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Encounter Data Analyst Resume

Phoenix, AZ

PROFESSIONAL SUMMARY:

  • Senior results - driven with over 6+ years of Data / Business Analysis as a Proficient in gathering business requirements and handling requirements management in the IT industry, with exhaustive knowledge in the Healthcare and Retail domain.
  • Analytical, highly adaptable professional with extensive experience in the field of software design, development and testing of business applications aimed at improving quality and efficiency.
  • In depth knowledge of Project management techniques and system analysis methodologies including Agile, Scrum, Waterfall model.
  • Involved in end-to-end implementation and enhancements on confidential mobile app data starting from requirement gathering and dashboards development in Tableau Desktop.
  • Participated in requirements analysis reviews and Design sessions to understand the requirements and designing Reporting Solutions.
  • Collaborated with team members in writing test SQL scripts , performing tests and providing appropriate follow-up actions and documentation.
  • Experienced in Data Analysis, Data Migration, Data Cleansing , Transformation, Integration, Data Import, and Data Export using multiple tools.
  • Suggest recommendations in eliminating issues that impact encounters.
  • Expertise in GAP Analysis of 4010/5010 of all transactions such as 837, 835, 999.
  • Proficient with Data Analysis, mapping source and Confidential systems for data migration efforts and resolving issues relating to data migration.
  • Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
  • Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document ( BRD ).
  • Adept knowledge of Unified Modeling Language ( UML ) and creating Activity Flow Diagram, Sequence Diagram, Use Case, Workflows, and Data Flow Diagrams.
  • Basic knowledge and understanding of HTML, CSS and Web Services.
  • Participated in formal Sprint Planning and Review meetings with project teams.
  • Knowledge of Business Analysis methodologies and Iterative Software Development Life Cycle (SDLC) using Rational Unified Process (RUP) and AGILE .
  • Produced reporting infrastructure for KPI program for the Sales Organization that resulted in an 85% increase in sales revenue in measured metrics.
  • Analyzed, redesigned, and implemented changes to the in-house Handset Replacement program, resulting in a change in monthly net revenue of -$50k to +$100k.
  • Knowledge of Basel II and Basel III regulations and implementation.
  • Cross Functional Team Management (On-Site, Vendors and Managed Services).
  • Wireframes, Mockups and Prototyping.
  • Change Management & Prioritization, Impact Analysis, Root-Cause analysis and Scheduling.

TECHNICAL SKILLS:

IDE: Rstudio, Eclipse, PySpark

Databases / Servers: SQL, MySQL, SQL Server, PL/SQL

Case Tools: R, Python, SQL, EDM application

Web Development: Java Script, HTML, CSS

Data Visualization: Tableau Desktop/Server, QlikView, PowerBI, VBA, Pivot Table

Programming Language: Java, PL/SQL, C

PROFESSIONAL WORK EXPERIENCE:

Confidential, Phoenix, AZ

Encounter Data Analyst

Responsibilities:

  • Extracted, transformed, and loaded data utilizing ETL Process. Responsible for analyzing health data and producing, verifying and interpreting client reports.
  • Experience developing efficient SQL queries, stored procedures, indexes, functions. Write and execute moderately complex SQL queries to extract and analyze healthcare claims data.
  • Research and problem solve pending and denied encounters.
  • Performed data mining on Claims data using very complex SQL queries and discovered claims pattern.
  • Cleansing of raw data sitting in the backend using SQL query to avoid duplicate submission of same claims. Work Extensively with Inbound 837 I and 837 P, 835s (Out bounds) claims processing systems. Hands on experience with daily claim processing and uploading 837 files into database.
  • Validated the reports and files according to HIPAA X12 enforced standards. Identify issues, related to claims processing issues that impact encounters.
  • Submission of backlog claims to run the required tests by submitting the batch jobs using EDM (encounter Data Manager) application.
  • Search provider’s file, making sure the correct provider has been selected, according to the Claim image. Determine reason for adjustment received and corrected claims as needed.
  • Executed SQL queries to identify and manage to eliminate Duplicate and Improper data that would load into the SQL Server via ETL. Met with the Provider and Trading Partners to ensure that HIPAA transactions pass the EDI gateway and interpret technical difficulties into simple language.
  • Designed a high level spec document to show various paths that need to be taken into consideration for the transformation phase of 4010 to 5010.
  • Process encounters claims according to state guidelines, correct encounters rejected by the state; research and problem solve rejection issues.
  • Managed and developed EDI specifications, for data feeds and mappings for integration between various systems, to follow ANSIX124010 formats including 270, 271, 276, 277, 834, 835 and 837, to meet HIPAA requirements set forth by the federal government.
  • Involved in impact analysis of HIPAA and 837P transaction sets on different systems.
  • Review critical errors from EDI submissions to verify and correct encounters using SQL server by writing complex queries to send claims for acceptance.
  • Performs manual testing by building 837 claims, converting them into EDI file, uploading them into mainframe region and doing error resolution & testing for 5010 requirements & NPI crosswalk.
  • Designed, coded, and implemented SAS code for analytic studies to fulfill internal and external client requests, maintained, evaluated, and reported on recurring analytic studies.
  • Develop Dashboard reporting solutions from existing Tables and Cubes in Tableau reporting tool.
  • Weekly team meeting to discuss the production support issues faced during every week.

Environment: R, SQL Server, Microsoft Project/Office, Pivot, 837, 835, 834, ICD 9, Power Point, EDM Application, Word, Tableau, SharePoint.

Confidential, Atlanta, GA

Business Data Analyst

Responsibilities:

  • Prepared the Business requirement Document BRD and functional requirement document FRD for the enhancement of the existing services.
  • Conducted JAD sessions with business units and stakeholders to define project scope, to identify the business flows and determine whether any current or proposed systems are impacted by the new development efforts.
  • Working to build extensions for FACETS Members, Claims, and Billing and enrollment applications.
  • Ensured all artifacts compiled with HIPAA 5010 policies and guidelines.
  • Worked on EDI transactions like 270,271,834,837 and 835.
  • Gathering requirements and preparing functional documents for Facets 4.71.
  • Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.
  • Involved in Facets Output generation, Interface development and Facets Migration Projects.
  • Created workflow diagrams, UML diagrams, activity diagrams, use cases.
  • Performed the detail comparison between 4010A and 5010 to identify differences across loop structures.
  • Did gap analysis for HIPAA P and 835 transactions and HIPAA P and 835 transactions.
  • Involved in impact analysis of HIPAA and 837P transaction sets on different systems as well as for ICD 9 to ICD 10.
  • Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using GEMs and incorporated that into a Translator Tool.
  • Designed and supported in Test cases, Test plan creation and Companion Guide from development stage to production, including both internal and external requirements.

Environment: HIPAA 4010/5010, FACETS 4.71, EDI 837, 835, 834, ICD 9 CM ICD 10 CM, MS Visio, Word, Excel, PowerPoint, SQL.

Confidential, SFO

Data Analyst/Tableau Analyst

Responsibilities

  • Conducted Business Requirements walkthrough with the business owners as well as the Technical Stakeholders.
  • Participated in the monthly steering committee meetings to update the Business Sponsors on the project schedule and financials.
  • Established Traceability Matrix using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.
  • Developing and maintaining high level overview of the project and design flows using MS Visio.
  • Prepared project reports for management and assisted the project manager in the development of weekly and monthly status reports, policies and procedures.
  • Building, publishing customized interactive reports and dashboards using Tableau.
  • Worked on Business Intelligence standardization to create database layers with user friendly views in Teradata that can be used for development of various Tableau reports/ dashboards.
  • Effectively used data blending feature in tableau and defined best practices for Tableau report development.
  • Created action filters, parameters and calculated sets for preparing dashboards and worksheets in Tableau.
  • Executed and tested required queries and reports before publishing.
  • Administered user, user groups, and scheduled instances for reports in Tableau.
  • Created side-by-side bars, Scatter Plots, Stacked Bars, Heat Maps, Filled Maps and Symbol Maps according to deliverable specifications.
  • Mastered the ability to design and deploy rich Graphic visualizations with Drill Down and Drop-down menu option and Parameterized using Tableau.
  • Provided support for Tableau developed objects and understand tool administration.
  • Consistently attended meetings with the Client subject matter experts to acquire functional business requirements in order to build SQL queries that would be used in dashboards to satisfy the business’s needs.
  • Worked with Tableau administrator in managing Production, Test and Development environments including installation of patches, security administration and access controls in Tableau.
  • Created Custom Hierarchies to meet the Business requirement in Tableau.
  • Created various connections, Data foundations and Business layers using Information Design Tool 4.1 (IDT) for AP Reporting.
  • Created Workbooks and dashboards for analyzing statistical billing data using Tableau 8.0
  • Developed formatted, complex reusable formula reports and reports with advanced features such as conditional formatting, built-in/custom functions usage, multiple grouping reports in Tableau.
  • Conducted walkthroughs and inspection meetings with the stakeholders and other management teams in the finalization of the User Requirement Documentation.

Environment: Python, R, R Studio, SQL Server 2008 R2, OLAP, OLTP, Multi-dimensional modeling, SQL, Microsoft Project/Office, Tableau 8.1

Confidential

Data Reporting Analyst

Responsibilities

  • Communicated and ensured compliance of all policies and procedures within the retail organization.
  • Established high standards for management performance and set clear expectations for the district and store manager functions.
  • Accountable for sales performance, KPI’s, payroll budgets, shrinkage, inventory levels, and overall P&L for the region.
  • Created the Traceability Matrix to ensure that all the requirements are being tested and covered in the testing plan.
  • Worked on implementation of the REST API for the UI screens, to make it more scalable and efficient.
  • Facilitated the design and development of Business Rule Engines to support SOA architecture and web services.
  • Worked with System Architect to implement SOA, Client-side, Server-side Validations and Verbiages.
  • Involved in end-to-end implementation and enhancements on confidential mobile app data starting from requirement gathering and dashboards development in Tableau Desktop.
  • Actively involved in gathering requirements from end users, involved in modifying various technical & business requirement specifications.
  • Studied and analyzed similar applications and brainstormed with business team to gather effective requirements for the system along with dashboard development.
  • Created numerous dashboards in Tableau Desktop based on the data collected from Mobile App's by importing and blending data from Adobe Marketing cloud (.TDE files), MS Excel and CSV files along with Teradata Database.
  • Created Crosstab's to display underlying data based on various graphs and charts created for further data analysis.
  • Complied interactive dashboards in Tableau Desktop and published them to Tableau Server, which allowed story telling behind the Mobile App usage with Quick Filters for on demand needed information with just a click of a button.
  • Developed and reviewed SQL queries with use of joins clauses (inner, left, right) in Tableau Desktop to validate static and dynamic data for data validation.
  • Incorporated Tableau workbooks into SharePoint though API’s and Web parts.
  • Performed data analysis on daily, weekly, and monthly scheduled refresh of data based on that business or system change to ensure that the published dashboards are displaying accurate and up-to-date information.

Confidential

Business Analyst

Responsibilities:

  • Identified ongoing issues and gaps within project plans, in order to eliminate implementation issues.
  • Provided technical assistance for development and execution of test plans and cases as per client requirements.
  • Involved in all the phases of the Software Development Life Cycle (SDLC) methodologies such as Waterfall, Agile-SCRUM.
  • Worked in a fast paced project environment to deliver project releases in a short period of time.
  • Created detailed report specification document that included KPI descriptions and data mappings.
  • Interviewed the stakeholders and project sponsors for mapping requirements and analyzing structured & normalized data sets.
  • Assisted in offering support to clients who were unable to access data and information in production support role.
  • Responsible for gathering system data requirement from business, Requirement Analysis, Functional Point Analysis and Client Interactions.
  • Worked with QA team to test the application quality and perform UAT, conducted Root Cause analysis for UAT environment.
  • Participated in JAD sessions to generate requirements and document BRD and FSD respectively
  • Modeled business processes and workflows using activity and sequence diagrams
  • Performed thorough GAP Analysis to check the compatibility of the existing software functionalities with the new business requirements.
  • Used SharePoint to maintain for document versioning.
  • Worked with teams to ensure timely releases, informing appropriate teams regarding any issues or defects.

Environment: SQL, MS Access, MS excel 2013

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