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Sr Business Systems Analyst Resume



  • Over 5+ years of diversified experience in Healthcare domain.
  • Expertise in translating user requirements into System Specifications and mapping the process design, work flows for SDLC with documenting and managing business requirements.
  • Worked on QNXT v 4.8, 5.0, 5.1 claims processing engine.
  • Good experience in data sources, data profiling, data validation, developing low - level design patterns based on business and functional requirements. Knowledge of relational data modeling and relational database concepts.
  • Good experience in developing work approach and project plans to meet client requirements, and manage and monitor progress.
  • Experienced in developing functional and non-functional specifications, process diagrams, sequence diagrams, user interface designs and field level descriptions Experience in Creating Test Plan , Test Procedures and Test Metrics .
  • Good experience working as Quality Analyst in Agile and Waterfall methodologies.
  • Performed GAP analysis and maintained requirements traceability matrix (RTM).
  • Experienced in conducting feasibility study and risk management.
  • Worked on ICD 9 and ICD 10 and HIPAA 4010 and 5010 migration.
  • Experienced in writing and reviewing test cases and test scripts Experience in backend data validation by writing SQL queries.
  • Conducted usability and user acceptance testing (UAT) on behalf of end users.
  • Experience in UNIX Shell Scripting and file manipulation techniques.
  • Understanding of insurance policies like HMO and PPO.
  • Experience with EDI transaction codes such as 270/271(inquire/response health care benefits), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
  • Familiar with Med claims billing services plan.
  • Strong business analysis skills and thorough understanding of full SDLC


Business Methodology: RUP, Agile, Waterfall.

Business Modeling Tools: Microsoft Visio, Rational Rose.

Project Management Software: MS Project.

Version Control Systems: Rational Clear Case.

Testing tools: Test Director, Quality Center, Requisite Pro, and QTP.

Database: MS Access, SQL-Server, Oracle.


Confidential, Tennessee

Sr Business Systems Analyst


  • Collaborate with the Quality improvement team to oversee and ensure HEDIS data accuracy and abstractions including investigations, auditing, and improvement opportunities
  • Develop and implement strategies related to data governance, data quality, metadata management, data security and master data management (MDM).
  • Used Facets Claims and Member/Subscriber modules, and have worked on editing and validating claim.
  • Manage and analyze clinical and non-clinical HEDIS measures such as comprehensive diabetic care, Human Papillomavirus Vaccine for Female Adolescents, Lead Screening in Children, Pharmacotherapy Management of COPD Exacerbation and Disease-Modifying Anti Rheumatic Drug Therapy for Rheumatoid Arthritis within Medicaid, Medicare and Commercial plans
  • Implemented Master Data Management MDM for all entities in the project by maintaining a master hub for improving the data quality by following various data governance techniques and data dictionary standards.
  • Requirements elicitation from Business. Prepared Business Requirements Documents (BRDs) and mapping specifications for MDM project.
  • Retrieve data through table queries within Facets.
  • Preventive Facets configuration, working closely with onsite physician for approval of preventive procedures.
  • Develop road maps and provide expert consultation on improvement methods and strategies for audit purposes
  • Collaborate with internal and external stakeholders to ensure HEDIS and CAHPS initiatives are fully integrated throughout the organization, maximizing opportunity to improve outcomes for members
  • Perform detailed review of varied healthcare data to evaluate programs and product solutions using healthcare medical, pharmacy, lab and utilization data
  • Monitor and ensure dataflow used by Medicare STARS department is accurate to ensure improvement of the overall STARS ratings for Medicare products

Environment: Oracle 12C, Teradata, Verisk Health (verscend) Software, Asana, DB2 10.5, Microsoft Excel, Microsoft Outlook, Microsoft One Note, Data Stage Designer Client

Confidential, Long Island, NY

Business System Analyst


  • Identified the scope, business objective and documented the functional requirements for each release.
  • Directly involved in process improvement Plans and implementing business change.
  • Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
  • Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
  • Set claims processing data for different FACETS Module.
  • Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions
  • Collaborated with Business and Data Governance to translate governance and business team needs into MDM Functional and Technical requirements.
  • Extensively worked with Member/Subscriber and HIPAA Privacy Facets application groups.
  • Involved in creating documents and diagrams for Membership Enrollment according to the HIPAA 834 Compliance Standards for Membership Enrollment.
  • Set claim processing data for different Facets Module.
  • Gathered requirements and developed process flows diagrams in accordance with care and Medicaid rules and regulations pertaining to the Facets configuration and evaluated the impact of proposed changes.
  • Worked on Data Mapping to map Facets data to outbound eligibility extracts.
  • Used Master Data Management (MDM) technology, tools to create and maintain consistent and accurate lists of Master.
  • Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
  • Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
  • Held regular meetings with the Business users and SME’S to priorities the business Requirements.
  • Facilitated the resolution of project-related issues, identified risks and mitigation steps to manage risk using PLSQL in RDBMS.
  • Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.
  • Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business work flow of applications.

Environment: Windows XP, RUP, UML, SQL, Rational Tools, MS Visio, Informatica, XML, MS Word, Excel, PowerPoint, Access

Confidential, Seattle, WA

Business System Analyst


  • Conduct gap analysis between the current system and new requirements to be implemented thereby mapping the business requirements to the application
  • Involved in training and test session on HIPAA Privacy policy.
  • Prepared high level and detailed system requirements documents for the application
  • Identified the requirements for accommodating HIPAA 5010 standards for 837P transactions and captured these requirements to develop new GUI for the internet based application
  • Set claim processing data for different Facets Module.
  • Involved HIPAA regulations in Facets HIPAA privacy module
  • Involved EDI Claim Process according to HIPAA compliance.
  • Tested the Facets 4.3 and Claims processing applications
  • Managed requirements using Quality Center
  • Documented Test cases corresponding to business rules and other operating conditions in Quality Center
  • Involved in Developing Test Plans, Test Cases and Test Scripts
  • Performed End-to-End testing manually
  • Responsible for GUI Testing, System Testing, Regression Testing and Acceptance Testing
  • Tested the backend database using SQL queries
  • Extensively worked with ANSI X12 HIPAA EDI Transactions 270, 271, 276, 277, 837, 835 and 997
  • Involved in testing the Medical and Hospital claims in Facets based on Service, Agreement and Pricing Id's
  • Tested the Web interfaces and Web Service Applications
  • Worked with ANSI X12 (835, 837, 834) EDI Transactions
  • Extensively used UNIX shell scripts
  • Responsible in providing regular test reports to the management
  • Reported the defects to the developers using Quality Center

Environment: Windows XP, Unix, RUP, Rational Rose, Facets, MS Visio, Information, HTML.

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