SUMMARY

• Qualified professional with 7+ years of extensive experience in the field of Data Analyst/ETL working with the technical staff to implement management and staff's business requirements into the software application in Health care and Insurance Industry.
• Mapped existing and future state business processes using Visio and Bizagi.
• 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,Waterfall and Agile.
• 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).
• Load and extraction programs involving HIPAA 834 and proprietary format files and Reports development.
• Hands on experience using Tera data utilities (SQL, BTEQ, Fast Load, Multi Load, Fast Export, T Pump, TPT, Query man.
• Experience in writing SQL queries and optimizing the queries in Sybase, Oracle and SQL Server 2000, 2008 r2, 2005.
• Rich Business domain expertise which includes Health care operations (HL7 protocol, Interfaces and Clinical Application messaging communication - Provider Domain), EHR implementation, ICD 9 to 10 migration and ITIL Service Management.
• Experience in providing logging, Error handling, Error Output and Audit in SSIS (ETL) Packages.
• Experience in Design and Implementation in Business Objects 4.0, XIR3/ XIR2/6.5, Web Intelligence, Oracle, SQL Server and DB2.
• Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and Data Mapping from an Operational Data Store to an Enterprise Data Warehouse.
• Excellent Knowledge in Electronic Medical Record (EMR) / Electronic Health Records (EHR) modules and process flow.
• Worked on different EDI health care 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 work flows in hospital environments. Knowledge of various HL7 EMR systems.
• Worked as a Data Analyst and UAT Tester for ICD9 to ICD10 project on the Professional Claims side.
• Extensive experience in configuring data mapping between different Databases.
• Ability to gather business and technical requirements from both formal and informal sessions utilizing a variety of software tools including, Use Cases and the Rational Unified Process.
• Expert in creating Jobs, Alerts, SQL Mail Agent, and scheduled SSIS Packages and created and deployed SSRS Reports on the portal for user accessibility.
• Proficient in discussing and defining project, Gap Analysis with the clients from both a business and technical perspective.
• Expertise in extracting, Transforming and Loading (ETL) data using Informaticaalong with ETL team.
• Skilled in System Analysis, E-R/Dimensional Data Modeling, Database Design and implementing RDBMS specific features.
• Expertise in broad range of technologies, including business process tools such as Microsoft Project, Pro model, 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.
• Proficient in Unit Test Plans (UTP), Integrated Test Plans (ITP) Extensive experience in User Acceptance Testing (UAT).

TECHNICAL SKILLS

SDLC Methodologies: UML,Waterfall, Agile - SCRUM

Defect Tracking and Testing Tools: Quality Center, JIRA, HP ALM

Operating Systems/Platforms: Windows, Linux

Modeling Tools: ERWIN r 9.1,ER/Studio, MS Visio, Sybase Power Designer.

Office Applications and other tools: MS Office Suite, Share Point, MS Project, Tableau, MS Excel

Databases: MS SQL Server, MS Access, MS SQL Server 2008 R2, Oracle 12g

DB Tools: SQL Plus, SQL Developer, Tera data, SQL Assistant, Toad for Oracle and DB2, SSMS

Programming languages: Java, SQL, T-SQL, PL/SQL, SAS, C, XML

ETL Tools: SQL Server, SQL Server Integrated Services (SSIS),Informatica Power Center 7.1/6.2, Data junction, Ab-Initio, SQL Reporting Services (SSRS), SQL server Analysis Services (SSAS), MS Visual Studio, Business Intelligence Development Studio (BIDS), DTS .

BI/Reporting: Microsoft SSIS, SSAS, SSRS, Tableau, Cognos, SAP Business Objects.

PROFESSIONAL EXPERIENCE

Confidential

Sr. Data Analyst

Responsibilities:

• Created Logical & Physical Data Modeling on Relational (OLTP), Dimensional Data Modeling (OLAP) on Star schema for Fact & Dimension tables using Erwin.
• 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.
• Prepared ETL technical Mapping Documents along with test cases for each Mapping for future developments to maintain SDLC.
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
• Worked with clients to better understand their needs and present solutions using structured SDLC approach.
• Implemented SCAD-Type 2 for change capture in the data.
• Wrote complex SQL queries to extract and validate the data from the Facets database.
• Developed Shell Scripts for filename validation of files from different locations.
• Experienced in data integration, meta data 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.
• Supported the EDI team with 5010 Implementation which involved correcting setup issues within File Maintenance and EPM.
• Performed Data Analysis and Data Profiling using complex SQL queries on various sources systems including Oracle, Teradata.
• Worked on import and export of data from sources to Staging and Target using Tera data MLOAD, Fast Export, TPUMP and BTEQ.
• HL7 Analyst knowledgeable in using HL7 and XML in designing and documenting interface requirements.
• Involved in the full HIPAA compliance life cycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Played the role of BPM technology specialist in a pilot automation project in BPM area.
• Mapped all core processes on IBM Blue works Live and found improvement opportunities to streamline the process and remove the waste.
• Worked with data mapping team for ICD 9 to ICD10 for forward mapping of the diagnosis and procedure codes.
• 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.
• Contributed in troubleshooting & support of IBM Info sphere 10.1/11 by applying fixes from IBM fix central.
• Coordinated all the Product upgrade activities from WCC7 to MDM10 and software upgrades (WAS, MQ, AIX, MDM, DB).
• Worked on Senior level SQL query skills (Oracle and TSQL) in analyzing and validating SSIS ETL database data ware house processes.
• Created Tera data Tables, Views and Stored Procedures for loading the data from Oracle to DW.
• Supported Extol Integrator EDI package and develop RPG/ILE interfaces for new trading partners.
• Used 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, 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).
• Developed and modified ETL and MDM using Informatica Developer 9.5.
• Used SQL procedures in SAS for creating SAS datasets and generating reports using them when Tera data was off line for maintenance.
• Frequently used SAS to bulk load tables to Tera data.
• Participated in weekly client meetings and internal meetings to develop, design, test and implement HL7 interfaces.
• 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 planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• 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.
• 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.
• 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.
• Designed and wrote code to enhance functionality and quality of HL7 interfaces.

Confidential

ETL Data Analyst

Responsibilities:

• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, ICD-9, ICD-10 coding.
• 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.
• Created ETL test data and tested all ETL mapping rules to the functionality of the Informatica mapping and Ab Initio graphs.
• Demonstrated the practical side of Six Sigma methodologies- resulting in higher engagement from classroom participants and strong end-of-class evaluations.
• Migrated several SQL Server 7.0, SQL Server 2000 databases to SQL 2008.
• Managed the team of consultants responsible for developing on-demand Medicaid Management System (MMIS) reports.
• Used ERWIN Data Modeler for Generating DDL, Stored Procedure and Trigger Code for Source to Target database.
• Patient domain configuration to accept HL7 messages into MDM.
• Performance Tuning the SQL for existing Informatica jobs and Tera data 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.
• 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.
• Worked closely with testing team and helped in testing the Informatica mappings, work flows, AB Initio Graphs and Tera data scripts.
• Followed the modeling process to make changes to the Erwin models.
• Performed back end testing using SQL queries and analyzed the server performance on UNIX.
• Involved in generation and execution of SQL queries.
• Developed and maintained sales reporting using in MS Excel queries, SQL in Teradata, and MS Access.
• Produced 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.
• Integrated complex Medicaid principles and policies into the Medicaid Management Information System (MMIS), requiring knowledge in areas of health systems and Medicaid information processing.
• Loaded XML data into Tera data 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).
• Troubleshooted and identified errors with EDI ANSI-X12 837 Electronic claim file rejections from both Government (Medicare and Medicaid) and multiple Major Commercial Insurance payer sources.
• Designed new database tables to meet business information needs. Designed Mapping document, which is a guideline to ETL Coding.
• 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.
• Supported SOA, data warehousing, data mining, and Enterprise Service model standards in designs, and developed standardization of processes like configuration management.
• Developed the on line screens and reports for the Medicaid On line Electronic Claims Submission System.
• Reviewed and analyzed 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.
• Tested claims Edits and Audits to ensure that the system would recognize and accept the ICD-10 changes.
• Identified customer marketing opportunities by applying data mining models and writing advanced T-SQL stored procedures and queries.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment
• Tracked UAT issues/bugs and prepared reports.

Confidential

Sr. Data Analyst

Responsibilities:

• Participated in CO-MMIS (Colorado - Medicaid Management Information System) knowledge transfer in preparation for Implementation and Operation of the 5010 standards.
• Worked closely with the customer to detail and convert business requirements into system and operations requirements while working with the external partners to complete the design, development and implementation of the requirements.
• Addressed requirements as a liaison among stakeholders in order to elicit, analyze, communicate, and validate the requirements and business processes.
• Analyzed business processes and performed needs assessment to align CO-MMIS information technology solutions with DHCPF business initiatives.
• Worked with clients to better understand their needs and present solutions using structured SDLC approach.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Involved in designing logical, physical, and dimensional database designs using reverse and forward engineering of ERWIN Data Modeler.
• Performed System testing, Regression testing and UAT for several claim types and test scenarios.
• Wrote Test Plans/ System Level Test Strategy document.
• Involved in Data flow analysis, Data modeling, Physical database design, forms design and development, data conversion, performance analysis and tuning
• Compared and validated 5010 system test results with 4010 results for the same test scenarios.
• Configured, set up and managed the automated build servers for EDI Gateway.
• Frequently resolved the issues with EDIFECS and Actt Now, primarily the generation of 997, 999, 824, 277CA reports.
• Worked with the system administration team, technical leads, and project managers to release builds to production through EDI Gateway.
• Designed, developed, implementation, and production activities associated with X12 transaction sets (270 / 271, 276 / 277, 277ca, 834, 837, and 835), and other proprietary data standards.
• Knowledge in EDIFACT, X12 and other formats compatible with EDI Gateway.
• Prepared various SOP's (Standards operating procedures: Ops BA, On Call BA, How to work on transmittal)
• Monitoring, tracking and documented system issues and presenting the status of system tickets.
• Documented all the claims edits/exceptions in updates from DHCPF CO (Colorado Department of Health Care Policy and Financing) and communication all related information between all the internal departments.
• Worked on all the operational CSR's results from system issues or requests from state through SDLC.
• Created various templates for BA's and SE's to track issue and monitoring the progress on them.
• Helping operations/call center issues coming from various provider communities.
• Assisted Other BA's for completing different CSR's, NCCI, DRG, PERM, CHP +, Radiology PAR, Zero Pay, CCT and SCI waivers.

Confidential - North brook, IL

Data Analyst

Responsibilities:

• Involved in development phase meetings for Business Analysis and Requirements Gathering.
• Created the logical models and generated the physical models in the databases using Erwin.
• Involved actively in determining the quality and quantity of data to be provided for UAT.
• Worked with the IT team to develop service oriented architecture (SOA), and data warehouse system to utilize data mining for data analysis.
• Extensively involved in the modeling and development of Reporting Data Warehousing System.
• Designed and developed Project document templates based on SDLC methodology
• Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.
• Facilitated JAR/JAD sessions with business and IT personals to understand and document the system requirements, and define the overall project scope.
• Defined, developed specs for federal reporting specific to Medicare Advantage
• Developed & executed several Optimized queries in SQL on this data.
• Tested Performance & Accuracy related queries under SQL Server.
• Created Graphical representation of reports such as Bar charts, Pie charts etc as per the End user requirements using Business Objects and Crystal reports.
• Analyzed Business Requirements performed gap analysis 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.
• Responsible to import the data from Crystal reports by using Business Objects Live office into Microsoft Excel and Word.
• Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
• Prepared Business Requirement Documents (BR D'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.
• Analyzed the given source Dimensions and target Fact table structures to develop Surrogate Key tables referencing required dimensions.
• Created and managed project templates, use case templates, requirement types and tractability matrix in Requisite Pro.
• 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.
• Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.