- Over 18 years of experience managing, leading and executing on enterprise data management solutions at various commercial and federal clients
- Hands on experience in teh 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 Confidential for number of healthcare organizations and and HIPAA 5010 Implementations.
Confidential - Rosslyn, VA
Data Architect / Specialist Master, Federal Information Management
- 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 teh data warehousing solution in SAS Data Integrator for Medicare Advantage plan appeals and reconciliation on teh 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 teh 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 teh principals of Infrastructure, Software and Data as a service by using informatica data services and propagation.
- Currently leading teh MDM Community of Practice within teh firm. Played Confidential 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 Deloitte's cognitive analytics lab to shape up AI solutions/offerings, industry use cases and solutions, leading techniques, cognitive computing tools, Deloitte vendor and partner alliances.
MDM Architect / Infrastructure Lead
- 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 teh 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 teh 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 teh roadblocks and other challenges relating to coordination with other parties (HP, Oracle) for obtaining teh 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 teh changes they are implementing to existing system design component by component as well as assigning an owner for teh impact and timeline for addressing teh 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 TEMPeffectively 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 & TEMPEffectively)
Confidential - Woodlawn, MD
Master Data Architect
- 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 teh MITA framework.
- Analyzed teh alignment between Medicare and Medicaid beneficiary data models, logical relationships and business rules impacting teh 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 teh hadoop distributed file system, as well as loading new profile information into teh 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 teh mapping of data sources, data movement, interfaces with teh 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 teh 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 teh 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 teh 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 teh solution development process to ensure bridging of teh 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 - Data Warehousing Team
- Owned and driven teh planning, tracking, scheduling, and releasing of medical claims, membership and pharmacy claims datamart solution releases.
- Worked with teh 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 teh design of MicroStrategy reports. (Attributes, Filters, Metrics, Facts, Consolidation and Custom Groups)
- Translated teh various work items, dependencies, and information about available resources into an integrated project schedule
- Participated teh claims and membership data discovery process for new clients while building internal data intake standards.
- Oversaw teh mapping of data sources, data movement, interfaces with teh goal of ensuring sufficient data quality and governance for membership and claim data.
- Assisted with defining teh 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 teh data collection (FTP) and support analytics activities for specific clients to ensure timely delivery of teh opportunity assessment, interfacing with teh client, UPMC and teh Evolent team.
- Provided subject matter expertise to data analysis team on designing, monitoring and training on HIPAA x12 transactions and EDI applications.
Confidential, Rockville, MD
Sr. Technical Business Systems Analyst / Core Systems Engineering
- 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 teh 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 teh 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.
Confidential, Alexandria, VA
Systems Analyst Advisor Sr
- Analyzed all reform provisions to define teh functional and technical impacts to teh existing membership eligibility,medical claim adjudication and benefit administration systems.
- Leveraged existing system architecture and data repositories to support new mandatory requirements including HIPAA 5010
- Proposed updates to existing system functionalities and data repositories including benefit administration coding changes as necessary, to serve teh key business needs of different stakeholders with careful consideration on upstream and downstream dependencies
- Prepared high level solution overviews, impacts and technical requirements for group, benefit and enrollment functionalities of consumer driven health plans. (Removal of annual and lifetime limits provision for claim adjudication, Grandfathering of benefits)
- Conducted process analysis and walkthroughs of technical changes with downstream and upstream system SMEs to ensure different all scenarios and conditions have been covered across integrated systems with use cases
Technical Business Systems Analyst
- sof member portal release 10 by external teams (DSI, Microsoft) leveraged knowledge of these teams to identify process improvement oppostunities. areas that can be improved; outlined teh solution advices, determined impacted layers and prepared remediation plans in pdlanview to manage execution.
- TEMPEffectively processed TSB (Technology Steering Board) Requests submitted to shared technology solutions team, brought them into a closure by managing external dependencies. Exceled at day to day execution and process improvement.
- Researched, found and facilitated technical solutions for these TSB requests which best fits teh e-business objectives and team needs.
- Articulated expectations of cross functional teams (MTM, CTO, TSB, OSB) from eBusiness domain to teh development team, identified teh changes needed in impacted areas to meet their process improvement needs and incorporated teh related tasks into master project plan in planview.
- Planned and facilitated end to end security assesment of new member portal by external teams (Microsoft and Internal Information Security Team). Acted as a bridge between development leads and security experts to review and understand teh issues found and fixes needed. Prepared teh remediation plan in planview and provided status to program management.
- Prepared security guidelines in developing web applications to help prevent most of teh known security risks under teh supervision of security architects.
- Prepared security enforcement flow including authorization steps thru each layer of MVC including content management system with application tech leads.
- Managed a team of off-shore .NET developers and architects in teh design and implementation of a two-tiered web-based test harness system that enables production support and MTM audit teams to validate member data being delivered to UI layer from source back end systems. Worked closely with MTM audit team to ensure meeting audit requirements.
- Led gathering and assessment of environment configuration requirements from tech leads of multiple tiers for accomodating multi stream development of member portal across all environments from development to production fix.
- Acted as a liasion between Microsoft and eBusiness development team for improving IIS and SQL server performance improvement initiative and adhoc basis technical support for issues involving Microsoft technologies.
Membership and Benefits Track Lead
- Implementing a new incentive product line across all books of businesses with same level of flexibility and customizability on a consolidated centralized technical platform
- Conducted walkthroughs with multiple teams to explain incentive benefits domain, current process analysis across systems, dependencies and growth and process improvement need comes with client migration.
- Participated and and provided thought leadership in design discussions with architects, conveying knowledge of incentive rule and claim adjudication, process flows and timeframe realities.
- Provided and created detailed process oriented flow charts for multiple different incentive process models.
- Communicated pros & cons and operational impacts of different incentive processing models to teh business, technical project management, channel leads.
- Led meetings on high level design with product architects to develop new 360 health product benefit meta data model.
- Developed technical solution approaches including incentive benefit administration and proposals across integrated Wellpoint systems to meet business needs and strategic goals within teh project.
- Facilitated discussions and organized gathering technical responses within system experts for teh system specific implementation requirements documentation
- Worked in conjunction with enterprise integration services (EIS) for realtime communication of benefit and eligibility information across source systems, rules engine, incentive vendors and disbursement systems.
- Identified eligibility and benefit data elements necessary for each system to perform assigned process workflows
- Worked with information architects for enterprise level common file layouts and benefit and claim data definitions
Senior Technical Business System Analyst
- Implemented a new hybrid line of business (HSAPLUS) across teh CDHP portfolio and embedding last quarter carry over logic into claim adjudication after analyzing state mandate provisions
- Prepared functional and technical requirements across all modules of enterprise CDHP claim adjudication system including benefit configuration dependencies based on teh high level business requirements.
- Conducted walk throughs to ensure accuracy, completeness and clarification of functional specifications with each module’s SMEs and architects. (eligibility, claim adjudication, benefit administration, member portal, call care browser for customer service, monthly health statements, pharmacy interface and datawarehouse extracts)
- Implemented of new business rule validations thru teh eligibility data exchange process and identified decision points and resolution steps of error occuring cases.
- Facilitated meetings to clarify key issues by use cases to come up with clear functional specifications across tracks.
- Provided status periodically to project management office about these issues, risks and decisions needed and made.
- Managed and communicated changes to teh custom extract layouts for new line of business including datawarehouse extracts, eligibility extracts for financial vendors, pharmacy vendors, incentive program vendors and external clients.
- Provided expertise of new line of business to teh operations for TEMPeffective and complete implementation across enterprise to support product launch processes and policies.
- Assisted EDI team on designing, developing, testing and maintaining EDI Maps with teh specified business rules in ECGateway. (837P Health Care Claim, 276/277 Claim Status Request/Acknowledgement, 270/271 Eligibility Coverage, 277U Acknowledgement Response, 835 Health Care Claim Payment Advise)
Senior Technical Business System Analyst
- Integrating LITES CDHP engine with Wellpoint source membership and claim systems.
- Facilitated 2 recurring weekly meetings between IT teams of different wellpoint systems to prepare common file layouts to sync up different business processes of integration. (Preparation of agenda items, facilitation of discussions, capturing and assignment of action items and follow ups for achievement of results)
- Performed mapping tasks for new file layouts to extract layouts of existing downstream systems.
- Prepared business requirements document for different levels of integration including client, group, product, subscriber and contract eligibility including use cases, end to end syncronization of different data flows and main requirements for datawarehouse.
- Wrote test cases for eligibility implementation, performed user acceptance testing, data mapping/validation testing.
- Provided ongoing support for claims team from eligibility, accumulators and benefit design perspective for medical and rx claim adjudication.
- Communicated directly with clients and client implementation managers to provide insight around CDHP benefit changes, impacts of HRA claims adjudication and downstream extracts.
- Performed data mapping and validation testing for medical claims for different eligibility scenarios.
- Provided weekly status for teh project milestones, key issues & risks, key decisions needed/made and key meetings for eligibility team.