SUMMARY:

• Qualified professional with 6+ years of extensive experience in the field of Healthcare Data Analyst working with the technical staff to implement management and staff's business requirements into the software application in Healthcare Industry. Analyst in Data warehousing, Business Intelligence (BI) Solutions design & development. Business Intelligence area dealing with data analysis, solution design metadata management and MDM.
• Extensive success in translating business requirements and user expectations into detailed specifications employing Unified Modeling Language (UML) in an SOA environment.
• Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Experience designing and developing SQL statements and queries for Oracle Sybase and SQL Server 2000 database.
• Experience in writing SQL queries and optimizing the queries in Sybase, Oracle and SQL Server 2000.
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans).
• Installation and Configuration of Informatica MDM Hub, Cleanse and Match Server, Informatica Power Center.
• Defining the Match and Merge Rules in the MDM Hub by creating Path components, Columns and rules. Implementing MDM solutions and real time enterprise application integration.
• Extensive experience in FACETS implementation and in-depth understanding of Trizetto/FACETS data model.
• Strong analytical, technical and problem resolution skills; good communication skills.
• Experience with Trizetto QNXT System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 834 and proprietary format files and Reports development.
• Hands on experience using Teradata utilities (SQL, BTEQ, FastLoad, MultiLoad, FastExport, TPump, TPT, Queryman, WinDDI).
• Experience in writing SQL queries and optimizing the queries in Sybase, Oracle and SQL Server 2000, 2008 r2.
• Rich Business domain expertise which includes Healthcare operations (HL7 protocol, Interfaces and Clinical Application messaging communication - Provider Domain), EHR implementation, ICD 9 to 10 migration and ITIL Service Management.
• Experience in Design and Implementation in Business Objects 4.0, XIR3/ XIR2/6.5, Web Intelligence, Oracle, SQL Server and DB2.
• Confidential BI technology (SSIS, SSRS, SSAS) dashboard design and implementation.
• Experience in Teradata Enterprise Data Warehouse (EDW) and Data Mart.
• Excellent Knowledge in Electronic Medical Record (EMR) / Electronic Health Records (EHR) modules and process flow.
• Worked on different EDI healthcare transactions like 837-Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions.
• Good knowledge on workflows in hospital environments
• Good Knowledge of various HL7 EMR systems.
• Worked as a Business Analyst and UAT Tester for ICD9 to ICD10 project on the Professional Claims side.
• Deep knowledge of PPACA rules surrounding the Enrolment and Eligibility piece.
• Strong knowledge on HL7 standards (v 2.5 through 2.7), HIPAA (Health information portability and accountability act), ICD-10 - International Statistical Classification of Diseases and Related Health Problems.
• Developed reports using SQL Server Reporting Services (SSRS).
• Worked extensively on creating reports using free form SQL queries in Microstrategy.
• Expertise in broad range of technologies, including business process tools such as Confidential Project, Primavera, Promodel, MS Excel, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and development.
• Proficient in developing Use Case Model, Analysis Model, Design Model, Implementation Model, Use Case Diagrams, Behavior Diagrams (Sequence diagrams, Collaboration diagrams, State chart diagrams, Activity diagrams), Class Diagrams based on UML using Rational Rose
• Worked extensively on user requirements gathering, gap analysis, and development of functional speculations for critical mission accomplishing projects.
• Experience in writing SQL queries and optimizing the queries in Sybase, Oracle and SQL Server 2000, 2008 r2, 2005.
• Proficient in Unit Test Plans (UTP), Integrated Test Plans (ITP) Extensive experience in User Acceptance Testing (UAT).
• Expertise in Logical Modeling, Physical Modeling, Dimensional Modeling, Star and Snow-Flake schema
• Provided technical and functional consulting to corporate and divisional users for Cognos.

TECHNICAL SKILLS:

• ERWIN
• ETL
• Ascential DataStage (7.x
• 6.x
• 5.x)
• Medicaid
• Medicare
• MMIS
• HIPAA
• ICD 9-10
• Star-Schema Modeling
• Snowflake Modeling
• FACT and dimension tables
• Erwin 4.0
• Business Objects
• Micro strategy
• SAS
• Macros
• Erwin 4.x
• C/C++
• Java SE 1.4
• HL7
• PPACA
• ANSI X12
• NCPDP
• TURBO PASCAL 7.0
• VB.Net
• HTML
• COBOL
• SQL Server
• SOA
• SAP SD
• MySQL
• Agile/Scrum
• Oracle 8i
• Facets
• Visio
• Sybase ASA (6 - 9).ASP/ASP.net
• PHP
• Microprocessors 8085 & 8086
• Unix
• MVS
• MS Windows/95/98/NT/2000/XP
• MS DOS
• MS Office 2000

PROFESSIONAL EXPERIENCE:

Confidential, San Diego, CA

Sr. Data Analyst

Responsibilities:

• Gathering and documenting the requirements in Requisite Pro those are critical to the business mission and using those requirements to design application software using a Use Case approach.
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
• Working with clients to better understand their needs and present solutions using structured SDLC approach.
• Implemented a MDM process to take strategy to roadmap and design development activities. Delivered MDM roadmap & MDM Architecture.
• Functioned as claims analyst with responsibilities that included all aspects of claims adjudication. Review and processed medical, dental and vision claims, oral and written communication with insureds and providers, claims audits and investigations, history updates, and special assignments as determined by the Claim Manager. Assisted in training and auditing of new claims personnel.
• Experienced in data integration, metadata management, ETL, data modeling tool sets.
• Developed plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Support the EDI team with 5010 Implementation which involved correcting setup issues within File Maintenance and EPM.
• Informatica MDM Hub 9.0 is used as the core MDM Hub.
• Worked on import and export of data from sources to Staging and Target using Teradata MLOAD, Fast Export, TPUMP and BTEQ.
• Analyze, and document business and functional requirements via uses cases for Medicare billing transaction-based middleware/database layers with SOA & XML.
• HL7 Analyst knowledgeable in using HL7 and XML in designing and documenting interface requirements.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. worked with data mapping team for ICD 9 to ICD10 for forward mapping of the diagnosis and procedure codes
• Analyzed the processes in medical coding and transition from ICD 9 to ICD 10.
• Created lists of ICD9 - ICD10 CM/PCS codes, with reference to the usage percentile and provided to Stakeholders to determine if codes were best-fit or all possibilities.
• Developed new mapping programs to convert NCPDP transactions into internal buffers for processing. New program replaced old RPG table driver.
• Populate MDM configuration tables through Management Agent & console process.
• Responsible for Installing, Mastering data with InfoSphere MDM Server.
• Coordinated all the Product upgrade activities from WCC7 to MDM10 and software upgrades (WAS, MQ, AIX, MDM, DB).
• Support and Maintenance for current HL7 users. Supported HL7 errors and messages provision.
• Review daily EDI transmission to ensure EDI is being sent and acknowledged successfully, if not then determine what is the issue and follow up to resolve.
• Senior level SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data ware house processes.
• Created Teradata Tables, Views and Stored Procedures for loading the data from Oracle to DW.
• Created OBIEE 10g Intelligent Dashboards, & Answers.
• Experienced in full life cycle MDM development including data analysis, database design, data mapping and data load in batch.
• Also support Extol Integrator EDI package and develop RPG/ILE interfaces for new trading partners.
• Using Latest HP Agile-Manager as SaaS based for organizing & planning Agile Project.
• Lead Agile-Scrum Daily Stand up meetings and attended requirements review meetings with business analysts, project manager and developers on end of day sprint.
• Responsible for architecting integrated HIPAA, Medicare solutions, Trizetto Facets.
• Validating the EDI 837 claim billing (professional, institutional and dental claims) & 835 (remittance advice or payment) claims adjudications.
• Developed test plans, created and managed test scripts for software development projects using HP Quality Center (QC).
• Edited claims through the electronic billing system to ensure that all errors are identified and resolved in a timely manner.
• Developed and modified ETL and MDM using Informatica Developer 9.5.
• Expertise in designing, developing, enhancing automated test scripts for Quick Test Professional (QTP) using VBScript.
• Extensively used SQL procedures in SAS for creating SAS datasets and generating reports using them when Teradata was offline for maintenance.
• Frequently used SAS to bulk load tables to Teradata and directed Implementation effort of Trizetto Facets 4.71.
• Participated in weekly client meetings and internal meetings to develop, design, test and implement HL7 interfaces.
• Instrumental in gathering client requirements, and documenting them; supporting and fine-tuning HL7 interfaces based on client input
• Helped in Development of test plans; wrote and executed test cases for HL7 Interfaces
• Conducted a requirements study for replacing their Order Entry and Billing applications including a review of their Customer Service operation, web sales, and other e-commerce needs.
• Participated in Trizetto Facets Table data modeling; planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• Prepared Business Context Diagram, Use Case diagrams and corresponding Activity Diagrams using Rational Rose to depict the workflows to be incorporated into the development of Pega Business Process Management (BPM) tool.
• Worked with developers and designers of BPM System to make sure development understands business process and detailed technical requirements.
• Used BEA (BPM Tool) to map Process flows and migrated Visio Process flows into BEA Tool.
• Set up conferences with clients and vendors to evaluate the specifications for any HL7 interfaces needed.
• Used the Unified Change Management (UCM) tool, Rational ClearQuest, to maintain and track the Stakeholders requested enhancements and changes.
• Experience with ANSI 5010 automated electronic billing. Which includes 270/271 Eligibility, 277ca Claim Acknowledgement, 835 remittance advice, and 837 File.
• Preparing BRD, Business Cases, and presentation to the clients, Business Re-engineering proposals.
• Documented, tabulated and reviewed methods of valuation in effect, using SQL (to continue working on prototype developed by self).
• Worked on Client/Server tools like SQL Server Management Studio to administer SQL Server.
• Conducted user interviews, gathered requirements and analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP.
• Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams so that developers and other stake holders can understand the business process by using UML.
• Develop migration plans to move Confidential Exchange accounts to our MDM enterprise server.
• Coordination with offshore team in the capacity of MDM lead was a major responsibility of the assignment.
• Spearheaded BI solutions development and implemented creative analytical solutions utilizing enterprise wide ETL and reporting strategy involving complex ETL, exceptions handling, compliance tracking and data reconciliation.
• Design and write code to enhance functionality and quality of HL7 interfaces.

Environment: Rational Unified Process (RUP), ETL,Informatica,JAVA,DB2,Business Intelligence, Office, MS Visio, PPACA, MMIS, Medicaid, MDM, MDMS, Medicare, Teradata 12.0/13.0, HIPAA,ICD 9-10,Test Director Quality Center (QC 9/10/11.50),HL7, QTP 11.5,NCPDP,MS Project, DB2, Trizetto Facets, SQL Server, PL/SQL, Oracle DB, Informatica, Agile, Rational Test Manager, Win Runner, Rational Clear Quest, HTML, XML, XSL.

Data Analyst

Responsibilities:

• Prepared Business Object / Business Process Models that included modeling of all the activities of business from conceptual to procedural level.
• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, ICD-9, ICD-10 coding.
• Conducted JAD Sessions periodically with various stakeholders at various phases of the Software Development Life Cycle (SDLC) to discuss open issues and resolve them.
• Proposed strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.Facilitate HIPAA integration and applied ANSI ASC X12 standards for 837 (P, I, D), 270/271, 276/277, 278, and 835 transactions.
• Promoted to Medicare-Medicaid Unit Lead, to assist staff with claim issues and training. Initiate payment audits when research indicates issues impacts multiple claims.
• Created ETL test data and tested all ETL mapping rules to the functionality of the Informatica mapping and Ab Initio graphs.
• Create Conceptual and Physical Data Models for the source system using Erwin 7.3.
• SQL Server migration from SQL 2005 to 2008 for all environments.
• Migrated several SQL Server 7.0, SQL Server 2000 databases to SQL Server 2005 and 2008.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System (MMIS) reports.
• Experienced in full life cycle MDM development including data analysis, database design, data mapping and data load in batch.
• Define downstream targets for MDM with design for attributes and sync methodologies.
• Gathered user requirements and directed developers for practical deliverables with also patient domain configuration to accept HL7 messages into MDM.
• POC for integration to IBM BPM server for workflow integration into MDM using v10.1 software.
• Evaluation and selection of various MDM technologies and products in view of the client requirements.
• Identification of Data Domains for MDM such as Patient, Organization and Physician etc.
• Performance Tuning the SQL for existing Informatica jobs and Teradata Utility Scripts that are running for long time.
• Conducted testing to confirm that HL7 messages from each application conform to the appropriate HL7 interface specification.
• Involved in designing and developing Data Models and Data Marts that support the Business Intelligence Data Warehouse.
• Met with relevant stakeholders to obtain EDI contacts for all vendors to communicate testing schedules and ensured project completion.
• Leaded the development of Business Requirements Documentation (BRD) for analysis related to the ICD-10 mandate.
• Maintained and troubleshot daily HL7 error logs by manually editing HL7 records when required.
• Designed and developed Sub-reports, Drill-down reports, Matrix and Summary reports in SSRS.
• Utilized SSRS 2008 through Visual Studio 2008 and interfaced to Oracle SAP database through a local Oracle client installation. Performed Oracle to Confidential SQL conversions using TOAD.
• Worked closely with testing team and helped in testing the Informatica mappings, workflows, AbInitio Graphs and Teradata scripts.
• Troubleshot SSIS packages, SSAS cubes and SSRS reports issues.
• Maintained MDM hierarchies and structures for Corporate and various business segments.
• Follow the modelling process to make changes to the Erwin models.
• Performed backend testing using SQL queries and analyzed the server performance on UNIX.
• Involved in generation and execution of SQL queries.
• Develop and maintain sales reporting using in MS Excel queries, SQL in Teradata, and MS Access. Produce performance reports and implement changes for improved reporting.
• Tailored product for each client providing customizations in data warehouse, ETL mappings, OBIEE Answers, Dashboards & BI Publisher.
• Collected and studied the Meta data about the master data for MDM and the transactional data.
• Created system DBA Stored procedures, triggers, queries.
• Implemented and delivered the MDMS Software (Meter Data Management Systems) to electric utilities.
• Maintained MDM hierarchies and structures for Corporate and various business segments.
• Integrate complex Medicaid principles and policies into the Medicaid Management Information System (MMIS), requiring knowledge in areas of health systems and Medicaid information processing.
• Used Object Manager to promote objects from Microstrategy development to QA & production environment.
• Loaded XML data into Teradata using XML import feature.
• Participated in Proof-of-Concept using IBM Info Sphere as a tool to move data between DB2 subsystems and between non-homogeneous RDBMS (DB2, Oracle and SQL Server).
• Troubleshoot and identifying errors with EDI ANSI-X12 837 Electronic claim file rejections from both Government (Medicare and Medicaid) and multiple Major Commercial Insurance payer sources.
• Handled the performance tune of SSIS packages and error output.
• Review and analyze data mapping document to determine ETL program design.
• Designed new database tables to meet business information needs. Designed Mapping document, which is a guideline to ETL Coding.
• Created SSIS Packages using Slow changing Dimensions, Pivot Transformation, Fuzzy Lookup, Derived Columns, Condition Split, Aggregate, Execute SQL Task, Data Flow Task, Execute Package Task for Each loop container, sequence container.
• Scheduled SSIS package jobs with SQL server agent.
• Created MicroStrategy Schema objects and Application objects using MicroStrategy Desktop and Architect.
• Gathered requirements and modeled the data warehouse and the underlying transactional database
• Identified/documented data sources and transformation rules required to populate and maintain data warehouse content.
• Performed GAP analysis to assess "AS IS" and "TO BE" scenarios between HIPAA 4010 and HIPAA 5010 and conversions of codes from ICD 9 to ICD 10.
• Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
• Review and analyze data mapping document to determine ETL program design.
• Designed new database tables to meet business information needs. Designed Mapping document, which is a guideline to ETL Coding.
• Configured the Data mapping between Oracle and SQL Server 2005.
• Created SAS programs that are used for data validation, statistical report generation and program validation and automated the Edit Check programs using Macros.
• Ensure current Edits and Audits are applicable for ICD 10 Diagnosis codes and ICD-10-Procedure Coding System (ICD-10-PCS) PCS Codes.
• Tested claims Edits and Audits to ensure that the system would recognize and accept the ICD-10 changes.
• Identify customer marketing opportunities by applying data mining models and writing advanced T-SQL stored procedures and queries.
• Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
• Participated in various Healthcare presales initiative for EHR applications, HIPAA 4010-HIPAA 5010 and ICD9 - ICD10 conversions.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment

Environment: UNIX, DB2 UDB, SQL, MDM,MS Power Point,HL7, Teradata, SQL Server, PPACA, Confidential BI(SSIS,SSRS,SSAS), ICD9-10, MMIS, Medicaid, Medicare, Teradata, MS Excel, ETL, HIPAA, NCPDP, ANXI, COGNOS, RUP, UML, SAS, Rational Rose, Oracle 10g, Testing Strategies.

Confidential, Austin, TX

Data Analyst

Responsibilities:

• Designed ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Performed In-Death analysis of systems and business processes of Medicare Part D as per CMS rules and procedures.
• Performed & demonstrated sample Static Report builds and provide visual capabilities of SSRS 2005 product.
• Involved in the development of SSIS Packages & SSRS reports using BIDS.
• Created and executed SQL Server Integration Service (SSIS) packages to populate data from the various data sources, created packages for different data loading operations for different applications.
• Created system DBA Stored procedures, triggers, queries.
• Participated on claims testing team to review benefit changes for accuracy and check various non-participating fee schedules.
• Built business requirements into the Medicare Advantage (MA) requirements database and created the Project Requirements Document for the three functional areas.
• Participated in SSIS and SSRS requirement gathering and analysis.
• Apply Teradata Fast Load utility to load large volumes of data into empty Teradata tables in the Datamart for the Initial Load
• Apply Teradata Fast Export utility to export large volumes of data from Teradata tables and views for processing and reporting needs.
• Developed dozens of complex SSIS and SSRS reports in SQL Server 2005 and 2008.
• Involved in defining the source to target ETL data mappings, business rules and data definitions.
• Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Reported and analyzed all application defects, user issues and resolution status to the higher manager using Mercury Test Director.
• Prepared Test plans which includes an introduction, various test strategies, test schedules, QA teams role, test deliverables, etc.
• Provided technical and functional consulting to corporate and divisional users for Cognos.
• Performed initial manual testing of the application as part of sanity testing
• 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.
• Designed and developed use cases, activity diagrams, and sequence diagrams using UML.
• Conducted Functional Walkthroughs, User Acceptance Testing (UAT), and supervised the development of User Manuals for customers.
• Established traceability matrix using Rational Requisite Pro to trace completeness of requirements in different SDLC stages.
• Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
• Used Query Analyzer, Execution Plan to optimize SQL Queries
• Conducted status report meetings with the business and the IT team on a weekly basis, as the most important aspect of the project is Data Mapping.
• Designed Physical Data Model using Erwin 4.1 for Projection and Actual database Worked with object modelers, worked with Business Analysts.
• Involved in defining the source to target ETL data mappings, business rules and data definitions.
• Performed extensive requirement analysis including data analysis and gap analysis.
• Worked on project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
• Created Error Files and Log Tables containing data with discrepancies to analyze and re-process the data.
• Developed business process models in RUP to document existing and future business processe.
• Troubleshot the designed jobs using the DataStage Debugger.

Environment: Confidential BI(SSIS,SSRS,SSAS),Director,Manager, Parallel Extender Debugger, ICD 9-10, EDI, HIPAA, MMIS, Medicaid, ETL, Teradata, DataStage BASIC language Expressions, SAP SD, SQL Server, Rational Test Manager, Data Stage, Rational Requisite Pro, Rational Clear Case, Erwin, Mercury TestDirector, Agile, Waterfall, MS Access, SDLC, RUP, UML, UAT, XML Files.

Healthcare Data Analyst

Responsibilities:

• Formulated procedures for data extraction, transformation and integration of health care data.
• Conducted assessment to ensure data quality and completeness with validation techniques.
• Assisted in designing and development of health related analytical products for overall enterprise.
• Provided assistance for quantitative data analysis with health care, biometric and survey data.
• Designed and developed continuous outcomes reporting for multiple intervention programs.
• Coordinated with technical teams for research and evaluation of healthcare and operational problem.
• Participated in critical review and revision of existing systems for updates and enhancements.
• Supported technical teams for development and execution of supplemental analytical tools and methods. Conducted independent statistical analysis, descriptive analysis, hypothesis testing and logistic regression.
• Provided assistance for health care projects through SAS statistical and analysis software tools.
• Assisted in development of data formatting and cleaning criteria from various data sources.
• Generated database reports, presentation and documentation of analytical methods.
• Performed ad hoc analysis of data sources for all external and internal customers.
• Coordinated with clients for management of data mining and recovery projects.
• Supported technical team members for technologies such as SSAS, Confidential Excel and SQL server.
• Participated in refinement and technical documentation of database reporting requirements.

Environment: Rational Enterprise Suite (Rose, ClearCase, ClearQuest), Python, RUP, Visual Basic, SQL, SQL Server, Oracle, DB2, CRM, Wintel, Unix, MS Visio, MS Office, LoadRunner, WinRunner, DOORS, Project Mgmt