Mujjad Mazhar
Summary
8+ years of hands-on experience as a Data and Business analyst dealing with Data Visualization, Business Intelligence, and Information Systems in the Healthcare industry. Validated data in accordance with HITECH, HIPAA, HEDIS, SNOMED-CT, ICD coding regulatory standards. Worked with Healthcare Standards such as HL7 messages, FHIR to improve healthcare operations and facilitate interoperability. Managed EMR, EHR, and Epic ambulatory services while working in Epic clinical applications. Analyzed Medicare and Medicaid reimbursement practices and made recommendations, which helped healthcare organizations operate more effectively and spend less money. Worked on P&C insurance experience with emphasis on personal lines and business owner’s lines. Experienced working on EDI Transactions like EDI 835(Medical Claims Payment), EDI 837(Medical Claims Submission) and EDI 270(Eligibility Inquiry), EDI data mapping and migration. Maintained knowledge of diagnostic coding conventions such as ICD-9-CM and ICD-10-CM. Worked on Cerner applications for Citrix Workspace and Relay to process claims and charge for medical services under CMS (1500) and uniform billing (UB04). Demonstrated expertise in conducting process assessments to identify inefficiencies, bottlenecks, and opportunities for automation or improvement within the claims payment process. Used LIMS to manage data and streamline laboratory procedures for better patient care. Ensured compliance with GDPR regulations for handling sensitive patient data, minimizing risk and ensuring privacy and security of personal information. Experienced in multiple SDLC models, including Waterfall and Agile methodologies, and created user stories using JIRA tool. Created process models, and revised the business requirement document (BRD), Use Case Diagrams and flow charts to support Product Owners to identify Functional Requirement Specifications (FRS). Conducted Gap Analysis, Root Cause Analysis, and Impact Analysis to identify discrepancies, underlying issues, and assess the consequences, enabling informed decision-making. Managed User Acceptance Testing (UAT) for healthcare systems and validated the business requirements. Participated in JAD sessions to develop detailed specifications as per user & stakeholder requests. Gathered User Requirements and designed Source to Target data load specifications based on business rules. Worked with Data Architecture teams in Snowflake schema and Star schema for data modeling. Designed and executed ETL processes for healthcare data migration across Cloud and Traditional databases using AWS, GCP, and Azure. Conducted Data Cleansing, Data Validation, Data Verification, Data migration using ETL tools like Talend and Informatica to facilitate data migration processes. Proficient in gathering and analyzing business requirements for EDW initiatives, including data integration, data modeling and ETL processes. Worked on complex ad-hoc SQL queries using Joins, DML, DDL, pivots, views, constraints, and functions using Oracle, MS SQL Server, and MySQL. Worked with T-SQL, Python, XML, JSON scripting to scrape data from multiple sources. Worked with Azure data bricks to speed up the preparation of high-quality data. Conducted analysis on more than one million rows of healthcare data to identify healthcare business trends and develop dashboards and stories using Power BI, Tableau, and SSRS. Utilized SAS to import clinical data from the company's field operations team & ensured that quality standards were met for our customer base whilst carrying out analysis. Utilized HEDIS data to locate care gaps, create interventions, and create dashboards to monitor development against quality measures. Strong experience in QlikView Product family such as QlikView Desktop Client, QlikView Management Console, QlikView Server. Experienced on Teradata SQL queries, Teradata Indexes, Utilities such as M-load, T-pump, Fast load, and Fast export.
Overview
9
9
years of professional experience
Work History
Healthcare Business Analyst / Data Analyst
State of PA
08.2022 - 05.2024
- Health Tracking system
- Responsibilities:
- Performed data migration and Converted paper-based medical records' data into the new system
- Integrated the laboratory, regulatory, and insurance data from various databases with the hospital and patient data
- Participated in user acceptance testing (UAT) and quality assurance (QA) testing to ensure the functionality
- Used Agile methodologies for iterative development, rapid prototyping, and adapting to changing user needs
- Handled facility, professional, and Medicaid and Medicare claims processing
- Used data definition to maintain data quality while storing hospital data in a MySQL database
- Conducted data mapping from the internal database and checked it for compliance with regulations
- Validated HL7 messages to prevent compliance problems
- Leveraged Electronic Health Records (EHR) system expertise to analyze and optimize data workflows, ensuring accurate and efficient health tracking
- Implemented effective business processes, a business requirement document (BRD) was created
- Conducted thorough analysis of business requirements and Source to identify target data mapping requirements
- Demonstrated expertise in conducting gap analysis to identify discrepancies between current coding practices and ICD-10 requirements
- Performed data mapping and data lineage analysis to ensure accurate data flow and integrity throughout the EDW environment
- Used LOINC codes to label and identify specific observations, ensuring accuracy, consistency, and semantic interoperability
- Configured and managed Azure API Gateway to facilitate secure and efficient communication between applications, adhering to industry best practices
- Worked with Azure DevOps pipelines to automate the build, test, and deployment processes, ensuring rapid and reliable delivery of software updates
- Integrated SOAPUI tests into continuous integration/continuous deployment (CI/CD) pipelines using tools like Jenkins or Azure DevOps, automating the testing process and enabling rapid feedback
- Developed and executed plans for CMS reporting, submitting accurate and timely data as required by CMS for various programs
- Created use case diagrams in accordance with the functional requirement document (FRD)
- Automated data extraction and migration from the old legacy system to the new system were accomplished using ETL tools
- Worked on numerous ad-hoc data pulls for business analysis and monitoring by writing SQL scripts
- Created SQL queries to add information to the database, including patient information, diagnoses, and treatment plans
- Created UMT tables, aggregate tables, Trend reports, DDL, DML, Pivot reports, and List reports using sophisticated SQL queries
- Utilized Python to explore and analyze large datasets, identify patterns, and generate visualizations for data-driven insights
- Developed reporting using Tableau BI Dashboard for various organizational units
- Combined sheets and dashboards using Power BI and stories were created to review hospital activities
- Environment: MS Visio, MS Office, XML, ETL, JIRA, MySQL, Tableau, Power BI, Python.
Healthcare Data Analyst / Business Analyst
Aetna Healthcare
01.2019 - 07.2022
- Significant effort was put into meeting filing and legal requirements for health insurance claims and policies
- Utilized SAS Fraud Framework to detect and prevent healthcare fraud in a comprehensive and efficient manner
- Verified the patient's Medicare Parts A and B eligibility
- Demonstrated expertise in conducting requirement gathering sessions with stakeholders to define business rules and criteria for claims eligibility determination
- Gathered patient information from electronic medical records (EMR’s) to determine how many patients had insurance
- Proficient in analyzing and interpreting complex medical documentation to ensure accurate ICD-10 code assignment
- Created clear and concise documentation, including BRD, FRD, and use cases
- Developed process flows, data models and user interface designs using tools like Visio
- Proven track record of conducting data analysis to identify trends, patterns, and anomalies in claims data, ensuring accurate and timely payment processing
- Conducted thorough analysis of business requirements and collaborated with stakeholders to define data mapping rules for source to target data integration
- Processed patient records and converted patient information, medical history, and billing data into ICD-10
- Gained knowledge about HL7's messaging and vocabulary standards
- Converted patient data in XML format from the CDA to the MySQL server database
- Worked closely with development teams to document Azure API specifications, providing comprehensive documentation for developers and end-users
- Used ETL tools to change the data's format so that it could be analyzed
- Proficient in creating and maintaining data mapping, data dictionary, and data definitions to ensure accurate and consistent interpretation and usage of data across business systems and processes
- Proven track record of conducting data profiling and data quality analysis to identify gaps, inconsistencies, and anomalies within EDW systems
- Stayed informed about changes in CMS policies and regulations, analyzing the impact on systems and processes and recommending necessary adjustments
- Created a use case diagram in accordance with the requirements after creating and compiling the business requirements
- Logged and tracked defects efficiently using Azure DevOps, providing detailed information on reproducibility, severity, and resolution status
- Worked within a waterfall methodology framework, ensuring adherence to sequential project phases and documentation standards
- Created and improved queries for handling encounter, billing, and medical claim data
- Reported the status during participation in the daily scrum meetings
- Performed data extraction from EHRs, claims systems, and pharmacy systems using ETL processes
- Created extensive SQL queries for data validation using the primary key, foreign key, and unique key constraints
- Developed and executed test cases in SOAPUI, covering various scenarios including positive, negative, and boundary cases to validate API behavior
- Developed tableau dashboards and investigated the reports for riders, déductibles, and copayments
- Developed data visualizations and reports using power BI dashboards to examine medication use, insurance coverage, and cost
- Environment: ICD 9-10, EDI, HIPAA, Medicaid, Medicare, HL7, FHIR, ETL, JIRA, SQL server, MySQL, Agile, SDLC, XML files, Ms Visio, Ms Office, UNIX, SAS Fraud Framework, Visual Basic, ETL, SQL server, MySQL, Tableau, Power BI.
Insurance Data Analyst / Business Analyst
Oscar Health
07.2016 - 12.2018
- Claims management systemResponsibilities:
- Participated in the development of Cerner Applications like Citrix Workspace, Health Quest, Relay to Access Claims Account Server, and Claim Processing
- Performed ad hoc analysis and offered suggestions to support business requirements
- Developed and put into practice a data management process that increased data security and quality
- Used SNOMED for meaningful reporting, data analysis, and insights into the types of diagnoses, procedures, and treatments mentioned in the claims
- Experience in conducting thorough system testing and user acceptance testing (UAT) to ensure compliance with ICD-10 coding requirements
- Data that has been verified in accordance with HITECH, EDI, PHI, and HIPAA regulations
- Checked the validity of the EDI X12 271 ("eligibility response"), EDI 276 ("claim status"), and EDI 834 ("enrollment") for the processing of claims
- Proficient in analyzing and documenting end-to-end claims payment workflows, including claim submission, adjudication, reimbursement, and payment reconciliation
- Experienced in developing and maintaining data mappings, data dictionaries, and data definitions, facilitating effective data analysis and ensuring data integrity
- Skilled in collaborating with stakeholders, including insurance providers, claims processors, and IT teams, to gather requirements and implement system enhancements for efficient claims payment processing
- Utilized data modeling techniques and data mapping tools to create comprehensive source to target data mapping diagrams, facilitating seamless data transfer and transformation processes
- Collaborated with vendors to verify EDI transaction sets
- Handled bundles of FHIR resources with Mirth using the FHIR extension, and mapping FHIR resources with Mirth using the RESTFUL API to interact with non-FHIR systems
- Prolonged work on the insurance billing appeal filing and timely filing limits
- Worked on API integration and is well-versed in data formats like JSON, XML, and RESTful APIs
- Used Tableau, to produce dashboards and reports for co-payment, deductible, and co-insurance
- Code reuse and efficiency improvements for new C-CDA interfaces
- Examined SQL queries used to build tables, pivot tables, and list reports
- Used SQL to perform source to target data mapping
- Made use of the patient data to develop tableau visualizations for reports and dashboards
- Used Power BI, for creating several business intelligence dashboards and reports
- Environment: FHIR, SNOMED, EDI, MS-excel, MS- access, MY SQL, Cerner Applications, Tableau, Power BI.
Data Analyst
Bio Haven Health
06.2015 - 06.2016
- Patient outcome analysisResponsibilities:
- Maintained sizable collections of patient data in well-organized spreadsheets in Excel
- Completed upgrades, data migrations, backups, and recovery tasks for databases
- To store the data, tables were made in the SQL database using facts and dimensions
- Examined the effects of the remote patient monitoring system, a connection to a SQL database was established using Tableau
- Expertise in designing star and snowflake schema and ETL data migration procedures
- Used RPM system devices to analyze patients with specific conditions like diabetes and hypertension
- Performed reporting and performance analysis on complex patient data
- Skilled in performing data mapping, creating comprehensive data dictionaries, and defining data structures to support data analysis and enhance data quality across diverse business systems and analytical initiatives
- Collected and arranged patient medical information from RPM devices
- Recognized patterns, trends, and anomalies in the patient data to spot potential medical problems
- Examined the patient's vital signs and medical history to provide any necessary health warnings
- Reviewed basic SQL queries and edited inner, left, and right joins in Tableau Desktop
- Created dashboards and visualizations in Tableau to track the usage of the system by patients and evaluate the results
- Designed dashboards in Power BI and Tableau to examine how the system performs under various conditions
- Reviewed reports of patient vitals following system use and evaluated advancements
- Environment: Ms Excel, Ms PowerPoint, Ms Access, Ms Office, UNIX, ETL, SQL server, MySQL, Tableau, Power BI.
Education
Master’s - Data Analytics
Trine University
Skills
- HIPAA Compliance
- Healthcare Industry Knowledge
- Clinical Data Management
- Healthcare Analytics
Additional Information
- Computer Skills: Data visualization, Data Cleaning, Data Mining, Data Warehouse, Microsoft. Office (Access, Word, Excel, Power point), Cerner Applications such as Citrix workspace, Relay, Microsoft teams, problem solving and analytical abilities. Analysis Tools: My SQL, SQL server, Tableau Desktop, MS-Excel, Power BI, Spreadsheets, Microsoft Azure. Languages: SQL, SAS, Python. Cloud services skills: AWS, Google Cloud Platform (GCP), Microsoft Azure and Data Bricks. Tools: Git, JIRA, Informatica. Databases: Oracle, MS Access, SQL. Operating systems: Windows, LINUX, Mac OS and DB2
Timeline
Healthcare Business Analyst / Data Analyst
State of PA
08.2022 - 05.2024
Healthcare Data Analyst / Business Analyst
Aetna Healthcare
01.2019 - 07.2022
Insurance Data Analyst / Business Analyst
Oscar Health
07.2016 - 12.2018
Data Analyst
Bio Haven Health
06.2015 - 06.2016
Master’s - Data Analytics
Trine University