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Sr. It Business Systems Analyst Resume

Jacksonville, FL

SUMMARY:

  • Over 7+ years of experience as a Business Analyst and Project management with extensive experience in SDLC
  • Solid understanding of Business Requirement gathering, Business Process flow, and Business Process Modeling and Analysis.
  • Several years of experience and advance knowledge of the Systems Development Life Cycle (SDLC), Waterfall, Spiral, Rapid Application Development (RAD), Extreme Programming (XP), Rational Unified Process (RUP)
  • Experience in conducting Joint Application Development (JAD) sessions for requirements gathering, analysis and design, and Rapid Application Development (RAD) sessions to congregate early toward a design acceptable to the customer and feasible for the developers
  • Worked with ICD 9 to ICD 10 upgrade, conversion and worked on HIPAA X12 EDI transaction codes such as 270/271(inquiry/response health care benefits), 276/277(Claim status), 834 (Benefit enrollment), 835 (Payment/remittance advice/ Explanation of benefits), 837(Health care claim)
  • Strong knowledge of Facets, HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
  • Experience in using tracking tools such as DevTrack, Quality Center, Bugzilla, dashboard and practical experience in defect tracking and Defect Lifecycle.
  • Extensive knowledge of Healthcare Insurance including Medicaid.Medicaid Information Technology (MITA), Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS)
  • Developed business requirements by analyzing the As - Is system and designing the To-Be system to streamline business strategies. Suggested improvements to business processes through better use of existing technology.
  • Exceptional Documentation Skills for writing Use Cases and Functional Requirement Documents as well as for creating Use Case diagrams, Activity diagrams, Data Flow Diagrams (DFD), Sequence diagrams, State diagrams, Diagrams based on UML Methodology and business process flow diagrams using MS Visio/Enterprise Architect/Rational Rose.
  • Strong expertise in employing Rational Unified Process (RUP) methodology throughout the SDLC process
  • Experienced in performing Business Process Reengineering/Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
  • Expertise in reviewing Test Procedures, creating Test plans, defining System & Integration Test Cases, executing Test Cases,Test Data reviewing, maintaining and executing detailed Test scripts for User Acceptance Testing (UAT), analyzing bugs,interacting with team members in fixing defects.

TECHNICAL EXPERTISE:

Operating Systems: Windows, UNIX, LINUX

Methodologies: Rational RUP, RAD, Waterfall (SDLC), Agile, Scrum, Incremental.

Case Tools: Rational RequisitePro, ERWIN, UML

Tracking Tools: QualityCenter, RationalClearQuest

Languages: SQL*Plus, SQL

Qa Tools: HP Quality Center, Facets, Jira

Tools: MS Office: Excel, Word, PowerPoint, MS-Project, WordPerfect Productivity tools, MS-Visio

Databases: MS-SQL Server, Oracle, MySQL, MS-Access

PROFESSIONAL PROFILE:

Confidential, Jacksonville, FL

Sr. IT Business Systems Analyst

  • Designed a claim processing system for the healthcare management client system, which allowed the users to inexpensively capture information regarding patient, summary of medical history, symptoms (ICD-9 & 10 codes), and treatment (CPT).
  • Conducted extensive Joint Application Development sessions and requirements workshop sessions between the development team and claim settlement experts making sure that the development of the project was meeting the business requirements.
  • Review and process vendor application requests, selection plans, assessments and contracts in accordance to federal regulations.
  • Gathered the business requirements for 4 phases out of 5 which comprises ofClaims Inquiry, Claim Adjustments, Pre-auth./Referral, Claim Correction, Electronic Enrollment and Billing, Group and Individual Application Status, Group Coverage Inquiry, Real Time Claims, Data Maintenance Apps, Provider Directory and Provider Data Exchange .
  • Reviewed and wrote requirements for Agent claims processing system, by reviewing current system process to identify errors and discrepancies and reviewed the system processes with supervisors and directors and provided new automation process plan.
  • Conducted daily interaction with the development team, stakeholders, keybusiness executives and Quality assurance team to coordinate all the engineered process.
  • Analyzed, documented and managed all project requirements and change to requirements throughout the software development lifecycle using Rational Requisite Pro.
  • Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD) and the Functional Requirement Document (FRD).
  • Tracked stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
  • Involved with the 837, 835, and 834 HIPPA-EDI Transaction Code Sets.
  • Created Use Case Models, Wireframes&Mock-ups, Analysis Models, Design Models, Use Case Diagrams, Behavior Diagrams (Sequence Diagrams, Activity Diagrams) based on UML Methodology.
  • Conducted Joint Application Development (JAD) sessions to develop and agree upon a system that focuses on a Business Requirement.

Confidential, Charlotte, NC

Sr. Business Analyst

  • Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
  • Coordinated with Business Owner, Application Vendor, Business Project Teams, Payers and Clearing houses to bring all processes to a level of execution to mitigate any impact to current revenue flow under the HIPAA 5010 compliance requirements.
  • Involved in full gap analysis for transaction sets 835 and 837 (I/P) against the documented application on HIPAA 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliance.
  • Designed robust HIPAA 5010 testing and HIPAA 4010 regression SIT and UAT Testing Scripts for the 5010 Project. Scripts were written on an application level and subset by payer resulting in over 600 combined scripts with a maximum of 70 testing scripts steps per script.
  • Documented workflows and executed comprehensive testing and training plans to ensure the new acknowledgement results demonstrated in the 999 and 277CA were properly interpreted and managed to ensure Payer acceptance of the 837 files.
  • Implemented SQL scripts considering SQL best practices with optimized performance to validate data in SQL tables as part of the requirements.

Environment: RUP, Rational RequisitePro, Rational Soda, Rational Rose, Rational Clear Case, Rational Clear quest, Java, MS VISIO, MS Project, Oracle, HTML, WINDOWS

Confidential, Boise, ID

Business Analyst

  • Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements.
  • Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
  • Created business workflows on the Claims Processing module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements.
  • Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the Implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Systems Life Cycle methodologies. Prepared various artifacts for all the phases of RUP.
  • Led JAD sessions with stakeholders to analyze system needs and integrate requirement to develop a consistent navigation structure
  • Involved in gap analysis in changing old MMIS and testing new MMIS.
  • Involved in up-gradation of HIPAA X12 4010 transaction to HIPAA X12 5010
  • Immense knowledge in CMS certification and Compliance and analyzing HEDIS data to compare the accuracy of care for Medicaid plan
  • Responsible for business analysis, requirement specifications, project planning and identifying the resources and implementation of the project.
  • Performed the Gap analysis of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
  • Created functional flow diagrams, context diagrams and other high-level diagrams for documenting the functionality of separate modules using MS-Visio and UML.
  • Based on the physical model, developed strategies for Extraction, Transformation and Loading (ETL) of the data into the data warehouse.
  • Performed unit testing, point-to-point testing and integration testing to confirm ETL code integrity.
  • Used MS Project to maintain the project schedule and track its status.

Environment: UML, RUP, MS-SharePoint, MS-Project 2000, MS-VISIO, CMMI, testDirector7.6, WinRunner7,windows 2000, EDI, HIPAA compliances.

Confidential, New York City, NY

Business Analyst

  • Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
  • Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
  • Conducted JAD sessions for communicating with all the project directors and stakeholders. Created process workflows, functional specifications and project initiation artifacts.
  • Analyzed, documented and managed all project requirements and change to requirements throughout the software development lifecycle using Requisite Pro.
  • Created Use-Cases, Sequence and Collaboration Diagrams to demonstrate software architecture and interaction of system components before prototyping. Used Rational Rose, Requisite-Pro for requirement traceability.
  • Involved in GAP analysis around the identification of business rules, business and system process flows, user administration, requirements and assumptions.
  • Developed test cases and scripts based on business requirements for the GUI, functional, User Acceptance & System Back-end testing.
  • Used SQL queries for the arrangement of customer data. Worked closely with QA and Developers to clarify/understand functionality, resolve issues and provided feedback to nail down the bugs.

Environment: Windows XP/NT, UNIX, C++, Java, HTML, XML, Java Script, Oracle, Rational Requisite Pro, UML, Load Runner, Quality Center

Confidential, Orlando, FL

Business Analyst

  • Involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
  • Developed the Project using the Iterative RUP model. The Project was streamlined through all phases of the RUP model starting from Inception through Transition. Used a Functional Decomposition strategy to divide system into sub-systems.
  • Authored Computer Validation Report, which involved extensive research and interaction with SME’s and our clients.
  • Created business workflows on the claims module for the client to get a better understanding of the software and prepared a detailed BRD including all functional and non-functional requirements.
  • UML was extensively used for specifying, constructing and documenting the software system.
  • Worked closely on 834 transaction code for Benefit Enrollment and did manual testing using Test Director.
  • Involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
  • Performed the Gap analyses of the earlier systems, generated a detailed Requirements document describing new system architecture through Use Cases and Activity diagrams.
  • Developed Class Diagrams, State diagrams and physical Component diagrams/ DFD’s to capture the entire system functionality and thereafter built a framework for the software development phase.
  • Designed message formats, queues, legacy systems interfaces, and worked with the business Users through interviews and JAD sessions. Created front-end prototypes as deliverables and projected the end-delivery modules.
  • Prepared requirement specification, functionality trace matrix, quality assurance plan and designed test cases. Communicated with business, technology leadership for overall project/program office milestones.

Environment: UML,RUP,MS-Sharepoint, MS-Project 2000, MS-VISIO, CMMI, Quality Center,windows, EDI, HIPAA compliances.

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