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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLEhttps://LINKEDIN LINK AVAILABLEExperience SummaryAS a Sr BI Data Analyst I have 11+ years of experience in Gathering Analyzing Designing and Interpreting Enterprise data for Health insurance clients UHG, Transamerica with SQL, Python, R, Power BI, Advanced Excel and Tableau.Strong experience programing language skill VBA, R.Created Tableau Dashboards for management to figure out which deals give more benefit by analyzing data.Drawing insights from the reports and present to the management for decision making.Created input forms with help of MS- Access for live production tracking and ticket status.Expert in Excel with knowledge of V-lookup, H lookups, Pivots, Charts, Power Queries, Macros, and Scripting VBA.Done small automations using Microsoft Power apps.Handling the reports through version control tools like GIT, Git HubHands on experience with the ticket monitoring and assigning tools like JIRA and ServiceNow.Strong experience with cloud technologies like AWS and Azure.Experience in working with different operating systems windows, Mac, and Linux.Managing the properties of client and delivering the projects in SLAs.Good experience with healthcare clients, worked with Optum, United Health, Transamerica, and Athena.Aware of the security polices of HIPPA, GDPR, state and federal regulations.Lead the risk and compliance audits for the project.Taken care of revenue cycle management, crated billings for a project of 300 people.Certified with Lean and Six Sigma.I worked in forecasting, Planning, and monitoring the project as MIS.Experience in doing Root cause analysis by using Lean and Six sigma techniques.Conducted grooming and training sessions to team.Good experience with healthcare plans Like A, B, D- Prescription Drug plans.Worked on CMS data for Appeals and Grievance ProjectsGood Knowledge of Payer side business of Health Insurance, and know CPT, ICD-10 coding systems.Experience in improving the CSAT score by analyzing the data and finding the root cause for the low scores.Experience in streamlining the projects, finding the scope of improving the automations and improving the revenue for the project.Hands on experience of using HTML, CSS, JavaScript, jQuery, and React JS to create user.Experience of Amazon Web Services' EC2 and S3 (AWS) lambda, IAMSkills:ProgrammingSQL, Python, R, VBA, JAVAVersion ControlGIT, GitHubIDEIntelliJ, VS Code, STSQueryingPower Query, DAX,Ticketing ToolsJIRA, Service NowSDLC MethodologiesWaterfall, Agile, ScrumDatabasesOracle, MySQL, MYSQL Server, PG(Postgres), MongoDB, SQL, Google sheetsCloudAWS, Azure, AWS QuickSigh, snowflakeData VisualizationPower BI, Tableau, Qlik, SSASOperating SystemsWindows, Linux, MS-DOSOffice ToolsExcel (Advanced), Word, PowerPoint, Access, Outlook, Power AutomateSEP-2023- PRESENTSr Business Intelligence Data Analyst/ORIEN SOLUTIONS INC, EDISON, NJROLES AND RESPONSIBILITIES:Analyzing large and complex healthcare data sets, including electronic health records (EHR), EDI (270,271,276,277,278, 837, 835,834,820) claims data, and clinical data, to extract meaningful insights using SQL and visualize with power BI.Utilize advanced analytics techniques and statistical methods to identify trends, patterns, and correlations in healthcare data.Develop interactive dashboards and reports using business intelligence tools (e.g., Qlik, Tableau, Power BI) to visualize data and communicate findings to stakeholders.Partner with business leaders and stakeholders to understand strategic objectives and business requirements related to healthcare analytics.Designed and implemented robust to support data pipelines for extraction transformations and loading process considering the data integrity with python and R.Provide data-driven recommendations and insights by using Python to support strategic planning, resource allocation, and decision-making processes within the organization.Monitor key performance indicators (KPIs) and metrics related to healthcare operations, financial performance, and patient outcomes.Working with Excel, creating macros using VBA, and good knowledge of pivots and lookups.Identify opportunities for performance improvement and cost reduction through data analysis and benchmarking against industry standards and best practices.Develop predictive models and forecasting algorithms to anticipate healthcare trends, patient demand, and resource utilization.Forecast patient volumes, readmission rates, and other critical metrics to support capacity planning and resource allocation.Taken care of Revenue cycle management for claim business. Facets and Large group claimsAnalyzed clinical quality measures and patient safety data to assess healthcare quality and identify areas for improvement.Collaborate with clinical teams and quality improvement specialists to implement interventions and initiatives aimed at enhancing patient care and safety.Ensure compliance with healthcare regulations and reporting requirements, such as CMS quality reporting programs (e.g., MIPS, PQRS).Risk and compliance analysis following the State, Federal and HIPAA.Prepare and submit regulatory reports and documentation as required by federal, state, and local healthcare authorities.Collaborate with cross-functional teams, including IT, clinical informatics, finance, and operations, to integrate data sources and streamline data workflows.Serve as a subject matter expert on healthcare analytics and data-driven decision-making, providing guidance and support to internal stakeholders.JAN-2023- MAY 2023Business Intelligence Analyst / Eniac Systems, Edison, NJCollecting and extracting healthcare data from electronic health records (EHR), claims databases, and other relevant sources with SQL and Python .Ensure data integrity and accuracy by performing data validation and cleansing processes.Analyzed healthcare data using statistical techniques and data visualization tools to identify trends, patterns, and correlations.As a MIS executive for the project assisting in forecasting and workforce management.Assist in developing predictive models and algorithms to forecast healthcare outcomes and identify areas for improvement.Created Excel macros with VBA scripting and Power apps for automations.Managed the data pipelines and build for the new processes.Prepare comprehensive reports and dashboards to present findings and insights to stakeholders, including healthcare providers, administrators, and policymakers.Summarize key metrics and performance indicators to track progress and evaluate the effectiveness of healthcare initiatives.Collaborate with healthcare professionals to identify opportunities for quality improvement based on data analysis findings.Assist in developing and implementing interventions to address identified gaps in healthcare delivery and patient outcomes.Ensure compliance with healthcare regulations and privacy laws, such as HIPAA, when handling and analyzing healthcare data.Stay updated on changes in healthcare regulations and industry standards to ensure adherence to best practices.MAY-2018- FEB-2022Assistant Manager / TATA Consultancy Services, IndiaClient: Transamerica.Roles and Responsibilities:Define, analyze, and report standard hospital quality measures and use them for a variety of projects, including but not limited to, physicians incentives, pay for performance and meaningful use of Electronic Health Record.Present quality dashboards to board members and provide insights related to improved quality of patient care.Delivered services to a Healthcare client Transamerica for their health and annuity business.Manage business intelligence team and projects focused on quality and data analytics.Work closely with finance department for projects involving various billing, insurance, and payments related reports.Oversaw the complete revenue cycle management for healthcare clients, including claims processing, payment collections, and account reconciliation to optimize financial performance. For NICE and Facets businessExpert in MS office tools. Create and edit excel macros using VBA scripting.Expertise in US Healthcare Operations (Manual Adjudication of claims, pre and post processing, Rework, Audits and Automations) filling up the gap between customer service and Healthcare technology.Proven track record of managing processes, streamlining workflow & creating teamwork environment to enhance productivity innovatively.Worked on clinical data, medical durable equipment data for analysis to provide insights.An effective communicator with strong analytical, interpersonal, and problem-solving skills. Ability to take ownership and multitask working against stiff timelines.Analyze the project data suggest the improving scopes and automate the reports for the project.Created the SOW and SOPs for the project keep all SLAs into consideration.Enhance revenue cycle efficiency, reduce denials, and improve reimbursement rates. Implemented best practices and process improvements to streamline operations.As a Risk management and compliance lead for the project lead the CMMI audits and external audit certification to the team.Awarded star performer consecutive 4 months and process champion.MAY 2012 APRIL 2018Assistant Manager / WIPRO Ltd, ChennaiClient: UHG, OptumLeading a team of 80 associates for end-to-end servicing for the globally most complex high-end queue, which handles - Government business (M&R) of both first pass, Appeal & Grievances.Delivered services to a Healthcare client UHG, Optum for their health and annuity business.Certified in Value Engineered Performance systems program, performance management, Variation Management, New process transition.Taken care of the revenue cycle management for the whole business.Worked closely with CMS for improving the Appeals and Grievances scores and Star ratings for the policies.Trained in Six Sigma Green belt, expert in Excel and well know about the data reporting tools Tableau and Minitab.Good understanding of healthcare business model of claims, HIPAA, ICD,9,10, Denials, Revenue codes.Managed the client communication and multiple locations for the smooth business flow and delivery.Organized training workshops to improve the performance of the members who were lagging in terms of performance.Multi linguistic know Telugu, English, Hindi, Tamil, KannadaCompliance SPOC Assisting the RMAC team in all compliance related activities Pre-Joining Formalities, HIPAA Adherence, Quarterly Assessments, and Access related activities, Updating BCP document regularly.SEED SPOC Working with the TT Team to arrange coursed which employee needs to pursue.EducationMasters in computer science / UCM, 2023B. Tech-ECE / JNTU-2011 |
