SUMMARY

• IT specialist with over 10 years of result - driven professional experience in the Analysis, Design, Development, Testing, and Implementation of business application systems for Healthcare and Insurance sectors.
• Worked as System Analyst and Data Analyst in implementation teams for Transforming Business Requirements into Software Requirement Specification (SRS) using MS Office Suite, team foundation server. Also interpreted data from primary and secondary sources using statistical techniques and provided ongoing reports.
• Expertize in in Waterfall, Rational Unified Process (RUP), agile methodologies (SCRUM/ XP), Unified Modeling Language (UML) and Use Case Specification Documents (USD).
• Expert in Business Process Re-engineering/Re-modeling developing different SOPs for the each of the department, designing workflows, batch processing, creating business rules, communicated trade-off decisions on product, budget constraints, and customer requirements.
• Proficient in Manipulating, cleansing, processing, loading, extracting and validating client data using Excel, Access and SQL and also have Strong experience in Data Analysis, Data Profiling, Data Migration, Data Integration and Metadata Management Services.
• Talented with the data management policies, procedures and widespread technical tools with strong logical, assessment and interpretation skills
• Sound Proficiency in analyzing and Creating Use Cases, Use Case Diagrams, Activity diagrams, Class diagrams, Data Flow Diagrams, Business Flow Diagrams and Sequence diagrams using MS Visio and Rational Rose.
• Involved in QNXT configuration, Customization, reporting, analysis and enhancement. Extensively worked on EDI transaction like 837, 835,834, 820, 270, 271, 276, 277,278 and NCPDP.
• In depth knowledge of HIPAA 5010 transaction processing’s, ICD 10 compliance, HL7 messaging, NCPCDP claims, CMS compliance, Medicaid, Medicare, provider network management and provider directory.
• Excellent Team Player to work in conjunction with other testers, developers, PM and other team members for creating Project Plan, Charter, Schedule, validation, testing complex scenarios, requirement analysis, verification documents and in the maintenance of Quality standards in projects.
• Proficient in holding Joint Application developments (JAD), Joint Requirement Planning sessions (JRP), Interviews and workshops with end-user/clients/stake holders/SME’s .
• Extensive Knowledge in reviewing test procedures, extensively interacted with the QA Team in building the test plans, RFP, prototyping, screen mockups, providing test data, creating test cases, analyzing bugs, interacting with team members in fixing errors and also assisted in Post - Production support.
• Expertise in defining scope of projects based on gathered Business Requirements including documentation of constraints, assumptions, business impacts & project risks.
• Extensively interacted with both user group and development team in coming up with structured charts, PRD, work flow diagram, data models, class and sequence diagrams and proficiently worked on HP quality center for bugs and requirement tracking.
• Strong business acumen, strategic thinking, communication, interpersonal and presentation skills, adept at creating, editing, and coordinating extensive communication networks to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
• Expert in developing user manuals, presentations and training manuals as per project specifications and timelines and actively generates process improvements; supports and drives change.

TECHNICAL SKILLS

Tools: MS Office Suite (Excel, Word, PowerPoint, Access, Publisher, FrontPage, Outlook), MS Project, MS Share Point, MS Visio, Rational suite and Documentum, HP quality Center, Power Designer, ERWIN4.0, Informatica, SQL management studio, visual studio, visual source safe 6.0, Win Runner, Load Runner, Red Gate, Test Director, TOAD, QTP, Notepad++, Ultra edit, Visual Studio 2008 & 2010, Visual Source safe, Microsoft Team Foundation Server, Bugzilla, Biz Talk, SAS Studio, Teradata Studio/SQL Assistant, Hadoop- Hive/Apache/NoSQL, IBM Mainframe, Clear Quest, IDQ Analyst, Informatica power center, IRIS

Claim adjudication tools: Amisys, FACETS, QNXT 3.4/4.7/4.8/5.01/5.2 , NASCO Mainframe, NMS mainframe, HIPAA, NCPDP, EDI X12, FDA Compliance, HL7, and HIX.

Databases: MS Access, Oracle 8i, SQL Server 2000/2005/2008/2008 R2, DB2, Teradata, MongoDB

Operating Systems: Windows 98/2000/ME/NT/XP/7, Mac OS

Methodologies: Waterfall, UML, RUP (Rational Unified Process), RAD (Rapid application development), Agile, Business and Data Modeling

Languages: C, C++, SQL, Java, SAS, HTML, VB Script, JCL (mainframe),NoSQL

Reporting tools: Micro strategy, Cognos, Business Objects, Crystal Report, Tableau, Qlikview

PROFESSIONAL EXPERIENCE

Confidential

Data Analyst

Tools: Teradata, TD SQL assistant, HADOOP Hive, Apache, Sqoop, Spark, Mongo DB, SQL server management studio, visual source safe, SSIS, SSMS, HP Quality Center 11.0, MS Office Suite, Agile,SQL,UML, SSRS,SSIS, MS Access, HIPAA 4010/5010, XML, Cyber Ark, VB, .net, Visual Studio, IRIS rating system, Oracle SQL developer, SAS software suite, Tableau 8.0 /9.0, IBM Clear Quest, Clarity, IDQ Analyst, IBM Mainframe, NASCO Blue2, SARS, Analytics, Actuarial.

Responsibilities:

• Worked under Data Strategy- Data Governance team that is responsible for identifying accurate and reliable sources for enterprise’s most valuable business/data fields as well as maintained integrity and quality of the data sources.
• Responsible for Acquiring data from primary or secondary data sources and maintain databases/data systems as well as performing data profiling and data mining on available data
• Created data Matrix document for the projects that consists of - current state and future state source to target mapping, data transformation applied, business rules involved, data definition for each data elements, defaults values, involved part, data formats, etc.
• Created and presented score cards to business using Informatica Data Quality Analyst to assess data quality
• Created rules and profiles using IDQ Analyst tool to analyze the data and perform data quality checks
• Documented code set matrix that involved list of the codes included in the project with the owner, description, stewards, current state scenarios.
• Acted as a liaison between the technical, businesses and testing groups to provide them with required specifications/documentation and to resolve any issues in between
• Worked with EAs and DAs to help them find out final source for the respective work streams that involved extensive data analysis, data comparison and data validation tasks.
• Worked with BA, stakeholders to define business requirements, analyze the requirements and documenting business rules as well as technical rules for tech BSAs.
• Analyzed current state SQL queries and SAS codes that generates current reports, documented those logic in pseudo codes to make better understanding to technical folks for their Technical requirement documentation
• Worked on Defining preprocessing validation checks for the data fields, files loaded in to target systems to minimize the validation errors in final system.
• Interacted with the “End-Users” and stake holders by interviewing them, by preparing appropriate questionnaire to better understand end-user needs, business processes and business rules that are applied to generate current reports/ data sets
• Analyzed and understood current state analytics SAS data sets to apply the logic to future state reports from Confidential Data Hub, Hadoop and EDW data.
• Involved in Analyzing and mining business data to identify patterns and correlations among the various data points.
• Created source to target mapping document for current and future state with details of current state transformations.
• Responsible for identifying issues, analyzing solutions and recommending effective short and long term solutions to management for implementation.

Confidential

Data Analyst/EDI Analyst/ System Analyst

Software: SQL server management studio, visual source safe, SSIS, SSMS, HP Quality Center 11.0, Biz Talk, MS Office Suite, Agile,SQL,UML, SSRS,SSIS, MS Access, HIPAA 4010/5010, XML, SAP Business Objects, VB, .net, Visual Studio, SQL Server Reporting Services, Paper claims processing, Notepad++, IDQ analyst, Ultra edit, EDI, Microsoft Team Foundation Server, Bugzilla.

Responsibilities:

• Interacted with the “End-Users” and stake holders by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process for QNXT 5.01/5.2 upgrade requirements.
• Extensively involved in claim scrubber process and claim loading process analysis and requirements changes.
• Worked on member, provider and affiliation matching logic for 837 claim files submitted by different submitters.
• Creating the test cases, test plans and test scenario for claim scrubber, loader and matching logic testing. Successfully logged defect, analyzed them, reporting them to the developers and resolved them using TFS.
• Worked on Deny, Pend, Incomplete, PNE, MNE, CMO letter for claims for different health plans, also successfully tested migrated SQL 2008 code for claim letter consolidation process
• Worked on 835,999 and Flat files validation by comparing output test files with the existing production files by using data analysis tools like ultra-edit, Red Gate and Excel.
• Worked on check print application to generate checks for different providers and submitters for the adjudicated claims.
• Involved in user acceptance testing and supported user for claim testing by dropping the claims files, moving to different server, BizTalk validation and running scrubber and loader jobs.
• Tested CCMS and Echo interface for QNXT upgrade impact, also performed parallel testing of all requirement of QNXT 3.0 and 5.01/5.2 QA environments.
• Created rules in profiles and scorecards to score the valid values for any column or the output of rules. Managed and fixed bad records and duplicate records.

Confidential, Danville, PA

EDI analyst / Data Analyst/ System Analyst

Tools: Agile /Scrum,SQL, UML, UNIX, Oracle, Cognos reporting, MS SQL Server, MS Access, HIPAA versions 4010A1 and XML 5010, Informatica (ETL), SAP Business Objects, XML Notepad, Medicaid, EDI transactions with Segment, Element, Loop, Sub element level details, SAML 2.0, CAQH CORE

Responsibilities:

• Identified all necessary business and system use cases from requirements, created UML diagrams including use case diagrams, Activity Diagrams, and Sequence Diagrams using Microsoft Visio.
• Developed and upgraded EDI maps for transactions (835, 837 (I &P), 834, NCPDP, 277) using the X12 standard.
• Tested new developments of X12 837 claims, 835 payment files and ensured timely and quality delivery of Revenue Cycle product releases.
• Responsible to understand EDI transaction (Inbound / Outbound) requirement coming to the MCO and going out to State of PA.
• Created functional specs documents and business requirements for EDI transaction for the development of accurate transaction platform.
• Worked with the state of PA Medicaid team in the submission/ Locating FTP/ Checking Frequency/ Error reports of the Daily, Weekly, Monthly 834 Enrollment files.
• Performed end to end testing of the Application and reports using HP Quality Center.
• Executed smoke, integration and system testing and used Mercury Quality Center for organizing requirements, test cases and defects.
• Created SQL queries and scripts to prepare data or validate data from databases to application.