PROFESSIONAL SUMMARY:

• Data Analyst/Business Analyst with 6 years of extensive experience, specializing within Health Care with Claim, Benefit Enrollment and Eligibility.
• Experience in data analysis and statistical modeling including data extraction, manipulation and validation techniques, writing macros and reporting on various projects using SAS, SQL Server, and Oracle.
• Aggressively productive and creative individual with excellent management, administrative, communicative, analytical, and integrative skills; with capabilities to maintain progressive and prosperous working environment.
• Exceptional abilities to build and maintain relationships with Business Users, Stakeholders and Subject Matter Experts (SME).
• Exclusive Experience in Data Warehousing working SQL Server Integration Services (SSIS), SQL Server reporting Services (SSRS), SQL server 2008 R2 in Development environments
• Good knowledge and skills in developing Strategies for Extraction, Transformation and Loading (ETL) mechanism using Microsoft SSIS 2012.
• Good knowledge on Agile, Waterfall methodologies of software development life cycle
• Experience in creating database, tables, indexes, complex queries, stored procedures, views, triggers, user defined functions, temp tables, complex joins, T - SQL, DTS/SSIS using MS SQL Server 2008/2008 R2/2012.
• Worked extensively on Extraction, Transformation, Loading (ETL) data from Oracle, SQL Server, DB2, Teradata, Access, Excel, Flat Files and XML using DTS and SSIS Services.
• Exposure in using Tableau for data scrubbing/ data cleaning.
• Experience in developing complex Tableau visualization reports using data from relational databases.
• Experience developing various data connections from data source to Tableau Server for report and dashboard development.
• Hands on experience in Medical Claims in Process Documentation, Analysis and Implementation in EDI X12 Standards and 835/837/834/270/271/277/997 processes of Medical Claims Industry from the Provider/Payer side.
• Strong Experience in Creating, Configuring, Deploying and Testing SSIS Packages.
• Solid understanding of Membership, Claims Processing, Benefit/Eligibility, COB and have experience in HIPAA standards and corresponding EDI transactions.
• Expert in all phases of MicroStrategy SDLC implementations and upgrades including Solution Architecture, Installation, Business, Technical and Infrastructure Requirements Gathering, Design, Configuration, Development, Testing, Deployment and Post Production Support.
• Maintained the Traceability Matrix table to track the Business Requirements to the design to the testing keeping track of all requirements in the BRD.
• Experienced in PBM requirements, and managing the claims.
• Excellent knowledge of the Software Development Life Cycle (SDLC), such as Rational Unified Process (RUP), Waterfall, and Agile (Scrum) methodologies.
• Expertise in documenting precise Business Requirements for various projects in the Pharmacy Benefit Management (PBM) domain.
• Experience with Trizetto Facets System especially with the Managed Care Credit policies.
• Expertise in the functional processes of Business Analysis and Data Analysis, such as Business Requirements Documents (BRD), Functional Requirements Specifications (FRS), Functional specification document (FSD), System Requirements Specifications (SRS), Use Cases (UC), and Requirements Traceability Matrix (RTM).
• Proficient in constructing detailed GAP Analysis, Analysis Models, Activity / Process Models, and Data Flow Diagrams in the forms of Swim Lane Diagrams, Sequence Diagrams, and Wireframes.
• Skillful in preparing User Guides, and performing System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Strong knowledge of SQL and experience of writing SQL commands.
• Skillful when utilizing Microsoft SQL for complex queries and in-depth data analysis.
• Highly knowledgeable in utilizing Health Care Integration systems and their respective applications, such as TriZetto Facets, NASCO, HIPAA Gateway, and Informatica HIPAA Validator.

TECHNICAL SKILL:

Data Warehousing: Ab Initio, GDE, Informatica, SSIS, Data Stage, SSRS

Reporting Tools: Business Objects, Cognos, Crystal Reports

Data Modeling: Star-Schema Modeling, Snowflake-Schema Modeling, FACT & dimension tables, Pivot Tables, Erwin

Testing Tools: Test Director, HP Quality Center, Rational Clear Quest, Rational Clear Case

RDBMS: Oracle, SAS, MS SQL Server, UDB DB2, Sybase, Teradata, MS Access 7.0

Programming: UNIX Shell Scripting, Korn Shell, Bash, SQL, SQL*Plus, PL/SQL, TOAD, C++

Web Technologies: JavaScript, HTML, and DHTML, Java, J2ee

PROFESSIONAL EXPERIENCE:

Confidential, Danville, PA

Sr. Data Analyst

Responsibilities:

• Involved in creating interactive, parametrized dashboards by extracting data from different sources using data blending and applying actions - filter, highlight and URL.
• Documented the requirements for the member and provider portal and Pharmacy Benefits Management (PBM) Integration on the member portal, encouraged members to use generic drugs by offering lower copy based on business rules and individual member profiles.
• Created dashboard from scratch that included drill-through, filters, Heat/Geo/Tree Maps, Pie/Bar Charts, Circle Views, Line/Area Charts, Scatter Plots and Bullet Graphs.
• Developed unlinked, on-demand sub reports and linked sub reports using shared variables and complex reports like cross-tab, drill down and hierarchical reports.
• Analyzed EDI transactions in XML and X12 responses.
• Worked in various applications such as EDI, IVR, Member and Provider Portals and Call Center front end systems.
• Creating visually compelling and actionable interactive reports and dashboards.
• Reviewed and optimized SQL queries and edited inner, left, and right joins in Tableau Desktop by connecting live/dynamic and static datasets.
• Tracked Encounter files from the PBM (Pharmacy Benefit Manager) to verify the data content by transactional analysis
• Created Context filters on the existing filters and Tableau data extract to publish it in server by optimizing it to reduce the report rendering time.
• Utilize data to prepare and conduct quality control with SAS.
• Troubleshoot file transmission problems and assisted customers in a call center environment with EDI claim related inquiries explained and enforced guidelines in the X12 Implementation guides
• Involved throughout the Software Development Life Cycle (SDLC) Scrum-Waterfall.
• Define, gather and create business requirements documents (BRD), Functional Specifications Documents (FSD) and Use Case Specifications
• Involved in data conversion to provide reporting capabilities as per the requirement.
• Involved in testing the Pharmacy Claims adjudication and Billing processing is done through PBM (Health Trans) and Claims Accumulation and Adjudication is done through Diamond.
• Performed data analysis on daily, weekly, and monthly scheduled refresh of data based on that business or system change that have happened to ensure that the developed dashboards are displaying accurate and up-to-date live data and sent those into production after editing.
• Validated the reports before publish reports to Tableau server, troubleshoot Tableau reports, dashboards.
• Involved in troubleshooting and performance tuning of reports and resolving issues within Tableau Server and Reports.
• Ensure to partner with internal teams to prepare analytics as well as validate results with SAS.
• Participated in weekly meetings, reviews, and user group meeting as well as communicating with stakeholders and business groups.

Environment: Tableau (Desktop /Server), Oracle, Waterfall, SQL Server, PBM,SAS, DB2, SSIS, SQL, Toad, Unix, Control-M, Erwin, MS Office Suite (Word, Excel, PowerPoint, Visio)

Confidential, Watertown, MA

Data Analyst

Responsibilities:

• Worked directly with the Project Sponsor, Project Manager and Business Stakeholders, gathered MicroStrategy environment, dash boarding and security requirements.
• Experience in query optimizations and performance tuning of the SQL Server Stored procedures.
• Involved in Data modeling using Informatica IDQ and MS Visio.
• Extract, Transform and Load data from various heterogeneous data sources like Access, Excel, CSV, Oracle, flat file, text format data using OLE DB connection by creating various DTS & SSIS packages
• Excellent in depth knowledge in data migration from any database to SQL Server Database.
• Experience in designing, developing and maintaining Kimball's Method Data warehouse system.
• Working Experience in designing, implementing, maintaining, and documenting complex database applications, data warehouse (OLAP, Star Schemas, Snowflake Schemas, Cube, Fact Tables, and Dimension tables).
• Played a key role in data analysis and data modeling (model design, development, and model implementation) using SAS.
• Experience in DTS Packages and data designer usage. Moving DTS packages from one environment to another (SSIS).
• Tested the HIPAA EDI, 834, 270/271, 837/835 transactions according to test scenarios.
• Validate claims of the member via EDI with the database and then the processing is done afterwards.
• Was responsible for testing the upgrade of HIX (Health Exchange Management) 2015, healthcare overhaul mainly the Claims (837) aspect.
• Responsible for gathering and analyzing Business and system functional requirements and for understanding and translating these needs into Business Requirement Specification (BRS), System Requirement Specification (SRS) documents, Conceptual design document (CDD), Client requirements document (CRD), and Functional specification document (FSD)
• Designed and developed Tableau visualizations which include preparing Dashboards using calculations, parameters, calculated fields, groups, sets and hierarchies.
• Verified electronic medical billing, eligibility, remittance and claims, in accordance with ANSI X12 specifications.
• Combined Tableau visualizations into Interactive Dashboards using filter actions, highlight actions etc. and published them to the web.
• Created geo-spatial analyses using built-in geocoding and generated latitude and longitude measures in Tableau Desktop.
• Worked with release management team and maintained the schedule for releases for both Agile and Waterfall model that the Program followed for each project.
• Created 834 AND 820 files in EDI to process enrollments.
• Facilitating requirements and design sessions for new state client's vision encounters.
• Created Encounters Data flow diagrams and process flow diagrams using Microsoft Visio.
• Involved in Testing the EDIs according to HIPPA code set 834 enrollments and disenrollment in a health plan. Process the /271, 276/277,834 files in the UAT environment using EDIFECS-Transaction management to validate the Output from the file.
• Conducted data cleaning, manipulation, modification and combination using variety of SAS steps and functions.
• Generated database monitoring and data validation reports in SQL Server Reporting Service (SSRS), created Data mart solutions to improve performance of SQL Server 2005 Reporting services(SSRS)
• Designed and developed the entire business intelligence reports using SQL Server Reporting Services 2005 and integrating it to the front end application.
• Used the report manager to create folder structures, modify data sources, controlling access to report services resources.
• Successfully designed logical and physical database models using Informatica IDQ, data modeler; designed initial database migration plans and procedures for migrating data.
• Experience and outstanding knowledge of high availability SQL Server solutions, including replication and SQL Server clustering.

Environment: Agile (Scrum), WaterFall, SQL, Web Services, SAS, Microsoft Office Suite, Microsoft Project, IBM Rational Suite, MS Visio, Word, Excel, PowerPoint, JIRA, Microstrategy, UML, XML, HP Application Lifecycle Management (HP ALM).

Confidential, Bloomfield, CT

Data/Business Analyst

Responsibilities:

• Coordinated in the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance.
• Responsibilities include the Analysis of inbound and outbound interfaces and extensions to Facets claims processing system.
• Completed Data Mapping for Group and detail Product analysis and report writing
• Analysis and Design of the Facets data model to ensure optimal system performance and tuning
• Configured Facets modules such as Claims, Membership, Billing, Benefit and plan
• Work closely with EDI to ensure accuracy in data transmissions and shared processes.
• Worked on Mapping documentation using the Implementation Guide for EDI HIPAA 834,835,837(D, P, I), 277/278 and other Health Care Transactions.
• Create customized Implementation Guides using the module of software for 837 Professional, 837 Institutional, 837 Dental, 835 Remittance Advice, 276/277 Claim Status/Response transactions /271.
• Utilized SDLC Methodology to configure and develop process, standards and procedures.
• Created use cases, process flow diagrams, and designed solutions using the Functional Specification Document (FSD).
• Conducted JAD sessions with business users and Subject matter expert and stakeholders to define project scope, to identify the business workflows & task analysis and determine whether any current or proposed systems are impacted by the new development efforts.
• Analyze and identify gaps/issues in claims, encounters process flow.
• Tracking and addressing the problems on timely manner encountered on Acknowledgement 997, Remittance Advice 835, & Eligibility Inquiry/Response 270/271.
• Performed data mining using SAS to detect relevant patterns in a database from the current and historical data.
• Created ETL documentation such as EDI X12 837(P,I, D), 834 and 835 Data Mapping, Transformation logic for Main Frame Layout, Updating Meta data documents for new Platform.
• Developed SQLs for Extracting data from database and built data structures, reports.
• Responsible for managing the Data Warehouse and Business Intelligence functions
• Coordinated with various IT teams related to various Facets backend database for Test Data Setup.
• Designed Test Plans, Scripts after analyzing various scenarios/requirements & performed defect tracking using Test Director & Clear Quest.
• Used SQL Queries in Oracle to pull out data from the databases for the data validation and routine report generation.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Provided Production support and documented System Release/deployment issues.
• Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance. Responsibilities include the - Analysis of inbound and outbound interfaces and extensions to FACETS claims processing system
• Completed Data Mapping for Group and detail Product analysis and report writing
• Analysis and Design of the Facets data model to ensure optimal system performance and tuning
• Work closely with EDI to ensure accuracy in data transmissions and shared processes
• Involved in claim adjudication process of Facets application.
• Performed in depth analysis of data & prepared periodic reports using MS Excel and SQL.

Environment: Rational Unified Process (RUP), SAS, Waterfall, HIPAA, EDI X12 (835, 271, 276, 277, 278, 837, 999), Java, IBM Rational Suite (DOORS, Rose, Clear Case, Requisite Pro), MS Visio, Word, Excel, PowerPoint, UML, Axure RP, Microsoft SQL, Microsoft Access

Confidential, Mineola, NY

Business Analyst

Responsibilities:

• Worked alongside Lead Business Analyst and Senior Business Analyst to deliberate on plausible approaches and System Development Life Cycle (SDLC) methodologies.
• Conducted numerous interviews with Subject Matter Experts (SME), utilizing Meeting Minutes to obtain details of the requirements, as envisioned by Business Users.
• Assisted in building Business Requirements Documents (BRD), as proposed by Confidential (SSHC).
• Produced Functional Requirements Specifications (FRS) based upon requirements analysis via Oracle PeopleSoft Suite.
• Created data structures by using SQL in Teradata & TOAD.
• Developed SQLs for Extracting data from database and built data structures, reports
• Designed and developed various Ad hoc, Daily, Weekly, Monthly and year-end reports for the Business Analyst using SQL, MS Excel, MS Access and Teradata
• Consistently interacted with Development Team and Quality Assurance Team to ensure requirements were delivered functionally.
• Utilized with TriZetto Facets to verify Electronic Data Interchange (EDI) Transactions 834 (Membership Enrollment), 835 (Enrollment of Benefits), and 837 (Claims Processing) were compliant with HIPAA standards.
• Identified Actors, Activities, Artifacts, and proper Workflows to develop substantial Use Cases (UC).
• Coordinated with various teams, located at multiple sites for Deployment.
• Performed functional testing of restful web services using both XML and JSON
• Subsequent to Transitioning phase, prepared User Guides, and performed User Acceptance Testing (UAT) alongside Business Users to determine latency or scalability irregularities.

Environment: Rational Unified Process (RUP), Waterfall, EDI X12 (834, 835, 837), Oracle PeopleSoft Suite, UNIX, UML, Java, Microsoft SQL, Microsoft Access, MS Visio, Word, Excel, PowerPoint, and TriZetto Facets.