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Click here or scroll down to respond to this candidate Ali KhanLead Business System AnalystEMAIL AVAILABLE
PHONE NUMBER AVAILABLEhttps://LINKEDIN LINK AVAILABLEPROFESSIONAL SUMMARY: 12+ years of HealthCare and Information Technology experience with expertise in Business Analysis, Data Analysis and Software Testing. Working on Healthcare Electronic Data Interchanges (EDI s), 837(I/P/D) Claims, 835 Remittance Advices, 834 Managed Care Organization s Enrollment Data, 270/271 Eligibility Inquiry/Response and 276/277 Claim Status Inquiry/Response.
Expertise in reading Edit logics used to adjudicate claims, duplicate checks and adjustments.
Expertise knowledge on HIPAA 4010 (Legacy), HIPAA 5010, ICD9(Legacy) & ICD10, MMIS and MITA framework.
Experience with Encounter data record (EDR) to paid claims by Medicaid managed care organizations (MCOs) and dental maintenance organizations (DMOs) for services provided to persons with Medicaid. Experience in Agile and Waterfall environment of application development mainly working on gathering business requirements, developing System Design Document (SDD) that provides detailed system architecture design including interfaces, file layouts, reference layouts, appendices, business users and business process. Experience in Business Analysis gathering business requirements from product owners to derive functional, non-functional requirements, software requirements specifications, technical architecture, business workflows and document these in appropriate Business Analysis Artifacts (BRD, FRD, SRS, RTM). Experience in Requirements Analysis conducted Gap Analysis, Impact Analysis (analysis on identified gaps), and Feasibility Analysis (solutions to identified gaps) to validate for S.M.A.R.T requirements. Analysis report with Decision Matrix was then provided to the product owner for decision making. Experience in writing Use Cases, User Stories and build them into Epics. Actively participated in prioritizing Sprint Backlogs.
Experience in creating BRD, FRS, RTM, S2T, DQ S2T (Data Quality), DED and process flow diagrams. Experience in building User Interface (UI/GUI), UML diagrams using MS Visio Pro, to illustrate business processes, building data flows, application interfaces, As-Is and To-Be systems. Experience in Data Analysis data mapping, validating file layouts (initial load layouts, weekly/monthly/quarterly incremental load records, reports) for multiple data attributes, written/modified/tested data conversion rules and built data extracts as required.
Experience in using code management tools IBM Clear Case for analyzing business logics embedded in application code. Experience in Teradata SQL and performed Data Analysis by pulling data from Enterprise Data Warehouse and DB2 tables. Experience in Microsoft SQL Server created and modified stored procedures, staging tables, data migration and resolved data quality issues. Experience in Quality Assurance of applications, performed Manual System Testing (Unit, Integration, Regression and UAT) using HP Quality Center and HP ALM tools. Experience in writing Test Cases, building Test Scenarios, extracting and building Test Data. Expertise in Administration, designing, development and deployment of Data Warehousing and Business Intelligence applications using Tableau and COGNOS. Experience with Tableau, Excel reports and other BI tools along with good Networking and SAP Concepts. Experience in Big data analysis and implementation of Big data projects using Hadoop, HBase and Hive, HQL, Scoop.TOOLS EXPERTISE:SDLC MethodologiesAgile, Waterfall.Business Process ModelingMS Visio.Project Management
MS Project, JIRA.Business Analysis
JIRA, IBM Rational Rose, Requisite Pro, IBM ClearQuest & Clear Case.Database ToolsTeradata SQL, T-SQL, PL/SQL, BI Query, Tableau, MS Access.TestingHP Quality Center, HP ALM, Load Runner, Manual Testing.Tools
SAP Business Objects, Cognos, Tableau, DevOps, ITSM.Issue TrackingJIRA, Remedy, MS Team Foundation Server (TFS), As-One, Rally.WORK EXPERIENCE:
Client: Blue Cross Blue Shield, Phoenix, AZ Mar 2023 - PresentRole: Lead Business System Analyst
Project Description: Worked on OnBase database is a content service platform that organizes, manages and optimizes your content, process and cases. Intelligently capture and process business data from various sources with automatic classification and verification for immediate use. Gain visibility into your content and processes in real time with interactive dashboards and audit trails of all content-related activities.Job Duties: Experience in performing Business Analysis across hybrid software development life cycle (SDLC) methodologies Waterfall and Agile. Working experience of Gap Analysis between As-Is and To-Be processes of software applications of data flows and business processes. Developing source to target mapping for Migration Project also performed data profiling. Involved in preparing Source to Target Mappings and coordinating UAT with business teams and reporting status periodically.
Developing complex SQL queries for querying data against different databases for data verification process.
Involved in Reconciliation and Recovery process for capturing the incremental changes in the source systems for updating in the staging area and data warehouse respectively. Developing Complex SQL queries to fetch the data from the Database as per the business requirement to analyze the gap or root cause and use the SQL queries for further processing. Proficient in implementing and managing Electronic Health Record (EHR) systems to ensure compliance with HIPAA regulations and other industry standards. Skilled in utilizing HIPAA compliance software to conduct risk assessments, develop policies and procedures, and provide staff training on privacy and security measures. Developed RESTful APIs using industry best practices to facilitate seamless communication between front-end applications and backend servers. Designed and implemented RESTful endpoints to enable data retrieval, manipulation, and storage operations, adhering to REST architectural principles. Utilized frameworks such as Flask, Express.js, or Django to build robust RESTful APIs, ensuring scalability, reliability, and performance under high traffic conditions. Implemented authentication and authorization mechanisms, such as OAuth 2.0 or JSON Web Tokens (JWT), to secure RESTful API endpoints and protect sensitive data. Experience in working with various Azure services such as Azure App Service, Azure Functions, Azure SQL Database Proficient in deploying, managing, and monitoring virtual machines, storage accounts, and networking resources on Microsoft Azure platform. Utilized Azure Monitor and Azure Log Analytics for monitoring application health, performance, and security,Technical Environment: JIRA, Oracle SQL Developer Version 4, IBM Infosphere, SOAP, Tableau, BLUEPRINT, JENKINS, GITHUB, Agile/Scrum methodologies.
Client: Florida Blue, Jacksonville, FL Dec 2021 Feb 2023Role: Sr. Business System AnalystProject Description: Florida Blue is the subsidiary of Blue Cross and owned by Guide Well, formally GuideWell Mutual Holding Corporation, is a mutual insurance holding company primarily focused on health insurance in Florida. It was created in 2013 by a reorganization initiated by Florida Blue, a member company of the Blue Cross Blue Shield Association. Florida Blue focused on transforming health care. In total, Guide Well companies serve more than 45 million people in 45 states.Job Duties: Experienced in working with Native Mobile App Project and other UI/UX projects. Leading the team and gathering the business requirements for Native POR project under SAFe agile and identifying the scope of the project and addressing the defects. Taking care of data flow from prod to test in depth analyzing the data. Involved in preparing Source to Target Mappings and coordinating UAT with business teams and reporting status periodically.
Defined project requirements by identifying project milestones, phases, and elements, forming project team, establishing project budget and sizing the project based on the gathered information. Created the user stories and have expertise in Rally (Features, Story, Defects, and Task). Experienced systems, subsystems, development methodologies, systems architecture, tools and processes that support the assigned business initiative or system. Understand a variety of architecture standards and ability to apply them in their design work and upload the content into bloom reach from approved content from the business. Experienced in conducting Technical Feasibility Study, Impact Analysis and Risk Analysis required for application development. Performed Data Analysis, Data Mapping, Data Profiling and Data validation across the systems. Implemented Tableau Online to enable cloud implementation of analytics developed on Tableau desktop, and to make dashboards available on the cloud platform being implemented by the client. Involved in Unit Testing of DataStage Jobs, integration testing and system testing in pre-production environment. Implemented data integration solutions to consolidate and transform data from disparate sources into a unified format for reporting and analytics. Proficient in performing data profiling, data quality analysis, and data cleansing tasks within DataStage to ensure high data accuracy and consistency. Designed and implemented data transformation logic using DataStage's built-in functions, custom SQL queries, and external libraries as needed. Involved in the Data Validation, Data Conditioning & Interacting with other impacted teams.Technical Environment: XML, Json, ClearCase, MS Office, MS-Visio, Java, Agile, Quality Center, MS Project, SQL server, SQL Assistant, Teradata, DB2, Mainframes, C#, Jira v7.13.5, Web Services.Client: WellMed Medical Management. San Antonio, TX May 2021 Nov 2021Role: Sr. Business System AnalystProject Description: WellMed Medical Management is a network of doctors, specialists and professionals providing care for older adults with over 18000 doctors offices in Texas and Florida.Job Duties: Experienced in performing Business Analysis across hybrid software development life cycle (SDLC) methodologies used Waterfall Developed complex SQL queries for querying data against different databases for data verification process.
Worked for a data governance team to help and analyze the data to understand before going to cloud (MS Azure). Involved in Reconciliation and Recovery process for capturing the incremental changes in the source systems for updating in the staging area and data warehouse respectively. Developed Complex SQL queries to fetch the data from the Database as per the business requirement to analyze the gap or root cause and use the SQL queries for further processing. Experienced in conducting Technical Feasibility Study, Impact Analysis and Risk Analysis required for application development. Performing Data Analysis, Data Mapping, Data Profiling and Data validation across the systems. Leading the team and gathering the business requirements for the project and identifying the scope of the project and addressing the defects. Taking care of data flow from prod to test in depth analyzing the data. Worked/updated the Erwin Data model based on change request and created DDL for this data model as well XML file.
Proficient in Business Requirement gathering, Business Process flow, Business Process Modeling (BPM), Process Redesign, Business Process Reengineering. Involved in Unit Testing of DataStage Jobs, integration testing and system testing in pre-production environment.Technical Environment: XML, Json, ClearCase, MS Office, MS-Visio, MS Azure, Java, Agile, Quality Center, MS Project, SQL server, MySQL, SQL Assistant, Teradata (TOAD), DB2, CA Erwin data model.
Client: Blue Cross Blue Shield Association (BCBSA), Chicago, IL Jun 2020 Apr 2021Role: Sr. Business System Analyst
Project Description: Blue Cross Blue Shield Association, is an independent association that provides health insurance. The Blue Cross Blue Shield Federal Employee Program (FEP) is a nationwide program which provides health insurance to US federal government employees and retirees. FEP enrolls more than half of the federal workforce which makes it the largest insurer of federal employees. FEP is developing an analytical application called A2.0 (Analytics 2.0) on the Datalake server, which has two phases COTS and FIRE.Job Duties: Experienced in performing Business Analysis across hybrid software development life cycle (SDLC) methodologies Waterfall and Agile (Kanban & Scrum experienced). Worked in experience of Gap Analysis between As-Is and To-Be processes of software applications of data flows and business processes. Involved in Reconciliation and Recovery process for capturing the incremental changes in the source systems for updating in the staging area and data warehouse respectively. Experienced in conducting Technical Feasibility Study, Impact Analysis and Risk Analysis required for application development. Reverse engineering and debugging to solve project issues throughout all phases of the implementation cycle and created the re-engineering tables for the new system. Performed Data Analysis, Data Mapping, Data Profiling and Data validation across the systems. Leading the team and gathering the business requirements for the FIRE project and identifying the scope of the project and addressing the defects. Taking care of data flow from prod to test in depth analyzing the data. Worked/updated the Erwin Data model based on change request and created DDL for this data model as well XML file.
Created SA design document, approach document and DED (Data Exchange document) for the project. Process flow diagram in MS visio. Created FRS, RTM, S2T and DQ S2T (Data Quality).
Proficient in Business Requirement gathering, Business Process flow, Business Process Modeling (BPM), Process Redesign, Business Process Reengineering. Experienced in writing complex SQL queries for extracting data from multiple tables. Tested several complex ETL graphs, for initial and daily data loads. Developed ETL packages with different data sources (SQL Server, Flat Files, Excel source files, XML files etc.) and created multiple stored procedures to load target tables with transformation rules as appropriate (Control flow transformations such as FTP, Loop Container, Execute Package, Data Reader Task, XML Task and Data Flow Transformations such as Lookup, Conditional Split, Derived Column, Audit, Merge, Merge Join and Sort) using SQL Server Integration Services (SSIS). Perform various data cleansing/cleaning using SSIS packages and ETL. Written manual SQL procedure for some of the ETL and data cleansing tasks in ETL loads to ODS. Involved in Unit Testing of DataStage Jobs, integration testing and system testing in pre-production environment. Hands-on experience in designing and building standardized Business Intelligence reports, Business Objects Crystal and Web Intelligence dashboards using BI Query and ad-hoc requests from SAP-BI users.Technical Environment: XML, Json, ClearCase, MS Office, MS-Visio, Java, Agile, Quality Center, MS Project, SQL server, SQL Assistant, Teradata (TOAD), DB2, Mainframes, Jira v7.13.5, CA Erwin data model.
Client: Blue Cross Blue Shield, Chicago, IL Sep 2019 May 2020Role: Sr. Business System Analyst
Project Description: Health Care Service Corporation (HCSC) is a subsidiary of Blue Cross Blue Shield of Illinois (BCBSIL). HCSC is developing a GOLD membership project, it is a new application and getting the data from all old legacy systems. To resolve this, obsolete business logics were removed and application was performance (including load test) and regression testing. We were getting the data from all sources (raw) to GOLD. During this process we were involved in data validation, data mapping, data profiling and new business requirement gathering.
Job Duties: Experienced in performing Business Analysis across hybrid software development life cycle (SDLC) methodologies Waterfall and Agile (Kanban & Scrum experienced). In-depth working experience of Gap Analysis between As-Is and To-Be processes of software applications of data flows and business processes. Developed source to target mapping for Migration Project also performed data profiling. Developed complex SQL queries for querying data against different databases for data verification process.
Involved in Reconciliation and Recovery process for capturing the incremental changes in the source systems for updating in the staging area and data warehouse respectively. Experienced in conducting Technical Feasibility Study, Impact Analysis and Risk Analysis required for application development. Experienced in Reverse Engineering on RDBMS, including MS Access, Teradata for data analysis Performed Data Analysis, Data Mapping, Data Profiling and Data validation across the systems. Involved in the Data Validation, Data Conditioning & Interacting with Acxiom project requirement. Leading the team and gathering the business requirements for Acxiom project and identifying the scope of the project and addressing the defects. Taking care of data flow from prod to test in depth analyzing the data. Performed various data cleansing/cleaning using SSIS packages and ETL. Written manual SQL procedure for some of the ETL and data cleansing tasks in ETL loads to ODS. Created the user stories and have expertise in JIRA (Epic, Story, Bug, and Task). Involved in Unit Testing of DataStage Jobs, integration testing and system testing in pre-production environment.Technical Environment: XML, Json, ClearCase, MS Office, MS-Visio, Java, Agile, Quality Center, MS Project, SQL server, SQL Assistant, Teradata, DB2, Mainframes, C#, Jira v7.13.5, Web Services.
Client: The State of Illinois Department of HFS, Springfield IL Jun 2017 Aug 2019Role: Sr. Business Systems Analyst
Project Description: Illinois Medicaid Program Advanced Cloud Technology (IMPACT), is a comprehensive replacement and enhancement project of Illinois s Information Technology Infrastructure. This project is currently focusing on replacing Illinois s over 35-year-old Medicaid Management Information Systems (MMIS) with web-based Advanced Cloud Technology which includes Provider Enrollment System, Pharmacy Benefits Management System, Integrated Eligibility System and Core MMIS Applications.Job Duties: Determine operational objectives by analyzing business functions and gathering data from project stakeholders and evaluate scope of work, project planning and budgeting. Provide Subject Matter Expert services with Medicaid and Medicare business and associated software applications used to process claims, Eligibility & Enrolment System, Pharmacy Benefits Management System (PBMS), New Medicare Card Replacement Project, Enterprise Data Warehouse and other MMIS upgrade/replacement systems. Elicit and analyze user and system requirements include functional, technical and nonfunctional requirements and maintain a traceability matrix of these system functionalities. Perform code review (COBOL, .NET programming language) to identify validity of business logics using IBM Mainframes and MS-Visual Studio. Write use cases, user stories, test scripts, test scenarios. Perform Requirements Engineering (including Gap Analysis, Feasibility Studies, and Impact Analysis) and write Detailed System Design Documents (DSDD) which is a blueprint architecture of complete functional application. Build Concept of Operations for applications including Business Continuity Contingency Plan and prepare technical documentation required for system certification by Federal Government Agency, Centers for Medicare & Medicaid Services. Build technical architecture using MS Visio for legacy MMIS and identify potential areas of development/automation. Implementing User Interfaces (UI) using HTML and CSS for web-based applications. Analyzed and Documented User Experience (UX) requirements for the MS Dynamics Portal. Working on Paper Claims (UB-04, CMS-1500) Automation Project conducted feasibility studies, risk analysis, data mapping, built architecture of AS-IS process.
Executing on the automation of developer pipeline from source control to production deployment using DevOps best practices. Developed detailed vision and scope for the project by gathering business requirements from federal government, Social Security Administration, business partners (MCO s & Providers) and state s departments (Human Services, Innovation & Technology, Child & Family Services). Wrote Functional Requirements (FRD), Business Requirements (BRD) and maintained traceability thru Requirements Traceability Matrix (RTM). Developed Software Development Life Cycle (SDLC) using Waterfall approach for making system changes, testing and deployment. Worked on developing and managing project artifacts project charters, advance planning documents, budgeting, concept of operations, business continuity & contingency plans, Work Breakdown Structures, project schedule, resource planning, milestones, deliverables, change requests management, project reports using MS Project and JIRA tools.Technical Environment: Agile & Waterfall SDLC approach, COBOL, .NET, Java/J2EE, DB2, Teradata SQL, JIRA,3M Core Grouper (V 10.5.1.1.18), IBM Blue Zone Mainframes (V 6.2.2325), OpenText BI Query, Sandbox (v 1.2.0.4), As One (version control proprietary tool).Client: Care 1st, Los Angeles, CA Jun 2016 May 2017Role: Business System AnalystProject Description: The project scope was to identify obsolete business logics embedded in application codes. Adding new business logic and creating alternative workflow to existing codes over the time caused technical glitches, extended system down times and increased system failures frequency. To resolve this, obsolete business logics were removed and application was performance (including load test) and regression tested. Code reconciliation was performed as required to integrate the same business logics used across multiple business scenarios.Job Duties: Experienced in performing Business Analysis across hybrid software development life cycle (SDLC) methodologies Waterfall and Agile (Kanban & Scrum experienced). In-depth working experience of Gap Analysis between As-Is and To-Be processes of software applications (data flows, business processes, reports, claims transactions HIPAA 5010). Experienced in conducting Technical Feasibility Study, Impact Analysis and Risk Analysis required for application development. Experience in extracting and reading EDI s (270/271 Batch Eligibility Transactions,837/835 Medical/Professional/Dental Claims Submission with Remit Advices, 834/820 Managed Care Enrollment). Hands-on experience in designing and building standardized Business Intelligence reports and dashboards using BI Query and ad-hoc requests from SAP-BI users. Experienced in developing Object Oriented Detailed Design for technical system architecture including functional and business stakeholders, data flows, infrastructure(hardware) and applications (software).Technical Environment: Requisite Pro, Rational Rose, XML, ClearCase MS Office, MS-Visio, Java, TOAD, Agile, Quality Center, MS Project, SOA, SQL server, Ultra Edit, Mainframes, C#, Jira v6.2.3, Remedy, Scrum Works Pro, JBoss Web Services, Oxygen XML Editor, Spring 3.0, BizAgi Suite
Client: Cardinal Health, Columbus, OH Sep 2015 May 2016Role: Business Analyst /Quality AnalystProject Description: A global manufacturer and distributor of medical and laboratory products, and a provider of performance and data solutions for healthcare facilities. With more than 50 years in business, we are building on our expertise in distribution, products and solutions to innovate and create customer-centric solutions that address healthcare s most complicated challenges.Job Duties: Experienced in building Data Mapping artifacts between AS-IS and TO-BE data warehouses.
Experienced in controlling versions of EDI 270/271, 276/277, 837/835, 834/820 depending on amendments made to proprietary data file layouts or adjudication business process. Worked on Enrollment Broker System, building and testing additional functionalities to existing systems mainly centralized to add/modify/cancel data related to enrollment brokers and their association with providers and state Medicaid agencies. Experienced in writing Use Cases and built Use Case Activity & Sequence diagrams and Logical views using MS Visioand Rational Rose for a clear understanding of the requirements by the development team. Performed Testing & Reporting on IND & SHOP: EDI 834/820/Audit/ Reconciliation work for Federal Centers for Medicare and Medicaid Services (CMS).
Facilitated Test Planning Sessions with Quality Assurance Team to develop Test Plan, Test Cases and required Test Data. Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly. Developed User Acceptance Testing (UAT) plan to guide a select group of key end-users in testing the user interface (UI) and functionality of the application. Performed System Unit testing, Regression testing and UAT on Enrollment Broker System and ad-hoc testing as required in other subsystems. Logged, monitored, retested & managed complex data defects using HP QC/ALM and produced defect status reports including defect density, defect age etc.
Experienced with functionalities of HP Quality Center to create test plans, document and track test requirements, test cases & generate reports as required. Working knowledge and implementation experience of Quality Assurance, Testing Principles, and Configuration and Change Management Disciplines.Technical Environment:SQL, JIRA cloud, Microsoft Excel, Microsoft Word, Confluence, Sharepoint, TFS, Agile/Scrum methodologies.
Client: National Heritage Academies, Grand Rapids, MI Mar 2014 Aug 2015Role: Data/Business AnalystProject Description: National Heritage Academies (NHA), set high standards, make expectations clear, personalize teaching, and as a result, our students thrive. In fact, according to Stanford University's Center for Research on Education Outcomes, NHA is a leading performer among charter schools and management organizations, outperforming both conventional district schools and other charter school operators.Job Duties: Document and analyze the required information and data. Understanding the technical designs as well as the specifications to design and deliver system solutions with the needs of stakeholders. Participate in requirement review and design meetings. Understand business process management and business requirements for translating them to Functional, Technical and Non-Functional requirements. Facilitate Joint Application Development (JAD) and Workshop/Brainstorming sessions to elicit business requirements and map it to functional specifications.
Developed detailed use-cases, activity diagrams, sequence diagrams etc. for Enterprise Data warehouse (EDW) Upgrade & another project Develop Test Strategies, Test Plans and Test Cases based on the technical requirement document. Identify/Develop Test Data Sources.
Perform UAT testing, UI testing Java, JavaScript, jQuery, AngularJS, JMeter and GitHub make sure the test results conform to requirement specification. Created SSIS Packages using SSIS Designer for exporting heterogeneous data from OLE DB Source (Oracle), DB2 and MS Excel to SQL Server 2008.
Worked extensively on DTS Package Designs for import/export of raw data (flat, .CSV, XML, .DAT files) to MS SQL Server 2008. Developed ETL packages with different data sources (SQL Server, Flat Files, Excel source files, XML files etc) and created multiple stored procedures to load target tables with transformation rules as appropriate. Developing stored procedures, triggers, views, and adding/changing tables for data load and transformation, and data extraction. Developed custom reports, Ad-hoc Reports by using SQL Server Reporting Services (SSRS). Created Reconciliation Data Sources to check data consistency between ECC, BI and Tableau systems and prepared test documentation.Technical Environment:GitHub, SQL, JIRA cloud, Microsoft Excel, SOAP, Confluence, Smartsheet, KAFKA, TestRail.Client: iGate Patni, India Oct 2011 Aug 2013Role: Software AnalystProject Description: iGate Patni are well renowned and are highly praised in different parts of the world. Our financial services, insurance and media services are quite adept for today s tech world and therefore is future-proofed as well
Job Duties: Facilitated requirements elicitation sessions with business users on eliciting required business rules and logics for predictive data modeling.
Written Shell scripts to balance the data between source and target tables after each ETL load. Experienced in Reverse Engineering on RDBMS, including MS Access and Teradata for data analysis.
Generated Data Definition Language (DDL) scripts using Erwin and supported DBA in implementing developed data models. Analyzed data for Online Transactional Processing (OLTP) and Online Analytical Processing (OLAP) systems and generated reports using SAP Business Objects reporting tool.
Experienced in Sybase Power Designer tool used in designing RDBMS data models.
Experienced in Data Quality Assurance includes data extracts, data cleansing and prepared ad-hoc analytical reports using Teradata SQL.
Developed DB Stored Procedures and Data ETL Functions, ensuring low data quality issues on warehouse data. Tested load performance on databases in OLTP and OLAP models.
Technical Environment: Agile(RUP), Windows, XML, MS Office Suite, Oracle, Adobe Photoshop, MS Visio, SharePoint 2013. |
