SUMMARY

• Senior Business Analyst with 71/2 years of experience with key focus in Healthcare/Insurance Industry and Excellent knowledge about health care industry and claims management.
• Expertise in understanding business needs and defining creative and useful software solutions.
• Excellent analytical and problem - solving skills in designing, developing and implementing innovative business processes using new approaches and technology.
• Proficient in Data Quality Management techniques like Data Profiling, Data Cleaning, Data Integrity, Data Mining, Data Reference and Security, etc.,
• Experience in conducting Joint Application Development (JAD) sessions and White Board Sessions with end-users, Subject Matter Expert (SMEs) team, Architects and design group development and QA team for project meetings, walkthroughs and customer interviews commensurate with excellent communication skills.
• Expertise in documenting business requirements (BRD) and functional request document (FRD).
• Worked effectively with the QA (Quality Assurance) team for designing and evaluating Use Case Scenarios, Test Plan, Test System, Test Data and Test Cases for the application.
• Created product requirement document (PRD), functional requirement document, system requirement document & technical design document, Creating Request for Proposals (RFP), creating Requirements Traceability Matrix (RTM).
• Hands on experience with UML modeling, Use Case Documents, Use Case Diagrams, class diagrams, interaction diagrams, activity diagrams, state chart diagrams and documentation of every method and attribute.
• Expertise in Software Development Life cycle (SDLC), Project Life cycle and in Software Development Methodologies including Rational Unified Process (RUP), Waterfall, and Agile
• Sound understanding of comprehensive health reform, the Patient Protection and Affordable Care Act (ACA) and medical claim policies and requirements including benefits, membership, enrollment and implementation.
• Expertise in ICD-9 to ICD-10 Conversion & creating a crosswalk between ICD-9 to ICD-10
• Experience in conducting manual testing, unit, system, functional, integration, regression and User Acceptance Testing (UAT) of systems.
• Experience with the working of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies, Personal Injury Protection (PIP) insurance, billing experience with life and disability in health plans with thorough understanding of CPTcoding, UCR, FS, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
• Worked on the HIX Program
• Experienced in HIPAA compliance, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10.
• Thorough understanding and hands-on working experience with standards of EDI/X12- 270/271 & 276/277, 834, 835, 837
• Experience with QNXT 3.4, QNXT 4.6, Facets 4.71, Inbound & Outbound interfaces, EDI configuration, and data mapping using ANSI X12 4010 and 5010.
• Expertise in maintaining the Requirements Traceability Matrix (RTM) across the Deliverables of a project.
• Good experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Rational DOORS, Crystal Reports.
• Proficiency in preparing Vision Document and User Interface Specification to define system boundary for the project.
• Extensive knowledge of Medical Management Information Systems (MMIS), and National Provider Identification (NPI)
• Strong in writing SQL queries and reporting the results to the business team.
• Analytical, methodical and resourceful approach to problem solving, identifying root causes and corrective actions to meet short and long-term business, financial and system requirements.

TECHNICAL SKILLS

Operating Systems: Windows 95/98/NT/2000/XP/07, UNIX

Software Methodologies: SDLC, SCRUM, Agile, Waterfall Model, Rational Unified Process (RUP), Rapid Application Development (RAD), IBM Curam

Databases: MS Access, SQL Server, Oracle 10g, DB2, T-SQL

Programming Languages: HTML, Java, C/C++, XML

Microsoft Office Suite: MS Project, MS Word, MS Excel, PowerPoint, MS Visio, MS SharePoint.

Business Modeling Tools: Erwin data modeling, Rational Rose, Requisite-Pro and Use cases

PROFESSIONAL EXPERIENCE

Sr. Enterprise Data Analyst

Confidential

Responsibilities:

• Involved in complete SDLC which includes requirement gathering, architecture, design, document, planning, development, deployment & End to End testing in multiple projects.
• Created CDMA Access Source to target mappings for Healthsparq, alacrity health and Cotiviti fraud abuse for outbound extracts.
• Gathered requirements for Medicare advantage BlueKC portal as per CMS policy. Created BRD’s for Inbound data for the vendors PBM, EyeMed, DentaQuest, etc.,
• Mockup test data for UAT validations of extracts.
• Created ETL parallel jobs to send extracts to outbound vendors.
• Created Erwin data models for altering existing tables and create brand new tables.
• Expertise in creating User stories, tasks, Bugs and cloning stories in ADO.
• Conducted backlog refinement and grooming sessions to prioritize the user stories.
• Write strong SQL’s to Analyze and profile data. Also, do validations and backfill missing data from EDW to data marts in case of any missing data in downstream as part of existing process.
• Created tables in DB2, views, Partitions, sequence, Indexes, Constraints & generated SQL scripts for physical implementation.
• Worked in multiple teams from different subject areas like enrollment, providers, Rx claims and Medical claims.
• Created test cases for UAT testing of both ETL and online portal and performed UAT testing.
• Worked on Facets application and captured process flow and created process flow document.

Environment: Windows 2010, MS Office, SQL Server 2012, AQT, Putty, DataStage, Putty, GIT, ServiceNow, .Net, Agile, Erwin data Modeling, ADO.

Enterprise Business Analyst

Confidential

Responsibilities:

• Gathered requirements from various ministries and documented them in SharePoint.
• Created Artifacts like Source to target, ETL specs, scope documents, test results etc.,
• Involved in complete SDLC which includes requirement gathering, architecture, design, document, planning, development, deployment & End to End testing in OPTUM extract and Cast light extract delivery.
• Profiled data & Worked with the Informatica team to document the transformation rules for data migration from Stage to Warehouse.
• Worked with ministries like HUMANA MA, OPTUM, CIGNA, CCOK, COTIVITI.
• Created new tables in Erwin data model and altered existing tables as per requirements.
• Mocked up data for testing, created test case documents and performed regression testing as well.
• Created and maintained the Requirement Traceability Matrix (RTM)
• Created Jira tasks for the team and provides weekly status to leadership about the milestones, accomplishments and obstacles.
• Performed Root Cause & GAP analysis to fix the defects found during testing.
• Facilitated Backlog Grooming sessions and sprint planning sessions.

Environment: Windows 2007, MS Office, SQL Server 2012, Jira, ServiceNow, Informatica, Agile, Erwin data Modeling.

Enterprise Systems Analyst

Confidential

Responsibilities:

• Involved in complete SDLC which includes requirement gathering, architecture, design, document, planning, development, deployment & End to End testing in CCTI.
• Gathered & analyzed the business & technical requirements. Created Functional Requirement Specification Documents (FRS) across multiple projects.
• Profiled data & Worked with the ETL (Ab initio) team to document the transformation rules for data migration from OLTP to Warehouse to marts for reporting purposes (Cognos and CCP).
• Created source to target documents with business rules after conducting Logical & Physical design reviews with SME's. Assisted Development team in creating Data Exchange Documents (DED).
• Created Aggregate and Summary tables that hold Historical Claims data used for Analytical Purposes.
• Identified the missing data in Marts while data is being loading from warehouse, Performed Backfill activities to load the missing data. So that the end users can have all the required data available for reporting purposes.
• Analyzed existing Logical & Physical data models & altered them using Erwin model to support enhancements. Conducted walk throughs with the DBA's & Architect's about the changes made. Reverse Engineered databases schema into Erwin Physical Data Model for re-usability.
• Maintained & updated Metadata repository (MDH) based on the CR's. Uploaded XML's in MDH for respective changes in Erwin model & updated MDH sheets regarding new codes.
• Developed S2T mapping documents to support ETL design.
• Attended design, coding, test case & test results review walk-through meetings to provide inputs regarding adherence to technical standards & customer requirements.
• Created and maintained the Requirement Traceability Matrix (RTM)
• Assisted QA, UAT & Development teams to mock up data to meet scenarios.
• Maintained test cases, results and SQL's in HP ALM. Tracked defects in Clear Quest(CQ).
• Performed Root Cause & GAP analysis to fix the defects found during testing.
• Organized touch base calls, Scrum calls, Check point calls and Triage sessions.
• Worked on PHI/PII data that involves Federal Employee Data, data masking.
• Conducted white boarding sessions to have concrete agreement with cross-functional teams.

Environment: Windows 2007, MS Office, SQL Server 2012, DB2, MDH, Ab initio, Query it, Clear Quest, Service Now, Unix, HP ALM, Erwin data Modeling, Cognos, Web EME.

Sr. Business Analyst

Confidential

Responsibilities:

• Helped in creating Request for Proposal (RFP) and Project Charter.
• Analyzed multiple databases and investigated areas of overlap/duplication.
• Created Excel Spreadsheets for all tables in different databases with Duplicates, Inconsistences, Source, Usage and Linkage by Mapping Manually.
• Created Current State of Procurement Services Database Structure Architecture Diagrams in Visio.
• Interviewed SMEs, Contract portfolio management, Bid Opening team, Bid Posting team, Contract awarding team, Asst. Directors of Customer Service Team along with OGS Management.
• Based on information obtained in these meetings it will help shape the order and depth of deep dive discovery into the following Business Processes.
• Discovered how a contract is awarded and how it is posted in State Wide Financing System (SFS) for public to view.
• Analyzed contract awarding life cycle from Bid Posting to Award winning with what all the Contract Amendments and Vendor Responsibilities involved.
• Identified Gaps in the Business process during JAD Sessions.
• Documented roles of people and their portfolios for those who all are involved in the contract life cycle.
• Organized SharePoint website for Confidential OGS i.e. to be used as project data repository by the client (OGS Team) and various Teams involved in the process
• Provided Final Recommendations Document for Future State Requirements and Options for Improvement

Environment: MS Project, MS Access, MS office 2013, SQL Server 2012, Waterfall, SharePoint, Visio