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Sr. Business System Analyst Resume


  • 8+ years of professional experience as Business Analyst/Business Systems Analyst, worked on projects related to Health Information Exchange (HIE), Medicare, Medicaid, EDI transactions (inbound and outbound), Eligibility and Benefit systems, ICD - 10, HCPCS, CPT, HIPAA 4010 and 5010, Claims Adjudication and expert in Affordable Care Act( ACA), aka Healthcare Reform (HCR).
  • Extensive experience working in Software Development Life Cycle (SDLC) including Waterfall, Agile (Sprint) and Iterative Rational Unified Process (RUP).
  • Strong experience working with Scrum methodology and well versed in writing user stories.
  • Thorough experience in all the phases of Waterfall methodology from requirements elicitation followed by analysis, design, coding, testing, and maintenance.
  • Extensive experience in gathering business requirements, functional requirements, non-functional using Rational Requisite. Created numerous SDLC artifacts such as Business Requirements Documents (BRD), Functional Requirements Documents (FRD), Requirements Traceability Matrix (RTM), Business Use Case documents, System Use Case documents, GAP analysis documents.
  • Expertise in Testing &Virtualizing various types of SOA based services including Web Services (SOAP/HTTP(s)) and REST Services.
  • Gathering business and technical requirements from both formal and informal sessions through interviews, Net-Meeting, questionnaire, video conferencing, JAD (Joint application Development) sessions and conference calls. Documentation of Business assumptions and Constraints.
  • Astute understanding of value created by AS-IS and TO-BE analysis and experienced in conducting process evaluations and writing recommendations based on the analysis.
  • Extensive experience on Web Service & Hands on experience in validating Web Services using SOAP-UI.
  • Involved in Joint Application Development (JAD) sessions with end-users, SMEs' and development team for project meetings, walkthroughs and customer interviews to converge early towards a design acceptable to the client and feasible for the developers and to limit a projects exposure to the forces of change.
  • Created DFDs- conceptual, Logical data model.
  • Worked on data migration and warehousing.
  • Experience in SQL ad-hoc queries to extract data from various databases for data analysis and generating reports per the format specified Subjects Matter Experts (SME's).
  • Created Source to Target data mapping and carefully captured the business rules
  • Captured business rules and requirements applicable to ETL process and mapped it as applicable for extraction, transformation and loading of data.
  • Experience in working on Data Dictionaries, Data Definition with explanation of concepts in the form of use cases.
  • Created system generated report specification document for scheduled database job daily membership file processing
  • Specialized in creating UML Diagrams such as use case, business process models, activity and data flow diagrams using MS Visio and Rational Rose; consistently translating business requirement into IT solutions Expert level skills in MS Office products and other tolls including MS Project, MS Word, MS Power Point, MS Visio, Axure, MS FrontPage, MS Excel.
  • Expert in conducting GAP analysis, Cost benefit analysis and SWOT analysis.



Project Tracking tool: HP QC/ALM, JIRA, Microsoft Test Manager

Modeling Tools: MS Visio, Rational Rose

Requirements Management Tools: JIRA, HP ALM, HP QC

Project Management Tools: MS Office Suite (Project, Excel, Word, PowerPoint)

Methodology: Agile(Scrum), Waterfall, Rational Unified Process (RUP)

Operating System: Windows, Unix, Linux


Confidential, Minnetonka, MN

Sr. Business System Analyst


  • Gathered and documented business requirements for existing and future business systems.
  • Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns.
  • Conducted daily SCRUM meetings during the Sprint Development as a part of Agile Methodology. Also captured and addressed concerns from IT to Product Management or Business Team as needed.
  • Gathered requirements, organized team meetings requirements from business users, generated business process models, & use-case models, and created business requirements document (BRD) & functional requirements document (FRD).
  • Analyzed trading partner specifications and created EDI mapping guidelines.
  • Converted various SQL statements into stored procedures thereby reducing the Number of database accesses.
  • Created surrogate key tables to map the required dimensions.
  • Created hash tables used for referential integrity and/or otherwise while transforming the data representing valid information.
  • Created and maintained data mapping document(s) in reference to the HIPAA transactions:, 837, and 835.
  • Involved in testing Web services and XML using SOAP UI. Verified the response received by updating the request XML.
  • Used Query Analyzer, Execution Plan to optimize SQL Queries.
  • 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
  • Worked on HIPAA Standard/Gstandard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set
  • Worked with facets claims data for claims subject area, Enrollment and billing data for membership subject area.
  • Prepared the 837 I&P Claims and validated these in Facets System.
  • Completed the documentation of Claims Scenario's for the source system.
  • Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
  • Ensured that all Lines of Business specifications were consistent in form and function to the Diamond Base System.
  • Ensured that project requirements are properly tracked and documented.
  • Assisted in identifying project scope, to confirm to the regulatory compliance related to X12 837 (I/P) and 835.
  • Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
  • 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.
  • Developed and automated Web Service testing using Soap-UI frameworks.
  • Capture and Formulation of Business Rules and delivery of Business Rules Templates.
  • Creation of UML Diagrams including Context, Business Rules Flow, and Class Diagrams.
  • Created requirements analysis and design phase artifacts using, Rational Software Modeler and MS Visio to create DFDs, ER diagrams, Use Case, Activity/State chart, Sequence, Collaboration and Deployment Diagrams.
  • Conducted mapping activities and configurations maps for (eg: 837, 270/271, 278, 276/277 etc.).
  • Used Microsoft Office suit to develop the documents such as Visio for creating wireframes, Word, Excel and PowerPoint for creation of Business Requirement documents.
  • Performed Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
  • Executed the test cases, used HP ALM (Quality Centre) to track execution against the plan during testing and manage defects from inception to resolution.
  • Used Rational Clear case for version control.
  • Drafted business Use Cases such that any future changes could be easily managed.
  • Used to execute test cases for several transactions such as 837, 835, 820, 834, 277, 278, 270/271.

Environment: JIRA, Sales force, MS Office, Windows, MS Visio, HP SharePoint, MS Project, MS Visio, SQL, SOAP, XML, Agile, QC ALM.

Confidential, Hartford, CT

Business System Analyst


  • Interacted with Business Owners, Users, and Stakeholders to identify Business System Needs, evaluated solutions for business problems, and followed Agile Methodology to prepare User Stories and defined the Acceptance Criteria (AC) for the same.
  • Gathered and created functional and non-functional requirement documents, BRDs, FRDs, Use Cases, end to end system work flows, interface diagrams, mapping documents.
  • Managed the project using Agile method and implemented scrum methodology.
  • Represented the business requirements in various alternative views such as analysis models, process flow diagrams and user stories.
  • Participated in User Experience Design and Business Process Design and thereafter interacted with the Design Team to help them create the designs and conducted gap analysis to identify the gaps between the requirements and the designs and documented the same.
  • Co-ordinated the modules from inception through development and to implementation of the product.
  • Created project documentation according to team standards, to allow stakeholder and technology team engagement and successful delivery.
  • Created tests with Assertions like Schema Compliance, SOAP, XPath assertions using SOAP UI.
  • Facilitated User Acceptance testing (UAT) when required with different business units.
  • Used to execute test cases for several transactions such as 837, 835, 820, 834, 277, 278, 270/271.
  • Interacted with business and technical professionals in multiple governance forums across delivery lifecycle.
  • Conducted Gap Analysis to define the impact of the new requirements on the existing GUI and further prepared Business Impact Analysis Reports.
  • Created complex SQL queries using SQL editor.
  • Conducted User, Development Team and QA Team walkthroughs to bridge the gap and worked with Project Managers and Development Team to facilitate project delivery.
  • Designed Use Case Diagrams, Activity Diagrams, and Data Flow Diagrams to define the Business Process.
  • Tracing requirements throughout the development process and verifying adherence using the Requirements Traceability Matrix (RTM).
  • Involved in Joint Application Development (JAD) sessions with different stakeholders to communicate with each other, resolve problems at an early stage.
  • Recommend on implementation of HIPAA 5010 (EDI X12 837,834, 820, 278,270,999) in the new System.
  • Coordinated with the test team to check the Weekly Status and Report it to the Project Manager.
  • Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modelling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards.
  • Designed and implemented complex SQL queries for QA testing and data validation.
  • Worked with the Quality Assurance lead to develop detailed Test Plan and Test Cases.
  • Created UAT Test Plans and Test Cases, Stakeholder Management, Scope Management.
  • 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.

Environment: SDLC, JIRA, MS Project, MS Office (Word, Excel, PowerPoint), MS Visio, Windows, ALM, Quick Test Pro.

Confidential, Detroit MI

Business System Analyst


  • Gathered and created functional and non-functional requirement documents, IRD’s, Use Cases, Wire Frames, end to end system work flows, interface diagrams, mapping documents, presentations, message specifications, test scripts for enrolling and maintaining groups and individuals.
  • Worked on the creation of user stories with the business team and then creation of functional from them.
  • Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs.
  • Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process.
  • Involved in writing Eligibility rules for Medicaid and SNAP and also Worked on process flow of the eligibility system.
  • Worked on creation of data marts where the outbound and inbound data from the Centre of Medicare and Medicaid could be stored.
  • Created architecture Solution flows, UML diagrams, service charters and detailed message specifications for development of messages/interfaces which using Business Process Modeling Notations (BPMN).
  • Create Requirements Traceability Matrix and support in creation of enterprise solution architecture to integrate business rules across domains.
  • Prepared Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio for complex processes and walks business and development team through the documentation.
  • Conducted Joint Application Development (JAD) sessions to expedite and streamline the requirement gathering process.
  • Involved with financial/billing analysis of Medicare Advantage (MAPD).
  • Conducted a crosswalk between the Billing Application and the HIPAA Implementation Guide.
  • Developed solutions for Management dashboards, BI Analytics or Operational BI; and documented technology roadmaps through collaboration with the data management, ETL and business teams.
  • Worked in claims Extract, Transform and Load (ETL) team for transferring the claims and enrollment data from EDW to Altegra and to CMS.
  • Utilized TriZetto Facets to verify Electronic Data Interchange (EDI) Transactions 834 (Membership Enrollment), 835 (Enrollment of Benefits), and 837 (Claims Processing) were compliant with HIPAA standards.
  • Worked on documenting existing downstream with Benefits, Claim processing and Enrollment & Pricing.
  • Created Source to Target mapping for ETL workflows and convey the requirements to ETL team.
  • Experience with TriZetto Facets Workflow for the Facets functional areas like Enrollment and claims data extracts.
  • Worked with the testing team to understand the Facets Claim adjudication process to ensure that they prepare valid test scenarios.
  • Maintained requirements/business rules for Enterprise Data Warehouse, Business Intelligence Tools.
  • Worked in testing the Professional, Institutional Claims processing and adjudication and validate data with facets.
  • Gathered requirement on facets EDI 834 Benefit Enrollment and Maintenance subsystems.
  • Worked closely with the MMIS testing team to ensure that test scenarios and test cases fully represent the requirements being tested for assigned projects.
  • Worked on Business Intelligence Analytical Reporting (BIAR), the base MMIS data warehouse subsystem, to extract and analyze Medicaid data and to support exchange of this data with various external data sources via a secure SFTP server.
  • Expertise in Business process modeling using BPMN for future and current processes and reviewed with business and development team. Extensively created Business Process Modeling Diagrams/Swim Lane Flows using BPMN notations and MS Visio indicating transformations and feeds.
  • Performed extensive GAP analysis and created Message Specification Documents for service calls.
  • Conducted process mapping to identify current as-is business processes and To-Be road map for reengineering the products.
  • Implemented agile methodologies (e.g. Sprint Sycle, burn down chart, velocity, backlog grooming) to transform into agile from waterfall environment.
  • Performed testing for Medicare, Medicaid and X-Over claims for Medicaid Management Information System (MMIS).
  • Wrote intermediate level SQL queries, understood source to target mapping.
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
  • Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.
  • Facilitated and participated in various enhancement meetings. Involved in the meeting with Business process owners, SME (subject matter experts) and Marketing Team for Requirements gathering in definition stage.
  • Developed prototype of new information processing application. Facilitated collection of functional requirements from system users and preparation of business requirement documents.

Environment: Windows, MS Office, MS Visio, SharePoint, SQL.

Confidential, Richmond VA

Jr. Business Analyst


  • Worked with the account managers, managements, and report requestors to gather requirements, get report requests.
  • Wrote Business Requirements, analyzed them and validate them.
  • Designed report templates based on the requests by account managers.
  • Designed Functional Specification Documents for the reports.
  • Worked in RUP environment using Rational Requisite Pro.
  • Analyzed trading partner specifications and created EDI mapping guidelines.
  • Extensive use of Excel to create Functional Specification Documents & Templates.
  • Designed the process flow diagrams for flow of information and report creation process.
  • Conducted JAD sessions for the report users, requestors, and the developers.
  • Prepared Need Analysis Documents of the requirements gathered through JAD sessions.
  • Documented all the changes in the initial templates and was responsible for Release Management.
  • Reviewed Requirements & deliverables for delivery timeline.
  • Used MS Visio to create Flow diagrams and Use Case Diagrams.
  • Created presentations explaining the entire report development process, while drawing a comparison between the legacy & the new report.
  • Coordinated with the developer, on day-to-day basis, during the development process.
  • Worked on Report Re-engineering Project and made enhancements to the system flow.
  • Worked with ETL team during the upload process.
  • Helped with Data Mapping between the data mart and the Source Systems.
  • Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
  • Worked as a liaison between the Business and Technology Department.
  • Enhanced communication lines between executives, managers, and peers.

Environment: RUP, MS Office, Excel, PowerPoint, SharePoint and Visio, Rational Rose, SQL.

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