Data Analyst

Rajendra Desai PHONE #: (***) *** – ****

**********@*****.***

SUMMARY:

Over ten years of extensive experience in the design, development, analysis, support, debugging, maintenance, reporting, and implementation of business applications using SAS Enterprise Guide, Base SAS, Cognos (Impromptu), Crystal Reports, MS Access (VBA), SQL, Visual BASIC, EXCEL, Word, PowerPoint.

Worked with different industrial and business setting that includes Health Care, Product Manufacturing, Hospital, Electronics, Pharmaceutical, Banking and Finance.

COMPUTER SKILLS:

SAS: SAS Enterprise Guide, Base SAS Programming on PC and UNIX platforms.

Languages: Visual Basic, ACCESS VBA, SQL,, Knowledge of R.

Reporting Tools: Crystal Reports, Impromptu (COGNOS), Business Objects.

DBMS: MS ACCESS, Oracle, SQL Server.

Operating Systems: Windows, UNIX, DOS.

Others: Excel, Word, Power Point.

WORK EXPERIENCES:

Horizon Blue Cross Blue Shield of NJ May 2016 – Jan 2018

Reporting / Data Analyst III in Broker Commission / Monitor Department

oOmnia / Non Omnia Membership – Study, research, understand, membership EDW data, maintain and automate existing projects, developed ad hoc projects and generate monthly Individual Brokers commission reports for On and Off Exchange and for MediGap members - accurate and in time.

oMBU ODS –Attend training sessions and expand business knowledge, and apply whatever learned in existing projects and in new projects. Create training manual.

oDeveloped reconciliation process.

oVerify data to ensure data quality is maintained and report to IT for any data anomalies.

oDeveloped Brokers Bonus calculation process.

Environments: SAS EG, Base SAS, Access VBA, SQL, Oracle under Windows and UNIX.

Emblem Health, NY. Oct. 2012 – May 2016

Lead Risk Adjustment Analyst in Government Programs Revenue Integrity Department

oModify and maintain the CMS SAS scoring model for Part C, Part D risk scores for both non-ESRD and ESRD members for coming payment year. Run the CMS SAS model on a monthly calendar to generate member level Part C and Part D scores for estimating accruals for both midyear and late claims adjustments. On a monthly basis generate Wt. Average scores at the plan level for each category of members and also for Medical Groups.

oMaintain a HCC part C and Part D SAS prospective model to predict the CMS premium amounts attributable to different initiatives/Vendors based on the submitted RAPS based on most current submitted RAPS.

The model should attributes credit to each vendor/initiative that were first contributory at the HCC level based both on dates of service and dates of RAPS acceptance.

oProvide data support and member level details during all internal and external data validation audits including RADV to the Medicare product management and Audit team.

oJointly with the other colleagues, design and develop a SAS model to meet risk scoring and other operational needs following the implementation of the State Health Exchanges for member enrollments.

oOn a quarterly basis, generate the Primary Care Incentive Bonus Payment (PCIP) data Files for qualified primary care physicians based on NPI provided by CMS derived from eligible claims, which based on CMS provided CPT codes, both HIP and CCI.

oOn an annual basis, generate the Provider bonus payment data files from the provider list from CMS (PQRS & ERX) and eligible claims for both HIP and CCI.

oDeveloped a menu driven Health Home Enrollment database in Access VBA.

Emblem Health, NY. Sept. 2009 – Sept. 2012.

Sr. Business Data Analyst in Medicare Product Management Department

oDelivered MLTC (Managed Long Term Care) Data Files of potential members to Marketing Department.

oDelivered new Loss of SNP compare files.

oOn an annual basis, generate the Provider bonus payment data files from the provider list from CMS (PQRS & ERX) and eligible claims for both HIP and CCI.

oDeveloped Claims reports to monitor MLTC use and cost.

oDesigned & developed Queries and Reports for Enrolment Db and Referral Db using VBA code.

oGenerate reports involving claims and membership data using SAS, Cognos Impromptu and MS Access.

Emblem Health, NY. Nov. 2006 – Sept. 2009

SAS Programmer Analyst in HealthCare Analytics Department

oDesign, develop, test, document and maintain programs for control and ad hoc reports.

oAnalyze clients’ project proposals, identify omissions and errors in requirements, and recommend optimum approach.

oGenerate reports involving claims and membership data using SAS, Cognos Impromptu and MS Access.

oApproximately completed 100 data requests, meet the deadlines.

oTo reduce usage of mainframe computer and make the maximize use of DW, converted some of the major mainframe codes to SAS Enterprise Guide (SAS EG).

oWrote MS Access VBA code to report certain information from CDW that would be difficult to report otherwise.

HIP USA, NY. Dec. 2005 – Nov. 2006.

Analyst in State Sponsored Programs Department

oDesign and developed menu-driven MS Access projects: Tracking of New Born Babies with low weight, Out of Area Report for all counties of NY, Tracking of Expected Delivery database, Quarterly HRA Report, Contract Claim for FHP and MED members and Daily Task Summary.

oEnvironments: SAS EG, Base SAS, Access VBA, SQL, Oracle, Cognos Impromptu under Windows and UNIX.

Tucker Distribution Center, NJ. Feb. 2005 – Nov. 2005.

ACCESS Developer in Inventory Department

oMaintain and implement the Inventory System with MS Access, MS SQL database and Excel Pivot Tables: Cycle counts, matching goods with the inventory, maintain the Transfers, Returns, and Cuts of goods, update the database for Stock Adjustments, Received goods in the system, Maintain weight and volume of goods.

Environments: Access, Oracle, Excel, SQL Server, Crystal Reports under Windows.

Education: MS (Applied Mathematics)

BS (Mathematics)

Skills: Excellent interpersonal and communication skills.

Works well independently and as a team member.

Immigration Status: US Citizen.

Reference: Available on request.

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