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Business Analyst Resume

Philadelphia, PA


  • Results - driven, versatile consultant with over 6+ years’ experience as a Business Analyst.
  • Specialized in Healthcare, Insurance, Risk and Compliance, Document management.
  • Good knowledge of Business Analysis methodologies, Iterative and Incremental Software Development Life Cycle (SDLC) using Rational Unified Process (RUP).
  • Proficient in gathering business and technical requirements from both formal and informal sessions through interviews, NetMeeting, questionnaire, video conferencing, JAD sessions and conference calls.
  • Strong knowledge of Use Cases, Sequence Diagrams, Collaboration Diagrams, Activity Diagrams, and Class Diagrams.
  • Extensive hands-on and HealthCare management experience in a variety of projects involving the customization, design, development, implementation, and testing of automated systems to support the Medicaid Management Information System (MMIS) as well as day-to-day business operations.
  • Hands on knowledge of various Health Care standards/requirements like HL7, CCHIT, Meaningful Use & Stimulus Program, HITSP, PQRI, HIE, CQM, DICOM, ISO, IEEE.
  • Experience in developing Test Plan and Test Cases as per the business process requirements to match the functionality requirements and UML diagrams.
  • Possess very good organizational skills, with the ability to multi-task and deal with shifting priorities.
  • Experience in Claims Processing, Claim encounters and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
  • Experience in EDI (270,271,835,834,837) transactions and high-level understanding of a health care claims processing system such as MMIS.
  • Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/XDM, HITSP, CCR (continuity of Care Record), CCD (Continuity of Care Document), NCPDP Script 8.1, ELINCS, and CDA.
  • Worked on various Professional billing and Hospital billing products.
  • Experience in working with HHS, CMS or Medicaid Programs, RHIOs, IHDNs.
  • Knowledge on medical necessities, software validation and healthcare compliance auditing.


Methodologies: RUP, Agile, CMMI, CMM, Six Sigma, OOAD, UML, Business Modelling, Process Modelling and Data Modelling.

Office Tools: MS Word, MS Excel, MS PowerPoint, MS Access, MS Project, MS Outlook, Lotus Notes.

Process/Modelling: MS Visio, Rational Rose, Rational Requisite Pro, Smart Draw, Clear Case, Clear Quest.

Testing Tools: Test Director, Quality Centre, Win Runner and Selenium

Operating Systems: Windows 7, Vista, NT/2000/2003/ XP/98

Quality Management: HIPAA, CMMI, CMM, Six Sigma, TQM

Languages: C/C++, Java, SQL, PL/SQL, HTML, XML

Database: MS Access, SQL Server 2000, Oracle 9i & 10g, Teradata

Other Tools: Macromedia Dream Weaver, Macromedia Flash and Adobe Photoshop.


Confidential, Philadelphia, PA

Business Analyst


  • Strong communication skills, both verbal & written, with particular emphasis on the production of clear & detailed written Test Plans, Business Requirements, & Functional Specification.
  • Experience in Database check points, bitmap check points, GUI check points by using QTP. Modified previously existing test cases that were driven by the manual testing.
  • Performed Sanity and Smoke Testing of the application manually after each build. Performed Functional, Regression, User Acceptance, and System of the Application.
  • Supported the implementation and ongoing development and testing of electronic transactions, including claims processing through electronic data interchange (EDI) with HIPAA standards.
  • Coordinate changes with customers, vendors and users for EDI. Track tickets related to EDI and provide periodic updates
  • Created test data from claim processing for different FACETS Modules like hospital, medical and dental claims.
  • Monitored all EM components thought E-Gate monitored where all components interfaces connected to central e-gate tool. Monitored all components ORM, ORD, Context based ADT, Bridges Tables, ambulatory clinical work flows through system, Results of lab, Syngo Dynamics, Radiology, Muse Holter, Agfa, Sunquest Lab Results etc. manage through In Bound and Out Bound Epic. Make sure EHR & EMR, ADT, PID, OBR, OBX, Providers ID (Verified through NPI Lookup) are correct.
  • Extensive healthcare experience in Medical Imaging, EHR/EMR, Mobile Apps, Medicare-Medicaid, HIPPA, HIX on EPIC software applications
  • Worked extensively through Agile development methodology by dividing the application into iterations
  • Used JIRA tool to track and maintain different versions of the project documentation.
  • Identified the organizational needs and provided suitable agile system based solutions.
  • Maintained pricing configuration in Facets System for Medicaid, Medicare and Dual Eligible Products; creating new and updating existing provider contracts
  • Trained the team on JIRA tool for Agile/ Scrum Methodologies and utilized JIRA to develop and track agile epics, stories and tasks.
  • Tested and delivered Inbound/Outbound Facets interfaces Analyzed X12 files for SNIP level edits using SpecBuilder.
  • Written SQL queries to access the data in Oracle database to execute back-end Involved in the team to adopt QA Testing Standards.
  • Involved in functionality, database and error testing of the E-bill application. Experience in testing Electronic Data Interchange (EDI) according to HIPPA Compliance.
  • Good working experience in analyzing changes and identifying areas of applications to be regression tested.
  • Experienced in Data Driven Testing, Batch Testing, Functionality Testing GUI Testing, Regression Testing.
  • Involved in cross browsing testing of the application on various Browsers to ensure that it functions similarly on all browsers.
  • Involved in FACETS Implementation Testing, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
  • Involved in writing PL/SQL programming to extracting data. Performed the extraction of data from various platforms to oracle RDBMS.

Environment: QC9.0, Word, Excel, JIRA, Toad, QTP, Windows XP, Oracle 10g, SQL Server

Confidential, El Paso, TX

Business Analyst


  • Good knowledge of Health Plans managed care concepts (Medicaid and Medicare) and experienced in determining the eligibility, billing experience within life and Disability claims in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
  • Maintained pricing configuration in Facets System for Medicaid, Medicare and Dual Eligible Products; creating new and updating existing provider contracts
  • Well versed in Requirement Gathering through techniques such as JAD sessions, Interviews, Document analysis and Reviews
  • Expertise in documenting Business requirement document (BRD), Functional and Non-functional requirements, Requirement Traceability matrix (RTM), Use case Specifications and the complete System Requirement Specifications (SRS)
  • Participate in Change Management related process meetings, advising and consulting across technology for process adoption.
  • Used MS Visio to carry out the Business Use Case Modeling and Business Object Modeling effort to develop the business architecture for rapid and controlled application development.
  • Developed HL7 messaging for bi-directional case and disease report exchange, in HTML and XML formats, in accordance with HL7 specifications.
  • Extensive experience with process modeling using UML, flow charts, system data flow, task diagrams, sequence, data mapping, and use cases.
  • Create story board of back log items in Agile and develop item according to business needs.
  • Redefined use cases, process flow, and activity diagrams using MS Visio for a clear understanding of the requirements. Reviewed test plan based on Requirement Traceability Matrix (RTM) and defect tracking using Clear Quest.
  • Facilitate all agile ceremonies including daily stand-ups, weekly grooming, retrospective, and review and planning session.
  • The project dealt with enhancements to the Healthcare Payment EDI transaction set to generate a payer level containing payer specific information.
  • Communicated New Business Process Model & Notations (BPMN) with client and suggested best solution to make the changes according to new regulation.
  • Executed test scripts in different cycles to get the perfection and logged defects in defect tab of Quality center.
  • Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
  • Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual for resolution.
  • Analysis of functional and non-functional categorized data elements for data profiling and mapping from source to target data environment. Developed working documents to support findings and assign specific tasks.
  • Writing Epics and user stories, managing sprints and backlog grooming, and tracking project progress in JIRA.
  • Expertise in performing Bug and Defect management using bug-tracking tools like JIRA and Confidential QC/ALM.
  • Claim Transactions and Billing Transactions created flows for adequate matching of claims. Performed data mapping by matching the billing file and EDI claim file record claims received from Medicare and Medicaid agencies.
  • Interacted with Subject Matter Experts (SME), Business Owners; Conducted detailed interviews with them, recorded the requirements, and reviewed the gathered requirement by both technical and business people to break down functional requirement and document detailed User Stories.
  • Analyzed the mainframe reports for member/eligibility/claims and mapped the fields with FACETS batch jobs and reports.
  • Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrolment, Claim Processing and Subscriber/Member module.
  • Worked on analysis of FACETS claims processing system and gathered requirements to comply with HIPAA.
  • Utilized Agile Software Methodology using Scrum framework. Actively participated in creating the user stories and prioritizing user stories along with tracking of burn up, burn down charts to estimate sprint delivery
  • Perform typical SharePoint administrative activities such as new site creation and managing user/group permissions
  • Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes EDI 837, 835, 270/271 and others.
  • Participated in frequent agile team meetings (Scrum planning, daily stand-ups, retrospectives) to provide guidance to an agile product development process.
  • Data mapping, logical data modeling, created Class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
  • Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
  • Good Knowledge of Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression Testing based on the Design Document and User Requirement Document for the Functional, Security, and Performance Testing.
  • Responsible for efficient document management using MS SharePoint and to update the document and transmit the information to all stakeholders
  • Interface with clients from Operations, Marketing, Sales, Technologies, and Outside Vendors and act as their customer interface point as the lead of the Projects
  • Highly motivated team player with excellent Interpersonal and Customer Relational Skills, Proven Communication, Organizational, Analytical, Presentation Skills, and Leadership Qualities.

Environment: EDI, HIPAA, Windows NT, UML, Facets Trizetto, ERWIN 4.0, SQL, Rational Requisite Pro, Test Director, MS Project, MS Office Suite.

Confidential, Austin, TX

Business EDI Analyst


  • Implemented an integrated RUP solution with complete line of traceability for all the artifacts of web development projects.
  • Good understanding of SDLC and STLC methodologies including Waterfall, Iterative, Agile and Scrum methodologies.
  • Executed test cases manually. Compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution.
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology
  • Extensively involved in mapping data from various sources and formats (flat files, XML files and web services) to the target database
  • Worked with solutions/delivery teams to implement data quality processes during acquisition, ETL, and delivery stages for Business Intelligence solutions and changes to Data Warehouses.
  • Collaboration and reviews with different application owners and SME’s to ensure the GAP Analysis was performed accurately.
  • Created and updated tasks in the MS Project and Project Management Directory for the senior management reviews.
  • Performed GAP analysis and documented business and system level use cases to derive the requirements illustrating the functional behavior.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard 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. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Gathered requirements for making changes to the existing Electronic Medical Records (EMR), Electronic Health Records (EHR) and Ambulatory Services for the existing Epic Interfaces.
  • Experience with EPIC user and provider record provisioning, including the development of role-based access, security classes, and user profiles
  • Worked extensively on EDI transactions 837 and 835 Involved in writing test cases for different LOB’s (ITS, FEP and Regular) for SIT, Parallel and UAT.
  • Performing business analysis, software validation and testing for client/server, multi-tier and web-based applications for EMR and commercial business for managed healthcare plans and Industries
  • Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
  • Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
  • Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • The Data in Medicaid Data Warehouse is Enterprise level Data and it holds various business functionality data like: Eligibility, Eligibility Plan, Health Record Id, Group, Group Contract, Contract Plan, Group Demographics, Group Hierarchy, and Medicare - Medicaid.
  • Proficiency with Microsoft Office applications (Word, Excel, PowerPoint, and Visio and Project Management Software), and Atlassian (JIRA, and Confluence)
  • Performed Defect Tracking and Project Tracking using Jira - Change Notification Request (CNR).
  • Understanding Source Data from these systems of FS, CM and TMS Regions coming into Medicaid Data Warehouse, also understanding business processes and data mappings of enterprise to department / module level for these regions and for various above functional modules.
  • Business Process Modeling: Business process improvement and optimization, Document and model business processes, automated workflows and Manage business rules.
  • Ensured UAT test scripts review sessions with business owners to test the application functionality, providing necessary material.
  • Clear quest and Confidential quality center to log defects and assign to the right team to ensure the defects are addressed on a timely manner.

Environment: RUP, Rational Rose, Business Objects, Clear Quest, RequisitePro, UML, SQL, MS-Office, MS Project.

Confidential, MD

Business Analyst


  • Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.
  • Gathered requirements for the inputs in the Competitive Intelligence System from the stakeholder’s including methods like personal interviews, questionnaires, surveys, JAD sessions and joint team meetings. Identified systems requirements that would help create the CI System by meeting up with the technology team and then having a JAD session to include SME’s from the business side.
  • Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.
  • Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus for BRD and FRD and business docs.
  • Tested the HIPPA EDI, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data with Facets on different modules.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Eligibility. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set. Interacted with Eligibility, Payments and Enrollment hence analyzing and documenting related business processes.
  • Involved in integration of various Customer Data Sources and provided Data Mapping from various sources like CCD, LPCD, and DCD into the target centralized customer data source.
  • Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
  • Worked in FACETS Reconfiguration of member/subscriber, Data Element Definition and Usage with values and completed configuring FACETS Applications like Related Entity, Parent Group, Group.
  • Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
  • Worked extensively on Business Requirements, Functional Specification, Data-Integration, Data Mapping, and Data Warehouse access using SQL and Crystal Reports, ETL process, use cases modeling (UML) using MS Office (Word, Excel, Access, Visio) and dashboards.
  • Developed Test Cases and Test Plans on the basis of requirements and also did manual testing of the functionality of the application to ensure that the application is able to handle a lot of data
  • Coordinated with the technical team, and developed new reports using Business Objects/Crystal Enterprises on SQL Server and DB2 databases, focusing on data verification and query performance.
  • Ability to analyses engineering product support issues described within a bug-tracking system (JIRA) and provide guidance to other Client Services members in an advisory capacity, focusing on the quick resolution of the production issue and using this as a opportunity for other team members
  • Worked on EDI transactions: X12, 835, and 837 P.I to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
  • Wrote complex SQL queries to perform the backend testing of the Oracle database using PL/SQL developer and UNIX shell commands and trained the team on JIRA tool for Agile/ Scrum Methodologies.
  • Assisting business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center.
  • Medicare Coordination of Benefits is the process for ensuring that payment of Medicare beneficiaries’ claims is properly shared among insurers when the beneficiary is covered by private insurance in addition to Medicare.
  • Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.

Environment: J2EE (JSP 1.1), EJB(2.0), Servlets 2.2, JMS, Java2 (JDK 1.3), STRUTS,JDBC2.0, XML, XSL, Rational Clear Quest, Rational Clear Case, Rational Requisite Pro, Rational Rose, UML,RUP, EDI, Microsoft Excel, Microsoft Word, Microsoft Power Point, Visio.

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