PROFESSIONAL SUMMARY:

• Proficient in Data Analysis, Business Requirement Gathering, Data Modeling, Technical Documentation with around 9+ years of experience in Healthcare industry.
• Experience in Data Extraction, Data Management, Data Cleansing, Data Profiling, Data Consolidation, and Data Quality for various business data feeds.
• Experience in HealthInsurancePortability & Accountability Act (HIPAA) standards, Medicaid and Medicare regulations,HealthCare Reform (HCR), Electronic Medical Record (EMR) and ElectronicHealthRecord (EHR) and Medicaid Management Information Systems (MMIS).
• Experience in Business Process Analysis, Data Extraction, Data Management, Data Cleansing, Data Profiling, Data Consolidation, and Data Quality for various business data feeds.
• Good working knowledge of Claims processing, HIPAA Regulations and 270, 837P, 837I, 837D EDI Transactions forhealthcareindustries.
• Proficient in preparing Source to Target mapping documentation. Used SQL queries for preparing analysis and reports from databases. Design documents to formulate Test Plans, Test Scripts and Test Strategies.
• Extensive experience in healthcare insurance payer systems, Security, Compliance, Healthcare Reform implementation, reporting, integration, equivalent consulting experience.
• Expertise in Facets Application Groups: Subscriber/Member, Plan/Product, Claims, Provider, Payer, Commissions and Billing Modules of Facets.
• Experience inSASProcedures, Macros, Report formatting, Data Loading, Exporting, and Batch Processing.
• Working knowledge of SQL Server Report Services and the design of business intelligencereportingsystems.
• Well versed with various types Software Development methodologies - Water fall, Agile, RUP, Iterative and extreme Programming.
• Experience in Software QA and Testing Methodologies, verification and validations in all phases of the SDLC.
• In depth technical knowledge and understanding of Data Warehousing, Data Validations, OLAP, SQL Server, Oracle and ETL.
• Extract, manipulate and analyze data and create reports using TSQL and Strong knowledge in writing TSQL queries using Joins, Sub queries, Stored Procedures, Triggers etc in TSQL in SQL Server and PL/SQL in Oracle client tools.
• Experience in Data Cleaning, Data Archival, Data Migration, ad-hoc reporting and coding utilizingSASon Windows and UNIX.
• Extensively worked with Claims, enrolment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
• Experienced with Processing Medicare Claims through FISS/MCS Systems. Identified system conflicts and defects.
• Determination of error corrections in those cases where the business units are not able to provide the information (example, the Claims department does not provide corrections for denied claims so the EPRA analysts will have to do it). Medical, Medicaid, and Medicare.
• Strong experience in Data Analysis, Data Migration, Data Cleansing, Transformation, Integration, Data Import, Data Export and writing SQL and PL/SQL statements - Stored Procedures, Functions, Triggers and packages.
• Excellent knowledge in Data Analysis, Data Validation, Data Cleansing, Data Verification and identifying data mismatch.
• Good Knowledge on Business intelligence, OLAP, Dimensional modeling, Star and Snowflake schema, extraction, transformation and loading (ETL) process.
• Knowledge in providing targetedad-hocreporting and analysis for individual clients and leverage methodology for other clients.

PROFESSIONAL EXPERIENCE

Confidential - Pittsburgh, PA

Sr. Data Analyst

Responsibilities:

• Working in the existing team ofdataanalystsand our business partners to gatherdatarequirements from business users.
• Provide analytical support, independently lead analysis, and present analysis to the Commercial Health Insurance management team and interdepartmental consumers.
• Worked on solving the errors of EDI 834 load to Facets through MMS. Created keyword files to have memberdatabulk loaded into the FACETS system through the MMS batch.
• Provide data validation, management and analysis of incoming health insurance claims from more than 60 contributors.
• Created data mapping document which contain source to target mapping with other intermediate system connections to load data with Data Validation before and after Loading.
• Data Extraction and Analysis using SAS to query portfolio data and extract data as needed for reporting analysis /development or for customer delivery from Hadoop, Oracle, SQL and Teradata.
• Creating SQL Stored Procedures and User-Defined Functions using TSQL for financial data fragments in Documents for Stakeholders.
• Worked on data analysis using SQL, TSQL and many other queries-based applications.
• Worked on requirements of the 835, 276, 277, 837, and HIPAA transaction across the enterprise.
• Worked on Creating Macros and developedSASprograms for Data cleaning, Validation, and Analysis and Report generation using created as well as existing macros.
• Worked with diverse team of Business users to gather requirement and prepared BRD and FRD.
• Worked on DataManagementand Business Solutions team, worked on Business Analysis,DataAnalysis, Requirement gathering, GAP analysis,DataMapping and Testing of ETL and BI Reporting requirements
• Involved in designing and producingad-hocreports measuringhealthoutcomes and costs utilizing primarily descriptive statistics.
• Troubleshoot any problems found within FACETS and when testing the SQLdatadatabase while validating the business rule.
• Worked on Requirement Analysis,DataAnalysis and Gap Analysis of various source systems sitting and coming from multi systems. Responsible for BIDataQuality.
• Actively participated in reports in Access, Excel using advanced functions not limited to lookup, pivot tables, formulas.
• Use SQL, PL/SQL to validate theDatagoing in to theDataWare House Creating complexdataanalysis queries to troubleshoot issues reported by users.
• Worked along with project manager to evaluatedatamining request requirements and help develop the queries for the requests.
• Worked on 276/277 transaction in order to enable easier and faster exchange of information between the payer and the provider.
• Conducted UAT (User Acceptance Testing) for multiple iterations by writing Test Cases and signed off the same after approval.
• In depth technical knowledge and understanding ofDataWarehousing,DataValidations, OLAP, SQL Server, Oracle andETL.
• Involved in Designing Star Schema, Creating Fact tables, Dimension tables and defining the relationship between them.
• Created Traceability Matrix to ensure that all requirements are covered in test cases.Skilled in various MS Office tools including MS Visio and MS Project.
• Excellent written and oral communication skills and a team player with a results-oriented attitude.
• Documented source and table specifications to be used by ETL developers and Quality Assurance Analysts in the construction phase of the project.

Confidential, Carmel, IN

Data Analyst

Responsibilities:

• Worked on analysis of end user requirements and business rules based on given documentation and worked closely with tech leads and Businessanalystsin understanding the current system.
• Analyzed system to make it compliant withHealthInsurancePortability and Accountability Act (HIPAA). The HIPAA regulation impacts healthcare organizations that exchange patient information electronically.
• Capturing data and building reports for clients in SSRS and creating stored procedures using TSQL daily.
• Enforce compliance withHealthInsurancePortability and Accountability Act (HIPAA) throughout all levels of the program.
• Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Medicaid Claims experience in Process Documentation, Analysis and Implementations in 835/837, 270, 276/277processes or Medicaid Claims from the Provider/Payerside.
• Suggested improvements in ongoing Tableau dashboards to meet changing system and business requirements.
• Documented and maintained the Source to Target Mappings STM documents during the design and development phases.
• Used the Agile methodology to build the different phases of Software development life cycle (SDLC).
• Analyzereportingdata to create a weekly Executive report that provides stakeholders across the Office of Intelligence and Analysis vital insight into key metrics covering the secure flight operational areas.
• Involved in DevelopingSASprograms to implement the End-End ETL data flow to support the developed Data Model.
• Involved in Issuance ofad-hocand standardized reporting, internal metrics and dashboards to various levels of the Business.
• Worked on Data Governance, Data management aspects and was responsible to maintain Business Glossary Referential Data & Data lineage in Metacenter and Collabra.
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify keydataset elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Worked ondatawarehousing projects dealing with ETL (extraction, transformation, loading) using various databases.
• Evaluate all SQL applications and prepare layouts for all logical models and maintain database objects for various application components.
• Performed walkthroughs for ConceptualDataModel, LogicalDataModel and PhysicalDataModel for validating designs for the enterprisedatawarehouse.
• Scripting in TSQL from tables in the student database, developing test procedure cases.
• UseSAS(base and macro), SQL, UNIX, Teradata and Oracle to manipulate large amounts of data
• Assisted BusinessAnalystin documenting business requirements, technical specifications and implementation of various ETL standards in the mappings.
• Met with users and stakeholders to understand the problem domain, gathered customer requirements through interviews (group and one-on-one) along with JAD sessions analyzed the business requirements and involved in writing Test Plans and Test Cases.
• Involved majorly in thedatamigration from legacy system to the new systems.
• Worked on SQL query (Oracle and TSQL) in analyzing and validating SSIS ETL databasedataware house processes.
• Developed views, functions, procedures, and packages using PL/SQL & SQL to transformdata between source staging area to target staging area.
• Assisted in Integration testing, Regression testing and UAT. Analyzeddataand created reports using SQL queries.

Confidential, IN

Data Analyst

Responsibilities:

• Performed the requirement analysis and documented the requirements using Rational Requisite Pro. Interacted with business heads to finalize the Business Requirements for the application.
• Worked on Development Life Cycle process, implementing the Rational Unified Process (RUP) in all different phases.
• Involved in writing TSQL code for stored procedures, managing tasks and meeting deadlines in response to ad-hoc requests.
• Involved in developingdataconversion strategy fordatamigration from legacy systems to Technology product modules.
• Involved in designing process to analyze data using natural language processing using Tableau to validate data.
• Liaison between business stakeholders and technical teams to ensure proper translation of Business Requirements to System Requirements.
• Worked on Preparing and maintaining project budget and forecastdata, modify and enhance macros and code in MS Excel for corporate forecasting tool, assess business processes for spending effectiveness for the statehealthplan.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
• Worked on Generating data element matrix encompassing all the data element report wise including the data mapping for the data warehouse.
• Worked as ETL Tester responsible for the requirements / ETL Analysis, ETL Testing and designing of the flow and the logic for the Data warehouse project.
• Responsible for integrating with Facets. Designed High level design for new process, integrating with legacy & Facets.
• Involved in developing Tableau Visualizations in support of Financial and Healthcare initiatives.
• Researched EDI claims and claims adjustments data to determine root causes of data errors.
• Wrote SQL queries to performDataValidation andDataIntegrity testing and SQL Stored Procedures and Views, and coordinate and perform in-depth testing of new and existing systems.
• Performed felid-by-field mapping of interface between parent EMR system and downstream system. Performed Load and Stress Testing using Load Runner.
• Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
• Wrote complex SQL, PL/SQL Testing scripts for Backend Testing of the data warehouse application.
• Exclusively involved in writing test cases, test scripts, test plans and execution of test cases reporting and documenting the test results using Mercury Quality Center.
• Involved in Preparing UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements.
• Worked on following applications Business Objects, Enterprise Architect, Toad, Plainview (project management), Microsoft Suite (Word, Excel, PowerPoint, Visio, Access, Project).
• Worked along with SMEs to Implement SDLC which included requirements specifications, design, and analysis and testing.
• Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
• Participated in Coordinating and developing QA activities with team members to support the Scrum methodology.

Confidential, MD

Data Analyst

Responsibilities:

• Worked on HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc.
• Participated in JAD Sessions with stakeholders and developers to have a clear picture of a project and extracting and cleansing of XML, JSON, and otherhealthcaredata using XQuery, SQL and ETL.
• Participated in Writing SQL queries to validate source data versus data in the data warehouse including identification of duplicate records.
• Involved in understanding the customer needs with regards to data, documenting requirements, developing complex SQL statements to extract the data and packaging/encrypting data for delivery to customers.
• Worked on FACETS batches like XPF and MMS to upload bulkdatainto the FACETS system through the HIPAA gateway by generating keyword files to enroll, modify or terminate providers and members Analysis of thedatausing SAS retrievingdataMS Excel Sheets.
• Initiated detailed discussions/functional walkthroughs with stakeholders.
• Actively participated in producing system documents, functional requirements, ETL mapping and modeling deliverables Worked with root cause of data inaccuracies and improved the quality of data by using Data Flux.
• Worked with Data Modeling team to create Logical/Physical models for Enterprise Data Warehouse.
• Worked with developers and testing teams to ensure that the requirements are communicated accurately and that the system being developed is verifiable against the requirements.
• Involved in Documenting/Executing business test cases.
• Analyzed the Business requirements and developed Test cases based on functional requirements, general requirements and system specifications.
• Involved in preparing test data for positive and negative test scenarios for Functional Testing as documented in the test plan.

Confidential - Dallas, TX

Data Analyst

Responsibilities:

• Analyze the client data and business terms from a data quality and integrity perspective.
• Worked to ensure high levels of data consistency between diverse source systems including flat files, XML and SQL Database.
• Involved in working within a growing environment of X12 4010/5010 HIPAA Transaction Processing 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
• Involved in Developing and run ad hoc data queries from multiple database types to identify system of records, data inconsistencies, and data quality issues.
• Participated in the JAD sessions along with the technical team members and clients to elicit requirements for HIPPA 4010 to 5010 migration process.
• Involved in translating the business requirements into data requirements across different systems.
• Involved in understanding the customer needs with regards to data, documenting requirements, developing complex SQL statements to extract the data and packaging/encrypting data for delivery to customers.
• Worked with Data Modeling team to create Logical/Physical models for Enterprise Data Warehouse.
• Participated in identifying the database tables for defining the queries for the reports using SSRS.
• Worked with senior DA in conducting JAD Sessions.
• Involved in developing data mapping documents between Legacy, Production, and User Interface Systems.
• Involved in documenting data content, data relationships and structure, and processes the data using Informatica Power Center Metadata Exchange.
• Worked on transferring data objects and queries from MS Access to SQL Server.