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Senior Systems Analyst Resume

Raleigh, NC


  • More than seven years of professional experience as a Systems Analyst in Healthcare Industry
  • Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, Facets, QNXT enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
  • Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.
  • Excellent in Developing and evaluating business process Models.
  • Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
  • Strong experience in RUP Business Modeling process.
  • Expertise in UML (class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams) as a business analysis methodology for application functionality designs using IBM’s Rational Rose.
  • Strong experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developing Test Plans and Test Scripts.
  • Excellent in Developing and evaluating business process Models.
  • Expertise include following the RUP/Waterfall/Agile methodologies in defining the business process and acting as a bridge between the Management and the Development teams.
  • Design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents
  • Familiar with HIPAA EDI transactions such as EDI 835, 837 (P, D, I) 276, 277, 278 etc.
  • Experienced with ICD9-ICD10 mapping.
  • Proven success as a business analyst through the years, providing a well-balanced understanding of business relationships, business requirements, and technical solutions.
  • Professional experience in business analysis, operations management and development, design, documentation and testing.
  • Excellent Analytical, methodical, and resourceful approach to problem solving, identifying and documenting root causes and corrective actions to meet short and long term business and system requirements.
  • Effective in executing multiple tasks and assignments ahead of schedule. Created and maintained effective budgets.
  • Advised management on improvement strategies, Competitive & Profitability Analysis.


Senior Systems Analyst

Confidential, Raleigh, NC


  • Involved in the analysis of the existing credit card processing system, mapping phase according to functionality and data conversion procedure.
  • Participated in the identification, definition and documentation of current business process including the customer service model and how the processing of payments and updates to corporate card features happen in the As-Is world
  • Participated in Joint Application Development (JAD) sessions by convening project sponsors, end-user representatives, development team members, subject-matter experts, technical personnel, and different stakeholders to communicate their perspectives with each other, resolve any issues and come to consensus.
  • Identified Use Cases and wrote Use Case Narratives.
  • Supported all QNXT modules initiatives in improving overall efficiency for Quality Standard and Claims Adjudication.
  • Created Use Case Diagrams and Activity Diagrams using Enterprise Architect
  • Worked closely with the development team to help them understand Use Case Narratives.
  • Reprocessed incorrect paid and denied claim using Facets.
  • Conducted requirement workshops among all project stakeholders to verify and validate the business requirements
  • Handled the development of business requirement documents (BRD) resulting from JAD sessions.
  • Gathered Business Requirements from users and used Enterprise Architect for documenting the requirements.
  • Involved in maintaining Requirements Traceability Matrix (RTM).
  • Experienced in creating mapping for loading Benefits in Facets.
  • Preparing service offerings, PPTs, Test approach, Road maps, assessments remediation, solution framework for 4010A1 to 5010, ICD10 Conversions.
  • Analyzed a wide range of FACETS configuration change requests for the purposes of determining the technical scope of the change, its impact on existing systems configuration.
  • Performed analysis in and billing data from Facets.
  • Configured Facets for Provider and performed data analysis on subscriber data in Facets.
  • Impact analysis, gap analysis, risk identification & estimations for 5010 and ICD-10 compliance.
  • Involved in Project plan, Test plan and other pre-sales activities for 5010 and ICD-10 compliance.
  • Providing business solutions as a SME for Healthcare-PBM and Medicare Part-D Projects.
  • Working with Confidential NC business teams to find out production issues and defects.
  • Preparing Daily and weekly status reports and submitting to customers.
  • Assisted QA department to write and execute Test plans and Test Cases
  • Participated in identifying opportunities and parameters for business process improvements.
  • Used the guidelines and artifacts of the Rational Unified Process (RUP) to release multiple iterations of the deliverable over the span of the project lifecycle; propounded early development and base lining of a robust executable architecture.

Environment: Enterprise Architect, Microsoft Office Suites (MS Word, PowerPoint, Access, Excel, Outlook, Project, Visio), RUP, Windows, Microsoft SQL Server (2000 & 2005), UML.

Senior Systems Analyst

Confidential, Pleasanton, CA


  • Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams
  • Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
  • Used HIPAA 4010 transactions to support the analysis of current business processes and work with management to improve and implement enterprise solutions to ensure compliance and got involved in designing future state processes for HIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
  • Responsible for GAP analysis of ICD9-ICD10.
  • Involved in Mapping Disease codes from ICD system to EHR.
  • Validated all health data in EHR as per HIPAA 5010.
  • Involved in testing Diseases codes and health information in EHR.
  • Helped in improving EHR as per customer service perspective and developed user guide for our customer support team.
  • Involved with ICD10 implementation testing.
  • Responsible for business system analysis of customizing the BPS Risk Management product with involvement through the whole SDLC
  • Consulted with healthcare insurance company to develop conversion specifications for other insurance Coordination of Benefits (including Medicare).
  • Performed Unit Testing and User Acceptance Testing and documented detailed defects.
  • Developed Test Cases to validate the requirements and documented the Traceability Matrix for Test Cases and Requirements
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements
  • Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business Process Modeling.
  • Developed business process models in RUP to document existing and future business processes.
  • Created Business Requirement Document (BRD), Functional Requirement Specification (FRS) document, User Requirement Specification (URS) and Change Request (CR) document for system application development.
  • Provided management support to the off-shore End to End Integration / Regression Test Team
  • Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper coverage of requirements

Environment: Windows XP Professional, Oracle9i, MS Excel, RUP, Oracle, UML, Rational Rose, Requisite Pro, MS Office suite, XML, MS Visio 2003, HP Quality center.

Systems Analyst

Confidential, Washington, DC


  • Work closely with Business Owners and Stakeholders to outline Business Requirements using rational requisite pro.
  • Work with System analyst and IS teams to understand the flow of data.
  • Reviewed and analyzed data from various sources.
  • Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I, P, & D), 835 Remittances and others.
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database
  • Created Mapping Documents, Report Mockups and modified existing report mockups as to CMS requirements and finalized for development
  • Created context and workflow models, information and business requirement models, Use Case and Object Models during the analysis using Rational tools.
  • Review requirements and understand technical recommendations and constraints, and develop comprehensive and accurate functional specifications; Data Mapping, and process flows.
  • Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
  • 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.
  • Analyzed the test results with Win runner reports
  • Created planning progress graphs in Test Director
  • Logged defects in Test Director
  • Used Test Director for bug tracking and reporting
  • Documented the success or failure of the test effort
  • Created checkpoints to check functionality of objects using Win runner
  • Extensively used Test Director & Quality Center to write Test Cases and for reporting. All the Scripts are maintained using Test Director & Quality Center.
  • Extensively uploaded test cases from MS Excel, MS Word to Test Director & Quality Center.

Environment: Windows XP, Business Objects, MS Excel, Word, Visio, power point, SQL, DB2, SAS database, Winn Runner, Quality Centre. RUP.

Systems Analyst

Confidential, Memphis, TN


  • Analyze and work with stakeholders to prioritize application defects/enhancements and participate in developing a change management process
  • Followed solely RUP methodologies during the course of the project.
  • Gathered user requirements for new reports through JAD/JAR sessions, which eliminated duplicate and obsolete data and provided a uniform reporting environment across the multiple trading desks.
  • Management of internal and vendor developed code to correct errors, and improve efficiency of inter-plan claims processing.
  • Executed offsite migrations of major processes like New Enrollments, Claims Adjudication, and Policy Owner Services, developed user manuals and trained additional resources thus saving onsite migrations costs for the organization.
  • Performed gap analysis for changed claims and enrollment business process of Medicare
  • Advantage SNP plan transactions. Expert in provider, subscriber, patient, code set data entities.
  • Involved in prioritizing the defects and writing system requirements to resolve them.
  • Conducted JAD sessions with management, SME, vendors, users and other stakeholders for open and pending issues.
  • Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Project.
  • Examined, analyzed and modeled Use Case Model cases based on RUP methodology.
  • Created and managed project templates, Use Case project templates, requirement types and traceability relationships in Requisite Pro.
  • Evaluated the Rational comprehensive approach to software development, featuring seamless integration between tools, services and best practices, enables the organization to successfully deliver high quality software while deriving impressive business benefits for their customers.
  • Worked extensively with MS Excel and MS access
  • Used Unified Modeling Language (UML) for process modeling and use cases.
  • Conducted review sessions on regular basis with QA and development teams for preparing status, delivery report and client reporting.
  • Suggested measures and recommendations to improve the current application performance.

Environment: Rational Enterprise Suite (Rose, RequisitePro, ClearCase, ClearQuest), Mercury, MS Office, Oracle, SQL Server Reports, WinRunner, Loadrunner, Quick TestPro

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