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Sr. Business Data Analyst Resume

Warwick, RI


  • Business Data Analyst with around 6+ years of experience in Healthcare domain and application development with excellent skills in client interfacing, requirement gathering, user support, quality assurance, problem solving and documentation.
  • Experienced in writing Use Cases. Proficiency in SDLC life cycle, understands the workflow concept, ability to gather and document the 'As - Is' and 'To-Be' processes
  • Experienced in data analysis with solid understanding of Business Requirements Gathering, Data warehousing, Business Intelligence, Data Mapping and Data Modeling.
  • Requirement gathering through interviews, workshops, JAD sessions with clients, developers and QA Analysts and referring to existing system documentation and procedures
  • Experienced in gathering and documenting test Scenarios and ability to train users to translate technical requirements and translate them to a business audience
  • Worked in a software development IT shop, created quality documentations such as Requirements Documents, Design Document, Test Plan, and User Acceptance Test Plans
  • Self-starter with excellent time management skills, task distribution, and preparing estimates.
  • Strong experience with different project methodologies including Agile, Waterfall, SDLC, RUP.
  • Good understanding of Relational Database Design, Data Warehouse/OLAP concepts and methodologies.
  • Knowledge of various HIPPA EDI transactions which includes 270/271, 834, 835, 837I/P, 276/277.
  • Good knowledge of SQL queries.
  • Experience in generating on-demand and scheduled reports for business analysis or management decision using SQL Server Reporting Services
  • Have good working knowledge in querying salesforce.com database using SOQL & SOSL queries using Force.com Explorer.
  • Good Knowledge of data warehousingtechniques and standards
  • Experience in various phases of Software Development Life Cycle (analysis, gathering requirements, and design) with expertise in documenting various requirement specifications, functional specifications, test plans, source to target mappings, and SQL joins.
  • Experience in conducting JAD Sessions and communicating with Stakeholders, Development team, SMEs, System Analyst, Business Analyst and Project Manager.
  • Involved in the design and development of user interfaces and customization of Reports using Tableau and OBIEE and designed cubes for data visualization, mobile/web presentation with parameterization and cascading.
  • Healthcare asset class knowledge in PHI, HIPPA, Medicare andMedicaid,reimbursementsupport, co-pay assistance, patient assistance, adherence services,and wholesale distribution, healthcare provider services, claims and billing, insurance, payers and plans, enrollment, and compliance requirements, risk and regulatory requirements.
  • Strong experience and understanding of claims management process
  • Strong experience and understanding of health care industry, claims management process, knowledge of Medicaid and Medicare Services
  • Strong knowledge of EDI Claims, member enrollment, and billing transactions.
  • Created data flow diagrams, data mapping from Source to stage and Stage to Target mapping documents indicating the source tables, columns, data types, transformations required and business rules to be applied.
  • Experience with FACETS solution for healthcare.
  • Understanding of HIPAA Standards and Compliance issues, HIPAA Privacy policy, opt in/opt out policy.
  • Requirements gathering in compliance with HIPAA 4010 and 5010 standard.
  • Experience web based application development.
  • Writing Use cases and producing Behavioral diagrams (Sequence diagrams, Collaboration diagrams) and Class diagrams based on UML Methodology & creating Business process flow diagrams
  • Writing & documenting Business Plan, Requirements Document, Functional Specification Document, and Test Cases
  • Defining Test Cases, analyzing bugs, interaction with team members in fixing errors and User Acceptance Testing (UAT)
  • Knowledge of SQL and experience of writing SQL commands.
  • Using project management tools like MS-Project for status reporting and planning.
  • Creative and aggressive self-starter with integrative thinking skills, capable of forming and maintaining positive and productive working relationships in internal, external, independent, and team environments
  • Highly motivated, organized and results and detail oriented with excellent interpersonal, communication and presentation skills. Proven capability of adapting to new and fast changing technologies


Project Methodologies: SDLC, Agile, Rational Unified Process (RUP), UML

Business Modeling Tools: MS Visio, UML

Requirement Management Tools: Rational Requisite Pro

Defect Tracking Tools: Rational Clear Quest, Quality Center, Test Director

Operating Systems: Windows NT/XP/2000, UNIX

Database: Oracle, SQL Server, DB2

Quality Assurance: Software Application Testing Life Cycle

Business Applications: Microsoft Office Suite, MS VISIO, MS Project, Outlook


Confidential, Warwick, RI

Sr. Business Data Analyst


  • Formulate and define system scope and objectives using knowledge of information technology and industry knowledge/requirements.
  • Act as a liaison between client and technical solutions/support groups, using strong communication skills to elicit, document, analyze and validate business processes, systems, and solution requirements.
  • Research, identify, and specify solutions to problems.
  • Support and conduct visualization, user experience and configuration elements of solution design.
  • Document requirements specifications using high-maturity methods, processes and tools.
  • Support requirements management and change management processes.
  • Experienced in Claim adjudication, Claim Adjudication Engine (CAE), Minimum Essential Coverage (MEC), and Medicare Advantage Plan.
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaidand Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
  • Support aspects of the business cycle, including proposals, feasibility studies, and implementations.
  • Worked intensively on enrollment (834), billing and finance related projects.
  • Consider the business implications of the application of technology to the current business environment.
  • Performs work assigned by others.
  • Provides time / resource estimates for assigned tasks.
  • Provide analytic support, independently and as part of a team, with regards to the Medicaid general operations
  • Createdbaddebtlogs for ManagedMedicareresulting in additional revenue to DXC Client.
  • Provide analytic support to assess program performance; identify budget, enrollment and utilization trends; and opportunities to maximize program efficiencies
  • Ability to identify and communicate data trends
  • Experience in system conversions (Mapping, Migrating, Enhancement) such as HIPAA (Health Insurance Portability and Accountability) X12 4010 codes to X12 5010 codes and PCS codes in Medicaid, Medicare, Procedural and Diagnostic codes.
  • Proficient in COB (Coordination of Benefits), EOB (Explanation of Benefits)/Drafts, Claims pricing and testing, HIPAA, enrollment EDI, Medicare, Medicaid, CDHP.
  • Perform other data and reporting tasks as requested
  • Used SQL for Data Analysis and MS Excel to generate reports and create data-entry templates.
  • Worked as a Clinical informatics resource for the Care Management Department for new system implementations and technical upgrades.
  • Wrote complex SQL queries to extract and validate the data from the HSDW.
  • Create a source to target mapping document.
  • Responsible for Data Profiling to determine data integrity for transformation of Data from Source to Target.
  • Involved in initial intake, evaluation, eligibility determination, Individualized Family Service Plan development, service provision, and all financial aspects including insurance, claiming, payments, andMedicaidreimbursement.
  • Responsible for creating the test plan and designing test cases for the EDI 834 members’ enrolment file loading process into Facets through HIPAA Gateway
  • Used Bulk Insert to load large data into staging table.
  • Experienced in Health Informatics and HL7 standards.
  • Conducted and automated the ETL operations to Extract data from multiple data sources, transform inconsistent and missing data to consistent and reliable data and finally load it into the Multi-dimensional data warehouse.
  • Experience as a Business Analyst activities with skills in Business Analysis, Data Analysis, Requirement Analysis, and Business Modelling.
  • Elicited and developed clear, traceable requirements using interviews, document analysis, requirement workshops, use case scenarios. Also, created data mapping specifications and testing strategies for Cognos Reports.
  • Used FACETS: Subscriber/Member, Medical Plan to validate the Eligibility benefits received in the 271 responses.
  • Validated the following: EDI 837 (HealthCare Claims or Encounters), 835 (HealthCare Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrolments/Dis-enrollment to ahealthplan)
  • Scheduled Reports through Schedule Management in Cognos Connection.
  • Migrated all DTS packages to SQL Server Integration Services (SSIS) and modified the package per the advanced feature of SQL Server Integration Services.
  • Involved in import and export of data from Excel, SQL Server and Text files using SSIS SQL Server Integration Services Packages.
  • Developed data quality test plans and manually executed ETL and BI test cases.
  • Created SSIS Packages to integrate data coming from Text files and Excel files
  • Designed the standard template for creating reports in Cognos report studio.
  • Performed Data Mapping to map the EDI 834 data to XML.
  • Performed different queries in MS access, exported data to excel for data analysis
  • Analyzed data and generated different kinds of graphs, charts using Excel.

Environment: MS Office, Waterfall, Toad, SQL server, Data Warehouse, Cognos BI, MS Office Tools, Informatica, MS Visio, Share Point

Confidential, Detroit, MI

Business System Analyst/Data Analyst


  • Business Analyst involved in documenting changes to the Benefits Administration, Enrollment Processing and Claims Processing Systems based on the Medicare Plan Changes initiative.
  • Involved in discussion with subject matter experts during gap analysis sessions to identify the areas of impact toGateway, Backend Systems and Front end Systems for the 5010 remediation.
  • Worked on Data Mapping to map Facets data to outbound eligibility extracts.
  • Wrote complex SQL queries to extract and validate the data from the Facets database for member and claims data.
  • Responsible for Data Profiling to determine data integrity for transformation of Data from Source to Target.
  • Responsible for creating the test plan and designing test cases for the EDI 834 members’ enrollment file loading process into Facets through HIPAA Gateway
  • Used Bulk Insert to load large data into staging table.
  • Conducted and automated the ETL operations to Extract data from multiple data sources, transform inconsistent and missing data to consistent and reliable data and finally load it into the Multi-dimensional data warehouse.
  • Experience as a Salesforce Business Analyst activities with skills in Business Analysis, Data Analysis, Requirement Analysis, and Business Modeling.
  • Understanding and assessment of the current EDI Transactions used.
  • Worked on claims which involve specific logic for Medicare and Medicaid Claims.
  • Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
  • Upgraded HMO Medicare EDI and reporting.
  • Performed different queries in MS access, exported data to excel for data analysis
  • Analyzed data and generated different kinds of graphs, charts using Excel.
  • Experienced in gatheringbusinessrequirements, JAD Sessions, Gap Analysis, UML diagrams, Process Flows,BusinessDocumentation, Claims Processing & Testing and Claims Adjudication for Medicare and Medicaid, Data Mapping/Modeling, Trizetto Facets 4.x and MedicalBilling.
  • Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
  • Constructed the Business Requirement Document and the Functional Requirement Document for Inbound (837-I, P, D, 270, and 834) and Outbound (835, 271) transactions.
  • Worked closely withTrading Partnersto ensure that requirements were met.
  • Contributed in the writing of5010 Implementation, Companion Guides for all ANSI X12transactions.
  • Performed Data Mapping to map the EDI 834 data to XML.
  • Involved in analyzing, designing, writing programming specification,coding, testing and transmitting to production ofEDImaps and transactions.
  • Complaints and grievance committee member responsible for rendering ruling based onhealthplan provided documentation and member testimony.
  • Demonstrated ability to troubleshoot to efficiently detect the source of errors in the coding and configuration of a Salesforce.com environment.
  • Appointed as the point of contact in theHIPAA 5010core team for responding to any queries.
  • Reviewing all codes and appropriately applying them.
  • Assist in preparing the context diagram.
  • CreatedEDImapping guidelines.
  • Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
  • Analyzed the data warehouse project database requirements from the users in terms of the dimensions they want to measure and the facts for which the dimensions need to be analysed.
  • Created and deployed reports using SQL Server Reporting Services (SSRS).
  • Used various report items like tables, sub report and charts to develop the reports in SSRS
  • Involved in testing new websites functionalities across different browsers.
  • Determined technical parameters forEDI by working with the development team for communication, security, and privacy.
  • Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 835, 837-(I, P, & D), 835.
  • Acknowledged HIPAA rules and regulations duringElectronic Data Interchange (EDI) and also ensured that the development team kept up with it.
  • Used MS Project regularly to monitor activities, schedules and communication during the project.

Environment: MS Office, Salesforce, FACETS, Agile, DB2, Toad, SQL server, .NET, JAVA, COBOL, MS Office Tools, MS Visio, HP Quality Center

Confidential, Plano, TX

Business System Analyst


  • In-depth knowledge of Health Insurance process, Claims, HIPAA & its approved transaction codes.
  • Used an extensive working knowledge of Facets.
  • Analyzing the Facets Requirements and thus conducting gap analysis.
  • Conducting business validations, covering the following deliverables: FACETS Providers, Facets Claims and Facets Membership
  • Interacted with business owners to identify business system needs, evaluated solutions for business problems and proposed alternate methods to increase efficiency.
  • Written several complex SQL queries for data verification and data quality checks.
  • Validated custom ETL Packages using PL/SQL.
  • Tested and debugged external and DB2 native stored procedures. Used MS Visio for Data Modeling.
  • Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
  • Re-engineering and capturing of EDI transactions with legacy systems Enrolment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
  • Implementation and system administration of Salesforce.com and provide routine maintenance.
  • Creating Salesforce.com based reports and dashboards showing data quality gaps and inconsistencies.
  • Experience in reporting and dashboards using the Salesforce.com platform.
  • Design and customize data models for Data warehouse supporting data from multiple sources on real time.
  • Involved in Medicare and Medicaid (CMS) pertaining to billinghealthplans
  • Apply data cleansing/data scrubbing techniques to ensure consistency amongst data sets.
  • Develop logical data and physical data models to capture current state/future state data
  • Develop queries using PL/SQL and many stored procedures to validate.
  • Create and maintain database objects such as tables, views, indexes, sequences, database triggers, stored procedures
  • Analyzed and documented requirements and the corresponding impact on business processes
  • Analyzed and transmitted the business requirements into detailed project plans.
  • Analyzed business requirements and organized high-level and low-level Use Cases.
  • Adapted UML standards to define modularized Data Process Models.
  • Conducted JAD / JAR and Elicitation sessions for user interviews to gather requirements
  • Performed GAP Analysis for new functionality requirements and prioritized them based on the business needs.
  • Tested Web services (SOAP and REST) using SOAP UI & HP Service Test and applications complete business flow.
  • Performed system analysis of mobile web, Android and iOS applications.
  • Prepared high-level logical data models and Business Required Document (BRD) and supporting document containing essential business elements, detailed definition and description of the relationship between the actors.
  • Provided management with metrics, reports and schedules as necessary, mapping business processes and documenting business flows.
  • Prepared UML activity, collaboration and sequence diagrams for detailed analysis of business objects using the Rational Unified Process (RUP).
  • Developed and implemented processes for Requirements gathering, Analysis, planning, tracking and delivery using Rational Requisite Pro.

Environment: Windows XP/2000, DB2, Salesforce, RUP, MS Office 2000, UML, JAVA, J2EE Environment, XML, ASP.NET, Oracle Applications

Confidential, TN

Business Data Analyst


  • Performed Requirements Gathering and Analysis, and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
  • Defined test cases based on the requirements outlined in the test plan as part of the development cycle.
  • Design, analyze and performed Integration and wrote System requirements on different leading health care software’s such as FACETS.
  • Interacted with the technical team for the claims transactions design.
  • Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios.
  • Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
  • Coordinating the release of project delivery with ETL developers and QAs.
  • Experience in areas of Information Management - Data Analysis, Data Modeling, Data Mapping, Data Warehousing, Data integration and Metadata.
  • Extensive experience with Data Warehousing, Extraction, Transformation and Loading (ETL) and Business Intelligence (BI) tools
  • Analyzed data mining, and rebillings forMedicare, Medicaid and third party billings.
  • Involved in requirement gathering and database design and implementation of star-schema, dimensional data warehouse
  • Extracted data from different sources was integrated and loaded into the Data Warehouse.
  • Worked with the development team to make sure that they understood the user requirements and that the system developed met those requirements.
  • Participated in developing test plans templates and guidelines to be used by the project team with detailed screen layouts with regards to various types of corporate actions.
  • Involved in User Acceptance Test.
  • Involved in the development of Test Plans and Test Cases and coordinated the tests with the QA team to verify implementation of new features and enhancements.

Environment: Facets, Windows, MS Visio, Quality Center, MS Project, SQL, Oracle.

Confidential, California

Business Analyst


  • Involved in gathering the requirements that were critical to the business process flow and using those requirements for the Business Requirements Document (BRD), for the implementation of the NPI in EDI X12 transactions as mandated by the Federal Regulation.
  • Conducted JAD sessions with Subject Matter Experts (SME’s) to obtain domain level information, interviewing and asking detailed questions and carefully recording the requirements in a format that can be reviewed an understood by both business and technical team.
  • Maintained a daily meeting with the Business and the NPI team on task order approval, increased and decrease frequency of the meetings as per the progress of the task.
  • Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and insures that critical requirements are not missed.
  • Revised policies and procedures forMedicare/Medicaid contracts and HIPAA.
  • Involved in database interactions for retrieving appropriate data and generation of output file and reports.
  • Involved in GAP analysis both at the time of requirement gathering and later after development with the Testing team to identify areas and possible scenarios that might have been overlooked.
  • Facilitated collection of functional requirements from system users and preparation of functional specification documents that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Participated in providing implementation assessment for Rational Requisite Pro, Rational Clear Quest using Unified Modeling Language (UML) and Rational Unified Process (RUP).
  • Additional responsibilities included mapping the requirements in Caliber to the Test Cases and Scenarios in Quality Center.
  • Involved in identifying dummy data for the testing scenarios for the QA team
  • Assigning defects detected by the Test Team to the relevant developers and escalating issues when and where required.

Environment: Windows 2000/XP, Excel, MS Access, Facets, MS Visio, Power Point, HP Quality Center.

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