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Business Analyst Resume

Columbus, OH


  • Over 6 Years of Business Analyst, experienced working in fast paced environments demanding strong organizational, technical and interpersonal skills.
  • Detail - oriented and resourceful in completing projects: able to multi-task effectively
  • Experience in creating and organizing deliverables in a secure retrievable area: such as BRD (Business Requirement Document), FRD (Functional Requirement Document), PDD (Project/ Product Definition Document), SRS (System Requirement Specification) and Change Management Documents.
  • Strong knowledge and experience with HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278 etc
  • Developed data conversion programs for , claims, and benefit accumulator data converted thirteen corporate acquisitions. Developed data field mappings.
  • Provided programming and support for claims processing functions and auto-adjudication.
  • Experience with Medicare and Medicaid: Claims processing, Medicaid billing, , and Eligibility Verification and care management.
  • Collaborate with WTX and WMI integration teams to design the backend integration solution which will be compatible with the new B2B solution in place
  • As a Business Object specialist, advised customers on infrastructure design, sizing, and implementation guidance.
  • Responsible for integrating with Facets, Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Validate data analysis and extraction against MMIS front-end system.
  • Expert using Microsoft Access (design and build), Excel (formulas and macros), PowerPoint, Project, Visio, and Word.
  • Integrated between various systems, including XML, to follow ICD 10 Code set, ANSI X12 and HIPAA 5010 formats.
  • Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
  • Over Five years of experience in programming PBM analyzing and reporting in various Pharmaceutical, Biotech, and Healthcare using SAS on Windows and Unix environments.
  • In depth knowledge of Health Insurance Portability and Accountability Act (HIPAA), MMIS, ICD codes and MITA business areas.
  • Working knowledge of data extraction from oracle clinical database and flat files as SAS views and datasets using PROC ACCESS , SQL pass-through facility and Oracle libname engine.
  • Documenting and creating Test Plans, Test Objectives and Test Cases. Also involved in maintaining Test Matrix and Traceability Matrix
  • Expertise in GUI (Graphical User Interface) Testing PBM Functional Testing, Performance Testing, UAT(User Acceptance Test), SAT (System Acceptance Test), FAT (Functional Acceptance Testing), Unit Testing, Integration Testing and Stress/ Load Testing.
  • Extensively used to PL/SQL validate the data in the Oracle database.


Operating System: Windows 365/ 2008/ XP/ 2003/2000/NT

Standard and Codes: HIPAA 4010A1/5010, ICD-10, ICD-9, ANSI X12, HL7, CPT and CMS form

Database: MS-Access, Oracle, SQL, Java

Methodologies: SDLC-Waterfall Model, Agile, Rational Unified Process (RUP), V-Model

UML Diagrams: Structure Diagram- Class & Object Diagram; Behavior Diagram- Use Case, Activity, Sequence

Testing tools: Mercury interactive tools- Win Runner, Test Director, Load Runner Quick Test pro

MS Office Suite: MS Word, MS Excel, MS PowerPoint, MS Project, MS Outlook

Modeling tools: MS-Visio, Rational Rose

Reporting tools: Crystal Reports, Cognos Reports, Power BI


Confidential, Columbus, OH

Business Analyst


  • Developed and prepared EDI documentation for 834 (Benefit & Enrollment Maintenance) for client processing the 834 transaction.
  • Responsibility to help the teams coordinate, to have the expertise in both WebSphere Enterprise Service Bus and WebSphere Transformation Extender (WTX) technologies. Responsible
  • Conducted and performed analysis of EDS (Encounter Data System)for 837 claim submission to CMS, document and produced test files and involved in validating EDS files.
  • Experience in developing Use case diagrams, Business flow diagrams, Activity and Sequence diagrams using tools like MS Visio.
  • Design EDI Dashboard for encounter data to identify and report errors in terms of graphical representation for accepted and rejected claims.
  • Work with Trading Partners and clients to facilitate error correction and identify process improvement opportunities to improve accuracy and reporting statistical metrics.
  • Strong experience in design and development of ETL process from Staging to Data warehouse and to Data mart.
  • Gathered requirements from the clients and developed crosswalks for 277/288, 834, 820, 835, 837 P/I claim
  • Perform system testing on all EDI transactions both inbound and outbound.
  • Setting up new trading partners and maintain existing TPA in submitter profile.
  • Built automated testing routines for the EDI system for NEHEN gateway, SFTP and FTP.
  • Perform Analysis, Design, Development and Implementation of X12 EDI maps by using Ramp Manager Application (an EDIFECS Program).
  • Developed the transformation maps using WebSphere Transformation Extender (WTX)
  • Working on the complete end-to-end processing of the 837 claims testing also helping debug and recommend change in Edifecs guidelines for 837 claims processing in Ramp Manager.
  • Wrote complex SQL queries to extract and validate the data from the Facets database.
  • Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI’S 271, 276 and 270, 470, 834, 820, 835, 837, 834, HIPAA 4010, 5010 , claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles and also well versed with ICD10 and Facets .
  • Responsible for integrating with Facets, Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Modified and created vendor specific maps for the 850, 820, 834, 855 and 856 transactions (EDI to XML, XML to EDI and delimited to XML)
  • Develop and maintain EDI maps such as 810, 811, 820, 850, 856, 860, in accordance with the related guidelines, which are in ANSI X12 standards.
  • 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 with Claims, enrolment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets. team monitored and tracked PBM progress of project following Agile methodology.
  • Involved in creating requirements that comply with HIPAA, HL7, and ANSI X12 format regulations to protect the privacy of the employee insured under any policy.
  • Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI)

Confidential, Minneapolis, MN

Business Systems Analyst.


  • Gap Analysis: Review 4010A1 and 5010 Implementation Guides, Addendum and Erratas to define gaps in Loops, Segments, Elements, Composites Business Rules, Qualifier and Code Sets. Document each gap item for further Impact Analysis.
  • Impact Assessment- Transactions: Use WPC Implementation Guide and WPC Gap Analysis documents to assist in Impact documentation. Stake holder interviews, Companion Guide analysis, Vendor Meeting (Apria Health) and IT staff input to determine critical Impact Issues.
  • Develop and certify test cases for 5010 compliancy for all HIPAA transactions (i.e. 834/835, 270/271, 276/277, 820 and 837 P and I) in EDIFECS.
  • Propose Strategies to Implement HIPAA 4010 in the new MMIS system.
  • Performing some ETL operations. Creating ETL Jobs and validating data flow through various ETL stages.
  • Worked with ETL developers to provide mapping / data conversion from OLTP to OLAP.
  • Actively involved in coordinating the EDIFECS programming application activities.
  • Analyze, design, implement and define UHG business guidelines in EDIFECS Spec Builder.
  • Develop UHG business rules and prepare Auto Fixes rules and set the .ECS files for successful claim validation in EDIFECS.
  • Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
  • Involved in implementation of HIPAA EDI Transactions ( 835,837,820,276)
  • Developed and prepared EDI documentation for 837 outbound EDS claim processing.
  • Worked on Web Spheres Integration Suite products like WebSphere Transformation Extender and WebSphere Partner Gateway
  • Conducted and performed analysis of EDI transactions, document and produced metric reports.
  • Involved in requirements gathering sessions with SME’s (Subject Matter Experts), Business Analysts and
  • Design and develop HCA (Health Care Application) for DDE Claim (Direct Data Entry). First this system is used as an Online Claim Submission by directly entering the claims. The second use is to correct the rejected claims online for an affordable desktop solution for Providers. support WMI/WTX system during performance testing and quality assurance testing
  • Involved in re-engineering of the EDI Gateway to assist in the development of HIPAA repository to process 5010 claims.
  • Performed validation of test scenarios in EDIFECS SpecBuilder and rectify the errors based on the .ECS file guidelines and HIPAA mandated rules to ensure the smooth claim processing.
  • Actively using “Mercury Quality Center”, a QA tool to log in all defects and prepare test plans.
  • Provide technical and procedural support for “User Acceptance Testing” (UAT) and “Systems Integration Testing” (SIT).
  • EDI Transaction Testing: Test EDI: X12, XML, and EMBARC files for compliancy with legacy system and business rules; perform business rule unit testing and HIPAA mandated compliancy testing via EDIFECS.
  • Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT).

Confidential, PA

Business Analyst


  • Analyzed client’s systems and business processes.
  • Also responsible for managing communication and expectations of system vendor, the former parent company IT and business departments, and Allied Worlds various business units (underwriting, claims, reinsurance, actuary, accounting, and IT).
  • Conducted user interviews, gathered requirements, analyzed the requirements by using Rational Rose, Visio and Requisite pro - RUP
  • Involved in the various aspects of project management - from resource planning to work flow and timeline management and in the process involved in learning the various facets of application of the Theory of Constraints to project management.
  • Worked on EDI transactions: 270, 271, 834, 820, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Facilitated requirements definition for new system.
  • Designed and developed Project document templates based on SDLC methodology
  • Responsible for integrating with Facets, Designing test scripts for testing of Claims in Development, Integration and production environment.
  • Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed.
  • Developed and wrote new Customer Implementation Procedures to be used for EDI
  • Provided key input in working with users in defining project and system requirements.

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