools: JIRA, HP-ALM, HP QC, Rational Requisite Pro, Clear Quest, Confluence

Healthcare Systems: Facets, EDIs, HIPAA.

PROFESSIONAL EXPERIENCE

Confidential - Danville, PA

ETL Developer

Responsibilities:

• Perform ETL techniques using Hive Query Language (HQL) to create and load tables for vendor extracts (data reports).
• Perform source system data analysis to identify and implement the business logic for extracts using SQL on Hive DB.
• Conduct extensive research on existing data extracts using Informatica PowerCenter Designer, Workflow Manger, data mappings, SQL, PL/SQL, Unix, Facets and existing documents.
• Prepared complex SQL and Shell scripts on Hadoop platform to conduct data analysis on Hive database.
• Created and integrated HQL/SQL and Shell scripts to create automated jobs using Cisco Workload Automation (Tidal).
• Worked on shell scripts/commands to access and navigate the Hadoop Distributed File System (HDFS).
• Created the file transfer B2B process using shell scripting by exporting data from Hive DB to the designated file format.
• Extensively worked on Informatica PowerCenter tools like Designer, Workflow Manager and Workflow Monitor.
• Responsible as a Facets data expert to help the team by resolving any Facets data conundrums.
• Conducted data analysis and created extracts using SQL for member, provider and claims data from Facets tables.
• Performed extensive claim analysis using Facets, SQL, architecture and mapping documents to identify mapping/logic defects and transform them into business requirements.
• Participated in ETL requirements process during data transition from legacy systems to Big Data platform.
• Involved in automating deployment process for multiple environments using Jenkins.
• Perform data lake validation after data ingestion on the Hadoop platform.
• Monitor the resource utilization of Hive queries and optimize the scripts as needed using Resource Manager in Ambari.
• Conduct code review tasks, unit testing and UAT and provide feedback to the team members.
• Extensively use Git and Git Bash for setting up repositories and maintaining code files.
• Actively participate in Agile SDLC activities like sprint planning, backlog refinement, documenting user stories and maintaining the sprint board using JIRA.
• Create and publish research documentation and product release notes on Confluence.

Environment: Apache Hadoop, Hive DB, Informatica PowerCenter, Facets, Microsoft SQL Server, DBeaver, Unix, Cisco Workload Automation, Jenkins, Azure DevOps, Git, Git Bash, MS Office, Agile, JIRA, Confluence, SharePoint.

Confidential - Norfolk, VA

Business Analyst

Responsibilities:

• Ensure timely, accurate and complete reporting of encounters via EDI transaction set 837 to CMS and DMS (Department of Medicaid Services).
• Involved in EDIFECS implementation for Medicaid markets from legacy system.
• Worked on stabilization of market performance after migrating to EDIFECS from legacy system by continuously performing process improvement activities.
• Work towards remediating internal and external exceptions to successfully report encounters via EDI set 837.
• Performing HIPAA compliance check and remediating compliance issues on 837 encounter files using RAMP management tool and EDIFECS.
• Successfully completed projects involving work on duplicate claims, crossover claims, COB issues and claim balancing.
• Coordinate with business, IT and state teams for successful implementation of standard HIPAA compliance and CMS rules in order to report encounters efficiently using EDIFECS.
• Involved in gathering, analyzing, refinement and validation of requirements for establishing EIDS (Encounters Integrated Datawarehouse System) database.
• Involved in Data Mapping activities to source data from Facets tables to EIDS (In house DB) tables.
• Involved in data dictionary management, extraction, transformation and loading (ETL) of data from various sources.
• Reporting market’s performance metrics, penalty estimations to leadership by extensively using SQL, PowerBI and Tableau
• Performed Facets data analysis and data mapping between Facets data elements and downstream system’s req.
• Gathering detailed requirements on provider and member validation rules by conducting JAD sessions with front-end, Facets configuration, operations and health plan teams.
• Identifying, logging and tracking defects with potential solutions using JIRA Biz and JIRA.
• Coordinated Sprint planning and backlog refinement meetings to ensure accurate and efficient development of business requirements using JIRA.
• Performed extensive UAT by creating and executing test cases and test plan.

Environment: EDIFECS, Medical Data Express Pro, EIDS, Facets, JIRA, UML, MS Visio, SQL Server, PostgreSQL, PowerBI, Tableau, MS Office, Agile, MS project, SharePoint.

Confidential - Denver, CO

Business Systems Analyst

Responsibilities:

• Working with development teams to ensure successful implementations of designed solution.
• Performed Gap Analysis to identify the requirements to be implemented and created data models to translate the requirements in the most efficient manner.
• Create and maintain technical documentation for architecture, systems, vendor solutions and strategy.
• Extensively worked on Claims Processing System to identify better alternative implementation methods.
• Worked on claims data and used data mapping to verify various necessary information.
• Performed data mapping and data analysis of claims data using Facets tables.
• Conducted Business validations for different Facets modules: Claims, Subscriber/Family, Provider and Plan/Products.
• Involved in the meeting with Product Owners, SME (subject matter experts) and Marketing Team for Requirements gathering in definition stage.
• Worked with the project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.
• Extracted data from existing data source, developing and executing departmental reports for performance and response purposes by using SQL, MS Excel.
• Participated in developing fast load and fast export scripts to load data in Teradata tables and extract data from them.
• Designed and developed weekly, monthly reports related to marketing and financial departments using SQL queries.

Environment: JIRA, Facets, MS project, Informatica, SQL, UML, MS Visio, Hybrid SDLC, Windows 10, MS-Office Suite, Cognos Report, Teradata Tools.

Confidential - Hartford, CT

Business Systems Analyst

Responsibilities:

• Involved in Data Analysis & Mapping to track all data elements used in the application from the user interface through different interfaces to the target databases in which they are stored.
• Developed tables, Views, Stored Procedures and Triggers using SQL Scripting.
• SQL scripts were developed for accessing data from the data warehouse tables to meet campaign needs.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, Object Oriented Design (OOD) using UML.
• Performed Gap analysis by identifying existing technologies, documenting the enhancements to meet the end state.
• Responsible for identifying and documenting business rules and creating detailed Use Cases.
• Participated in the process of internal and external auditing activities and developed timelines for project delivery, and managed projects and resources to successful completion.
• Involved in Sprint Planning and creating Sprint Backlogs.

Environment: JIRA, UML, MS Visio, SQL Server, MS Office, Agile, Claims Data Validator, MS project, SharePoint.

Confidential - Long Beach, CA

Business Systems Analyst

Responsibilities:

• Worked with leadership hierarchy for discussing high-level project reports and reporting project status.
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 EDI (834- Benefit Enrollment and Maintenance, 837- Health Care Claim) standards.
• Reviewed data model and reporting requirements for Cognos Reports with Data Warehouse/ETL and Reporting team.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Worked closely with project manager and others to create work flow diagrams and data flow diagrams using MS Visio.
• Facilitated JAD sessions to collect requirements from system users and prepared Business Requirement Document (BRD) that provided an appropriate scope of work for the technical team to develop prototype and overall system.
• Involved in ad-hoc data analytics using SQL queries.
• Created Test plans and Test cases based on the business requirements.

Environment: MS Visio, SQL Server, MS Office, MS project, SharePoint.