| Candidate Information | | Title | Data Analysis Business Process | | Target Location | US-MD-Sykesville |
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Click here or scroll down to respond to this candidateProfessional Summary:Comprehensive knowledge and experience in different SDLC methodologies like Agile/Scrum, waterfall, RUP, V-model.Extensive experience in designing and reviewing different documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Requirement Traceability Matrix (RTM) and testing documents.Strong experience gathering requirements by conducting Joint Application Developments (JAD) sessions and Joint Requirement Planning sessions (JRP), walkthrough, Interviews, Workshops and Rapid Application Development (RAD) sessions, interviews, focus groups, prototyping with end-user/clients/stake holders.Specific expertise in Business Analysis, SWOT analysis, GAP Analysis, Impact analysis, Business Rules and developing and creating business process documents.Experienced in Object Oriented Analysis and Design (OOAD) like UML, Use Case Documentation, and creating UML diagrams like Activity Diagrams, Sequence Diagrams, and Class Diagrams using MS Visio.Excellent knowledge in Data Analysis, Data Validation, Data Cleansing, Data Verification and identifying data mismatch.Performed data analysis and data profiling using complex SQL on various sources systems including Oracle and Teradata.Experienced working with Excel Pivot and VBA macros for various business scenarios.Deliver expert technical/SQL database support and troubleshooting on databases, mainframes, mini-computers, and personal computers and able to read pseudo codes.Expertise in data analysis and reporting using Business Intelligence tools like Business Objects, Crystal Reports and creating visual representation of data using Tableau.Experience in Data Mining, Data mapping and Data modeling and good understanding of the ETL tools like SSIS, Data Stage and Informatica Power Center.Involved in various projects related to Data Modeling, System/Data Analysis, Design and Development for both OLTP and Data warehousing environments.Strong Experience in using different requirement management and testing tools including IBM Rational Requisite Pro, JIRA, HPALM/QC.Expertise in developing Test Plan, Test Conditions, and Test Cases for User Acceptance Testing (UAT) in coordination with QA team.Efficient in translating Business Requirements into Functional and Non-Functional Requirements using UML diagrams and RUP Methodology. Strong Knowledge of MS Office Suite (including Excel and Word).Extensive knowledge of reporting tools such as SQL and MS ACCESS for underlying database tables and resolve data issues.Strong experience in Analysis of Problem Severity, Defect tracking and reporting system.Technical SkillsMethodologies: Waterfall, Agile, Agile-fall.Requirement Management Tools: IBM Rational Requisite Pro, JIRA.UML and Use case Tools: MS Visio, Blueprint.Project Management Tools: MS Project, Dev suite, Jira, Confluence, SharePoint.Testing Tools: HP ALM/Quality Center, Dev suite, PWB.Database: MS SQL, Oracle.Office Tools: MS Office, MS power point, MS Excel, MS Power point, Notepad ++, Ultra Edit.Professional Experience:New York State of Integrated Eligibility System for WMS and child support systems, Albany NY June 2021 CurrentSr. Business Analyst.Under the Integrated Eligibility System of New York, I am working on an AS IS study of the EECM (Eligibility Enrollment and Case Management) and Child Support system workstreams. The project's goal is to develop system capabilities and applications that will aid the state's overall business goals (Improved Client outcomes, client focused service delivery, improve referrals and interagency coordination, More efficient and accurate service delivery, improve worker experience, Maximize value of state and federal investments, provide a flexible state wide solution and reduce operational risks ), A straightforward, seamless, no-wrong-door customer experience that directs New Yorkers to programs that improve their health and independence. A statewide solution that supports both statewide and local workers, allowing clients to obtain all relevant information and apply for service and benefits through one portal, my benefits. The IES initiative focuses on developing system capabilities and applications that can assist the State in meeting its overall business goals. These include components such as automated client referrals, a common client index, and mobile access capabilities, for both clients and workers.Responsibilities:Analyze AS IS Business process and create Process Flows, Swim lanes, Use cases.Work with WMS users and subject matter experts to develop and review detailed Process flows, Swim lanes, and Use cases for WMS Modules and open systems pertaining to TANF, SNAP, HEAP, and SNA.Provide team members with the necessary information to perform the assignment within the given deadlines.Collaborate closely with the rules extraction vendor, Team Lead, Tech Leads, PMs, and SME's to identify and resolve issues.Process flows for each module in the WMS Upstate and Downstate systems were meticulously built.Developed and maintained the Rules Matrix for various WMS programs and processes during the AS IS study.Update and work on Inventory of Process Documents, which comprises several modules and sub processes from WMS, CSMS, and ASSETS, such as Determining Eligibility, Benefit Management, Case Management, and Service Operations.Extensively reviewed Use cases and their attachments consisting of Business and Process Rules.Thoroughly examined COBOL codes and logics for missing Business and Process rules, ensuring that critical BRs are not neglected.Working knowledge of state systems and subsystems that interact with WMS, such as AFIS, ASSETS (Automated State Support Enforcement Tracking System), ATC (Automated Time Card), BICS (Benefit Issuance Control System) and its interface with WRTS and the OCFS Data Warehouse, DV (Domestic Violence), DTS (Daily Timekeeping Systems), FHIS (Fair Hearing Information Systems), FS Recoupments, PA Recoup Time limit tracking, RFI (Resource file integration), TA food stamp recertification Inquiry, WMS CIN Consolidation (WMS CIN Consolidation is a weekly batch operation that consolidates CIN and sends it to WRTS and eMEDny) ABLE, MABLE, and MRB, RFMS (Recipient fraud matching system WMS subsystem used by SSD Users for detection of potential fraud recipients, contains information from), RFMS (Recipient fraud matching system WMS subsystem used by SSD Users for detection of potential fraud recipients, contains information from.Extensively created Process flows in Blueprint for each modules present in Child Support System.Created and maintained the Rules Matrix, during AS IS analysis for different Child support System components.Analysis on AS IS process of Child Support Systems, ASSETS, CSMS.Created thorough Swim lanes, Process flows of the functionalities and modules present in Child support in Blueprint.Schedule meetings with SME's to address concerns and comprehensively create process flows and use cases, as well as identify possible business rules, and policies.Collaborate with the Lead to update the Process Inventory and Rules Matrix documents.Work closely with Technical team and team to understand and capture the information of the Run books, ECLs or the technical side of the processes.Create Technical flows working closely with Technical team, this helps in tying the functional process flow with technical process flow for assisting the System Integrator.Constantly update the status of the AS IS analysis Tracker.Worked closely with SMEs to build the Process flows of the Child Support system for Case initiation IV-D, referrals as IVA IVD, IVE IVD, Medicaid Referral XIX referral, DMV Enforcements, safety concerns DV, FPLS, Excess Support, Case Management, Batch reporting, Support establishmentWorking knowledge of COLA Adjustments, CSEU, SCU, UCI, Lottery Intercept, unemployment benefit intercepts, Passport Denial, Financial Adjustments, FCR, NDNH.Extensively reviewed Use cases and their attachments consisting of Business and Process Rules.Update the State and Vendor Trackers in SharePoint to reflect the defect and comments. Defects and comments are added to the Identified Business Rules, and these defects and comments are updated based on the UCS review and vendor attachments.Client: Optum for State of New York. Feb 2019 - June 2020Role: Business System Analyst/ EDI Analyst.Optum is a health-care innovation company that has been creating a strong presence in the healthcare industry for many years. OSDS (Original source data submitter), the name of the project I was working on for Department of Health in New York. This project is an augmentation of the EIS (Encounter Intake System), which primarily was responsible for dealing with healthcare encounters comprising of several transactions, such as 873 and NCPDP (Pharmacy), specific from EP, CHP, QHP. OSDS now processes member enrollment 834 (X318) and encounters (837, NCPDP) from not only a few LOBs but also from Commercial LOBs because it is an expansion of EIS. OSDS also supplies encounter extracts like MAEE, which will be used for a variety of applications by the healthcare business.ResponsibilitiesCreated the X12 Transaction Source to Target Mapping document for EDI 837 (X298 Professional X299 Institutional X300 Dental NCPDP (Pharmacy)).Extensively verified and validated the fields of the STTM with the fields in the DB to eliminate any discrepancies.Created the 837 Companion Guides on all transaction type (X298, X299 and X300) for submitter as per the business requirement.Created the NCPDP (Pharmacy) Source to Target Mapping document for multiple stages.Created the Companion Guide for the NCPDP Submitters as per the business requirements.Created the EDI 834 Member Enrollment (X318) Source to Target Mapping Document, communicate back and forth with the client for the approval Purposes.Created the Companion guide for the EDI 834 (X318) that outlines the information and the criteria on different field used in the Transactions as per the business requirement.Created the clear and concise Transformation rules for Developers/ ETL developers as per the requirement.Conducted Scrum meeting and maintained the track of IRAD document to help address the known issues in time.Worked closely with EDI SME to work on the Transformation Rules to meet the clients expectation.Created Source to Target Mapping documents (STTM) for multiple Transactions and functionalities, verifying and validating them working closely with ETL Dev team.Created Requirement Specification Document that outlines the detail explanation of each piece of the requirement. Communicated back and forth with client for their approval.Extensively worked on the GAP analysis to figure out the differences and their impacts going from AS IS system to TO BE system. Verifying and Validating against STTM and Database on 834, 837 and NCPDP transactions along with updating the companion Guide, Data submitter companion Guide, Edit Masters, reference tables for 834, 837 and NCPDP are few of the examples.Communicated with stakeholders to get the approval on different documents created such as BRD, FRD, RSD, HLD, LLD, Edit Master, Companion Guide, STTM.Prepared multiple process flow, work flow, use cases, on different Functionalities using MSVISIO.Maintained and updated the documents in the share point.Validated EDI Claim Processes according to HIPAA compliance.Conducted JAD sessions with Stakeholders SME, Data Architect, Test Lead, Developers to find the best solutions to address some of the challenging requirements. (Creation of the MD5hash key to address complex process for History Mapping, Member validation table, create a temp table for MAEE Extraction process DETKAT, Reference table dependencies with the APD Project)Performed Gap analysis on existing History logics for original, Adjustment and Void and Created the History Mapping STTM for all 837 (X298, X299 and X300) and NCPDP transaction per TO BE requirements. Wrote the complex transformation Logics to address the business requirements for considering transactions as Original/ Adjustment or void.Extensively communicate with developers on complex functionalities and transformation rules and data transformations logic.Maintained and kept the track of the EDI registration forms from submitters by uploading and update them in the client's SharePoint.Communicated with different team members to work on dependencies related tables shared by multiple projects and created the STTM for multiple reference tables used for the 837 encounters.Created the Data Submitter companion Guide for the submitters that outlines the conditions required to submit the Data to the OSDS system.Extensively worked on creating the source to target mapping document on Member validation table on 834transaction.Extensively worked on creating the source to target mapping document on reference tables.Extensively communicated with the developers to answer the questions regarding the functionalities, BRD's, change orders.Created multiple training documents on different EDI response Transactions as TA1, 999, 277DRA, RXTA, RXFA, RXCA. These Training documents were created to train the submitters.Extensively worked in MAEE process, Created and updated requirements, Created STTM from different sources i.e.: 837/NCPDP transactions. Define the Transformation and translation rules for each field to the developers for the Extraction process.Communicate with different stake holders for MAEE requirement clarifications.Performed Gap analysis, communicate with Client, Developers for the resolution purposes.Worked closely with Test Lead and test team to Create and update the Test plan, Test Scenarios, Test files, Test artifacts and update the defect Track log documents for the testing purposes on different transaction type and their functionalities.Worked on updating the EDI Registration form/ Submitter Enrollment: worked on setting up the connection for the Data submitter with infrastructure team.Performed SIT Testing / UAT Testing, 834/837/NCPDP testing, updated the status of the TC's in the "Devsuite". Provided the resolution on the issues faced by submitter during UAT testing.Engage with different team on UAT testing concerns and provide the feedback on test files and status of existing defects after being resolved from the development side.Verify and validate the outputs of XML and X12 files from inbound files.Verify validate and communicate with developers on the defects raised on the UAT by making sure bugs are fixed in multiple environments.Highly involved as a Junior SME in addressing submitter concern through Service now on 834/ 837 and NCPDP transactions.Created Training Document on different responses i.e.: RJ file/ TA1/ 999/ 277 DRA.Extensively worked on creating and releasing the FAQ Documents from the Submitter training sessions.Incorporated the functionality of the entire project in the document like RSD.Collaborated with the developer team in working of the document like HLD, LLD.Highly involved in peer reviewing the documents to send to state for approval.Client: Anthem, Norfolk, VA Oct 2018 Nov 2018Role: Business Data AnalystThe main aim of the project was to enhance the existing legacy application by initiating new functionalities in the claims processing module in compliance with the HIPAA X12 standards. They planned to Improvise the existing modules associated with Claim Numbers. So, that it could filter the duplicate Claim Numbers and the repeated claims automatically. Hence the duplicate claim cannot not be accommodated in the system. The claims module also incorporated Claims and encounters of Receiving and Verification Forms EDI (837), Claims Status Enquiry and Response EDI (276/277), Payment Oder/Remittance Advice EDI (820), Healthcare Claim Payment/Advice EDI (835), Implementation Acknowledgement EDI (999).Responsibilities:Prepared the Business Requirements Document (BRD), functional Requirements Document (FRD), User Stories and Acceptance Criteria for the enhancement of the existing services.Followed agile methodology and participated/arranged daily sprints to keep the pace of task assignments and achieve desired target dates.Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.Identified User Story points with the Developers and assigned user stories to Sprints in JIRA.Helped the team to come up with user stories for our project and prioritizing the user stories.Actively engaged in all aspects of the scrum Ceremonies, including Sprint-Planning Meeting, Backlog Grooming Meeting, Daily Stand Up Meeting, Sprint Review Meeting and Sprint Retrospective Meeting.Organized requirements into high level Use Cases and low-level Use Case Specifications, also prepared Activity and Sequence Diagrams using MS Visio.Analyzed the Business Requirements Specification Documents and Source to Target Mapping Documents.Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.Involved in gathering requirements, configuration, and data conversion of the Facets application modules like Enrollment, Membership and Claim.Developed Use Case / Analysis / Design / Implementation Model, Use Case Diagrams, Behavior Diagrams and Class Diagrams based on UML methodology using Rational Rose. Created app to XML, app to SQL and vice versa maps using AI mapper for new customers in X12 5010 standards and moved them into production.Worked on Facets to check the HIPAA Claims and encounters Validation and Verification Process (Pre-Adjudication).Conducted eligibility analysis of EDI (X12) 837, 834, 820, 835, 999, protocols in Medicaid and Medicare Services.Assisted Information Management team with Implementations and Processing of 837 Encounter and 834 Member Enrollment transactions (both inbound and outbound).Used Facets to receive, store and send HIPAA-standard transactions EDI (835, 837, 270, 271, 276, and 277).Designed Data mapping and filtering, consolidation, cleansing, Integration, ETL, customization of data mart.Performed Requirements Traceability and managed changes to requirements for this application using Rational Requisite Pro.Setting up Enterprise Data Warehouse (EDW) and associated ETL service to generate business reports.Extensively used ETL tool Informatica power center for extraction, transformation and loading process.Performed Data Profiling of current state of data in the Data Warehouse by doing Data Analysis using advanced SQL Queries and Microsoft Excel, finding Gaps in Data and formulating solutions for the same.Involved in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.Performed Data Mapping to map the EDI 834 data to XML.Designed business intelligence dashboard using Tableau Desktop and publishing the same on Tableau server.Wrote several complex SQL queries for validating and verifying the data in Oracle.Requirement analysis/documentation, developing functional and technical specifications, DW and ETL designing, developing detailed mapping specifications, DFD's and scheduling charts.Creating and maintaining data mapping documents to map data attributes from source-to-target systems.Designed coding and testing of new and enhanced application components on the data warehouse and created packages using ETL tool for the users to check the codes.Used SQL to test various reports and ETL load jobs in development, QA and production environment.Involved in UAT of applications by providing users with test cases, scenarios, guiding them during testing process.Created business reports by joining multiple tables from multiples database using SQL queries.Extensive backend testing using SQL queries, generating the reports to ensure the data integrity and validate the business rules.Client: HP (DXC) for State of WI, Madison, WI Feb 2017 Sep 2018Position: Business System AnalystHewlett Packard has been in IT for more than 75 years. HPE has been delivering high-quality, high-value products, consulting, and support services. HPE is one of the world's largest providers of health and life sciences IT services. The Project I am working on is Insurance Based Billing (IBB) is currently handled by a paper-based manual process that results in a low rate of return. The Electronic IBB Projects main purpose is to improve payment return rates on IBBs through systematic and procedural enhancements including electronic billing functionality, automated processes, and specialized reporting.Responsibilities:Firm Understanding about the IBB and PBB.Firm Understanding about the TPL, TPLAR and create them for Testing Scenarios.Validated EDI Claim Processes according to HIPAA compliance.Create Test cases, Verify and Document them as per requirements and as per different Environments.Process the Test data through the SEs and verify them with XML, X12, Mapping Documents, Guides.Assist Team members in the need for understanding about requirements and Testing.Create TPL ARs for Professional, Institutional, Dental Claims, and NCPDP. Create the X12, run them through SEs for compliance check and test them accordingly as per the Scenarios.Read and interpret EDI Implementation guides and assist BAs in creating X12s.Highly experienced in Testing 837, NCPDP, 999,835,276/277 and Verifying the Transactions with respect to Companion Guide, Mapping Documents and Panel.Extensive experience creating 837 claims 276/277/277CA request response on EDI X12.Worked in creating X12 of, healthcare and claim Payment/Advice.Analyze, Troubleshoot, Maintain EDI Transactions 837,835, 276/277.Analyze and identify the possible issue during the testing and communicate with team members for the possible solutions.Experience with Medicare and Medicaid: Claims processing, Membership, and Eligibility Verification and care management.Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. 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 ALM Quality Center to create and maintain Test Requirements and to communicate the bugs with the DevelopersGHI Medicare, New York, NY Feb 2016 Jan 2017Business System AnalystGHI Medicare is a multi-state managed healthcare insurance company focused on serving people who receive healthcare benefits through publicly sponsored programs, including Medicaid, Medicare, State Childrens Health Insurance Program, Family Care and Special Needs Plans. GHI collaborated with the third party to offer benefit card for real-time healthcare transactions to its Medicare members. The objective of the project was to create standardized eligibility extracts and securely transmit them to the corresponding vendor.Responsibilities:Identified the scenarios based on business requirement and HIPAA compliance for each transaction such as 837(Claim), 834(Enrollment) and 276/277 (Claim Status).Gathered business requirements through JAD sessions and one-on-one interviews with the Business StakeholdersUpdated the core consolidated project plans: project schedule, tracking and oversight plans, cost tracking reports, etc., and maintain the project on-line database or site using MS Project.Tracked status reports involving multiple projects using MS Project.Created class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.Defined and documented the vision and scope of the project.Followed AGILE methodology throughout the software development life cycle and analyzed risks that might lead to scope creep between releasesConducted one on one interviews with high level management team and participated in the JAD session with the SMEs.Worked with subject matter experts (SMEs) internally and externally, and participated with software developers in Scrum team meetings, documenting agile software processes.Worked as a liaison between the business and technical side to convey the business needs to the system architects.Managed and Billed Medicare, Commercial HMO/PPO claims on a daily basis.Generated all Medicare claims review and transmitted to Medicare.Validated EDI Claim Processes according to HIPAA compliance.Participated in weekly status meetings to present status and incorporate any digressions from the original scope.Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions.Carried out a thorough target organization assessment and risk analysis.Analyzed the As is and To be system documents to show the current and proposed functionalities of the system using MS VISIO.Worked with the clients on the verification process for the requirement phase documentsImplemented Standardized process throughout the software Development Life Cycle (SDLC).Performed UAT testing by manual test scripts. Created test cases for functional testing.Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager. Observed the compliance of the requirements with federal and state government regulations Medicaid, Medicare, and accreditation body requirements.Analyzed user and data issues related to Medicaid eligibility determination system.Involved in testing the Member Enrollment, Eligibility Enquiry, Eligibility Response, Claim Status Enquiry, Claim Status Response and conversion of Financial Claims.Actively participated in designing test plans, test cases and test scripts.Met with business users and stakeholders to understand the customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions.Involved in understanding the current business process, defining scope of the project along with position statement.Extensively worked on Managed Care Provider Enrollment.Responsible for creating business work flows and processes and creating management reports based on the analysis.Developed and executed SQL queries on claim records to validate reporting data.Affinity Health Plan, Bronx, NY Mar 2015 -Nov 2016Business AnalystAffinity Health Plan is an independent, non-profit managed care plan that serves the needs of over 210,000 residents of the New York Area and provides healthcare coverage through its family health plus, Medicare & Medicaid programs.Responsibilities:Prepared high level and detailed functional requirements documents for the clinical aberrancy rulesExecuted SQL statements to check if the data integrity has been maintained.Create internal reports using Dashboard and basic SQL queries in the tool to track activities of the teams.Gathered claims processing requirements from business users.Actively participated in defining scope of project, gathering business requirements, and documenting them.Created Use Cases that defined the role of users who receive claims, users who process claims, and users who adjudicate claims. Used MS Visio to develop UML diagramsAssisted the project manager in the creation of the project charter & vision document during the inception phase of the projectPerformed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing processUnderstood EMEVS, the NY state's electronic Medicaid eligibility verification system & the Medicaid & Medicare welfare system intermediary along with their roles in claim processing.Produced Activity diagrams with defined swim lanes as part of claims process analysisInvolved in gathering and prioritizing requirements using 1 to 1 interview, job shadowing, brainstorming & developing questionnairesTranslated business requirements into functional specifications and documented the work processes and information flows of the organization.Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactionsContributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership managementPerformed Data Mapping to map the EDI 834 data to XML.Effectively used Rally Agile software to write the User Stories and to walkthrough the stories in planning and grooming sessions with the SCRUM teams.Created the data dictionary for the clinical aberrancy rulesManaged business requirement document (BRD) using Rational Requisite Pro.Write high level and low-level integration requirements for integrating our product with clinical editing tools, predictive analytics tool and SIU services.Created Activity Diagrams and Workflow application to automate the process using MS Visio.Involved in performing User Acceptance Testing (UAT) for release.Identified, analyzed and documented defects, error and inconsistencies in the application using Quality Center.Created and maintained Test Matrix and Requirement Traceability Matrix and performed GAP Analysis.Work closely with the business team, development team and the Quality Assurance team to ensure that desired functionalities have been achieved by the application.Location: MarylandEducation: Bachelors in information Management. |
