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Edi Healthcare Business Systems Analyst Resume

Houston, TexaS


  • Overall 8+ years of diverse experience in business analysis, system analysis, requirements gathering, data mapping, processing medical claims, implementing Electronic data interchange (EDI) transactions, developing Electronic Medical Records (EMR) and designing a web based healthcare applications by partnering with the Information Technology group to ensure a smooth and efficient project implementation.
  • Experience in System Development Life Cycle (SDLC), agile methodology, and expertise in managing cross - functional teams in a fast-paced changing environment.
  • Committed to delivering the quality projects that meet the healthcare business needs.
  • Outstanding knowledge of System Development Life Cycle (SDLC) and project lifecycle with particular strong emphasis on Waterfall and Agile Scrum Methodology.
  • Experience on all stages of project from requirement elicitation, defining scope, project planning and estimation, execution, implementation and post-production support.
  • Experience in creating User Stories (Functional Stories, Logic User Stories, Service User Stories) from Product Backlog and facilitated Sprint Planning meetings and prepared Sprint Backlog. Experience on all stages of project from requirement elicitation, defining scope, project planning and estimation, execution, implementation and post-production support.
  • Strong knowledge of claims management process, Medicaid and Medicare Services. CMS, Health Assessment Systems, Hl7 Standards, HIPAA, Compliance issues, EDI Mapping, ICD 9 to ICD10 conversion and Electronic Health records.
  • Comprehensive understanding of the laws and guidelines concerning medical claims. Adept at analyzing complicated insurance data working in conjunction with insurance representatives and monitoring payment progress.
  • Experience writing queries with SQL server.
  • Served as a critical resource and liaised between subject matter experts and technologists throughout project life cycles.
  • Responsible for conducting gap analysis as is to be for ICD9 and ICD10. Prepared Data Flow Models for code sets validating in Facets and Claim Process Engine
  • Responsible to Track, Document, Capture, Manage and Communicate the Requirements using Requirement Traceability Matrix (RTM) which helped in controlling numerous artifacts produced by the teams across the deliverables for a project.
  • Participated in Joint Application Development (JAD) sessions, conducted Interviews with users as well as Subject Matter Experts (SMEs) to draw the business requirements in detail and to resolve the conflicting issues.
  • Excellent conceptual and technical skills to create Business Requirements Document (BRD), Functional Specifications Document (FSD), Use Case Diagrams, Process flow Diagrams, wireframes and skilled in transforming the needs of business users and stakeholders to functional/technical requirements.
  • Experience in conducting SWOT Analysis, Cost Benefit for business operations.
  • Strong team building, Conflict management, time management and escalation protocol skills


Project Methodologies: Waterfall (System development lifecycle), Agile Scrum

Domain Expertise: Healthcare Information Technology, Electronic data interchange (EDI), Claims

Healthcare Standards: HIPAA, X12, HL7, NCPDP, WEDI Snip Testing

Business Modelling Tools: MS Visio, Rational Rose

Document Management Tool: MS Office (Word, Excel, Power point)

Business Modelling diagram: Unified modelling language (UML)

Requirement Management Tool: Rational Requisite

Database management: SQL server

Scripting Languages: HTML, XML, Flat files, Java, XSD

Defect Tracking Tools: JIRA, Bugzilla, Rally, HP QC

Testing Tool: HP ALM

Reporting Tool: Qlick view

Wire Framing Tools: Balsamiq, Blueprints, Mock ups


Confidential, Houston, Texas

EDI Healthcare Business Systems Analyst


  • Responsible for business documentation and deliverables and participated in requirement validation/ analysing sessions leveraging business expertise to facilitate a clear understanding of the requirements.
  • Participated in Implementation Planning leveraging their business expertise to facilitate a complete implementation plan.
  • Involved in implementation of HIPAA EDI 837, 835, 820, 834,270, 271, 276, 277, 278 request and response and NCPDP transactions.
  • Involved in upgradation of HIPAA 4010 and 5010 transactions and data mapping.
  • Designed crosswalks as per the TR3 Implementation guides and customized it as per the business requirements of the State Medicaid ensuring it to be HIPAA compliant.
  • Conducted gap analysis of EDI transactions between the existing application and stated customer requirements and actively participated in data mapping from XML tag and flat files.
  • Facilitated JAD Sessions, user meetings, interviews and requirement elicitation sessions to extract business requirements and to confirm that the requirements are in alignment with up gradation of 5010 and to resolve issues and roadblocks during the project.
  • Responsible for troubleshooting the transaction file issues, defects or errors in each environment effectively and conducted triage meetings to resolve it.
  • Delivered precise functional specifications to include functional hierarchy, workflow, business rules, interface design and definitions, outstanding issues, data analysis, and data mapping to clients.
  • Prioritized and coordinated deliverables among the various IT Teams.
  • Functioned as business expert during project presentations to the client.
  • Responsible for systems & process design and implementation
  • Attended relevant webinars as conducted by CAQH core operating rules and participated in DXC System provided training.
  • Participated in Design Sessions leveraging their business expertise to facilitate a solid business design.
  • Participated in n scheduled release meetings for the server maintenance and change requests.
  • Participated in scheduled release meetings for the server maintenance and change requests.


Business systems analyst


  • Served as a liaison between business units, development and support teams that developed the medical protocols
  • Researched state and federal rules, regulations and accreditation requirements relative to compliance issues, inquiries and new business plans/operations.
  • Worked with IT teams and business experts and identified issues affecting work progress and recommended solutions
  • Worked with the clients to demonstrate the changes to the system to ensure all relevant business needs are addressed.
  • Gathered requirements and help build and document specifications for development
  • Conducted research in collaboration with the R & D team to reduce time, cost and scope of a project.
  • Organized work plan for each phase of the project and arranged for recruitment and assignment of project personnel.
  • Designed the training manuals and trained a team of health workers on the new systems and processes.
  • Assisted in the design & development of the computer applications and the software and documented all the system design procedures
  • Worked with Development, QA, and Production Support teams to communicate, verify, and test the desired functionality changes.
  • Worked with the project team and test manager to determine appropriate test plans, deployment plans and supported the product launch.


Software functional analyst


  • Worked as functional Analyst in the software development team for outsourcing Electronic medical records (EMR) and paperless office system implementation to the medical facilities.
  • Responsible for EMR interface development and implementation. Specialised in Nephrology EMR, Internal medicine EMR, Psychiatry EMR, Oncology EMR, Anaesthesia EMR etc.
  • Provided affordable and secure, HIPAA compliant, back-office services such as medical billing and medical transcription services,
  • Worked with business representatives to understand requirements and priorities and ensure that the software development work is appropriately aligned.
  • Analyzed healthcare data trends to produce an appropriate improved solution.
  • Interviewed the business users to determine functional requirements of the software system
  • Worked with systems analysts and analysed the data processing problems to improve computer systems.
  • Collected medical record data via fax from physician offices, hospitals. Maintained complete confidentiality of protected health information
  • Organized JAD sessions to understand the client’s existing business process.
  • Interviewed the business users to determine the functional requirements of the software system
  • Performed Gap Analysis to check the compatibility of the existing system with the new business requirements
  • Documented all phases of QA process. Developed business based functional test scenarios
  • Performed unit testing, functional testing and system testing for the EMR web application
  • Prepared UAT Test Plan for various Test Scenarios and assisted in User Acceptance testing.

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