SUMMARY

• 9+ years of IT Experience as Business Data Analyst especially with Healthcare Data Warehousing and Business Intelligence applications in Healthcare Industry.
• Strong understanding in various stages of SDLC using various methodologies such as RUP, WATERFALL, AGILE, SCRUM.
• Experience as a Data Analyst with a good knowledge and expertise in all phases of SDLC methodology including creating and maintain data mapping documents and artifacts.
• Conscientiously followed agile methodology and conducted scrum/sprint meetings with the team members.
• Experience in payer, health plan industry, that includes working on projects involving enrollment and billing, claims processing and adjudication, member/customer support, member care managements and wellness process.
• Experience in preparing, analyzing, and distributing standardized monthly Data operational reports and ad - hoc analysis for operations leadership.
• Technical expertise in Excel/PPT, Power BI, Tableau, Clara bridge, Google Analytics, Adobe Analytics, SPSS, Arc Map, SQL, VBA, Salesforce, Nielsen Answers
• Expertise in creating numerous artifacts such asBusinessRequirement Document (BRD), Functional requirement Document (FRD), writing and maintaining Test Matrix and Requirements Traceability Matrix.
• Expertise in conventional and non-conventional requirement elicitation techniques such as Joint Application Development (JAD) sessions, brainstorming, document analysis, project meetings, prototyping, questionnaires, focus groups, and interviews.
• Experience in creating Product Backlog, Sprint Backlog and facilitate sprint planning and review meetings.
• Performed planning and development of Test Plans, Test Cases and Test Scenario to meet product'sbusinessand solution requirements.
• Worked collaboratively with the Development and Quality Assurance teams during the Test Life Cycle in understanding and documenting Test Cases and performing User Acceptance Testing (UAT).
• Experience in claims adjudication, migration, provider, eligibility and prior authorization for Medicaid and Medicare programs.
• Medical Claims experience in Process Documentation, Analysis, and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/ Payer side.
• Worked with various FACETS online modules such as Billing, Provider, Claims and Membership/Subscription modules.
• Experienced with testing tools such as HPQualityCenter, Quick Test Professional (QTP and SQL Management Studio Tool.
• Proficient in Tableau datavisualization tool to analyze and obtain insights into large datasets, create visually compelling and actionable interactive reports and dashboards.
• Extensive experience in working closely with key stakeholders in identifying the critical reporting metrics and otherreporting needs of the department.
• Experience in developing automated reports and dashboards using BI Visualizations tools (Tableau, Microsoft Power
• Experience in developing source to target Mapping Document for migration andDataTransformation documents for the development team to facilitate the development of interfaces.
• Experience in performingDataAnalysis andDataValidations to ensure theDatais as per Business needs.
• ProficientStar Schema dimensional modeling, which includes understanding business, processes, modeling dimensions, hierarchies, and facts.
• Obtain understanding of customer's business model and intended use of Health Rules.
• Experience in working on generating various dashboards to Tableau Server using differentdata sources such asTeradata, Oracle, SAS datasets, MS Excel etc.
• Expertise in Advanced MS-Excel (G Suite, sheets), PowerPoint, spreadsheets (Pivot table & Pivot Charts, Macros, VLOOKUP) Jupyter/python notebook, Version control software (GitHub, Bugzilla, Jira
• \Hands on database experience in Oracle 9i/10g, SQL Server and in ETL tools like Informatica.
• Excellent knowledge in DataAnalysis, DataValidation, Data Cleansing, DataVerification and involved in designing and Preparing Test Scenarios, Test Plans, Test Cases and Test Data.
• Excellent analytical, inter-personal and communication skills with clear understanding of business process flows.
• Creative, self-motivated, quick learner and excellent team player, ability to meet deadlines and work under pressure.

TECHNICAL SKILLS

Data Modeling: Logical Model, Conceptual Model, Physical Model, Star-Schema Modeling, Snowflake Schema, FACT & Dimension.

OLAP Tools: Tableau, SAP BO, SSAS, Business Objects, and Crystal Reports 9.

ETL Tools: SSIS, Informatica, Power Center 6.0/7.1/8.1.1, Power Mart 6.0.

Programming Languages: Base SAS, SQL, T-SQL, UNIX shells scripting, PL/SQL, PythonDatabase Tools Microsoft SQL Server 2000/2008/2012, IBM DB2, Teradata, Oracle 12c/10g/9i, and MS Access, PostgreSQL.

Business Objects Tools & Reporting Tools: Business Objects XI 3.1/3.0, XI R1/R2, 6.5, Business Objects, Crystal ReportsOperating Systems Microsoft Windows 9x / NT / 2000/XP / Vista/7 and UNIX.

Quality Assurance Tools: Quick Test Pro, Load Runner, Quality Center.

MS Tools: Word, Excel, Project, Visio, PowerPoint, Access

PROFESSIONAL EXPERIENCE

Confidential, Deerfield, IL

Sr. Business Data Analyst

Responsibilities:

• Work in Payer Data Warehouse team to build/manage an effective health claims data warehouse.
• Involve in defining the source to target data mappings, business rules, and business and data definitions.
• Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claim payment information system in conjunction withhealthplan.
• Build thoughtful and detailed models (such as regression analysis and classification using R/Python) to support business cases and to forecast the outcomes.
• Define terms, conducted stakeholder analysis, elicited business needs, conduct business process modeling, and facilitate JAD sessions. Elicit, document requirements, and use cases. Analyze, validate & prioritize requirements; trace requirements to related project documentation (process models, designs, test scenarios & scripts).
• Design database solution for applications, including all required database design components and artifacts.
• Provide input into database systems optimization for performance efficiency and work on full lifecycle of data modeling (logical - physical - deployment)
• Maintain data in the database with consistency and integrity.Involve with data cleansing/scrubbing and validation.
• Involve in dataprofiling and data cleansingto eliminate dataredundancy and enhance performance of the database.
• Use Forward engineering to develop sound Physical Data Model by implementing referential integrity, database rules, super types, and sub types.
• Create innovative executive dashboards, scorecards, and weekly/monthly reports on the status of keybusinessmeasurements using Tableau features such as such as parameters, sets, calculated fields and table calculations, user filters, action filters and applying advanced technical charts.
• Handle portfolio steering committee meeting and monitor performance of portfolio companies to anticipate necessary adjustments to strategies.
• Analyze BusinessRequirements and translate them into HP Project and Portfolio Management (HP PPM) functional requirements.
• Medical Claims experience in Process Documentation, Analysis, and Implementation in 835/837/834/270/271/277(X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Deep understanding of healthcare/payer data, subject areas, and source systems
• Experience with advanced analytics utilizing healthcare payer data (health insurance/claims/Medicare).
• Extensively involve in using hints to direct the optimizer to choose an optimum query executionplan.
• Assist informational needs in mapping of Test Cases. Used Project to maintain the project schedule and track its status.
• Performing in depthdataanalysis and created weekly, biweekly, monthly reports by using MS Excel, Pivot table/charts, SQL, and UNIX.
• Work on requirements of the 820, 835, 837, and HIPAA transaction across the enterprise.
• Gathering sessions for the EDI Transactions between providers, payers, and employer groups.
• Use FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Involve in DataAnalysis, Data Cleansing, Requirements gathering, Business Analysis, Entity Relationship diagrams (ERD), Architectural design docs, Functional and Technical design docs, and Process Flow diagrams.
• Provide Efforts Estimate and coordinated the test schedule using Agile testing methodology in UAT phase.
• Involved with data profiling for multiple sources and answered complex business questions by providing data to business users.

Environment: Oracle11g, DB2, Erwin9.5, Teradata, SQL, Business Objects,HIPAA ANSI X12, HL7, AGILE, Waterfall,HealthcarePayer, CPT and ICD-9 Coding, MS Excel, UNIX, Oracle PL/SQL, PPT, DataMining, HTML, TOAD, MS Office Visio, TableauDesktop 9.1, 9.0, 8.1, 8.0, Tableauserver, Informatica.

Confidential, Springfield, IL

Business Analyst

Responsibilities:

• Gathered and translated business requirements into detailed, production-level technical specifications, new features, and enhancements to existing technical business functionality.
• Designed, developed, maintained, and evaluated statistical and predictive models to identify historical trends and forecast future patterns and other performance measures usingSAS.
• Involved in defining the source to target data mappings, business rules, and business and data definitions.
• Extensively used star and snowflake schema methodologies in creating dimensional models.
• Worked onMedicareAdvantage(Confidential),MedicarePart D (Confidential), Medicaid Options (Under 65 and Over 65) and Managed Care (Care, Disease and Case Management and in Insurance regulations and Claims Processing and claim scrubbing in HMO, PPO,Medicare,and Medicaid.
• AnalyzedStateMedicaidpaymentsystems requirements and worked with development team to implement regulatory changes intopaymentsystems.
• Provided advanced analytical support for business operations in all or some of the following areas.
• Participated in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claim payment information system in conjunction withhealthplan.
• Interacted as BSA to analyze and configureHealthCareReform system applications in current NAVIbusinessand systems.
• Conducted JAD sessions withbusinessstakeholder.
• Assuring timely compliance with regulatory andbusinessneeds as theMedicareAdvantageenrollment subject matter expert.
• Started Requirement Analysis and reportdecompositionfor all their key reports which will help them captureall the keydataattributes and map.
• CreatedSASmacros from scratch to automate periodicdatarequests and reporting metrics.
• Designed database solution for applications, including all required database design components and artifacts.
• Provided input into database systems optimization for performance efficiency and worked on full lifecycle of data modeling (logical - physical - deployment)
• Maintained data in the database with consistency and integrity.Involved with data cleansing/scrubbing and validation.
• Involved in dataprofiling and data cleansingto eliminate dataredundancy and enhance performance of the database.
• Used Forward engineering to develop sound Physical Data Model by implementing referential integrity, database rules, super types, and sub types.
• createdSAS datasets, mergeSASdatasets and run statistical procedures to understand the procedural cost differences.
• Create innovative executive dashboards, scorecards, and weekly/monthly reports on the status of keybusinessmeasurements using Tableau features such as such as parameters, sets, calculated fields and table calculations, user filters, action filters and applying advanced technical charts.
• Handle portfolio steering committee meeting and monitor performance of portfolio companies to anticipate necessary adjustments to strategies.
• Analyzed BusinessRequirements and translate them into HP Project and Portfolio Management (HP PPM) functional requirements.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277(X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Deep understanding of healthcare/payor data, subject areas, and source systems profiling and mapping from source to target data environment. Developed working documents to support findings and assign specific tasks.
• Involved with data profiling for multiple sources and answered complex business questions by providing data to business users.
• Created Automation process to create the table withDatausingTeradata, Unix.
• Worked onTeradataUtilities like Fast load, Multiload and Fast Export.

Environment: Oracle11g, DB2, Erwin9.5, Teradata, SQL, Business Objects,HIPAA ANSI X12, HL7, AGILE, Waterfall,HealthcarePayor, CPT and ICD-9 Coding, MS Excel, UNIX, Oracle PL/SQL, DataMining, HTML, TOAD, MS Office Visio, TableauDesktop 9.1, 9.0, 8.1, 8.0, Tableauserver, Informatica.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Involved in extraction, transformation and loading ofdatadirectly from different source systems like flat files, Excel, Oracle, andTeradataDatabases.
• Analyzed business data for all regions of the province, report sales, PPT production using EXCEL (Pivot tables, VLOOKUP, other calculation formula, etc), PowerPoint.
• Created Reports using Claims Data at Member, Provider and Facility Level
• Performed in depth analysis indata& prepared weekly, biweekly, monthly reports by using, MS Excel, MS Access, SQL, and UNIX.
• Assisted in the planning, analysis, design, implementation, and/or maintenance of operational analyticdatasources, reports, and tools.
• Developed key performance indices and designed operational control dashboards using SQL and Tableau to provideoperationteam members with real-time actionabledata.
• Analyzed the optimal warehouse design, work measurement, material handling applications,dataanalysis, operations planning and improvements.
• Used python packages (Pandas, Numpy, Scikit learn) for feature engineering and machine learning models.
• Used machine learning algorithms (Logistic regression as Baseline Model) to analyze the user demographics and trends.
• Reviewed payer reports and identify trends across contracts, patient populations, practices, and physicians.
• Maintained all tables in the System, i.e., procedure charge-map, procedure name, payer, and cost, when requested.
• Extensive business understanding of the healthcare payer.
• Performed HIPAA Analysis and Testing on 4010/5010, including Claim’s handling, with Payer and Provider experience and EDI file generation and testing.
• Created and updateddatamapping document(s) with reference to the source for 270/271 (Eligibility & Benefit Inquiry & Response), 276/277 (Claim Status Inquiry & Response) and 837 (Health Care Claim).
• Helped streamline the 276/277 transaction to enable easier and faster exchange of information between the payer and the provider.
• Reviewed all payer contracts resulting in appropriate reimbursement and data integrity.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Followed AGILE methodology and created User Stories, assisted the business analyst in creating Product backlog, sprints and sprint backlog.
• Assisted in the meetings with the technical team as well as the clients regularly to assess the current process and how it could be changed in making a better proposed process.
• Worked on EDI 834 mapping from X12 to XML.
• Worked on member enrollment processing and member enrollment module.
• Worked with FACETS team for HIPAA Claims validation and verification process (Pre-Adjudication).
• Involved in testing the Scripts for report development, Tableau reports, Dashboards, Scorecards and handled the performance issues effectively.
• Employ subject-matter expertise inhealthsystemassessment anddataanalysis to advise senior leadership on the development and implementation of administrative andhealthinformation technology systems.
• Worked on EDI transactions: 270, 271, 834, 820, 835, and 837 (P.I.D) to identify keydataset elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting relatedbusinessprocesses.
• Contributed to the development of project plans, scope statements, and communication plans.
• Identified entities and attributes and developed conceptual, logical, and physical models using Erwin.
• Generated comprehensive analytical reports by running SQL queries against current databases to conduct data analysis.
• Writing Complex SQL queries in Teradata to pull the records with data issues reported by the users using complex joins, partitions, ordered analytical functions, aggregate functions etc.
• Lead problem solving and coordination efforts between Corporate andHealthPlanstaff to correct various issues including claims pending.
• Implementation of Agile Framework (SDLC) using Scrum methodology in Payer domain.
• Extensively usedSSIStransformations such as Derived column,Dataconversion, SQL task, Script task and Send Mail task,DataFlow task etc.

Environment: Oracle 11g, SQL, Erwin, Teradata, PPT, Oracle PL/SQL, FAST EXPORT, UNIX Shell Scripts, Business Objects, SAS/GRAPH, OLAP, Python, SQL Server 2005/2008/2012, SQL, Tableau, MVS, HTML, MS Excel, Agile methodology, SQL, TOAD, Visio, SQL-Loader, MS office.

Confidential, Northbrook, IL

Data Analyst

Responsibilities:

• Deduced & formalize Functional Requirements from business and design specifications.
• Analyzed payer/submitter specific 4010 claim editing to migrate it to 5010 claim editing system Identify and document transition issues from 4010 to 5010 format.
• Used Agile methodology supported the Compass system that manages budgets during the bidding and contract management project for Clinical Research studies.
• Worked on HL7 including complete lifecycle of interoperability specification (Deployment, Adoption, utilization, Adherence etc.), clinical decision support, exchange of clinical documents.
• Understood existing data model and documented suspected design affecting the performance of the system.
• Authored Enterprise technology standards specifically Data Information Architecture, ETL implementation as well as Data Modeling standards.
• Ensured that the claims processing is strictly under the HIPAA compliance regulatory document to safeguard patient information.
• Created/EnhancedTeradataStored Procedures to generate automated testing SQLs between Source and Target.
• Involved in modeling (Star Schema methodologies) in building and designing the logical data model into Dimensional Models.
• Created views in TableauDesktop (Tree maps, Heat Maps, Scatter plot). And, created Context Filters, quick filters, table calculations, calculated measures, and parameters.
• Created test data for EDI 837I, 837D, 837P to have Segments/loops information with different combination of Submitter, Receiver, Billing Provider, Pay-To- Provider, Subscriber, Payer, Patient, Claim Information, Physicians, Referring Provider, Service Line Info, Adjudication Information
• Developdataprofiling solutions, run analysis jobs, and view results in the form of reports generated by Information Analyzer tool or Podium.
• Testeddatato check HIPAA- eligible & participation check for individual coverage.
• Profiledatain IBM Info Analyzer or Podium using rules based on HIPPA standards and categorize them into PHI, PII, PCI categories
• Automated the template creation process using IA report and categorization ofdataas per HIPAA rules by developing macros.
• Worked on building sensitivedatarepository and eventually build aDataLineage for the identified sensitivedataelements.
• Identified different or inconsistent standards in structure, format, or values - Missingdata, default values - Spelling errors,datain wrong fields - buried information in free-form fields.
• Created FRDs, User Stories and Data Remediation documentation including flowcharts using MS Visio.
• Deep understanding of healthcare / payer data, subject areas, and source systems.
• Created SSRS report which shows current running SQL job health (Running time, pass/fail status, number of records processed).
• Applied my expertise inETLconcepts/methodologies in buildingETLsolutions.
• Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.
• Created Dashboards using calculations, parameters, calculated fields, groups, sets and hierarchies in Tableau.
• Developing Tableau interactive dashboards to monitor KPIs related to Overages, Shortages and Damages etc.
• Performed GAP Analysis involving thehealthplans.
• Maintained quality levels with the use of agile development practices such as automated testing, continuous integration, and refactoring, in addition to regression testing.
• Created entity / process association matrices, entity-relationship diagrams, functional decomposition diagrams and data flow diagrams.
• CreatedDataQuality Scripts using SQL and Hive to validate successfuldataload and quality of thedata. Created various types ofdatavisualizations usingPythonand Tableau.
• Performeddataanalysis on daily, weekly, and monthly basis to ensure that the developed dashboards are up to date live and sent those into production.
• Co-ordinate with documenting processes used agile methodology to write the Business Requirements documents and designed Functional specifications.
• Responsible for working closely with program lead to perform complex business and/or systems process analysis, design, implementation,operationand/or monitoring.
• Expertise in creating databases, users, tables, triggers, macros, views, joins and hash indexes inTeradatadatabase.

Environment: IBM DB2, SQL Server, Tableau, Oracle 10g, Oracle PL/SQL, SQL, Teradata, MS Excel, UNIX, OLAP, Erwin, Business Objects, Visio, Informatica.