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Senior Business System Analyst Resume

Miami, FL


  • Around 8 years as Business Analyst with extensive and diversified experience in the Healthcare and Pharmaceuticals Industries, CRM Systems like sales force and SQL. Particularly effective at requirements gathering and preparation of functional design specifications, Use cases, leading JAD sessions, handled user acceptance testing and pre prod and post prod issue management.
  • Expertise in HIPAA, Medicare, Medicaid, Duals, CMS, Market Place and HealthCare Management.
  • Possess excellent knowledge on various EDI formats like 834, 837 and 835
  • Experience in Data Bases and SOL, Azure, Reporting and Jira
  • Exposure to HIPAA Compliance requirements and HL 7 standards.
  • Adept in creating Narrative Use Cases, Use Case Diagrams, Sequence Diagrams, Activity Flow Diagrams, Flow Diagrams and other related UML Diagrams.
  • In - depth experience in all the Software Development Life Cycle (SDLC) phases as well as new product development from requirements gathering, system analysis, design, testing, user acceptance and implementation of projects.
  • Excellent client facing skills clubbed with hands on technical expertise; perfect fit as a bridge/ liaison between IT teams/ SME’s and Project Stakeholders to ensure understanding of business processes/requirements, meeting projects milestones and delivery dates, and improving business processes through the product lifecycle. Strong facilitation skills, experience in leading Joint Application Development (JAD)/ Joint Application Requirement (JAR) sessions, walkthroughs of use case and functional requirements
  • Thorough exposure of conducting JAD sessions and interviews with Subject Matter Experts (SME) and data stewards to understand the business process, business rules, and data requirements.
  • Worked in complete project life cycle of Analysis, Design, Implementation, Integration Testing, Functional and Regression testing.
  • Responsible for User Acceptance Testing (UAT) - interacting with business community from a junior level to the VP level, providing the necessary test cases, hand holding the users when needed and making sure the sign-offs are in place; responsible for escalating the issues to the right teams; responsible for change management activities and roll out.
  • Effective communication skills and good record of accomplishment with coordination among globally located teams.
  • Excellent verbal and written skills especially with regards to presenting critical decision points to both technical and non-technical audiences.
  • Managing requirements and managing changes to the requirements through the life cycle of different projects; document the changes and communicate to varied groups of stake holders and IT teams.
  • Single point of contact/ liaison for different IT groups spread over different geographical locations; coordinating their issues over the evenings, holidays & weekends; IT Groups included were - Development team, QA team, Deployment team. Excellent communication and organizational skills including the ability to multi-task in an extremely fast paced matrix environment
  • Ability to prepare RTM (Requirements Traceability Matrix) & do requirements analysis
  • Proficient in using UML for Business Process Modeling, Use Cases, Activity Diagrams, Sequence Diagrams, Data Flow Diagrams, Collaboration Diagrams, Class Diagrams and document them using Microsoft Visio


Operating Systems: Windows 9x/XP/2000/2003/Vista/7

Business Modeling Tools: MS Visio, AML

Packages: MS Office, MS Project, MS Share Point

Project Methodologies: Waterfall, Agile

Bug Tracking Tools: HP Quality Center, JIRA, IRAAD


Confidential, Miami, FL

Senior Business System Analyst


  • Assisted with/facilitated mapping of “to-be” processes and worked on the gaps of “as-is” to “to-be” processes
  • Created appropriate documentation (e.g., validation requirements documentation, business and technical design documentation).
  • Created and documented current state business process flows to map the business processes around sales, marketing enrollment and agent onboarding systems.
  • Created future state business process flows for the new Medicare CRM, Enrollment and Agent onboarding and maintenance system.
  • Worked with telesales, field sales, marketing, enrollment services, digital services and sales operations team to understand their current process and document them
  • Captured logical flow of system/business through use case documentation.
  • Data retrieval from multiple external/internal sources utilizing ODBC interface.
  • Data cleaning, processing, analysis and interpretation.
  • Integration of advanced Excel formulas and macros/VBA techniques (vlookups) to manipulate spreadsheets.
  • Experience with creating dynamic dashboards and visual reports.
  • Experience in Visual Basic for Applications to develop Excel based reporting tools aiming to bring data from external and further analyze and systematize the information in Excel spreadsheets.
  • Participated in UAT testing using CollabT.

Environment: Waterfall, Agile, Edifecs, salesforce, CollabT, Jira, MS office, MS Visio, Management Studio

Confidential, Long Beach, CA

Senior Business Analystand Project Manager


  • Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications.
  • Assisted in creation of the Functional Design Document and TDD from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing
  • Also created several RRD’s (report requirement document), and RTM’s for each project as needed.
  • Developed Functional and Design Specifications, including use cases and data flows
  • Hands on experience with Requirements Management and Traceability tools such as the IBM Rational suite and HP Quality Center.
  • Worked on the Confidential Medicaid Management Information System
  • Participate in the Executive meetings with Confidential Senior Management team to understand the company’s Strategic and Tactical initiatives.
  • Prioritize the Projects in the Eligibility, Claims and Encounter area for Medicare, Medicaid and Marketplace Lines of Business based on the driving factors like business demand, regulatory needs, and financial impact.
  • Involved in the Project initiation activities and perform various Project Management roles like facilitating the Project Kick-off meetings, providing the Project charter and Scope documents.
  • Performed all the Project Management activities like Planning, Execution, Monitoring and Control and Closing the Project.
  • During the entire Project Life cycle, act as a liaison between various Stakeholders and Business and IT Teams that include Business Analysts, Developers, Testers and Implementation Specialists.
  • Work with Director - EPMO Business Architecture to build document repository, use best practices, document lessons learnt.
  • Worked with the enrollment team and health plan members.
  • Interacted with SME’s to gather the requirements for business.
  • Wrote FRD’s and BRD’s for the system
  • Actively participated in almost all the phases of SDLC beginning from requirement until implementation and user training and training manuals.
  • Performed SIT testing, including planning and executing unit, integration, and acceptance testing, in support of timely, quality project implementation
  • Interacted with the Subject Matter Expert (SME), Operational/Technical Managers and Stakeholders to get a better understanding of Business rules/processes and gather core Business Requirements.

Environment: Waterfall, QNXT. QC, MS Visio, Jira, MS Office, Sales Force and P6

Confidential, Buffalo NY

Business Systems Analyst


  • Compiled Vision and Scope documents to better define the rationale for the project. Gather requirements from business to determine the functionality that should be provided to the users.
  • Tracked Business requirement traceability matrix (RTM) and handled scope creeps.
  • Worked toward claim processing such as Claim Adjudication and Claim Reimbursement.
  • Determine which claim system to interact with to display data on the UI.
  • Considered HIPAA rules while data validation and testing.
  • Was responsible for the research and analysis of data requirements and issue resolution as they related to the design, development, testing, implementation and support of the data warehouse.
  • Participated in / facilitated data requirements definition (e.g. extracts, sourcing, reporting) and design sessions; wrote and maintained detailed technical documentation to record the architecture and development for system data projects.
  • Worked with ICD 9 encoding to verify the validity of incoming claims documented ICD 9 codes presently used by the system.
  • Dealt with 834 import member lookup processes and resolving issues with member attributes, enabling multiple rules associated with member lookup process.
  • Dealt with the 835 claims payments and remittance advice, which deals the payment from payer to provider.
  • Developed an automated approach for capturing all 837 data received from GHI that supports claim utilization and reporting.
  • Worked with 276/277 transactions where exchange is used.
  • Builds and Runs Test Claims from subscriber information on NPS, working on those claims to ensure that they process through the system, and obtaining the results from the claim processes.
  • Used Process log browser to view different types of log history files to figure out issues with 834 transactions.
  • Attended daily SCRUM and guided QA and Developer regarding the defects, Technical Specification Documents and Mapping Documents.
  • Prepared and maintained data for Core Measure reporting.
  • Provided all standard and ad hoc quarterly reports including data analysis and graphs.
  • Developed a set of best practices with regard to Part 11 remediation and have implemented innovative and cost effective strategies for achieving compliance.
  • Interacted closely with QA to finalize the Test strategies using Quality Centre.
  • Conducted Joint Requirements Planning (JRP) sessions with management, SME’s (Subject Matter Expertise) users and other stakeholders for open and pending issues to develop specifications.
  • Designed Use Cases, Use Case diagrams, Activity diagrams, Sequence diagrams in UML methodology using MS Visio.

Environment: Mainframe, DB2, SQL Server 2005, MS Visio, Business Intelligence, MS Project, MS Office, AS/400, SharePoint, UML.


Business Analyst


  • Responsible for verification of initial and ongoing eligibility/enrollment of members for assigned groups.
  • Issuing new policies to the clients according to company rules.
  • Policy Renewals, Terminations and cancellations
  • Responding to e-mails from agents & clients regarding the Queries, New policies and Renewals
  • Review enrollment applications to determine eligibility of individuals for coverage in accordance with applicable contracts. Process quality assurance/error reports timely and accurately to ensure appropriate coverage for members.
  • Initiate billing and enrollment adjustments and coordinate reconciliation of billing problems.
  • Work closely with Finance to ensure communication of discrepancies in billing.
  • Developed use cases, workflow, screen mock-ups and conversion requirements.
  • Coordinated work plans between project manager and client using MS Project.
  • Helped in reviewing and editing of the test scripts.
  • Followed UML based methods using Rational Rose to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams.
  • Reviewed business process, URS, and functional requirements.
  • Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
  • Created and tested scripts for the premium calculations and claim limits and deductible.
  • Involved in detailing project mission, data process flow diagrams, and timelines.
  • Developed Test plans and Test cases according to business requirements with the help of Mercury Test Director.
  • Used Rational Clear Quest for handling change requests.
  • Participated in automated regression and Non-functional test plans.
  • Maintained Requirement Traceability Matrix throughout the project.

Environment: RUP, Rational Requisite Pro, Rational Clear Quest, MS Office, Visio, Project, Windows XP, UML, SQL.


Business Analyst


  • Assisted with/facilitated mapping of “to-be” processes and worked on the gaps of “as-is” to “to-be” processes
  • Created appropriate documentation (e.g., validation requirements documentation, business and technical design documentation).
  • Captured logical flow of system/business through use case documentation.
  • Conducted JAD sessions between the business users, Developers, testers & Subject Matter Experts resolve bottlenecks.
  • Collaborated with the customer to develop acceptance test criteria.
  • Wrote requirements for the designing data marts that were used as the source for the various reporting systems in the company.
  • Performed testing on a data warehouse platform, including data integrity and data validation.
  • Performed Data Analysis and Data validation by writing complex sql queries.
  • Collaborated with the customer to execute acceptance test(s) to confirm MMIS functionality
  • Worked with the DBA and developers to identify bottleneck and performance issues of the ODS population and work together to resolve the issues.
  • Knowledge of RDMBS concepts and exposure to various databases systems like Oracle and MS SQL Server
  • Extensive experience with Data Analysis on Data warehouse system for various reporting systems within an organization
  • Strong knowledge of Data Warehousing concepts and Dimensional modeling like Star Schema and Snowflake Schema
  • Extensive knowledge of flush loading, incremental loading and escalation procedures.
  • Collaborated with the project team to achieve customer and team objectives.
  • Coordinated with appropriate State customer and team staff to ensure compliance with the project management methodology, documented work scope, and technical standards, policies and procedures.

Environment: Oracle, SQL Server, UML, MS Project, MS Office.

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