Summary:

• 7 years of Industry experience as a Data Analyst with Master Data Management MDM solid experience in Information Technology with expertise in data warehouse design, development, implementation and maintenance. Worked extensively with Microsoft Excel Macros, VLOOKUPS, and Pivot Tables . Proficient Microsoft Word, Power Point, Access and Lotus Notes.
• Understanding the full healthcare lifecycle including all payers and end to end revenue flow within the industry
• Knowledge in the ETL Extract, Transform and Load of data into a data ware house/date mart and Business Intelligence BI tools like Business Objects Modules Reporter, Supervisor, Designer, and Web Intelligence
• Efficient in elicitation techniques like interviewing, questionnaires, brainstorming, focus groups and cost/benefit analysis.
• Having experience in data modeling tools such as Informatica Data Explorer IDE and data quality tools such as Informatica Data Quality IDQ
• Extensive experience working in back end tester by writing SQL Queries and PL/SQL scripts on large data warehouse systems involving Terabytes worth of data.
• Extensive experience with Medicare/Medicaid processing as well as the Claims/Billing.
• Strong hands on ability to use SQL in RDBMS SQL Server, Oracle for verifying source data preparation and assisting of data design input and trouble-shooting.Strong knowledge of Business Intelligence, Data Warehousing and Business Architecture
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from a Operational Data Store to a Enterprise Data Warehouse
• Conducted JAD sessions with CRMs SME, system Architectures, Technical teams and other stakeholders for open and pending issues Highly expert in developing and implementing web-based applications with C and MS Visual Studio .NET.
• Extensively worked on Dimensional modeling, Data cleansing and Data Staging of operational sources using ETL processes
• Excellent Knowledge in Electronic Medical Record EMR / Electronic Health Records EHR modules and process flow.
• Designed and implemented stored procedures, views and triggers for automating tasks in TSQL
• Extensive Data Warehousing experience using Informatica as ETL tool on various data bases like Oracle, SQL Server, TeraData, MS Access.
• Knowledge of software Development life cycle SDLC and a thorough understanding of its phases like Requirements, Analysis/ Design, Development and Testing. In depth knowledge of RUP's Iterative Software Development Life Cycle process i.e. Inception, Elaboration, Construction and transition.
• Proficient in Technical and Business Writing, Business Process Flow, Business Process Modeling, Business Analysis and Testing various complex data driven methodologies for commercial lines integration with Documentum.
• Extensive experience with the SAS programming and in data step and with various SAS Procedures in Base SAS and SAS/Stat, including thorough knowledge of SAS Macro.
• Expertise in Project Management i.e. Project Scoping, Planning, Estimating, Scheduling, Organizing, Directing, Controlling, Budgeting and Drafting Remedy Procedures
• Extensive experience with Data Analysis on Data warehouse system for various reporting systems within an organization.
• Design and review of various documents including the Software Requirement Specifications SRS , Business requirements document BRD , Use Case Specifications, Functional Specifications FSD , Systems Design Specification SDS , Requirement Traceability Matrix RTM and testing documents
• Experience working with the medical claims and ICD9 HEALTH EVENTS code that was feed to the PHR PERSONAL HEALTH REOCRD application
• Well versed with ICD-9, ICD-10, HL-7, HIPAA, EDI Electronic data interchange Transaction, Medicare Medicaid, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions
• Expertise in Functional Decomposition, Business Requirement gathering, Process Analysis, Business Analysis, Functional design and documentation FDD , Gap analysis, Use case analysis and design.
• Expertise in the area of Requirements Gathering, designing and drafting Requirement Traceability Matrix RTM , requirement planning and analysis Functional, User and Design requirement specification FRS, URS, DS , performing Gap analysis, Process Analysis, Prototype design, designing and analysis of Use Case Scenarios.
• Extensively used IBM Rational RequisitePro for Requirements Management, writing Use Cases and Requirements Traceability.
• Proficient in developing UAT plans, UAT cases, UAT scripts and executing UAT.
• Well versed in writing queries/Scripts for Data Analysis and QA reporting and testing
• Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, and Leadership Qualities

Technical Skills:

Professional Experience:

Sr.Data Analyst

Responsible for systems and applications start-up of FCHP a hospital-based community health plan payer . Responsible for the Claims Adjudication System Managed Care application training for all departments administration of control files, formulary, provider demographic, provider payment, enrolee maintenance, benefit configuration Claims Systems Processing, fee schedules, capitation schedules, data warehouse, on-line pharmacy over 200 pharmacies claim and benefit troubleshooting, ID cards, and system generated Plan correspondence design and maintenance.

Role Achievements:

• Responsibilities include gathering business requirements, developing strategy for data cleansing and data migration, writing functional and technical specifications, creating source to target mapping, designing data profiling and data validation jobs in DataStage, and creating ETL jobs in DataStage.
• Have considerable expertise in Data Analysis, Data Profiling Quality, Data Governance and Master Data management MDM .
• Conducted knowledge sharing sessions on Business Process Modeling Notation and Healthcare Payer business for team members.
• Performed claims Processing and Billing is done through PBM Health Trans and Claims Accumulation and Adjudication is done through Diamond
• Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Working on Membership Datawarehouse MDW including the areas like Members, Benefits, Products, Groups, etc as Database Analyst and Business Systems Analyst, and same also for Enterprise Datawarehouse EDW .
• Responsible for the development and implementation of enterprise data warehouse EDW with emphasis on data warehousing, OLAP, star schemas or reporting cubes for reporting and data analysis
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
• 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
• Interacted with the users and logged any defects, enhancements from the UAT and communicated them to the development team
• Design and develop the data load process using Informatica PowerCenter and XML Style sheets and ACORD XML.
• Involved in Administration, Database Design, Performance Analysis, and Production Support for Large VLDB and Complex Databases up to 1 Terabytes.
• Worked on EDI transaction 835 and 837 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• Created and maintained Data Dictionary and DB Schema for the database. Helped in standardization of naming convention, development of system inventory, source system metadata and DBMS metadata.
• Senior level SQL query skills Oracle and TSQL in analyzing and validating SSIS ETL database data ware house processes.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros
• Created Business Requirement Document BRD , Functional Requirement Specification FRS document, User Requirement Specification URS and Change Request CR document for system application development
• Lead multiple project teams of technical professionals through all phases of the SDLC using technologies including Oracle, Erwin, DataStage, Data Warehousing, Websphere and Cognos.
• 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.
• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle. Worked with ODS and OLAP system.
• Created a test plan and a test suite to validate the data extraction, data transformation and data load and used SQL and Microsoft Excel..
• Validated the test data in DB2 tables on Mainframes and on Teradata using SQL queries.
• 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.
• Experience with designing and verifying databases on Oracle and SQL Server RDBMS using Entity-Relationship Diagrams ERD .
• Performed the Analysis Design workflow for various processes by following the Rational Unified Process RUP to document Use Cases.
• Conducted Joint Application Development JAD sessions with IT groups. Identified the Key Changes, and participated in Stakeholder Management to communicate effectively with them
• Conducted current state study which included data collection methodologies, data quality and data integration problems, data storage and infrastructure related issues.
• Designed and implemented basic SQL queries for QA Testing and Report / Data Validation.
• Documented business workflows textually as well as in UML diagrams State diagrams according to RUP, for the stakeholder review.
• Data conversion from other platforms to native database. Creating Customized modules or data maintenance.
• Conducted User Acceptance Testing, gathered and documented User Manuals and Business Rules

Confidential

Sr.Business /Data Analyst

Confidential Cancer center has integrated programs in cancer treatment, clinical trials, education programs and cancer prevention. A web based application, Know Chart navigator was created to provide online access to the components of disease management programs and staging process. This system recommended a treatment based on patient's staging information and then matched the patient with appropriate clinical trial as recommended by practice guidelines.

The goal of the project is to implement a clinical data repository a statistical computing environment. The repository will be used to store manage clinical data for Phase II III trials from the different data sources like Rave, Oracle Clinical, Watson LIMS, IVRS, etc. Business users of the project include statistical programmers, clinical scientists, and biostatisticians.

Responsibilities:

• Conducted Joint Application Development JAD and interview sessions to elicit requirements from the users and subject matter experts.
• Successfully designed and implemented statistical reporting processes for regular data collection and clinical data analysis. Analyzed safety and efficacy data from Phase II and III clinical trials.
• Integrate Data from wide range of sources including in-house clinical data management systems, labs and contract research organizations and perform data cleaning.
• Reviewed administrative and clinical practices and procedures: point of care, scheduling, registration, clinical documentation, patient care, and charge entry, medical coding and diagnostic testing procedures associated with multiple business units.
• Used senior level SQL query skills Oracle and TSQL in analyzing and validating SSIS ETL database data ware house processes
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Created Source to target data mapping documents identifying key data elements and prepared Data Flow Diagrams
• Created/Reviewed data flow diagram to illustrate where data originates and how data flows within the Enterprise Data warehouse EDW .
• Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
• Facilitated sessions with the senior management to identify business flows and determine whether any current or proposed systems are in compliance with HIPAA guidelines.
• Manage the vendor selection process via a formal RFP process
• Worked with the development team to ensure that they understand the functional specifications.
• Designed, authored, reviewed and revised Clinical Data Management Plans and Drug Safety Technical Reports are FDA 21 CFR Part 11 compliant
• Implemented Master Data Management MDM for all entities in the project by maintaining a master hub for improving the data quality by following various data governance techniques and data dictionary standards.
• Executed SQL queries using TOAD for Oracle dB and AQT for DB2 , for data extraction and validation
• Developed application using Visual Basic. Wrote reports using Crystal Reports and MS Access.
• Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
• Involved in the formulation of Business Requirements Document BRD after all business requirements were defined clearly.
• Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.
• Creating Dash Board using visual Basic and integrating with business objects
• Extensive use of Excel to create Functional Specification Documents Templates
• Writing functional and technical specifications, creating source to target mapping, designing data profiling and data validation jobs in DataStage, and creating ETL jobs in DataStage
• Responsible for delivery of all customers, shareholder and employee dash board metrics as per goals.
• Involved in Testing by using SQL and work with QA together to develop test Scenarios and test cases.
• Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
• Authored the product backlog for the complete project, derived User Stories for individual iterations, assigned tasks and allocated appropriate resources for completion and acceptance of individual stories
• Developed and maintained the project plan using MS Project
• After Executive confirmation did Gap analysis to assess needs that could not be met by core EHR.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile Unified Process, especially from the project management, requirements and architecture perspectives..
• Created customized report using OLAP Tools such as Crystal Reports for business use.
• Collaborated with the QA team in designing test plans and test cases for the User Acceptance Testing.
• Worked closely with the QA team and Developers to resolve issues.

Confidential

Data Analyst

Member of team that supports the financial portion of the claim payment System for the state of Texas Medicaid program. Facilitate meetings with state of Texas Medicaid representatives to determine requirements for changes to the financial portion of the claim system that pays over 100 million dollars a week in Medicaid claims. Also responsible for the successful implementation of an IBM mainframe state of Texas Medicaid Management Information System MMIS . Interfaced closely with the Texas executive Medicaid Management committee while defining system and reporting requirements.

Responsibilities:

• Implemented RUP and followed iterative, Use Case driven process for requirement documentation and deployment.
• Responsible for evaluating, configuring and testing healthcare claims payer system.
• Responsible for analyzing current claims payer system to improve current system.
• Created specifications for EDI HL7 A28, A31, ADT and X12 837/835 transactions that were transmitted between Claims Editor and Legacy Billing application and external Payers
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse
• Updated the functional design document for NPI related changes in the Encounters project.
• 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
• Developed SQL-based data warehouse environments and created multiple custom database applications for data archiving, analysis, and reporting purposes.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction. Populated ICD-9, NDC Disease code sets as per the standards. Experience with transaction sets 834, 835, 837, 270, 271, 276, 277 and 5010.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process
• Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements
• Extensively used ETL to load data from Oracle database, SQL Server, Flat files
• Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data
• Implemented Excel pivot tables for extraction of informative data from these databases using SAS excel plug-ins.
• Experience in data governance/ data stewardship business/systems analyst needed to work as part of a team on data governance and writing SQL queries
• Assist other project teams with data analysis, data mining and data profiling as needed.
• Worked on Performance, Tuning and loading data for fast access of reports in Client/Database. Server balancing, business Rules Implementation, MetaData, Data Profiling.
• Used Informatica to extract and transform data from various DB2 database to the data warehouse.
• The data needed to manage and grow the business is the focus of Master Data Management MDM .
• Met with various HMO, PPO, Medicaid/Medicare, and Tricare / Champus Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues
• Involved in analysing the claims on basis of Primary and Secondary Payers and performed Medicare subsidy eligibility check for employee group plans.
• Created the test data 837P, I, D and tested multiple fields for HIPAA validation and business edits.
• 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 Enrollment hence analyzing and documenting related business processes.
• Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
• Worked on 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.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases Test Scripts that are executed during testing process.
• Extensively worked on the ETL mappings, analysis and documentation of OLAP reports requirements
• Conversion of data from different database environments, while performing Back End Testing.
• Supervise and manage projects throughout SDLC to ensure that project management methodology based on RUP is followed during the project lifecycle using MS Project and NIKU Workbench.
• Responsible writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational and Mercury Interactive such as test Director, Winrunner.
• Trained new Business analysts about the system and the data model.

Confidential

Data Analyst

The Project deals with development of an online health information exchange HIE and a secure web portal to enable authorized providers to have fast and easy access to patient's electronic health record. The web portal features EMR functions and Integrated Clinical decision Support tools for better care management. The project dealt with development of a Health Care Cost Containment System and implementation of an automated inter-operable web application that tracks patient medical history and health care plans via Viewer application and Electronic health records Including the Medicare Part D pharmacy and Medicaid features The Viewer/EHR system provided online access to mobile patient records and improved communication in public health

Role Achievements:

• Elicited and gathered requirements using prototype design, interviews, document analysis, surveys, site visits, use cases, scenarios, business analysis, task analysis and workflow analysis for various maintenance and new applications.
• Develop implementation guidelines and principles for practice-based clinical applications, including various practice management and EMR systems
• Conducted knowledge sharing sessions on Business Process Modeling Notation and Healthcare Payer business for team members
• Involved in requirement gathering and testing of consumer web portal for the enrollment of Medicare members.
• Participated in Facets Table data modeling planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• Assisted others in defining technical solutions for projects utilizing the Oracle RDBMS.
• Completed project to gather data from physicians in order to update the EMR system and GE Centricity EMR system with the provider's specialties, addresses, National Provider Identification NPI number, and other pertinent information. Used that information to form HL7 interface with the Hospitals
• Worked with key members from various cross-functional teams to analyze various third-party CRM solutions to make a 'buy vs build' decision. Conducted cost/benefit and impact analysis.
• Develop and implement change control policies and procedures for EMR template change requests
• Facilitated review of Enrollment, Claims, Commissions, and membership portlets' designs with architects and developers to ensure that the goals of the portal requirements were satisfied
• Recorded retention stored in Knowledge Link. Ad Hoc reporting, Admin for MS Project, Excel dbase and pivot tables, Clarity and MS Project Server Admin duties
• Participated in an enterprise level Electronic Medical Records EMR system implementation.
• Designed Data Flow Diagrams DFD's , Entity Relationship Diagrams ERD's , and web page mock ups using modeling tools.
• Involved in making Use Case Diagrams, Activity Diagrams, and using analysis and design models tools like MS Visio, Rational Rose through RUP, Agile and Waterfall Model
• Involved in Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL
• Was responsible for sales and marketing specializing in practice management, managed care systems, thin-client technology, Electronic Media Records EMR/HER and full integration tools.
• Prepared a handbook of standards and Documented standards for Informatica code development.
• Involved in all phases of software development life cycle SDLC in RUP framework
• Used SAS for pre-processing data, SQL queries, and data analysis, generating reports, graphics and statistical analysis.
• Interacted with the users and logged any defects, enhancements from the UAT
• Developed SQL-based data warehouse environments and created multiple custom database applications for data archiving, analysis, and reporting purposes.
• Involved in performing defect tracking activities using Rational Clear-Quest.
• Facilitated meetings with business users to perform process modeling by re-engineering Using RUP and formalize and documenting business requirements Using UML
• Imported XML files with hierarchies are maintained under Hierarchy.
• Responsible for developed Use Case Diagrams, Activity Diagrams and Functional Diagrams using Visio.
• Conducted and was speaker for various internal trainings and discussion forums.
• Involved in regular reports, feedback, and communication with management coordinated team members and maintained the project presentation and documentation of the project.

Confidential

Data Analyst

GHI contracted with the Medicare Centers and Medicaid Services CMS to provide quick, easy, and affordable access to the health care service of their choice. Market Prominence is the only system that provides management with the ability to tailor each step of the regulatory process based on the health plan's interactions with each of its beneficiaries. Project involves integrating Market Prominence and the Claims processing System with the data warehouse to support the reporting requirements. My duties were included designing the model of ODS to automate and maintain the ETL process

Role Achievements:

• Designs and develops the logical and physical data models to support the Data Marts and the Data Warehouse
• Reviewed and streamlined existing CRM processes, information, and data requirements to ensure accurate adoption metrics reporting. Deactivated users to release licenses.
• Managed the privacy and security environments of healthcare data that was governed by HIPAA and other government mandates.
• Designed conceptual and logical data models of Data Warehouse and tables
• Acting as First point of Contact from the Wintel Services for the VMware and System Management Server Activities.
• Completed a thorough customer analysis and prepared a Request for proposal RFP document and got the shortlisted vendor document signed off
• Completed the documentation of Claims Scenario's for the source system
• Creation of Data Comparison Utilities and Excel Macros for IDW to Data Mart Comparisons
• Highly contributed to the enterprise metadata efforts by completing the data mapping repository DMR information.
• Good Knowledge of Relational Database Management System RDBMS
• Used MS Visio for Process modelling, Process mapping and Business Process flow diagrams.
• Designed and developed Use Cases using UML and Business Process Modelling.
• Involved in using maestro scheduler for running Informatica mappings.MDM strategy, architecture, and enabling technologies dealing with various aspects of customer data constitute
• Worked with data management and other groups to make sure that quality procedures are integrated into their work processes.
• Worked in all the different processes of Claims processing from Claim Online editing /processing /Adjudication /Payments system
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process
• Created SQL reports, data extraction and data loading scripts for different databases and Schemas.
• Used Microstrategy dashboards for data analysis and custom reports.
• Designed and Administered Teradata Scripts, Tables, Indices and Database Objects
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases Test Scripts that are executed during testing process.
• Worked in association with RUP mentors to ensure fidelity to the standard RUP practices of the institution.
• Performed backend testing using SQL queries and analyzed the server performance on UNIX..
• Using Shared Containers and creating reusable components for local and shared use in the ETL process.
• Prepared Logical Data Models that contains set of Entity Relationship Diagrams and Data Flow Diagrams and supporting documents and descriptions of the Relationships between the data elements to analyze and document the Business Data Requirements.
• Defined the duplication of data and columns between tables using TOAD and SQL.
• Verified the Business Scenarios on new builds to allow extended testing by the QA team.