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Sr. It Business System Analyst Resume

WA

SUMMARY:

  • Qualified professional with 8 years of extensive experience in the field of Business / System Analyst working with the technical staff to implement management and staff's business requirements into the software application in Healthcare domain.
  • Expertise in documenting the Business Requirements Document (BRD), Technical Requirement Document (TRD), generating the UAT Plan, maintaining the Traceability Matrix and assisting in Post Implementation activities.
  • Good experience in the EDI transactions and knowledge on EDI transaction process flows.
  • Strong experience and understanding of health care industry, claims management process, Knowledge of Medicaid and Confidential Services.
  • Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 837 - Institutional, 837-Professional, 837-Dental, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications
  • SME for Oracle Letter generation based on the HIPAA guidelines involved in protecting the patients information
  • Working experience for Dental, Professional and Institutional Claims (UBO4 and 837D, 837P & 837I).
  • Expertise in understanding and supporting the client with Project Planning, Project Definition, Requirements Definition, Analysis, Design, Testing, System documentation and user training.
  • Used Rational Clear Case for Version Control of requirement documents.
  • Exceptional knowledge in the dynamic process of data warehouse creation, deploying a variety of techniques in extraction, transformation, and loading that further the business intelligence (BI) goal of effective analysis and reporting of company data.
  • Experience in Confidential (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
  • Experience with TriZettos Facets Application Groups/ Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
  • Good knowledge of Workflows and Content Management Tools.
  • Expert in creating Use Cases, Use Case Diagrams, Class Diagrams, Sequence Flows using MS Visio and UML concepts.
  • Experienced in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound 834Membership Enrollment, 837Institutional, 837Professional, 837 Dental, 835 Claim Payment/Remittance Advise, 270/271 Eligibility Benefit Inquiry/Response, 276/277 Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
  • Worked with different Business Areas like Claims and Enrollment to document proposed ICD 9 - 10 Code changes.
  • Proficient in using TFS in managing the defect lifecycle.
  • Experienced in modeling Transactional Databases and Data Warehouses using tools like Erwin and Informatica and Cognos to generate the reports
  • Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor Management Business Areas.
  • Extensive knowledge on data modeling, Data Analysis, Data Mining, and defining the conceptual and logical model of the data warehouse.
  • Good knowledge and extensively used RDBMS, Oracle, SQL, and PL/SQL along with MS SQL administration, SQL Enterprise Manager, Data analysis and reporting.
  • Maintained the Traceability Matrix table to track the Business Requirements to the design to the testing keeping track of all requirements in the BRD/Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases

TECHNICAL SKILLS:

Project Methodologies: SDLC, RUP, UML, Agile, Waterfall

Business Modeling Tools: Microsoft Visio, Rational Rose

Healthcare Tools: EDI X12, HIPAA, 4010, 5010, Trizetto, FACETS, ICD

Testing tools: Quality Center

Change Management Tools: Rational Clear Quest

Office Tools: MS Project, MS Office, MS Visio

Version Control Systems: Rational Clear Case

Database: MS SQL Server, MS Access, and Oracle

PROFESSIONAL EXPERIENCE:

Confidential, WA

Sr. IT Business System Analyst

Responsibilities:

  • Helped in defining Change Management Process for Release Management Team.
  • Researched, defined and deploy BI improvement opportunities and streamline the business intelligence processes
  • Prepared Business Object / Business Process Models BPM that included modeling of all the activities of business from conceptual to procedural level.
  • Setting up Enterprise Data Warehouse (EDW) and associated ETL service to generate business reports.
  • Performed Data Profiling of current state of data in the Data Warehouse by doing Data Analysis using advanced SQL Queries and Microsoft Excel, finding Gaps in Data and formulating solutions for the same
  • Identified Member, Provider, Coverage, Confidential, and Medicaid.
  • Requirements were gathered through interactions and meetings and periodic walkthroughs with SME’s.
  • Worked with the MMIS application development team on dependencies with the ongoing project.
  • Responsible for providing BI support and ensuring high levels of availability in the Business Intelligence environment.
  • Gathered requirements, created user stories using Version One, documented use cases using MS Blueprint and UI design Mock ups.
  • Reviewed Medicaid MMIS vendor deliverable during System Development Life Cycle; worked closely with business and IT folks along with SME’s to amend, create, and updating process flow charts from “AS IS” to “TO BE” system.
  • Analyzed plan requirements and then contributed further defining the plan requirements with their Project Manager. Observed the compliance of the requirements with federal and state government regulations Medicaid, Confidential, and accreditation body requirements.
  • Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan).
  • Reviewed MMIS documents to understand the customer requirements.
  • Performed Gap analysis between customer requirements and the MMIS solution.
  • Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
  • Developed and maintain information and documentation related to developing and modifying business processes and systems.
  • Planned and defined system requirements to Wire Frame with Use Case, Use Case Scenario and Use Case Narrative using the UML (Unified Modeling Language) methodologies.
  • Led and conducted JAD sessions for requirements gathering, analysis and design of the system.
  • Created context and workflow models, information and business rule models, Use Case and Object Models during the analysis using Rational tools.
  • Worked on TFS(Team Foundation Server) for managing bugs and SharePoint for document storage
  • Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process
  • Used SQL, Data Warehousing and Data Cleansing for the arrangement of customer data. Used Data mapping for collecting the data.
  • Performed Data analysis from the data warehouse along with business intelligence solutions delivery team.
  • Experienced analyzing, compiling, verifying, extracting, converting data, validating data and identifying data inconsistencies and anomalies, experience with government projects and experience with a data warehouse project
  • Extensive experience creating metadata/data dictionaries, and designing and implementing reports, and creating database views used for the purposes of establishing live data feeds as well as the development of data-driven dashboard applications, Performs other related duties as required and assigned.
  • Experience in data governance/ data stewardship business/systems analyst needed to work as part of a team on data governance and writing SQL queries.
  • Involved in creating automated Test Scripts representing various Transactions, Documenting the Load Testing Process and Methodology. Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.
  • Responsible for documenting trade reconciliation, clearing and settlement.
  • Articulated UML through Use Cases, use case document by specifying actors, normal flow, sub flow, alternative flows
  • Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data
  • Worked intensively on the PL/SQL for creating and working on the database for multiple projects.
  • Documented XML file processing use case as well as identified XML file level processing errors.
  • Performed SQL queries for retrieving, organizing the database with general commands like select, create, update, and joins.
  • Conducted Data analysis using SQL on the backend databases for producing mapping documentation and transformation rules for developers.
  • Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
  • Established RUP (Rational Unified Process) methodology and provided assistance in developing Use cases and project plans.

Confidential, Sacramento, CA

Business System Analyst

Responsibilities:

  • Managed the various phases of the Software Development Life Cycle (SDLC) during overall over project coordination.
  • Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
  • Prepared the business requirement document (BRD) and system requirement document (SRD).
  • Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
  • Set up Provider's Access to the System (Security Setup).
  • Helped creating Provider Reports i.e. Financial, Claims processing.
  • Wrote FRDs for the defects and enhancements and got approval from business for the developers.
  • Worked on Technical design documentation (TDD) of the claims processing system.
  • Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Part C and Part D Claims.
  • Involved in HIPAA/EDI Medical Claims, Design and Documentation
  • Extensively used Agile Methodology in the process of the project management based on SDLC.
  • Performed testing for Confidential, Medicaid for Confidential (MMIS)
  • Conducted Joint application development (JAD) sessions by convening project sponsors, end-user representatives, SME’s. Also, used Brain storming, Document analysis, and user task analysis for various reporting types like CLUE (Comprehensive loss underwriting exchange, Change Report, Claim Count, Claim summaries).
  • Produced Initial Medicaid Information Technology Architecture (MITA) State Self-Assessment Report to support the current Confidential (MMIS) Replacement Project.
  • Interacted with the SMEs and stakeholders to get a better understanding of client business processes and gathered business requirements.
  • Regression Testing of Web applications and applications dealing with MEDICAID and Confidential Services
  • Recommended changes for system design, methods, procedures, policies and workflows affecting Confidential / Medicaid claims processing.
  • Developed test cases based on the crosswalks and compliance guidelines for 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
  • Generated test data using X12 generator for transactions 837P/I/D. Conducted Gap Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 standards.
  • Participated in the JAD sessions along with the technical team members and clients to elicit requirements for HIPPA 4010 to migration process.
  • Involved in the testing of web portal of New MMIS system.
  • 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 good knowledge of Medical and Healthcare Standards and Regulatory vehicles such as HIPAA, FDA, ICD, MMIS, EDI, and.
  • Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010 and ICD-9-CM to ICD-10.
  • Broad domain exposure in the areas of EDI, HIPAA Testing privacy with multiple transactions related to claims, payments, registration etc and extensive knowledge in Medical Management Information Systems (MMIS) and National Provider Identification.
  • Came up with test cases from the requirements, validated/exercised those test cases in form of integration and regression tests.
  • Worked with Data Warehouse for data mining, making consolidated reports and finding relationships & correlations
  • Documented business processes, operational processes and fulfilled test case and testing plans
  • Wrote extensive SQL queries using PUTTY on a UNIX / LINUX platform to communicate with the Oracle Backend for data accuracy, integrity and security checks.
  • Extensively involved in mapping data from various sources and formats (flat files, XML files and web services) to the target database.
  • Utilized Microsoft Team Foundation Server (TFS) to manage the team's software development lifecycle.
  • Skilled at utilizing EDI translation software, including mapping, debugging, trading partner relationships, and user files. Extensively uploaded test cases from MS Excel, MS Word to Test Director & Quality Center.
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest.
  • Analyzed trading partner specifications and created EDI mapping guidelines.
  • Maintained requirements/business rules for Enterprise Data Warehouse, Business Intelligence Tools.
  • Created ad hoc reports inquired by the client and/or internal staff.
  • Designed the system, prepared UML and sequence diagrams using Rational Rose.
  • Used Toad and SQL Plus for testing execution of ETL Processes' PL/SQL procedures, packages for business rules
  • Responsible for managing the Data Warehouse and Business Intelligence functions.
  • Worked with solutions/delivery teams to implement data quality processes during acquisition, ETL, and delivery stages for Business Intelligence solutions and changes to Data Warehouses.
  • Assisted in the testing of all phases of open enrollment/special projects including system functionality, forms, web and online screen functionality
  • Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
  • Documented the dimensional models of ETL system.
  • Involved in design of the data warehouse using Erwin, created Informatica source and target definitions and mappings.
  • Developed test scenarios and implemented test plans for Product test, integration test, system test and user acceptance test (UAT).
  • Created and Managed User Stories. Also calculated velocity and story-points in TFS.

Confidential, NY, NY

Business System Analyst

Responsibilities:

  • Managed the various phases of the Software Development Life Cycle (SDLC) during overall over project coordination.
  • Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
  • Prepared the business requirement document (BRD) and system requirement document (SRD).
  • Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
  • Set up Provider's Access to the System (Security Setup).
  • Helped creating Provider Reports i.e. Financial, Claims processing.
  • Wrote FRDs for the defects and enhancements and got approval from business for the developers.
  • Worked on Technical design documentation (TDD) of the claims processing system.
  • Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
  • Developed test cases based on the crosswalks and compliance guidelines for 837 Professional, Institutional and Dental claims and for 270/271 eligibility benefit inquiry and response
  • Participated in the JAD sessions along with the technical team members and clients to elicit requirements for HIPPA migration process.
  • Involved in the testing of web portal of New MMIS system.
  • 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 good knowledge of Medical and Healthcare Standards and Regulatory vehicles such as HIPAA, FDA, ICD, MMIS, EDI, and HL7.
  • Broad domain exposure in the areas of EDI, HIPAA Testing privacy with multiple transactions related to claims, payments, registration etc and extensive knowledge in Medical Management Information Systems (MMIS) and National Provider Identification.
  • Skilled at utilizing EDI translation software, including mapping, debugging, trading partner relationships, and user files. Extensively uploaded test cases from MS Excel, MS Word to Test Director & Quality Center.
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest.
  • Analyzed trading partner specifications and created EDI mapping guidelines.
  • Identify Use Cases from the requirements and create UML Diagrams including Use Cases, Activity/State Charts, Sequence diagrams, and Data Flow Diagrams using MS-Visio thus defining the Business Process Model and Data Process Model.
  • Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
  • Formed advanced SQL Queries and used Microsoft Excel to investigate data issues in the Data Warehouse and worked with the Users and Technology Team to formulate a solution to resolve the issue
  • Prepared separate FRD for Data Warehouse piece. Highly involved in both ‘Data Integration’ and ‘Business Intelligence’ (Reporting) section.
  • Worked on development, implementation, administration and support of ETL processes for large-scale Data Warehouses using SSIS and DTS.
  • Implemented Business Intelligence (BI) to help users make better business decisions. Conducted workflow, process diagram and GAP (GAP) analyses to derive requirements for existing systems enhancements.
  • Developed test scenarios and implemented test plans for Product test, integration test, system test and user acceptance test (UAT).

Confidential, Raleigh, NC

Business System Analyst

Responsibilities:

  • Responsible for requirements analysis, design and developing technical requirements.
  • Involved in the creation and maintenance of the Workflow plans and artifacts. Used Agile Scrum methodology.
  • Utilized SDLC Methodology to configure and develop process, standards and procedures.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicaid Claims.
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS
  • Created Simulations and wrote requirements using iRise studio.
  • Facilitated SME interviews and assisted in identifying and analyzing the possible technical solutions.
  • Profound understanding of insurance policies like HMO, PPO, EPO and POS with proven experience in HIPPA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
  • Assisted in upgrading HMO Confidential EDI and reporting.
  • Assisted in managing and billing Confidential, Commercial HMO/PPO claims on a daily basis.
  • Involved in creating BRD and FRD for Medicaid managed care requirements and documenting them.
  • Acted as a SME for the application team and the Infrastructure team.
  • Gathered managed care specific business requirements from several different managed care programs.
  • Used RequisitePro for writing/analyzing project vision, goals, specifications and requirements.
  • Constantly partnering with project leads to ensure the team is producing solutions that meet established standards, procedures and practices, address issues, risks and mitigation plans.
  • Use case analysis of Web Portal, Enterprise Data e (EDW) and associated transactional systems, interfaces.
  • Provided coaching on Agile values and practice to other teams within the company.
  • 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
  • Involved in the testing of web portal of New MMIS system.
  • Performed Back-end Testing using PL/SQL for Database Validation.
  • Performed gap analysis by matching the requirements for managed care programs.
  • Matched the requirements for programs such as Confidential and Medicaid, which are part of the Social Security Act.
  • Worked with the Team Foundation Server (TFS) defect management system.
  • Constantly partnering with project leads to ensure the team is producing solutions that meet established standards, procedures and practices, address issues, risks and mitigation plans.
  • Use case analysis of Web Portal, Enterprise Data Warehouse (EDW) and associated transactional systems, interfaces.
  • Provided coaching on Agile values and practice to other teams within the company.
  • Designed and implemented basic SQL queries for reports and data validation.
  • 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.

Confidential, New York, NY

Business Analyst

Responsibilities:

  • Facilitated JAD sessions to collect requirements from system users and prepared business requirement that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Involved in gathering, documenting and verifying business requirements.
  • Generated a streamline process to understand the various steps in the loan lifecycle and desired functionality of the new system by interacting with users, management, SME (Subject Matter Expert), stakeholders, lenders, underwriters.
  • Involved in requirement gathering phase (Provider, Claim components and HIPAA)
  • Participated in changes for system design, methods, procedures, policies and workflows affecting Confidential /Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
  • Met with report users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions.
  • Involved in understanding the current business process, defining scope of the project along with position statement.
  • Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.
  • Implemented automated COB processing of Confidential claims into s
  • Validated business rules and all artifacts with users, got approval and sign off.
  • Followed Unified Modeling Language (UML) methodology using Reqisite Pro and Rational Rose to create/maintain: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
  • Extensively wrote SQL Queries (Sub queries, correlated sub queries and Join conditions) for Data Accuracy, Data Analysis and Data Extraction needs.
  • Gathered requirement on FACETS EDI 834 Benefit Enrollment and Maintenance subsystems.
  • Tested and delivered Inbound/Outbound Facets interfaces.
  • Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 837 and proprietary format files and Reports development.
  • Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.
  • Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
  • Documented the dimensional models of ETL system.
  • Led the testing efforts of the datamarts in development, coordinated moving/setting up of processes in dev/qa/production. Worked with QA team and UAT team to go over the various test scenarios for different types of loads in the Datamarts.
  • Analyzed all data warehousing components (e.g. tool integration strategy; source system data ETL strategy; data staging; and data quality strategy)

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