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Sr. Business System Analyst Resume

Dallas, TexaS

SUMMARY:

  • Seven plus years of experience as a Business Systems Analyst with keen understanding in Healthcare and Banking field.
  • Expertise in Business Analysis, Joint Application Development (JAD), Business Process Analysis, Requirements Gathering, Management of Documentation, Software Analysis, with strong understating of software development life cycle (SDLC).
  • Worked on various Line of business Medicare and Medicaid, Healthcare Claims processing. Good Mixture of experience in Provider, Payer and Government - CMS line of business.
  • Deep knowledge of Medicare-Medicaid Rules, HIPAA, ICD-9/ICD-10 codes, CPT, HCPCS, EMR, EHR, PHR, HL7, X12 EDI transactions’ (270/271, 276/277,834,837/835).
  • Deep knowledge in conversion from HIPAA 4010 to 5010.
  • Acted as a primary liaison/driver between Business, Product, IT, and End-users to gain a common goal on the requirements.
  • Extensive experience in all phases of Planning, Requirement gathering, Design, Testing, Deployment, Maintenance. Experience of different methodologies (Agile, Waterfall, Rational Unified Process (RUP) of SDLC.
  • Adept in making Business requirement document (BRD) and Functional requirement document (FRD).
  • Expertise in analyzing Business and Development Specifications, Use Cases and High level design to develop Requirement Gathering, conducting Business scope/Technical Feasibility studies, creating Business/Functional requirement documents, Use Case modeling and conducting JAR/JAD sessions and brainstorming sessions.
  • In-depth knowledge on Data Migration. Experience in industry standard tools like Rational Rose and MS Visio, Rational Requisite Pro., Quality Center. Expertise in Use Case, Activity -Flow Diagrams, Sequence Diagrams and other Graphical presentations.
  • Ability to prepare RTM (Requirements Traceability Matrix) and making sure all requirements are delivered.
  • Adept in MS Office (Word, Excel, Access, Visio, Power Point, Outlook, Project) for calculations, graphs, analysis, presentation and documentation.
  • Experienced in reviewing Test Procedures, defining Test Plan - Test cases, reviewing and maintaining Test scripts, Defect Tracking and Test Evaluation.
  • Assisted Testing team for Functional, Regression, Compatibility, Security, and UAT (User Acceptance Testing) testing.
  • Flourished in ‘independent as well as collaborative work environments’ with ‘quick learning abilities for new technologies/tools’ and ‘quickly adapting to new environment’ with excellent ‘communication/interpersonal skills, leadership and presentation skills, and time and group management skills’. Have ability to Multitask and always keen to use all resources (including Google-Wikipedia, Guideline Documents and other Smart Technologies)

TECHNICAL SKILLS:

Databases: MS Access, Oracle, DB2

Languages: C, C++, SQL, HTML, XML

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes

Performance Testing Tools: Virtual User Generator, Load Runner

Operating Systems: MS-DOS, Windows95/98/NT/2000/XP, Apple McIntosh, Linux

Automation Tools and Standards: Requisite Pro, Win runner, QTP, Test Director, Quality CenterEDI standards, HIPAA Compliance, Medical Claims clearinghouse,: ASC X12 (cross industry standards), ANSI

PROFESSIONAL EXPERIENCE:

Confidential, Dallas, Texas

Sr. Business System Analyst

Roles and Responsibilities:

  • Gathered requirements from Business Owners, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
  • Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Systems Life Cycle methodologies. Prepared various artifacts for all the phases of RUP.
  • Led JAD sessions with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure
  • Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non functional requirements.
  • Used documentum to store and manage documents in a single repository using a secure web based system.
  • Conducted brainstorming sessions to analyze provider contracts, provider reimbursement, benefit rules, medical policies and medical management rules to see the impact of ICD10 diagnosis codes.
  • Gathered and validated inventory of applications, interfaces, and reports that will need to be modified to comply with ICD-10 requirements.
  • Worked with different teams such as HIPAA 5010 to identify any project dependencies or initiatives competing against ICD10 schedules.
  • Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010
  • Responsible for business analysis, requirement specifications, project planning and identifying the resources and implementation of the project.
  • Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
  • Created functional flow diagrams, context diagrams and other high level diagrams for documenting the functionality of separate modules using MS-Visio and UML.
  • Implemented Traceability Matrix and Business Requirement Specification Document verified the functionality coverage.
  • Involved in Validation of HIPAA for 837, 270/271, 276/277, 835, 834 EDI transactions. Worked with the QA (Quality Assurance) team for designing Test Plan and Test Cases for the User Acceptance testing - Defined test cases, creating test scripts, analyzing bugs, interacting with QA / development teams in fixing errors and User Acceptance Testing (UAT).
  • Used MS Project to maintain the project schedule and track projects status.
  • Interfaced with end-users, obtaining approval, identifying information, procedures and decision flows, evaluating existing procedures, methods and technical documentation.

Environment:: UML, RUP, MS-SharePoint, MS-Project 2000, MS-VISIO, CMMI, TestDirector7.6, WinRunner7,windows 2000,EDI, HIPAA compliances.

Confidential . Franklin, TN

Sr. Business System Analyst

Roles and Responsibilities:

  • Performed SWOT and Gap analysis for the new functionality requirements
  • Worked with HIPPA rules and regulations to draft business rules and claim processes.
  • Interacted with the client and the Technical Team for requirements gathering and translation of Business Requirements to Technical specifications.
  • Leveraged the initial ICD 10 assessment and detailed risks, gaps, and issues.
  • Conducted JAD sessions.
  • Involved in processing Medicare stand-alone plan part D and Part C managed care plans.
  • Worked on healthcare EDI systems and electronic claim transaction technology.
  • Used HIPAA 4010 transactions to support the analysis of current business processes and worked with management to improve and implement enterprise solutions to ensure compliance. Also, got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837, 835.
  • Analyzed HIPAA 5010 related to 837, 835, 834 transactions and performed gap analysis between the 4010 and 5010.
  • Hosted the application online using Microsoft share point excluding some functionality which was meant for internal use (employees only).
  • Identified and documented the dependencies between the business processes.
  • Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for providing a clearer understanding of the requirements for the development team.
  • Data modeling using UML.
  • Worked with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
  • Created and maintained Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams using UML.
  • Handled HIPAA- claim adjustments and claim processing from point of entry to finalizing, claim review, identified claims processing problems, their source and provided alternative solutions using best practice model and principles.
  • Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology).
  • Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products.
  • Responsible for teaching sessions for providing end user with tools training.
  • Used MS Project for various planning and budgeting activities.
  • Used Quality Center to upload, execute and run scripts to compare and verify two outputs.

Environment: Rational Unified Process (RUP),HL7, UML, Dreamweaver, Rational Test Manager, WinRunner, Rational Clear Quest, Windows, MS Office, HTML, Windows, Quality Center.

Confidential, Nashville, TN

Sr. Business System Analyst

Roles and Responsibilities:

  • Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) including the facility claims and professional claims.
  • Involved in the day-to-day implementation of the Rational Unified Process (RUP) methodology of application development with its various work flows, artifacts and activities.
  • Documented business requirements - for process improvement - through client interviews, JAD sessions, and analysis on existing functional specifications
  • Worked on HIPAA Claims Validation and Verification Process (Pre-Adjudication).
  • Worked on claim processing module which involved Receipt and Verification of Claim Forms (837) and Claims Attachments (275), Claims Enquiry and Response (276/277), Adjudication, Healthcare Claim Payment/Advice (835) as per HIPAA guidelines.
  • Gathering User and Business Requirements and creating Scope document, Business Requirement documents (BRD), Functional Requirements, (FRD), Use Cases, Work flow, Wireframes.
  • Knowledge of the complete EDI format used in the electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
  • Assisted the UI architect in developing a new UI for the claims reimbursement process.
  • Thorough understanding of the business process to help determine the user needs.
  • Prepared Dataflow diagrams, Business Flow diagrams, UML Activity diagrams and Use Case diagrams.
  • Performed GAP analysis and documented business and system level use cases to derive the requirements illustrating the functional behavior.
  • Organized use case documents and developed RTM using Rational Requisite Pro.
  • Submitted change requests and worked with change request records in Clear Quest.
  • Participated in entering, tracking system defects in Rational Clear Quest.
  • Followed Six Sigma discipline and methodology for eliminating defects in process.
  • Actively participated in the Weekly Defect Status meetings to review and prioritize the defects within a functional area.
  • Supported User Acceptance Testing with UAT cases and resolved any issues with the users
  • Involved in the different phases of test effort like Integration testing, Black Box testing, User Acceptance testing, Regression testing, and Back End testing.

Business System Analyst

Roles and Responsibilities:

  • Held regular JAD meetings with the system architects, developers, database developers, quality testers during the entire project to assure that the critical as well as the minute details of the project were discussed and issues were resolved beforehand.
  • Created Use cases, Activity, Sequence and Collaboration diagrams using UML.
  • Involved in Backend Testing to verify data integrity by using SQL.
  • Extracted the business requirements from the stakeholders keeping in mind their need for the application and documented them using Rational Requisite Pro.
  • Generated Project Plan using MS Project identifying key resource constraints, deadlines & dependencies. Documented & created weekly project status reports.
  • Defined project milestones, schedules, and monitored progress using MS-Project and updated plans as required.
  • Analyzed and optimized the process, prepared Business Requirement Document and managed requirements using Rational Requisite pro.
  • Analyzed and tested Data Interface needs with external systems.
  • Analyzed the client’s applications programs in order to determine the impact of the HIPAA rule on EDI Transaction Set and Code List implementation using GAP Analysis and defined the changes to bring the affected systems into HIPAA compliance.
  • Analyzed Claim validation and Pend/Denied Claims for the Health plans Medicaid programs.
  • Maintained Requirement Traceability Matrix ( RTM ).
  • Involved in Analyzing, manipulating and updating Database using SQL .
  • Registered defects using Rational Clear Quest & developed defect status reports to ensure quality standards.
  • Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.

Environment: UML, MS Word, Rational Requisite Pro, Rational Clear Quest, Quality Center, SQL, FTP

Confidential, Deerfield, IL

Business System Analyst

Roles and Responsibilities:

  • Interacted with stakeholders and gathered requirements as per the business needs.
  • Implemented RUP methodology for iterative and incremental development of the system.
  • I was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
  • Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME’s.
  • Compiled the Vision Document and composed detailed Use Case Specification Documents in RationalRequisitePro.
  • Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
  • Ensured the accuracy and consistency of the data during the data loading process.
  • Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
  • Created ProcessFlow Charts, Business Requirements Documents (BRD), Functional Specification Documents.
  • Worked on Required Traceability Matrix (RTM) in Rational Requisite Pro for traceability of requirements through test cases.
  • Was involved in managing the Daily Standup meetings and also ensured that quality standards were enforced as per the build-release schedule.
  • Developed Test Plan and Test cases based on the Use cases and Functional specifications and also performed manual testing of the functionality of the application by inserting varying data on different test runs.
  • Developed Flowchart and process diagram using Microsoft Visio.
  • I was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
  • Contributed in reviewing and editing of the test scripts.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, RationalRose, Community Manager, BPML, SQL, ClearCase, Agile

Confidential, Kansas, MO

Business Analyst

Roles and Responsibilities:

  • Address all aspects of the loan lifecycle, starting from identifying a deal right up to loan closure
  • Used standard Business Analysis methodology centered on RUP (Rational Unified Process).
  • Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
  • Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
  • Understood the various steps in the loan lifecycle and then constructed the system in a way that the riskier loans could be easily identified and monitored.
  • Created the Business Requirement Documents (BRD) and Functional Requirements Document resulting from JAD sessions and communicated requirements to development teams.
  • Analyzed and prioritized key reports for day to day servicing needs for Loan monitoring, Inspection and Insurance
  • Clerical work processes had to be streamlined and mapped to the automated system.
  • Provided the client's management quick and easy access to all current economics (i.e. construction status, leasing status etc.) of the collateral pertaining to all the loans in the portfolio.
  • Helped develop use cases, project plans and managed scope.
  • Assisted in building a business analysis process model using Rational Rose and Visio.
  • Performed requirement analysis, went through all the use cases and workflows.
  • Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
  • Played a key role in the planning, testing, and implementation of system enhancements and conversions
  • Responsible for managing the documented requirements by Requirement traceability Matrix.
  • Provided key input in working with users in defining project and system requirements.
  • Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.
  • Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
  • Assisted with product evaluation, product customization and system integration.
  • Financial Statement Productivity, Property Inspection, Loan Data Analysis
  • Performed analysis on enterprise data / report integration.
  • Provided functional specification to development team to build Enterprise Reporting Systems.
  • Help in presenting reports and analysis to management.
  • Assisted the team members in writing the test cases and executed the test plans for the User Acceptance Testing

Environment: Project Plan, project scope, use cases, sequence diagrams, production plan, Business Requirements Document, UML

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