SUMMARY

• Over 18 years of experience managing, leading and executing on enterprise data management solutions at various commercial and federal clients
• Hands on experience in the data management lifecycle from initial business requirement analysis, translation to data requirements, and ultimately developing and implementing innovative business processes and data solutions for healthcare, energy, e - commerce, manufacturing and finance organizations.
• Demonstrated experience in healthcare data domains, master data management, advanced analytics, data governance and data quality practices on data warehousing, data distribution and relational data modeling.
• Proficient in identifying business rules, preparing workflow process models, predictive modeling, use cases, collaboration diagrams, concept of operations, testing scenarios and implementation guidelines.
• Strong EDI technical & business background across SDLC with a focus on HealthCare Transactions, ANSI X12 standards and HIPAA Security Protocols.
• Functioned as EDI X12 SME for number of healthcare organizations and and HIPAA 5010 Implementations.

PROFESSIONAL EXPERIENCE

Confidential

Data Architect / Specialist Master

Responsibilities:

• Currently creating future environment operating model and BI modernization roadmap for entire RADV program. (SAS Visual Analytics Upgrade)
• Defined, planned and coordinated key migration activities with technical team while transforming from on premise servers to MS Azure Cloud.
• Designed and delivered the data warehousing solution in SAS Data Integrator for Medicare Advantage plan appeals and reconciliation on the Risk Adjustment Data Validation (RADV) program for CMS, an annual BI $4.0M effort
• Developed a unified reporting platform to help CMS with operational and analytical insights into a complex payment validation Review process under the Medicare Advantage Program (SAS as a technology platform).
• Identified pilot use cases and their technology solutions utilizing IBM MDM to reduce provider enrollment burden on three specific areas: historical tracking of location changes, reassignment of benefits and ownership/controlling interest changes.
• Prepared cloud based, flexible and scalable solution architecture proposals to support CMS’ current and future provider enrollment, encounter data and innovation model needs using the principles of Infrastructure, Software and Data as a service by using informatica data services and propagation.
• Currently leading the MDM Community of Practice within the firm. Played SME role within multiple client engagements leveraging informatica MDM, IBM MDM and Reltio MDM to manage full lifecycle of shared data and integration with standards-based data services.
• Successfully demonstrated proof of concept for predicting future cost of diabetes patients to Medicare program through medical claim payment calculation with machine learning. Used sparse matrix algorithms and trained them iteratively with historical claim data from multiple states. Demonstrated applicability of same methods to capture data anomalies on claims, risk adjustment for health risk and cost.
• Played founding architect role on establishing Confidential 's cognitive analytics lab to shape up AI solutions/offerings, industry use cases and solutions, leading techniques, cognitive computing tools, Confidential vendor and partner alliances.

Confidential

MDM Architect / Infrastructure Lead

Responsibilities:

• Analyzed upcoming production operation problems (data quality problems, process improvement needs, data governance needs, data model extension needs) and their underlying design root causes. Provided advises around how to address these business requests and issues by translating the business need into technology implementation models with specific flows and technical implementation steps. (Understands Business to Technology Translation)
• Re-designed facility master data domain logical model, match and merge process and publish layer based on the inspection management and user fee management specific business scenarios.
• Prepared implementation roadmap options for domain re-design by decoupling architectural changes accordingly with business release schedule, resource availability and system decommissioning plans.
• Created facility business & data process scenarios providing mapping of facility business events back to redesigned facility relational data model
• Led and instructed development team on informatica MDM 9.7 and ETL Powercenter 9.6 upgrade project and addressing the roadblocks and other challenges relating to coordination with other parties (HP, Oracle) for obtaining the results timely as well as completing installation and configuration tasks on time. (Manages to Results)
• Developed relationships with Confidential (client) stakeholders and decision makers to understand their expectations on outcomes from O&M team for ensuring client satisfaction. (Builds Relationships)
• Teamed up with other Deloiite project teams on understanding the changes they are implementing to existing system design component by component as well as assigning an owner for the impact and timeline for addressing the impact. (Teams with Others)
• While developing solutions their level of efforts for Confidential requests, communicated our business requirement assumptions, technical and data dependencies and implementation risks clearly and effectively for ensuring proper support from client, help client make decisions timely as well as establishing consensus between multiple parties involved while executing a change request. (Communicates Clearly & Effectively)

Confidential - Woodlawn, MD

Master Data Architect

Responsibilities:

• Analyzed Medicaid data domains (Operations, Program, Performance, Quality) in detail to create process workflows and multi-tier requirements for analytical processing environment between MDM, Medicaid Data Environment (TMSIS) and States based on the MITA framework.
• Analyzed the alignment between Medicare and Medicaid beneficiary data models, logical relationships and business rules impacting the unique identification of a beneficiary through identity resolution in IBM Initiate Enterprise Edition v11.4
• Determined and proposed master data management integration points and methods with big data platform for sharing master data records with the hadoop distributed file system, as well as loading new profile information into the MDM system from big data sources for existing master records.
• Created process workflows for consumer registration and initial enrollment processes on federal and state based exchanges, defined attribute level information exchange packages across multiple interfaces with states and issuers utilizing various X12 EDI transactions.
• Oversaw the mapping of data sources, data movement, interfaces with the goal of ensuring data quality for person, application and policy data across marketplace.
• Evaluated and modified data models and metadata policies and reconciliation procedures for functional design of marketplace enrollment payment system including aggregated X12 files for enrollment reconciliation.
• Identified opportunities for master data index reuse, sharing and federation related platform initiatives.
• Identified key data elements that defines the relationships between medicaid Beneficiaries, Programs, Providers, Health Plans and Claims for MDM.
• Created master data quality management plan including master data quality dimensions and metrics, data process quality components including identification, cleansing and matching quality based on the data governance direction.
• Proposed master data governance framework and work flow relationships between MDM and CMS data governance board.
• Participated into workflow and algorithm design for Medicaid beneficiary identity resolution process in IBM Workbench 11.4
• Provided subject matter expertise relating to transforming Medicaid beneficiary and provider data into MDM index database and design of medicaid beneficiary and provider profiles as part of Medicaid EMPI.
• Determined the impacts of findings of Medicaid EMPI Pilot with states to MDM as it relates to matching performance and accuracy comparison between CMS enterprice cross referencing (ECR) systems vs. IBM initiate 11.4 against state data.
• Proposed areas MDM will support integrated data warehouse strategy including data quality management, business relevance, scalability, accessibility, transparency and data governance in Informatica Data Quality Center.
• Experienced in creating and aligning solution architectures utilizing IBM Websphere application server, IBM MQ processes, SOAP and RESTful webservices to ensure end to end solution will meet client expectations and comply with enterprise architecture standards.
• Provided leadership and strategic guidance during the solution development process to ensure bridging of the gap between business problem faced by client and benefits available from infosphere solutions and services.
• Created use cases on utilization of Initiate WorkBench & Inspector tool for membership data reconciliation
• Catered to end user inquiry requests by providing detailed analysis on core MDM building blocks

Confidential, Arlington, VA

Data Architect / Sr. Technical Advisor

Responsibilities:

• Owned and driven the planning, tracking, scheduling, and releasing of medical claims, membership and pharmacy claims datamart solution releases.
• Worked with the various stakeholders and managing directors to plan, scope, and identify present and future datamart improvements for claims and membership facts and dimensions based on star schema.
• Worked with MicroStrategy BI suite of tools that interfaced with SQL Server analysis services data and dimensions.
• Worked with clinical analytics team to determine measurements, metrics, and facts for clinical performance measurement processes that determine the design of MicroStrategy reports. (Attributes, Filters, Metrics, Facts, Consolidation and Custom Groups)
• Translated the various work items, dependencies, and information about available resources into an integrated project schedule
• Participated the claims and membership data discovery process for new clients while building internal data intake standards.
• Oversaw the mapping of data sources, data movement, interfaces with the goal of ensuring sufficient data quality and governance for membership and claim data.
• Assisted with defining the claim and membership layout standards and interfaces that Evolent will propose to clients during implementation.
• Assisted with defining standard data quality checks at appropriate stages to ensure that vendor data meets requirements for analytics and reporting.
• Assisted with documenting client specific data mapping needs, transformation rules, and any business rules related intelligence.
• Helped coordination of the data collection (FTP) and support analytics activities for specific clients to ensure timely delivery of the opportunity assessment, interfacing with the client, UPMC and the Evolent team.
• Provided subject matter expertise to data analysis team on designing, monitoring and training on HIPAA x12 transactions and EDI applications.

Confidential

Sr. Technical Business Systems Analyst

Responsibilities:

• Conducted IT Systems Assessments, created Business Process Documentation for building a master data management system from ground up. Exhibited an attention to detail and excellent verbal/written communication skills.
• Demonstrated ability to synthesize client master requirements into technical specifications and to generate functional and technical requirements documentation.
• Led Joint Application Design (JAD sessions) for small groups of users to understand master data domain.
• Acted as a liaison between application development, client services, finance and billing teams for a new client and contract master management system development project
• Analyzed and captured existing functional, reporting, integration needs of business from master data and created business requirements document, vision and scope documentation for multiple releases. Conducted walk thru sessions and obtained project stake holders signoff.
• Translated business requirements into their functional components thru wireframes and use cases.
• Created non-functional requirements document containing information to support system functionality including scalability, user access management, security and usability. Obtained agreement and sign off from business stakeholders.
• Defined reporting attributes for client services operations, finance & billing reports and datawarehouse client reporting needs for end to end view of master data thru enterprise.
• Created requirements for custom client (sold case) object in Salesforce including picklists, field dependencies, and custom formula fields with validations.
• Defined custom workflow rules and approval process based on the client master business requirements in Sales force that updates fields, send notifications as per approval steps and actions.
• Determined process improvement opportunities within existing opportunity and client setup process and planned for functional and business flow implementation.
• Defined integration requirements and created field & entity maps between Salesforce and Client master application thru Salesforce web service APIs.
• Defined synchronization requirements for integration with multiple claim adjudication engines thru web services, host integrator tools.
• Produced traceability matrices to ensure requirements are covered against functions, attributes, wireframes and test scenarios thru SDLC.
• Created master test plan including testing objectives, testing level & strategy and test cases to support testing efforts.
• Performed project management duties in planview to meet management expectations including project plan maintanence, monitoring of the consumption of total hours spent, activity progress tracking and reporting, internal and external dependency management.
• Provided weekly project status reports including key accomplishments, milestones reached, pending decisions, risks and dependencies to support enterprise PMO processes and policies.
• Served as EDI Subject Matter Expert for HIPAA version 5010 readiness and implementation for claims, eligibility and referral authorization transactions.