SUMMARY

• Highly motivated and result oriented with over 7+ years of industry experience as Business System Analyst/ Data Analyst / Facets Analyst in Healthcare Industry.
• Excellent in Developing and evaluating business process Models.
• Proven success as a business system analyst through the years, providing a well - balanced understanding of business relationships, business requirements, functional requirements and technical solutions.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Experience with FACETS Health Plan Software Experience in the areas of Product benefit component configuration, Enrollment, Enrollment Pre-processing (834 & proprietary enrollment file mapping, Business rules design & Enrollment Keyword creation), MMS Batch processing, Provider, 837 Claims processing, Utilization Management, Member Subscriber processing, Provider, Accumulators, NetworX Pricer, Integration & interfaces to third party systems. Extensive experience with the Trizetto FACETS Data models. Extensive experience on (full project lifecycle) Facets implementation & conversion projects. Facets Upgrade Program and Project Manager. Full Software Development Lifecycle project experience. Managing Teams ranging from four to thirty one individuals located in multiple locations. Excellent communication, presentation and customer facing skills.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as 837 for submitting claims, 835 for payments, 834 for benefit enrolment, and 820 for premium payments to insurance products, 270, 271 for healthcare benefits and eligibility, 276, 277 for claims status and 278 for transmitting health care service information.
• Experience in working with QA team to develop the Test plans, Test scenarios, Test procedures, and Test cases to ensure adequate testing of software both before and after completion
• Worked on various EDI X12 transaction sets 837 I/P, 275/276, 270/271, 834 etc
• Proficient in Requirement Analysis - conducting Stakeholder interviews & JAD sessions, understanding Business Process(As is and to be) & Business Rules, creating Flow charts, Data Flow diagrams, Use Case diagrams, ERD, State transition diagrams.
• Extensive experience in Analysis, Implementation of Healthcare Application using Facets.
• Extensive knowledge of Facets Billing, Enrolment and Claims processing.
• Proficient skill in risk analysis, quality assurance plans, requirements documents, hardware/software specifications, Design Qualification (DQ), installation qualification (IQ), operational qualification (OQ), Process Qualification (PQ) and final report writing.
• Expertise in GUI testing, functional testing, performance testing, UAT, unit testing, integration testing with the extensive knowledge of smoke testing, volume testing and stress/ load testing.
• Solid understanding of Business Process definition, Risk Analysis and SDLC methodologies.
• Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
• Proficient in the implementation of productionchange managementtechniques and service delivery disciplines
• Extensive experience in translating business requirements and user expectations into detailed specifications by using various Text formats & Unified Modeling Language (UML).
• Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
• Experience in dealing with different data sources ranging from Flat files, Oracle, Sybase, SQL server, Teradata, Ms Access and Excel.
• Experienced with Data warehousing for Data Profiling to examine the data available in an existing database.
• Professional experience in business analysis, operations management and development, design, documentation and testing.
• Extensive experience in reviewing and understanding of Business & Testing requirements and writing detailed Test Plans, Test Cases, and Test Scripts.
• Experience in implementing Microsoft Office SharePoint 2007 and 2010.
• Advised management on improvement strategies, Competitive & Profitability Analysis.
• Excellent in Business proposal Risk Assessment. Highly effective management and organizational skills with ability to prioritize.
• Exposure to Client/Server, Web Application developmental tools and Software development and design.

TECHNICAL SKILLS

Programming Languages: C, C++, C#, VC++, VB, VB.NET, C#.NET, ASP.NET, Java, SQL, PLSQ

Development Methodologies: RUP, AGILE, Waterfall, ESDM, STV

Databases: MS-Access, MySQL, SQL Server, Oracle, Teradata, DB2, Sybase

Application Servers: IBM Websphere, ATG Dynamo, BEA WebLogic.

Internet: HTML, XML, VBScript, ASP, JavaScript, JSP, J2EE.

Automation Tools: MS Visio, Rational Rose, Rational ClearCase, Rational RequisiteProBug Tracking Tools Mercury TestDirector, Rational ClearQuest

Utility Tools: MS Office Suite, MS Project, TOAD, Adobe Photoshop

Reporting Tools: Crystal Reports, SQL Server Reports (SSRS)

Data warehousing Tools: Informatica, Business Objects, Cognos, Erwin

Testing Tools: Quick TestPro (QTP), TestDirector, WinRunner, LoadRunnerEducation MBA

PROFESSIONAL EXPERIENCE

Confidential, New York, NY

Facets Systems Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while gathering Functional Requirements.
• Extracted the Functional Requirements from the end users keeping in mind their need for the application and prepared Functional Requirement Documents (FRD).
• Performed the requirement analysis, impact analysis and documented the Analysis Result into mapping document.
• Used Facets Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrolment hence analysing and documenting related business processes.
• Work closely with Business Owners and Subject matter expert to outline Functional Requirements and Requirement Analysis.
• Facets Product Configuration of new products and components including research, testing and trouble shooting in Facets.
• Reviewed and analyzed data from various internal sources and Created STTM document.
• Identified gaps and performed gap analysis.
• Understand the flow of data, Reviewed and analyzed data from various sources.
• Conducting session with developing teams for the coding of functional requirement for projects.
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Studied previously created mapping document and updating them according to the new requirement.
• Creating the testing scenarios, Queries, and test the different individual field. Related with the OBAMACARE health plan.
• Work with developing team to solve the defects generated by the Testing team.
• Uploading and Modifying document on SharePoint Site.

Environment: Windows Vista, Toad-11,Toad-Data Modeler, HP Quality Center, MS Excel, MS Word, Visio, MS Power Point, SQL, SharePoint 2010, Data stage 8.1, Ms Visual Studio .

Confidential, Southfield, MI

Business/Data Analyst

Responsibilities:

• Interaction with operational staff at all levels in gathering business requirements relating to application design.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Wrote Test scenarios and test cases for testing the migration of EDI and the processing of member enrollment and benefits, batch jobs corresponding to the claims(837) and real time transactions like 270/271/276/277
• Interacted with Technical team in understanding Operational and Technical functions of the existing Payment Engine.
• Participated in Facets Table data modeling; planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• Gathered requirement for the Facets implementation and performed solution analysis.
• Designed and developed Use Case Diagrams for the Facets process modules.
• Worked with Data Warehouse in the development and execution of data conversion, data cleaning and standardization strategies and plans as several small tables are combined into one single data repository system MDM (Master Data Management).
• Substantial report development experience utilizing SQL Server Reporting Services (SSRS), Cognos Impromptu, and Microsoft Excel
• Create and maintain data model/architecture standards, including master data management (MDM)
• Deployed Business Intelligence solution using Business Objects to ensure proper delivery of information to the users and Oracle Projects Suite for proper Project Management.
• Validated the test data in DB2 tables on Mainframes and on Teradata using SQL queries.
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data migration in to the CI System Knowledge Data Base in Microsoft SharePoint Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams using UML.
• Created Graphical representation of reports such as Bar charts, Pie charts etc as per the End user requirements using Business Objects and Crystal reports.
• Designed, developed and tested data mart prototype (SQL 2005), ETL process (SSIS) and OLAP cube (SSAS) for Computer Maintenance Management System (CMMS)
• Created DTS and SSIS Packages to vendors in which records were loaded Daily, also to other data resources such as Excel, Access, flat file, and XML in order to Create and maintain a centralized data warehouse.
• Developed application using Visual Basic and wrote reports using Crystal Reports and MS Access.
• 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.
• Responsible to import the data from Crystal reports by using Business Objects Live office into Microsoft Excel and Word.
• Configured the Data mapping between Oracle and SQL Server 2005.
• Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835)
• Created DTS Packages for migration of data between MS SQL Server database and other databases like MS Access, MS Excel and Flat Files.
• Performedcustomerdataanalysis, toextract, transform and load datato the customerdataWarehousingsystem.
• 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.
• Dealt with data mapping issues between various source systems and staging area and data-marts.
• Involved in coordinating with the database design team, using SQL to Query databases and providing inputs in finalizing the data model, report layouts.
• Analyzing the ETL process created in Informatica, developed SQL queries and tables which replicated the ETL, and compared the SQL results with the Informatica tables.
• Developed the ETL Informatica Mappings for importing data from ODS into subsequent data marts.
• Develop, build and manage Reporting Services (SSRS) reports using both SSAS cube and relational database sources including distribution of reports using subscription services

Environment: Windows 2000/XP, Microsoft Office SharePoint 2007, JAVA/J2EE, Rational Requisite Pro, MS Office, SQL Server, Agile, WebSphere, MS Project, SSRS, Cognos, Crystal Reports, UML

Confidential, North Richland Hills, TX

Business/Data Analyst

Responsibilities:

• Interviewed Business Users to gather Requirements and analysed the feasibility of their needs by coordinating with the project manager and technical lead.
• Prepared Source to Target Master Mapping Document which identifies the services consumed by Web from Amdocs Billing system
• Utilized corporation developed Agile SDLC methodology. Used ScrumWork Pro and Microsoft Office software to perform required job functions.
• Conducted UAT (User Acceptance Testing) to make sure that all the user requirements are catered by the application.
• Used Microstrategy dashboards for data analysis and custom reports.
• Analyzed systems requirements and systems architecture /design.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Prepared the SRS for the project with approved version
• Design, development, implementation and roll-out of Microstrategy Business Intelligence applications
• Responsible for cost estimation and timelines for various Business Intelligence reports
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Designed, developed, and maintained various Business unit reports by using Teradata, SQL, and Ms Excel.
• Created Teradata SQL Assistant scripts, Temp tables to be compatible for the monthly segmentation and migrated tables.
• Developed complex stored procedure using T-SQL to generate Ad hoc reports using Business object and SSRS
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Performed numerous Ad-hoc requests, financial reports involving SQL scripts, UNIX, SAS and Teradata.
• Developed Report Models, Ad hoc reports and distributed reports in multiple formats using SQL Server Reporting Services (SSRS) in Business intelligence development studio (BIDS).
• Responsible for updating and maintaining the Share Point Documents, Issues and Action Items

Environment: Microsoft Office Suite, Microsoft Visio, Windows NT/XP, SSRS, OLAP, OBIEE, UNIX, Oracle, SQL, SQL Server 2008, Sybase

Confidential, Towson, MD

Data Analyst

Responsibilities:

• Worked with multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, Data Stage, Data Warehousing, Websphere and Cognos.
• Worked in mainframe environment and used SQL to query various reporting databases.
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models.
• Worked closely with the Enterprise Data Warehouse (EDW) team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
• Used Microsoft SharePoints to create sites to support specific Content Management, Records Management, and/or Business Intelligence Needs.
• Extracted data from disparate sources by SAS/ACCESS.
• Involved in Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Data dictionary are also considered essential components of a data warehousingsystem.
• Initiated multiple projects that focused on Data Warehousing and financials.
• Developed schemas for extraction, transaction, and loading (ETL) using Solonde Warehouse Workbench to expedite data integration between systems.
• Responsible for executing User Interface Testing, System Testing, Data Quality Testing on the configuration design and prototypes.
• Analysed the existing as-is system for Insurance Personal Lines, tracked defects, provided recommendations to make enhancements in the future to-be system.
• Developed a file of ACORD Forms used as the standards in all Property and Casualty markets, for both Personal and Commercial Lines of Business.
• Created various reports such as ad-hoc reports, drill-down, drill-through, and parameterized reports using Reporting Services (SSRS) for internal teams.
• Prepared the Functional and Technical specification documents for transforming the Policy administration application from old legacy mainframe Vantage to Navisys system using the Textpad Macro's and UNIX scripts.
• Participated as a core team member of a Clinical Development initiative to create an architectural business end-to-end solution for clinical trials as a standard for all remote data capturing clinical trials.
• Mapped process flow; assess as-is processes through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Analyzed the data collected and process maps to determine the root causes and identify opportunities.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Worked with the QA team in testing the upgraded system for data retrieval, using complex SQL queries.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Used Informatica to extract and transform data from various DB2 database to the data warehouse.
• Wrote test cases and test scripts for the User Acceptance Testing
• Worked on Master Data Management (MDM) for maintaining the customer information and also for the ETL rules to be applied.
• Incorporated Rational Unified Process (RUP) to create Requirement Document Specifications using Visible Analyst.
• Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
• Used Rational Clear case for version control

Environment: Windows XP Professional, Oracle9i, MS Acces, SAS, JAVA/J2EE, RUP, Oracle, UML, Rational Rose, Requisite Pro, Clear Case 2002, WebSphere, Rational Clear Quest 2002, MS Office suite, MS Visio 2003.

Confidential, NY

Business/Systems Analyst

Responsibilities:

• Created detailed Use Case documents, Business Requirement Document, Functional Requirement Documents (FRD) and other business documents necessary for the development team and their better understanding of project milestones.
• Facilitated and managed meeting sessions with committee of SMEs from various business areas of Mortgage.
• Conducted JAD sessions with stakeholders, management and LPS technical team to determine the scope, processes and requirements of the project
• Primary duties included analyzing existing Client Server Empower platform and work towards making it better and robust.
• Assisted Project manager in establishing project methodology, estimating resource needs, handling conflicts with finances and deadlines and presenting propositions to project sponsors.
• Involved in Client and user group interaction, Design and Specification development based on discussions with various users from different departments and studying the existing system.
• Developed script to perform Data validation on Account level by using Teradata SQL Assistant, SQL scripts.
• Exposed to and worked with Subject Matter Experts in Fixed Income Annuities, Equities, Swaps, Finance, Trading Cycle, Portfolio Analysis & Management, Asset Management, Bonds and Bond Trading Cycle, Pricing, Derivatives.
• Worked on compliance related regulatory issues.
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
• Modifying existing reporting procedures to eliminate dependence on current Client Server Empower systems thus making reporting error free and accurate. It involved migrating existing processes from Client Server Empower systems to Empower.net systems.
• Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
• Preparing for conducted User Acceptance Testing (UAT) before Empower.net can be released.
• Designed, developed, and maintained various Business unit reports by using Teradata, SQL, and Ms Excel.
• Extract data from Teradata, Excel and flat files into SAS Datasets.
• Worked closely with the technical and QA teams during all phases of the project starting from inception to transition.

Environment: Microsoft Office Suite, Casewise modeler, Borland Caliber RM, Unix, Documentum, Windows NT/XP, Oracle, SQL, SQL Server, Sybase, VBScript, C#. DOORS, C++, NET, ASP.NET, Business Objects, Test Director, Load Runner