SUMMARY:

• 7+ Years of experience as a Senior Business /Data Analyst with extensive experience and subject matter expertise completing Facets billing Gap analyses, Business Impacts and IT System Assessments for both Health Care Providers and Payers.
• Knowledge of compliance acts like HIPAA and diagnostic conventions like CPT and ICD9 codes.
• Knowledge of healthcare system products like Facets, Care Advance, Impact Pro and CWS - Health web.
• FACETS version upgrade implementation project and worked extensively on 837i (Institutional Claim), 837p (Professional Claims) and 834 (Enrollments).
• Knowledge of reporting tools like Business Objects XI and Cognos 8.
• Extensive knowledge of various DW & BI tools: Databases, OLAP, ETL and Data Cleansing, especially Business Objects, ETI and Teradata.
• Solid understanding of RAD, Waterfall, Spiral Methodologies Rational Unified Process (RUP) using Rational Rose, Requisite Pro, Unified Modeling Language (UML), and Extreme Programming (XP).
• Excellent Business writing skills in writing Business requirements document, USE Case Specifications, Functional Specifications, Systems Design Specification (SDS), Systems Requirements Specification (SRS), and Workflows.
• Expert in Data quality Management, Data profiling, Data Cleansing, Data Integrity, Deference Data, Data Security, Document management and Identity Management.
• Experience in Database design, ER modeling for OLTP, and dimensional modeling for OLAP, Star Schema and Snowflake with Kimball methodology.
• Possess reasonable understanding of different relational databases, writing SQL queries, creating tables, and generating reports. Working knowledge of stored procedures triggers and views.
• Highly skilled in preparing and reviewing of Test Strategy/Test Plan/Test Cases/Test Scripts for UAT, Functional, System, Integration and Performance testing.
• Professional, Institutional Claims processing and adjudication and validate data with facets.
• Experience in Project Management and Business Analysis tools like MS Project and MS Visio for Functional Flow charts, Organizational charts and defining Business Process diagrams.

TECHNICAL SKILLS

Software development methodologies: RUP, RAD, AGILE SCRUM, UML

Enterprise Business Applications: Facets, EDI transactions, Clinical Care.

Visual Tools/Diagramming: MS Visio, Smart Draw

Business Intelligence Tools: Business Objects, Cognos 8

Languages: C, C++, SQL, PL/SQL, Java, HTML

Testing Tools: Win runner, QTP

Databases: Oracle, MS SQL Server 2005, Sybase 12

Microsoft Tools: MS Office 2007, MS Project 2007

Operating Systems: Windows XP/7, Mac OS X.

PROFESSIONAL EXPERIENCE

Confidential Chicago, IL

Sr. Business/Data Analyst

Responsibilities:

• Participated in JAD sessions, finalizing BRD / BTRD and creating high-level designs for the technical and configuration team
• Managed the collaboration with users, analyze and redesign Billing and Enrollment processes.
• Performed Facets Data Analysis and data mapping between Facets Data and legacy system and downstream systems.
• Understood business requirements for AS-IS existing and TO-BE for Group Member Billing.
• Developed and maintained sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Responsible for Data Extraction, Data Compilation, Data Analysis, Data Manipulation and Data Validation using SQL queries in a MS SQL Server 2005 environment.
• Provided high level of data analysis and insights using Business Intelligence tools such as Cognos.
• Worked on Membership information info related to Payment methods and Associated Bill date for the selected payment method required financial system - People Soft Account Receivable system (PSAR).
• Participated in the meetings for creating stratification criteria and provided Facets perspective on those processes.
• Analyzed User and Functional requirements to point out gaps between used SQL queries to extract the data from the database.
• Involved in the Data Migration meeting and process to provide feedback from Facets side based on its technical functionality.

Environment: Facets, Rational Clear Quest, Rational Clear case, Sybase, Business Objects, Lotus Notes, MS SQL SharePoint, Share Drive.

Confidential, Tampa, FL

Business/Data Analyst

Responsibilities:

• Worked on developing the business requirements and use cases for FACETS batch processes; automating the billing entity and commission process.
• Worked Facets Data Models and their relationship between all functional areas.
• In depth knowledge of Process Flow and Integrations between Teradata and Informatica.
• Participated in the Data consolidation / Extraction (includes: pre-work, Inputs, Configuration, Load/ Conversion, Validation and output) and cleanup process from Legacy system to Facets system.
• Developed SQL queries, functions, stored procedures and triggers to perform the backend testing of the data
• Updated Mapping document for including new business from different locations with associate eligibility info and associated products with those Subscribers and Groups.
• 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.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Supported users in developing reports for data analysis and trend analysis using Cognos Report Studio/Query Studio, MS Access, and Toad
• Worked with business leaders to translate business requirements and processes into test cases according to FACETS package requirements and subsequent effective FACETS configuration.
• Used HL7 and FACETS to receive, store and send HIPAA-standard transactions.
• Interacted with the client’s business focal points to capture the requirements right in the time, update about the work progress and escalate the issues much in the advance to ensure smooth and timely delivery to the clients.

Environment: TMS, Facets, SQL server 2005, Crystal reports, SSRS, C# ASP.NET

Confidential, Orlando, FL

Business System Analyst

Responsibilities:

• Involved in gathering, documenting and verifying business requirements.
• Developed, coordinate and support Information Technology Division on all operational requirements of FACETS claims processing system and production management.
• Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse ETL and Reporting team.
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions.
• Responsible for creating complex SQL queries such as Select, Update and Insert Codes. Also, experience working on complex SQL queries and setting up queries.
• Used Data warehousing for Data Profiling to examine the data available in an existing database.
• Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
• Developed, designed & implemented department plan to operationalize new FACETS integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
• Identified end to end requirements for all systems and business units that may be impacted by the project.
• Prepared validation documents, created test cases on various forms of the application such as clinical data capture.
• Developed requirements integrating Use Case diagrams and designed the testing process flows.
• Used MS-Visio analyzed business requirements and process through Use Cases, Class, Sequence, and Activity diagrams, and adapted UML standards to define modularized Data Process Models.
• Developed a Business Acceptance testing strategy and plan.
• Created test files and analyzed test results using MS-Excel.
• Coordinated and facilitated the execution of User Acceptance testing.

Environment: Facets, Agile, Java, Java Script, Data studio, MS Office Tools, SQL, MS Visio, Share point, Mantis BT, UML, COGNOS, Oracle 10g

Confidential, Round Lake, IL

Business/Data Analyst

Responsibilities:

• Organized and conducted extensive JAD sessions with users to identify, understand and document requirements.
• Implemented SDLC which included requirements specifications, design, and analysis and testing.
• Wrote Use Cases, prepared use case diagrams (using Rational Rose) and followed Rational Unified Process at every stage of the process.
• Used Agile and Rational methodology in the project development for Rational Test Suite for various phases of RUP.
• Provided technical Expertise on the use of Rational Clear Case, Rational clear quest and Requisite pro, which were used for Data archiving and Requirements Management.
• Used Informatica to extract and transform data from various DB2 database to the data warehouse.
• Extracted data from Oracle database with MS Access, and performed SQL query, data analysis and verification.
• Dealt with data mapping issues between various source systems and staging area and data-marts.
• Produced functional specifications and led weekly meetings with developers and business units to discuss outstanding technical issues and deadlines that had to be met.
• Assisted the Senior Business Analyst in writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).
• Identified Actors, Activities, Artifacts and Workflows and developed use case diagram using Rational Rose.
• Participated in Automated regression and Non-Functional test plans.

Environment: Mercury Test Director, PVCS Tracker, Forms design software, Oracle 9i, SQL, Java/J2EE, RequisitePro, ClearCase, MS Project.