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Sr. Data Analyst Resume

Chicago, IL

SUMMARY:

  • Nearly 7+ years of diverse progressive experience in Information Technology, with emphasis on DATA Analysis and Software Development. Expertise in working with Data Migration, Data Integrity, Data Quality.
  • Experienced in MS Access 03/07/10 version for Data conversion/Data Cleansing/Reporting process.
  • Experienced in Facets working with Provider Life cycle, Members Enrollment process, and Claim processing and other data models.
  • Experienced in identifying the Data Sources, ETL methods, Data Conversion process, OLAP designing and Reports generation required for reporting purpose.
  • Good working knowledge in Claims processing, Medicare/Medicaid, HIPAA Regulations, ICD 9, ICD 10 codes, Facets and 276, 277, 837P, 837I, 837D, 835 and 834 EDI Transactions for health care industries.
  • Comfortable in working with different requirement gathering techniques like Brainstorming, JAD sessions, Focus Analysis, Reverse Engineering, Survey, Document Analysis, Interview, Prototyping and Observation.
  • Experience in Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
  • Worked on Facets to help payers efficiently execute core administrative functions, including claims processing, premium billing and customer service.
  • Solid background in Software Development Life Cycle methodologies such as the Traditional Waterfall Model as well as Iterative approach to software development.
  • Extensively used the Teradata utilities like BTEQ, Fast load, Multi load, DDL and DML Commands (SQL).
  • Worked on MS Excel for Data Analysis and reporting purpose.
  • Experienced with all the phases of SDLC throughout the project life cycle in Rational Unified Process (RUP) environment and the creation of Artifacts and management of various roles specified by RUP
  • Worked on Facets to help payers efficiently execute core administrative functions, including claims processing, premium billing and customer service.
  • Utilized a combination of business knowledge, technical skills, and strategic analysis to provide solutions and creative insights to critical business problems.
  • Proficient in requirement analysis and creating Use Cases, Sequence Diagrams, Activity Diagrams, Class Diagrams etc.
  • Strong experience in Microsoft Office Tools(Excel, Word, Access and PowerPoint)
  • Experience in the use of tools like Rational Rose, Rational Requisite Pro, Rational Clear Case, and MS Visio.
  • Involved in reviewing test procedures, defining test cases, reviewing and maintaining test scripts, analyzing bugs and User Acceptance Testing (UAT).
  • Reputation for dedicated teamwork, high energy, work ethics and commitment with capability to handle new technologies and situations.

TECHNICAL SKILLS:

Operating Systems: Windows 95/98/NT/2000/XP, Linux, VSE Mainframe.

Languages: C, C++, VB, VB.NET, SQL/PLSQL

Databases: MS - Access03/07/10, SQL Server, Oracle, Sybase, DB2, Teradata

Tools: MS Visio, Rational Rose, Rational Clear Case, Rational RequisitePro.

Defect Tracking Tools: Mercury TestDirector, Rational ClearQuest

Testing Tools: Test Director, Quality Center

PROFESSIONAL EXPERIENCE:

Confidential, Chicago, IL

Sr. Data Analyst

Responsibilities:

  • Worked on enrollment of FEP eligible. Generated ad hoc reports when needed or on weekly basis, helped developers in generating Cognos reports.
  • Gathering requirements from business users based on new market rules and Desk level procedures.
  • Worked with Architects to Create Data flow model for Government owned Facilities, and for new oncoming ROSTERS.
  • Created business requirements document (BRD) & functional requirements document (FRD) to map the business rules as documented.
  • Built databases in Microsoft Access07/10 as per new market guideline based on business rules and Desk level procedures, to asses Data Cleansing.
  • UsedSQL Assistantto query theTeradatadatabase tables.
  • Worked on Excel to create Pivot chart for reporting purpose.
  • Working with Teradata 12 utilities like BTEQ, FastLoad, MultiLoad, Tpump, Fast Expert and Queryman.
  • Ensured availability of all support tools needed for the Teradata environments.
  • Analyzed and provided solutions for all database related issues. Provided general support in technology including Informatics and BI Tools.
  • Did Reconciliation of Data on Providers back-end table to gauge the quality and enhance quality of existing entities.
  • Worked with Facilities to get the correct count on number of Members/ Eligibility and Demographic information to set Groups/Subgroups/Subscribers/Members accurately in facets
  • Reconciled the Relation tables to ensure the dependencies does match with Health products selected.
  • Built Automated system to Add, Terminate and update existing data based on incoming weekly ACT files from existing Rosters.
  • Analyzed the ICD conversion information provided by the CMS and Gained understanding of ICD-9 versus new ICD-10 codes sets.
  • Created Audit Adhoc update system to capture any changes that were skipped.
  • Worked with Operational and Implementation team to built a system where loading Providers and Eligibility checks can be made successfully which overcomes efforts of keying records through GUI.
  • Reported Vendors about the data issues and Data Quality the is actually required.
  • Created a Mapping document to map Codes provided by Vendor/Roster/Government owned Facilities to match the codes that are acceptable in Facets.
  • Worked with Operational team and End users to ensure the quality of data to help them get agreements from new providers.
  • Worked with Users to make sure Claims get Adjudicated correctly for the new providers added into the Network.

Confidential, Downers Grove, IL

Sr. Data Analyst

Responsibilities:

  • Perform gap analysis between HIPAA and HIPAA Companion Guides
  • Perform impact analysis of other enrollment processing systems to determine potential scope/impacts
  • Prepare Use cases for functionalities of the project.
  • Tackle with the consistent requirement changes and prepare Change Requests (CR’s).
  • Performed thorough analysis of the companion guides from each trading partners both Medicaid and Commercial clients and identified the changes that specific clients need.
  • Review with business owners to identify data requirements and business rules based on the changes within the transaction set
  • Map the data according to the client requirement.
  • Provide dual usage processing capabilities to support both the 4010 and 5010 versions of the 834 transaction set to accommodate those clients who choose to remain on the 4010 version and for those clients who convert to the 5010
  • Monitor state communications to determine if states will be moving from proprietary formats to 5010.
  • Prepare Requirement Traceability Matrix, Functional Specification, System Change Documents, Technical Specification Documents, As-is and To-be flows for the entire conversion process.
  • Extensive data validation on the back end using SQL queries to verify the data has been loaded in the correct tables.
  • Extraction of test datafrom tables and loading of data intoTeradatatables.
  • Work with the commercial business owners as well as the state representatives in process of gathering the requirements.
  • SQL output comparison between the 4010 set of data vs. 5010 set of data.
  • Used SQL queries to validate the load of the data to the correct column in an existing table and the newly added tables.
  • Build a brand new translator for accepting the 834 and 5010 files and converting into the flat file layout.
  • Involved in testing the dimension and fact tables inTeradatadatabase.
  • Mapping the new data in 5010 to the translator to make it 5010 compatible.
  • After performing the thorough analysis, design the new translator based on the specific requirement from the commercial and state clients.
  • Tested the new translator to verify and validate if the input data is being translated correctly to the correct positions in the Flat file.
  • Maintained the dual usage functionality in order to receive the 4010 formatted files for the clients who are not ready to switch to 5010 and 5010 formatted files that are willing to switch to 5010.
  • Prepared the common as well as the translator specific test plan for testing the new 5010 process flow.
  • Performed System Testing for the X12 formatted data that gets translated to the flat file through translator.
  • Validated the positions and the characters after the data gets translated through See Beyond.

Confidential, Sunrise FL

Data Analyst

Responsibilities:

  • Responsibilities include gathering business requirements, developing strategy for data cleansing and data migration, writing functional and technical specifications, creating source to target mapping, designing data profiling and data validation jobs in DataStage, and creating ETL jobs in DataStage.
  • Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
  • Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835)
  • Worked on EDI transaction 835 and 837 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Associated extensive backend testing to verify correctness of the report data using SQL scripts and data comparison.
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
  • Identified gaps between current policies and procedures and new HIPAA 5010 compliance and developed an action for the migration process.
  • Created a test plan and a test suite to validate the data extraction, data transformation and data load and used SQL and Microsoft Excel.
  • Used Requisite Pro for the Requirement Documents Preparation and Prepared Business Process Models that includes modeling of all the activities of the business from the conceptual to procedural level. Followed top down, leveled technique for building Business Process Models.
  • Conducted Joint Application Development (JAD) sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate effectively with them
  • Conducted current state study which included data collection methodologies, data quality and data integration problems, data storage and infrastructure related issues.
  • Data conversion from other platforms to native database. Creating Customized modules or data maintenance.
  • Responsible for Data Extraction, Data Compilation, Data Analysis, Data Manipulation and Data Validation using SQL queries in a MS SQL Server 2005 environment
  • Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.
  • Used Data warehousing for Data Profiling to examine the data available in an existing database.
  • Worked on data modelling and produced data mapping and data definition documentation
  • Used Informatica to extract and transform data from various DB2 database to the data warehouse.

Confidential, PA

Business / Data Analyst

Responsibilities:

  • Mapped process flow; assess as-is a process through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
  • Well versed with Agile and RUP methodologies as well
  • Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level. Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
  • Designed and developed Use Cases using UML and Business Process Modeling.
  • Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
  • Developed data conversion programs for, claims, and benefit accumulator data - converted thirteen corporate acquisitions. Developed data field mappings. Provided programming and support for claims processing functions and auto-adjudication.
  • Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
  • Performed Data mapping, logical data modeling, created class diagrams and ERdiagrams and used SQL queries to filter data
  • Assisted process owners in process and implementation.
  • Streamlined the Restatement Financial Data Warehouse access review Process.
  • Gathered requirements from users of the Clear Quest (CQ) tool for any Enhancements or change requests for any defects.
  • Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
  • Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
  • Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using Rational tools.

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