SUMMARY

• 6+ years of IT experience in Data Analyst with extensive usage of SQL, Tableau and HP ALM/QC.
• Good understanding of SDLC and STLC methodologies including Waterfall, Iterative, Agile and Scrum methodologies.
• Good experience in data sources, data profiling, data validation, developing low level design patterns based on the business and functional requirements.
• In a data warehouse environment, designed the staging area based on OLTP concepts, cleansed and profiled before loading into data marts.
• Efficient in Dimensional Data Modeling for Data Mart design, identifying Facts and Dimensions and Strong understanding of principles of data warehousing, Fact tables, Dimension tables, Slowly Changing Dimensions (SCD) Type I and Type II.
• Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837
• Created data Mappings to load data from the target using different transformations and executed workflows for data loads to target systems.
• 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.
• Strong knowledge of Facets and actively involved in end - to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
• Strong visual modeling and Business Process Modeling (BPM) skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
• Excellent analytical, organizational, communication and documentation skills along with good project management skill to gather requirements to bring out the quality product.
• Knowledge in Data Modelling, Data Extraction, Transformations and Loading, Mappings Workflows, and Customized Analytics Reports.
• Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships in Requisite Pro.
• Excellent written and oral communication skills with the ability to communicate appropriately in business and technical situations at all levels of project management.
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Skilled and managing the breakdown of the Epics in the product backlog into user stories that abide by the invest criteria
• Extensive experience in Healthcare/Claims and encounters adjudication with knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271, 276/277).
• Developed Test Scenarios and Test cases for Data Conversion, Functional, Integration, Security and UAT testing.
• Extensive working experience with HL7, EDI X12 transactions, Facets, claims process, HIPAA, Billing Process etc.
• 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.
• Well-versed in MS Visio, MS Project, Mockup screen, and Microsoft suite (Word, Excel, Access, Visio, Power Point, and Outlook) for analysis and presentation
• Facilitated User Acceptance Testing (UAT)and test strategies with developers and testers, and participated in manual front-end testing to check all functionalities of different modules

TECHNICAL SKILLS

Business Skills: Business Process Analysis & Design, Gap Analysis, Impact Analysis, JAD Sessions, Requirement Gathering, and Use Case Modeling

Languages: SQL, HTML XML

Database: MS SQL Server, Oracle, MS Access

Project Management: Microsoft Project

SDLC Methodologies: Agile Scrum, Waterfall, Hybrid

Operating Systems: Windows, UNIX

Other Tools: MS SharePoint, MS Visio, HP ALM/QC, MS Office, FACETS

PROFESSIONAL EXPERIENCE

Confidential, Tampa, FL

Data Analyst

Responsibilities:

• Support Enterprise Data Governance processes including Business Glossary Definitions, Metadata Definitions and Data Lineage working with Technical resources during the Software Development Lifecycle.
• Assisted Business Process Modelling team in requirements gathering for the process models as per the APQC’s Process Classification Framework
• Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships in RequisitePro.
• Verifying and updating the technical requirements for Facets products feature enhancements & new/existing table changes
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
• Expertise in writing SQLQueries using Oracle, SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
• 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.
• Responsible for conducting the overall System Testing to verify operations of key FACETS modules involved in the processing of claims (including benefits), providers and members.
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• 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.
• Analyzed system performance and initiated process improvement measures for mainframe and Web-based applications.
• Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment
• Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
• 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 and Involved in extraction of data from various sources like flat files, Oracle and SQL Server. Coordinated with the ETL team to come up with processes for ETL involving Oracle/Informatics
• Responsible for creating test scenarios, scripting test cases using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
• Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
• Involved in development of the system for data exchange from EMR, EHR to Electronic Lab Reporting Systems

Confidential, Conway, AR

Business/Data Analyst

Responsibilities:

• As Business System Analyst I was involved in developing and documenting Product Test Plans, using Agile/Scrum Methodology for Software Development Life cycle.
• Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams. Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers
• Performed end-to-end System Integration testing which covered the entire business process flow from the initial point of sales through to all the downstream systems and XML output files, including apps/interfaces.
• Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
• Provided the required test data for the developers in order to fix the defects
• Monitored EDI Eligibility/Inquiry/Response (270/271) transactions via reports generated by the developers.
• Worked on solving the errors of EDI 834 load to Facets through MMS.
• Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
• Created and managed Project Templates, Use Case Project Templates, Requirement Types and Traceability Relationships.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
• 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.
• Generated a streamline process to understand the various steps in the loan lifecycle and desired functionality of the new system by interacting with users, management, SME (Subject Matter Expert), stakeholders, lenders, underwriters.
• Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Worked on the Patient Management System (integrated version of Patient Information System with EMR/EHR)) is intended to remotely communicate with a compatible pulse generator from BSC CRM and transfer data to a central database (HIT EHR).
• Conducted brainstorming sessions with the business users and SMEs to elicit requirements and worked in the creation of Agile Epics, user stories, Acceptance criteria documents.
• Extracted data by running SQL queries, and reviewed securities, financial and customer metadata that gets populated on the web application.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.
• Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• 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 and Worked with ETL groups and Acquisition team and business analyst for understating mappings for dimensions and facts
• 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.
• 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.
• 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.

Confidential, Bloomfield, CT

Data Analyst

Responsibilities:

• Developed SQL queries /scripts to validate the data such as checking duplicates, null values, truncated values, ensuring
• Loaded data to different databases using SQL scripts and maintained a repository for data loading scripts.
• Utilize Member module to verify eligibility, benefits and PCP assignment to maintain accuracy.
• Update and analyze Claims 101 edit errors for missing contracts in an accurate and timely manner to avoid penalties.
• Ensure system configuration and functionality adheres to Medicare, Medicaid other market-specific regulations and business rules.
• Conducted brainstorming sessions with the business users and SMEs to elicit requirements and worked in the creation of Agile Epics, user stories, Acceptance criteria documents.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. 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 hence analyzing and documenting related business processes.
• Strong experience in all phases of Software Development Lifecycle (SDLC) using Waterfall, Agile/Scrum, RUP (Rational Unified Process) and Software Testing Life Cycle (STLC).
• Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,270 and 271.
• Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Experience in Epic Resolute product implementation and deployment
• Worked on FACET modules such as pricing, payer, eligibility under claims processing system.
• The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information.
• Full knowledge of application interoperability configurations and managed the implementation tasks of HIE clinical applications.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. 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 Enrolment hence analyzing and documenting related business processes
• Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS)
• Analyzed set behavior and contribution to business performance, critical business metrics & tracking underlying business trends using Business Objects.
• Involved extensively in writing Agile User Stories and get them reviewed with Business lead and project manager for Sign Off.
• Worked on AGILE Environment with daily scrum meetings, grooming sessions, planning and sprint cycles.
• Constantly updated the BRD as per the changes in the requirement and informed the whole team regarding new changes
• Facilitated JAD sessions for defining business requirements and follow-up for Project Plan updates.
• Have experience with user story creating through agile software development methodologies.
• Constantly updated the BRD as per the changes in the requirement and informed the whole team regarding new changes
• Helped the QA team conduct the testing process by setting up the test environment.
• Used QC/ALM in executing the test cases, logging them and directing it to the right team for any issues encountered during the testing phase.
• Used QC/ALM in executing the test cases, logging them and directing it to the right team for any issues encountered during the testing phase.
• Validated claims such as professional and institutional with the related data in the reference subsystem

Confidential, Louisville, KY

Business/Data Analyst

Responsibilities:

• Work on EDI X12 transactions, HIPAA standard transaction codes including 837, 834, 835, 270, 271, 276, 277 and perform analysis of such transactions.
• Develop test plans based on test strategy. Created and executed test cases based on test strategy and test plans based on ETL mapping document
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• 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.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
• Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
• Ability to analyze engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production
• Expertise in the EPIC Medical software application (EMR, EHR) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
• Documented requirements associated change requests with requirements and connected requirements with Use cases.
• 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
• 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.
• Trained the team on JIRA tool for Agile/ Scrum Methodologies.
• Utilized JIRA to develop and track agile epics, stories and tasks 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.
• Conducted daily SCRUM meetings during the Sprint Development as a part of Agile Methodology. Also captured and addressed concerns from IT to Product Management or Business Team as needed.
• Work with CMS business owners to define their target goals and propose alternative business solutions
• Gathered user and business requirements through open-ended discussions, brainstorming sessions and role-playing.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Designed and development of test cases based on functional requirements for Institutional and Professional claims for EDI and HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.