SUMMARY:

Data/Business Analyst with more than 15 years of experience in Healthcare, Pharmaceutical and Bank industries. Deep data analysis, software design and development experience using COBOL, SQL, and MQSeries. Strong Experience in Providers area and Claims Processing in HMO, PPO, and Medicare/Medicaid. Strong knowledge of the PowerMHS (Claims, Membership and Benefit configuration), ALDON Change Management Application, and Hawkeye (cross reference and impact analysis software). Experience in Data Analysis and Profiling.Strong understanding of SDLC methodologies such as Waterfall and Agile with hands on experience.Strategic critical thinking evident in the application of the development methodologies - Business Requirements Gathering and Analysis, Functional Specification, Detailed Design, Development, Implementation, Testing, and Support of highly complicated Financial, Pharmacy Benefits Management, and Health Care Insurance Applications. Excellent analytical, programming, problem solving, and communication skills with the proven track record of reliable quality service.Strong experience querying data (SQL). Working experience in ad-hoc and heavy-duty financial and claim reporting. Expert technical competencies in the customer support, positive working relationship with all departments and co-workers.

PROFESSIONAL EXPERIENCE:

Confidential, Philadelphia, PA

Sr.Data/Business Analyst

Responsibilities:

• Worked on the government mandated adoption of the ICD-10 code set in claims processing utilizing two external database systems (Mainframe and Oracle)
• Revised the data conversion process of the 837/835 EDI transactions for HIPAA 5010 utilizing the information from the external databases
• Analyzed business requirements of the enrollment via the Self-Service Portal of new members and the management of existing members. Provided recommendations for the design of custom web services
• Involved in UAT Testing, Functional Testing (E2E)
• Created a new Medicare Advantage EOB (Explanation of Benefits) process to meet the latest CMS (Center for Medicare & Medicaid Services) standards
• Supported migration of data from the in-house Data Warehouse to the external system
• Automate the reconciliation of the PowerMHS generated data with the 3rd party custom aging data for the Medicare A/R and produce the variance and no-match reports
• Analyze business requirements by working closely with business and end-users
• Evaluate requirements gathered from multiple sources, reconcile conflicts, decompose high-level requirements into details, abstract up from low-level requirements to a general understanding, and distinguish user requests from the underlying true needs.
• Analyze data use and data structures
• Design the solution architecture of processes and structures and write functional specifications and corresponding technical documents
• Perform the Data Analysis and Data Mapping
• Design, develop, test, and implement new business applications and modify existing applications
• Lead off-shore developers providing SME expertise
• Analyze reported production incidents/issues and provide solutions As the Business Analyst working in an Agile environment
• Helped to set priorities and design the overall project roadmap
• Addressed the need for greater linkages between team members, managers and users, and an increased reliance on:
• User stories
• Active feedback loops
• Integrating the customer’s perspective
• Served as the “bridge” between the stories, the requirements definitions, and the task list
• Made sure user stories translated into effective changes

Confidential, Somerset, NJ

Sr. Business Analyst

Responsibilities:

• Hold Joint Application Development (JAD) sessions with Business users, SMEs, and Stake holders
• Produce Business Requirements Documents (BRD)
• Analyze business requirements for claims, enrollment, and benefits processing and identify gaps
• Analyze data use and data structures utilizing Hawkeye
• Design the solution architecture of processes and structures for the Data Warehouse; write functional specifications and corresponding technical documents
• Perform the Data Analysis and Data Mapping (ETL)
• Define test strategy and test cases for the developed parts of the application
• Facilitate the Change and Release Management activities utilizing ALDON
• Analyze application incidents/issues related to the HIPAA compliance act

Confidential, Philadelphia, PA

Sr. Systems Analyst

Responsibilities:

• Defined requirements and ensured appropriate technical solutions to business needs by working closely with end-users
• Designed, developed, tested, implemented, and documented new COBOL AS400 programs producing reports based on customers’ business requirements in the PowerMHS application environment utilizing ALDON (Change Management, Distribution & Release Management software)
• Revised existing business applications, programs, and procedures to correct errors, improve efficiency, and added new features
• Responsible for the maintenance of over 400 production batch and online programs and reports
• Worked on the project to perform the data conversion using EDI transaction 837 for HIPAA 4010.
• Worked on the project to implement requirements for the NPI - Nation Provider Identification
• Responsible for the project to establish data interfaces across multiple platforms - AS400 and OS390 and insure protection of patients private information such as Social Security Numbers, etc.

Confidential, Malvern, PA

Sr. Programmer/Analyst - Consultant

Responsibilities:

• Made enhancements and performed maintenance of existing programs in a large-scale mainframe environment
• Designed, developed, tested, implemented, and documented programs producing financial reports using COBOL II, JCL, VSAM, DB2, and EASYTRIEVE PLUS
• Worked on the conversion from IDMS to DB2 and VSAM to DB2
• Supported GEAC Accounts Payable and Accounts Receivable System
• Performed necessary troubleshooting, worked on the resolution of various production support issues, and communicated changes/enhancements to end users

Confidential, Philadelphia, PA

Programmer/Analyst - Consultant

Responsibilities:

• Designed applications on the project for CoreStates Bank, Inc. (Philadelphia, PA)
• Wrote various programs, which provided detailed analysis of the Sales and Distribution information extracted from the DB2 tables with the further load of the products information into the ORACLE environment using COBOL, JCL, and DB2

Confidential, Valley Forge, PA

Sr. Systems Integration Analyst

Responsibilities:

• Designed, developed, tested, and implemented the important business analytical tool - ‘FAST TRACK’ for the company’s Cost Management System using COBOL, JCL, DB2, and CICS
• Created new reports, modified existing applications according to users’ requirements, wrote technical documentation