SUMMARY

• 7 Years plus experience in Healthcare data, Data Analysis, Software testing, Proficient excel user and MS access with VBA coding. Tableau Advanced Level Certified.
• Worked extensively on Business Process Development and Maps
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets
• Experience working in Microsoft SQL Server and Oracle BI
• Firm understanding of HIPAA regulations and experienced working in all phases of healthcare insurance processing like defining Membership Eligibility and Enrollment and various Medical Claims processing, including Medicaid and Medicare claims processing.
• Detail oriented, innovative, and excellent analytical decision - making skills and ability to develop database tables through standard queries
• Exceptional ability to manage high volume of projects and tasks and Multiple years of work using Agile software development methodology.
• Experience in Business analysis to Translate EDI requirements into functional specifications.
• Extensive experience in developing SQL and PL/SQL (Coding Procedures, Functions, Database Packages and Triggers).
• Expertise in Database Performance Tuning, Performance Monitoring and Optimization
• Extensively involved in UI Automation by using Selenium WebDriver, Java, Database Testing, Web Application Testing.
• Well versed with Software Development Life Cycle (SDLC), Software Testing Life Cycle (STLC), Logging and Tracking defects in all phases. Extensive knowledge of HTML, JavaScript, Web testing, API testing, and XML.
• Highly motivated team player having team mentoring skills with strong communication, analytical and organizational skills.

PROFESSIONAL EXPERIENCE

Confidential

Business/Healthcare Data Analyst

Responsibilities:

• Reviewing Medicare transmittals for cost report changes and managing the annual Institutional Cost Report (ICR) audits. Writing analytical queries to extract data from cost reports using Dbeaver and Oracle MySQL.
• Working with MDW Warehouse to extract encounter data, cost reports and analyze the future rate setting for the plans.
• Analyzed business requirements and provided support to the technical team in developing MS Access databases and related system using VBA and SQL programming as per established standards and procedures.
• Designing and executing efficient VBA code for developing new Access applications and modified access tables, database templates, SQL queries.
• Designing solutions, gathering department/bureau requirements, and performing analysis on Medicare data along with generating reports.
• Understanding various Medicaid reimbursement methodologies of NYS and assisting with rate appeals for new programs. Demonstrated new cost saving fiscal models for the upcoming programs.
• Responsible for analyzing and evaluating the criticality of issues and making decisions as to the appropriate level of escalation.
• Organized Functional Design Documents (FDD) handoff meetings with the Business and technical team, explaining them the requirements, review the Functional Designs and getting a formal signoff.
• Assured standardization of policies, procedures, workflows, in accordance with the organization's approved EHR practices.
• Knowledge of medical terminology, and procedure codes, pricing, and provider contracts
• Experience working with transactional databases and data warehouses.

Confidential

Business Analyst

Responsibilities:

• Ensured accuracy and adequacy of budget justification data by creating logical data model for the data systems.
• Created and controlled features or functionalities for MS Access database applications and related systems and designed user interfaces and user-defined functions using VBA as well as protected Access data, databases, and reports for assigned applications by adhering to best security practices and methods as required
• Analyzed and updated financial records for consistency and compliance as per changed laws.
• Provided efficient analyzing and reporting of budgetary data using Tableau software solutions and presented the same in the reports.
• Assisted with financial analysis of mailing process and saved $25,000/year per department by recommending the use of new business software. Developed SQL codes to extract the required data.
• Involved in migration from MS Access reports to Oracle reports, Provided support to various MS Access applications
• Import/Export of data from oracle database to MS access using linked tables
• Developing new oracle reports as per business requirement by writing code, developing forms, reports in Microsoft Access VBA
• Mapped clearing house provided service codes to Facet by developing crosswalk tables
• Documented claims extraction process using Visio and worked with provider relation & membership department

Confidential

EDI Analyst

Responsibilities:

• Develop efficient service oriented B2B Architecture for Partner Onboarding effort
• Engage with customers to understand clinical data and workflow requirements, complex interoperability problems, and design innovative solutions.
• Train peers on the development and maintenance of Integration systems
• Worked on HIPAA 7 Standard Transaction Forms X12, X12-Health Care Claim status request and Eligibility for a Health Plan and X12-820 Premium Payments.
• Subject matter expert for HL7, CDA, and FHIR interoperability standards.
• Build Mapping Requirement Specifications for all business units: Auto, property
• Build transaction maps such as 810, 811, 837, 820 and 835 from XML to EDI and EDI to XML
• Create Implementation guides for various business lines.
• Create onboarding booklet/questionnaire that will be shared to all new and old trading partners to ease the onboarding process
• Establishing connectivity and performing end to end testing.
• Production support and troubleshooting activities.

Confidential

Consultant/Test Engineer

Responsibilities:

• Created test cases in Java/Selenium based on the input and the different requirements provided by the product owner for the Payments and Credits team.
• Created the test automation framework using Selenium RC.
• Developed and Tested SQL Server reports based on the requirements.
• Responsible for analyzing, designing, implementing, testing, and maintaining all EDI processes and relationships in the environment.
• Liaison between the technical teams and business to address any issues.
• Work with mappers to ensure the data is mapped correctly in Application Integrator and flowing through the systems without any blocks.
• Developed and prepared XML documentation, as well as provided content and format testing for internal and external use.
• Established and supported communication with XML and API to proactively share information via incoming calls.
• Actively participated in test plan meetings and gathering the inputs and work on the GAP Analysis to determine the steps taken to move the process from its current state to desired state.
• Involved in identifying and create a test plan, scenarios and documenting the XML, API test cases.