Abhaya Kulshrestha

703-***-****

adcyv0@r.postjobfree.com

Professional Summary:

7+ years of experience as an accomplished Business/System Analyst, providing solutions to enhance business systems in Data Migration Data Warehouse.

Have knowledge of HL7 Messaging protocols, HIPAA transaction and code standards and electronic data interchange (EDI) standards like X12 837, 270, 271, 276, 277, 278, 835, 275 and knowledge of claims encounters process.

Worked extensively on Extraction, Transformation, and Loading (ETL) data from Oracle, SQL Server, Access, Excel, Flat Files and XML using SSIS Services.

Strong experience in Data Analysis, Data Migration, Data Cleansing, Transformation, Integration, Data Import, and Data Export through the use of multiple ETL tools.

Expertise in Data Analysis/Business System Analysis/Data Modeling and BI reporting.

Strong experience implementing software lifecycle methodology (Agile, Waterfall, Iterative, etc.), Software Development.

Knowledge and experience in implementation of HIPAA, HL7, FHIR and other transactional standards

Experience in managing multiple projects concurrently by using exceptionally strong organizational skills, analytical, problem solving, decision making, leadership skills and Project Management skills.

Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards

Skills in developing Use Case diagrams, Sequence diagrams, Activity flow diagrams, and Entity Relationship diagrams.

Extensive understanding of Software Development Life Cycle (SDLC) including analysis, design, development and testing of software application in methodologies such as RUP, Agile (SCRUM).

Expertise in preparing Test Plan, Test Scenarios, Test Documentation, Test Scripts and Test Cases.

Highly collaborative team player with extensive customer relationship skills, also possess excellent facilitation & mentoring skills and ability to prioritize tasks according to business needs

Technical Skills:

Healthcare

HL7, FHIR, Facets Data Model, Facets Modules such as Billing, Provider, Claims,Membership,HIPPA5010compliancy, X12,Medicare,Medicaid HL7 and EDI

Methodology

Agile, SCRUM,RUP, UML, Waterfall, Agile, RAD

Defect Tracking tools

HP ALM, Rational Clear Quest

Project Management

Microsoft Project, Microsoft Office.

Languages

C, C++, JAVA, NET, SQL, PL/SQL.

ETL ToolS/Database

Oracle, SQL Server,Data modeling EnterpriseData warehouse, Teradata.

Tools and Applications

MS Visio, MS Office, MS Project, Excel.

Business Intelligence

Tableau, Cognos, SSRS

Cloud Databases

AWS, Azure

Requirement Management Tools

Rally, JIRA

Professional Experiences:

Regence Blue Cross Blue Shield, Portland, OR Mar-2019 to Present

Sr. Systems Analyst

The Regence Group is the largest affiliation of health-care Plans in the Pacific Northwest/Mountain State region. It includes Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington).Regence Group is implementing a set of projects under a common program called CP-SS (Common Process Single System). CP-SS will bring individual four states legacy system affiliated with Regence group into a common Platform to deliver valuable experiences to its members.

Responsibilities:

Created SSAS cubes for BI to be used by Division of Insurance (DOI), Health Policy Commission (HPC), Group Insurance Commission (GIC), etc.

Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet. Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts. Acted as a liaison between client and payer/intermediary.

Gathered requirement on FACETS EDI 834 Benefit Enrollment and Maintenance subsystems.

Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.

Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards

Using Agile methodology and engage in an iterative workflow and incremental delivery of working.

Worked with ETL (Informatica) developers for creating real-time data interfaces and DB extracts (ETL Design).

Designed SSIS Packages to transfer data from various sources like Oracle, DB2, SQL Server, Excel and Access to SQL Server using Business Intelligence Development Studio.

Designed various packages for Parallel ETL mechanism using SSIS Control flow and Data Flow components.

Developed Technical Specification documents and Data Discovery Documents.

Worked on EDI 834, 837, 835 and 278 files and validated the functionality according to HIPAA regulation

Designed various packages for Parallel ETL mechanism using SSIS Control flow and Data Flow components.

Developed Technical Specification documents and Data Discovery Documents.

Involved in bug fixing and resolving issues for ETL Packages.

Optimized queries and ETL packages for better and faster performance. Participated in designing and developing data marts and cubes.

Used various Agile modeling techniques in order to elicit and capture the requirements. For e.g. modeled Data Flow Diagrams (DFD) using MS Visio since the data flow was complex and involved multiple applications, internal and external to the environment.

Wrote stored procedures and triggers based on requirements.

Developed SSIS packages for ETL to migrate data from different sources including insurance groups etc to the data Involved in FACETS configuration, Customization, reporting, analysis and enhancement and also worked on membership, claim module, Batch Processing, Pricing Module.

Performs configuration activities, which included the following institutional, and Provider Contracts, Benefits, Authorizations, and Fee Schedules updates

Ensures the provider, authorization and benefits configuration meets established business rules and procedures.

Modified the provider contract, authorization rules and benefit plan configuration as required

Identifies business users, document as-is and to-be processes.

Participate in gap sessions to identify and document possible risk and constraint of new system.

Gathers requirements from business users and document as-is and to-be process.

Reviews DSDDs documents and ensures new system meets client's requirement.

Monitors project deliverables and align the design and delivered solution with stakeholder needs.

Analyses customer needs and devise strategies and solutions for them.

Facilitates solution sessions and documents action items to business leads

Beaumont Health, Dearborn, MI Feb-2016 to Dec-2018

Business Analyst

Health Information Exchange - HL7 Infobutton Web Services:

The project involved working on Data Integration and Health Information Exchange implementations, connecting with different client EMR systems to deliver clinical patient data, and achieve Meaningful Use Criteria utilizing Medicity Exchange and EPIC Interfaces.

Responsibilities:

Gathered requirements through a series of interview sessions and group meetings with the identified users and developers to design, build and release the Public Facing Website.

Conducted Joint Application Development (JAD) sessions with stakeholders throughout the Project to resolve open issues.

Expertise in Agile methodology, Use Cases, Software Development Life cycle (SDLC) Processes.

Performed HL7 standards analysis and documented the enhancements to meet the end state requirements.

Methodologies like Agile, Waterfall Model and Data Modeling; Creating Process mapping, Use Cases, Sequence diagrams, Activity diagrams.

Conducted analysis of client Business Intelligence (BI) processes and functional or reporting requirements.

Worked with HL7, claims processing platforms like ClaimsXten.

Developed EPIC’s from the Themes and Documented the Product Backlog for the release.

Presented and Detailed Product Backlog Items to the Scrum Team in the Sprint Planning Sessions and assisted them in arriving at the Story Points for the User Stories.

Involved in writing extensive SQL Queries for back end testing oracle database.

Retrieved files using SQL statements.

Design a PHI exposure contingency plan with dev teams.

Performed Data Quality Analysis to determine cleansing requirements.

Involved in requirement gathering of the Data Warehouse, ETL testing effort, analyzing business requirements, Data Model Design, Data flow from various Sources to Target.

Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.

Reviewed user Stories and Acceptance Criteria with the team

Assisted the Scrum Master in Creating and Managing the Release Planning Documents in the VersionOne and Share Point Repository.

Extensively designed Data mapping and filtering, consolidation, cleansing, Integration, ETL, and customization of data mart.

Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.

Extracted data from the databases (SQL Server) using SSIS ETL tools.

Designed and Developed SSIS packages for performing ETL process using SQL Server 2008 Integration Services

Involved in designing and developing Data Models and Data Marts that support the Business Intelligence (BI) Enterprise Data Warehouse.

Performed manual testing, including validation/smoke testing of HL7 interface messages on each new build before delivering to quality assurance team.

Generated queries on SQL to verify the integrity of database.

Conducted requirements Churns between Sprints to update the product backlog.

Conducted Analytics and Assessments to derive the Team Velocity based on the various sprint outputs.

Worked with dependent teams to resolve issues and gathered the necessary data.

Aetna Inc. Hartford, CT Sep-2013 to Nov-2015

Business System Analyst

The project implemented increased scalability, capacity, and service delivery, streamlining internal processes for real time data integration between legacy systems and external vendor systems. The focus was to enhance workflow processes for the entire claims processing cycle, involving HIPAA ANSI X12 transactions like 837, 270, 271, 274, 276, 277 and 278. Enabling the IT teams to identify and resolve system errors in the adjudication process.

Responsibilities:

Assisted in creating implementation guides for various EDI X12 transactions such as 834, 835,837,270, 271, 274.

Responsible for importing all Reports from web report studio, Stored Process, BI Dashboard and Information Map to Information

Coordinated agile based planning/review activities and meetings, followed Iterative Software Development Life Cycle Process, Agile using Scrum

Understood and articulated business requirements from user interviews, weekly requirement gathering sessions and then converted requirements into technical specifications

Prepared, scheduled and lead meetings between enterprise business and technical resources and multiple vendors in preparation for demonstrations and site visits resulting in more efficient and productive meetings with fewer follow up questions and communications.

Worked with the data governance team to ensure the data quality of compliance reports for EDI transactions.

Assisted in closing gaps for associated Stories in each individual Sprint.

Assisted in entering and updating Issues (Epics, Stories, and Tasks) onto JIRA Agile application.

Delivered Enterprise Data Governance, Data Quality, Metadata, and ETL Informatica solution

Was part of daily Scrum work meetings and weekly project progress meetings

Assisted the Project Manager in defining the project plan, project charter, scope, vision, and timelines. Handled requests for proposals (RFP), making presentations to customers, and negotiating project timelines and deliverables.

Conducted complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration.

Prepared Business Process Models (BPM) and UML diagrams like workflow diagrams, activity diagrams, sequence diagrams, use case diagrams, by using MS Visio, for visual representation to explain various steps involved in business.

Involved in creating and executing test cases, test plans and test scripts for EDI 837 Claims (I & P) Transactions.

Performed Data mapping to validate and customize Claims daily load into FACETS for processing the transactions.

Performed Data profiling through careful range and pattern analysis and checked for data integrity by looking for various data anomalies and doing data normalization and data verification using Informatica Data Quality Center.

Built Data Dictionary for various designers, developers, users, and administration with information on contents, data-type, and data element in various tables, columns and rows, and data modeling through star and snowflake schema.

Participated in Validating ETL process by creating various simple and complex SQL queries.

Responsible for the development and implementation of HIPAA EDI Data Mapping artifacts for various claims related transactions like 270, 271, 274, 276, 277, 820, 834, 835, and 837.

Validated HL7 messaging protocols for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications for electronic communication of patient health information.

Created test cases for the premium calculations and Claims limits and deductibles (Claims calculations).

Wrote SQL queries to match the results with the actual BI report for various analytics purposes.

EDUCATION:

Master’s in business administration

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