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Business Systems Analyst Resume

Louisville, KY


  • 7+ years of IT experience as a Business Analyst in business consulting and application development with excellent skills in process implementation, client interfacing, requirement gathering, user support, problem solving, and documentation.
  • Strong understanding of various SDLC methodologies such as RUP, Waterfall and Agile with hands on experience in all of them.
  • Strong at writing requirements in Waterfall and Agile style.
  • Experienced in working with the offshore teams.
  • Proficient in identifying, documenting and analyzing Business Requirements Specifications (BRS), System Design Specifications (SDS) and Software Requirement Specification (SRS).
  • Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR).
  • Experienced in gathering requirements for HIPPA (Health Insurance Portability and Accountability Act) EDI (Electronic Data Interchange) Transactions 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277, 278, 997 and 999 in various phases of implementation.
  • Experience in conversion of HIPAA ANSI (ASC) - X12 4010 codes to ANSI (ASC) - X12 5010 codes and International Classification of Diseases (ICD) 9 codes to ICD 10 codes.
  • Strong knowledge of Facets and actively involved in end-to-end implementation of Facets Billing, Enrollment, Claim Processing and Subscriber/Member module.
  • Good knowledge of Lab Results and HEDIS (Healthcare Effectiveness Data and Information Set).
  • Strong Experience with HL7 CDA (Clinical Document Architecture), HL7 file formats, and compliance/SNIP level HIPAA validations.
  • Proficient in soliciting requirements, creating architectural diagrams, data model, and driving project through execution.
  • Good knowledge of Informatica, SQL Server, Teradata and B2B tools (Informatica B2B, Axway, IBM Sterling).
  • Proficient in Requirement Engineering Process, including gathering, analyzing, detailing and tracking requirements.
  • Experience in interacting with stakeholders like business clients, end users, vendors, SDLC team, configuration manager and production team to identify information needs and initiate process change.
  • Expertise in creating various artifacts like BRDs, Functional Specs, Used Cases, UML Diagrams, Data Mapping Documents, Test Plans and Test Strategies, pre and post RTMs and Status Weekly Reports etc.
  • Strong visual modeling and Business Process Modeling (BPM) skills using Rational Unified Process (RUP) with tools like Rational Rose, and MS Visio.
  • Expertise in using various tools like RequisitePro and MS Office for requirement gathering, Quality Centre and Clear Quest for Defect Management/Defect Tracking, MS-Visio for UML Diagrams, MS Outlook, IBM Lotus Notes and SharePoint for information sharing.
  • Excellent analytical, organizational, communication and documentation skills along with good project management skill to gather requirements to bring out the quality product.
  • Excellent written and oral communication skills with the ability to communicate appropriately in business and technical situations at all levels of project management.
  • Effectively used various elicitation techniques to gather requirements like JAD sessions, brainstorming, prototyping, one and one sessions, workshops, surveys, interviews and conferences.
  • Proficient in using TFS in managing the defect lifecycle.
  • Hands on experience in the complete Quality Assurance (QA) life cycle from Requirements Gathering and Documentations to developing Test Plan, Test Cases, Traceability matrices and conducting User Acceptance Testing (UAT) for QA Testing.
  • Hands on experience with SQL database, SSIS (SQL Server Integration Services), ETL (Extract, transform, load) and ODBC (Open Database Connectivity) connections.
  • Hands on experience with SQL in writing joins, triggers, tables, user defined functions, views, indexes, and relational database models and data integrity.
  • Strong experience with database structures, table layouts and Data Mapping.
  • Strong experience with Contact Center.
  • Proficient with data integrations and integration patterns to help identify data requirements for source to target systems.
  • Worked with PMO (Project Management Office) to review time line and schedule for the implementation and discussing the milestone.
  • Experienced in working with middleware, SOA, Web Services, EAI (Enterprise Application Integration) and Enterprise Integration.
  • Excellent analytical, organizational, communication and documentation skills along with good process management skill to gather requirements to bring out the quality product.
  • Motivated self-starter, good team member with exceptional team building, leadership, and interpersonal skills to resolve issues.
  • Thorough knowledge of Eligibility and Affairs for Medicare and Medicaid. Also knowledge of HIPAA, ANSI (ASC) - X12, and HL7 standards, and Medicaid provider best practices.
  • Experienced with Medicare and Healthcare Insurance; as well as Medical Standards (HIPAA and HL7).


Project Methodologies: Rational Unified Process (RUP), Waterfall, Agile, Spiral, Scrum

Business Process Modeling Tools: Rational Rose, MS Visio, Axure

Requirement Management Tools: Rational Requisite Pro

Project Management Tools: MS Project

Defect Tracking Tools: Rational Clear Quest, Quick Test Professional, Quality Center, (Application Lifecycle Management) ALM 11

Databases: Oracle, MS SQL Server, IBM DB2

Languages: Visual Basic, Java, XML, SQL

Front End Tools: MS Office Suite(Word, Access, Excel, Outlook, PowerPoint, SharePoint) - Advanced Skills

Claim Processing Tool: Facets 4.8

Version Control Systems: Rational Clear Case

Operating System: Windows, MAC OS, UNIX/Linux


Confidential, Louisville, KY

Business Systems Analyst


  • Involved in business analysis and project management, coordinating between the team members and addressing budget issues.
  • Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.
  • Worked on healthcare standards such as HIPPA 4010, 5010, DICOMM, CPT, ICD-9 and SOAP.
  • Assisted in project management to multiple projects successfully completing them on-schedule and on-budget.
  • Track project progress in conjunction with project and program managers and update the schedule status regularly in accordance with the deliverables schedule.
  • Provide project status reporting to stakeholders, program and project management.
  • Improve project documents and ensure the outcome is delivered according to client specifications.
  • Provided ITIL overview to customers' senior management.
  • Build and managed a cohesive team to meet deliverables per project / track assigned.
  • Involved with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
  • Used SOAP web service for sending patient files in XML format.
  • Handled the Change Management Process for Release Management Team.
  • Met with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.
  • Worked with the clients on the final signing process in the User Acceptance stages.
  • Manage and facilitate simultaneous end-to-end Electronic Health Record (EHR) integrations by on-boarding new clinical requests through implementation who ultimately go-live receiving electronic toxicology reporting services.
  • Create roadmap to migrate EHR Web to migrate from Ruby on Rails to Java
  • Integrate EHR Practice with Patient Portal using SPRING and ACTIVE MQ
  • Compiled requirements obtained from key stakeholders.
  • Designed the Vision and Scope document for the project including the Major Features and all the associated Functional Requirements.
  • Identified all the business requirements of the customer and ensured that all these requirements are traced to the use cases identified.
  • Perform Business Process Modelling for increasing process speed, reducing cycle time; increasing quality and reducing costs, such as labor, materials, scrap, or capital costs.
  • Lead and interact with diverse cross-functional teams to coordinate business analysis processes and requirement activities.
  • Participates in the creation of complex PRD (Project Requirements Document) which includes defining Business, User, functional and non-functional requirements needed for approval by Business and for use by Design, Development and Testing teams.
  • Participates in creation of Requirements Management Plan (RMP) for complex projects and may create RMP for less complex projects, to define, organize and schedule requirements management and development activities.
  • Works closely with system analysts to help create Proof Of Concepts (POCs) and alternative.
  • Develops key project deliverables including requirements specifications, use cases, system test cases, and documentation and user manuals for projects of for low to moderately complex. Supports the production of Requirements Traceability Matrixes (RTM) and RTM gap analysis reports for complex enhancements, automations and implementations.
  • Collaborated with the Clinical SIT and Business teams for generating Test Cases for SIT (System Integration Testing) and UAT (User Acceptance Testing) respectively, using Business Process Modelling workflows and ATGen.
  • Review Medicare Part A and Part B data to see if Beneficiary was eligible for Part D program.
  • Involved in the testing of web portal of New MMIS system.
  • Managing and Billing Medicare, Commercial HMO/PPO claims on a daily basis.
  • Involved in heavy data analysis, customer support/consultation, and software vendor communication for clients that sought to sell durable medical equipment under Part B Medicare/Medicaid regulations.
  • Worked on ICD conversion from 9 to 10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D).
  • Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions.
  • Worked specifically with EDI 820, 834, 835, 837 (I, P and D), 270, 271, 276, 277 and 999.
  • Develop, design & implement department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
  • Involved in identifying and studying the Facets system data and conducting field by field analysis of Facets system for the attribute mapping purpose.
  • Worked out to get the correct count on number of Members, their Eligibility status and their Demographic information to set Groups/Subgroups/Subscribers/Members accurately in Facets.
  • Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage.
  • Participated in all phases of the Facets Extended Enterprise administrative system implementation to include the planning, designing, building, validation, testing, and Go-live support phases.
  • Performed Claims Unit and Regression testing.
  • Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulation are met across all the modules.
  • Developed Requirements Traceability Matrix using MS Excel.
  • Interfaced with application architects, subject matter experts (SME’S), healthcare provider information specialists, managers, quality review specialists, and service team supervisors.
  • Collaborated with QA and Development managers to institute a flexible SDLC for the web development team.
  • Created SQL queries involving Joins, Functions and Stored Procedures.
  • Worked on the modification of existing SQL queries in the reports, creating new queries, modification of existing actuate basic code, adding new columns in between the existing columns in the report layout, adding new conditions and addition of a completely new section in the report structure.
  • Worked with issues coming from, Cross, Operational tables in the Oracle Database and updating the tables per the requirements using Oracle, SQL.
  • Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
  • Assist end users and IT staff in the use of data to satisfy informational and reporting requirements and implementing and using SQL and DBMS (Data Base Management System).
  • Analyze the medical data feed and it involves generation of HL7 message for ADT, orders and lab results.
  • Created Using Case Models, Analysis Models, Design, Models, Use Case Diagrams, Behavior Diagrams and Class Diagrams based on UML methodology using MS Visio and knowledge of HL7 and xml interface messaging.
  • Served as an interface resource Analyst and developer during the analysis, build/configuration, validation and execution of HL7 ADT interfaces between HIS (Hospital Information System) application and Ancillary (EMR and Ambulatory) Applications.
  • Worked with the Team Foundation Server (TFS) defect management system.
  • Developed the Epics and Themes for the Scrum Project under Agile - Scrum methodology.
  • Devised and prioritized the Product Backlog under Agile - Scrum methodology by conducting requirement churning sessions with various Business / Product Teams.
  • Used Agile - Scrum methodology and worked in short Sprints to achieve goals.
  • Mentored various teams on Agile - Scrum methodology and helped the company transformation in to an Agile Development Shoppe.
  • Participated in daily Scrum meetings under Agile- Scrum methodology and discussed the open issues and statues.
  • Co-ordinated with the Release team to align the User Stories with Release schedule.
  • Review User Stories written by Junior Business Analysts and provide constructive feedback.
  • Lead group of 6 Business Analysts for Profile team and define process around breaking down features into independent User Stories.
  • Authored Epics and User stories in JIRA and created a backlog of the stories to be used for the Release Planning and Sprint Planning.
  • Worked on reviewing the production defects and put it into proper release phase in JIRA for quicker escalation and resolution.
  • Prioritized the Epics and User stories in JIRA to address the key customer requests and product enhancement features.
  • The project involved creation of new database connection in all 29 reports pointing to DB2.
  • Worked on the analysis and understanding of existing reports pointing to DB2 database.

Environment: MS Office, Visio, Version One, SQL, JIRA, Grasshopper, Agile, Scrum, .Net, Quality Center, QTP, TFS 2013, ANSI (ASC) - X12 - EDI, Oracle, ATGen, Facets 4.8, ALM 11, DB2.

Confidential, Long Beach, CA

Business Systems Analyst


  • Conducted ITIL assessments and gap analysis based on customers' goals.
  • Created Business Analysis risk analysis to make sure project is on track and what factors can affect the timeline of the project.
  • Manage and share all formal and information project deliverables in SharePoint under project specific site.
  • Created new templates for the Business Analysis team to use on various projects.
  • Applied and shared best practices with the Business Analysis team for them to apply it on several projects within the firm.
  • Conducted JAD sessions with Subject Matter Experts (SME's).
  • Interacted with the QA team and involved in End to End testing of the interfaces with various scenarios to make sure that the Interface Integration is complete and accurate for different kind of data and protocols (tab/pipe delimited, positional, xml data via SOAP, SFTP, HTTP protocols).
  • Did Presentations making Stakeholders understand how the changes would affect different modules w.r.t. Medicare and Medicaid.
  • Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
  • Conducted User Acceptance Testing (UAT) prior to and after implementation phase.
  • Worked on conversion from ICD-9 to ICD-10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D).
  • Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix (RTM).
  • Part of the team for migration of HIPAA - EDI ANSI (ASC) - X12 4010 series to ANSI (ASC) - X12 5010 series for EDI Transaction code sets: 820, 834, 835, and 837 (I, P and D).
  • Performed GAP analysis of 4010 and 5010 EDI transactions 270, 271, 276, 277 and 999 using implementation guide to identify the changes in the segments and data elements.
  • Completed a review of existing documentation for orders, referrals and reports and compared it to the clinical details needed for ICD-10.
  • Involved with ICD-10 implementation testing.
  • Assisted in writing test case scenarios and performed Claims Unit testing, Regression testing, Integration testing and Compliance testing.
  • Extensively worked on Facets, the claim processing tool used in the project.
  • Involved in configuration of Facets Subscriber/Member Application group.
  • Analyzed the member/eligibility information on claim to that in Facets.
  • Worked on Facets to efficiently execute core administrative functions, including claims processing, premium billing and customer service.
  • Worked with SME close to analyze the Claim Adjudication Process setup in Facets.
  • Implemented automated COB (Coordination of Benefits) processing of Medicare claims into Facets.
  • Worked with Claims, enrollment, eligibility, benefits verification for members and providers, benefits setup, and backend payment cycle in Facets.
  • Analyzed the change detection process on Facets database tables to capture the daily changes done by Users through Online Facets Application.
  • Done Business Process Modeling for representing processes of an enterprise, so that the current process may be analyzed or improved.
  • Created Business Process Modelling workflows for projects using Microsoft Visio.
  • Worked on ETL (Extract, transform, load) -based design.
  • Responsible for development/implementation of systems project or cross functional teams focused on the delivery of the Electronic Health Record or any systems associated with the EHR.
  • Conducted sessions on EHR application and suites.
  • Working with respect to EHR towards standardization in methodology, performing testing and implementation and build, error proofing, and data integrity and LEAN methods.
  • Performed SQL Backup and Restore tasks on Various SQL Servers.
  • Ensured different internal & external systems exchanged data according to the specification to transform data from enterprise data warehouse to SQL Server & load data to fact tables.
  • Deployed Reports for Internal, Departmental & Executive Reporting based on the requirements using SQL Server Reporting Services.
  • Involved in migration of various objects like, stored procedures, tables, views from various data source to SQL Server.
  • Created various weekly and monthly portfolio reports showing detailed information by using SQL Server Constraints (Primary Keys, Foreign Keys, Defaults, Checks and Unique) in writing Transact SQL queries.
  • Facilitating Sprint planning, Daily Scrum, Sprint Review, Dev validation/ Story estimation, defect prioritization, retrospective as Scrum master for 5 Scrum teams under Agile - Scrum methodology.
  • Work with stake holders / product owners under Agile - Scrum methodology to prioritize the User Stories for Sprint.
  • Allowed the User Stories under Agile - Scrum methodology into the Sprint based on team velocity and individual capacity.
  • Coached and mentored 5 Agile teams containing a total of 54 team members.
  • Motivated the team under Agile - Scrum methodology to come up with quality shippable product and meet the product goals.
  • Worked with Product owners under Agile - Scrum methodology on artifacts Such as Product Backlog, Spring Backlog, Sprint burn up / Burn-down, and Release Burn up / Burn-down.
  • Set up and maintain the Scrum Board for Project tracking in JIRA.
  • Decomposed Epics into user stories and created category hierarchy for the backlog.
  • Performed bug checking, requirements management using JIRA and Grasshoppers.
  • Created and Managed User Stories in Epics, Themes and Sprints also calculated velocity and Story-points in TFS.
  • Assisted in monitoring ancillary data transactions and addressed problems with HL7 messages.
  • Performed manual testing, including validation/smoke testing of HL7 interface messages on each new build before delivering to the quality assurance team.
  • Implemented various HL7 interfaces which integrated with EMR (Electronic Medical Record) including ADT Inbound and Outbound messaging, Lab Orders and Results messaging, Radiology and Document messaging.

Environment: MS-Project, Visio, .Net, JIRA, Grasshopper, Rational Rose, Requisite Pro, SQL, Clear Quest, QC, QTP, ANSI (ASC) - X12 - EDI, Oracle, Facets 4.8, Agile, TFS 2012.

Confidential, Clayton, MS

Business Systems Analyst


  • Developed and delivered a defined set of ITIL service support process documentation (e.g. Incident/Problem/Configuration/Release/Change management) for each customer from a baseline process set incorporating standards (including sections defining: policies, procedures, people, process flow, etc.).
  • Assisted Project Manager in planning the project time-line and scheduled various project deliverable dates according to the various phases of the project.
  • Developed and maintain the integrated Master Project Plan for cross-functional teams and outside vendors assigned to the project.
  • Developed WCF Services to encapsulate business logic components to be used in a distributed environment and exposed them through SOAP and XML.
  • Prepared Project reports for management and assisted the project manager in the development of weekly and monthly status reports, policies, and procedures.
  • Perform a baseline assessment of Hospital-Provider systems and related interfaces, the existing service level agreements and/or policies and operational business procedures for readiness to comply with HIPAA as well as ICD-10 requirements
  • Have strong experience in requirements gathering by conducting interviews with end users.
  • Actively worked on Data analysis and Report analysis with respect to ICD-10 impact.
  • Performed Gap analysis for better understanding of transaction from HIPAA 4010 to HIPAA 5010 inside Trizetto QNXT different modules.
  • Analyzed System flows of various department of the hospital.
  • Identified risks, problems, requirements and concerns of the Hospital in order to comply with ICD-10 changes.
  • Highly involved in understanding of department workflows and process flows with respect to applications.
  • Collected the information related to ongoing application upgrade and their impact on ICD-10 implementation and created awareness within the departments regarding the need, impact, benefits and risks of ICD-10 code application.
  • Re-Organized the collected data and prepared documentation for implementation.
  • Involved in providing about the ICD-10 codes and 5010 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Figured out the requirement of in various departments of the hospital based on their daily work.
  • Performed impact analysis on applications for deadliness of ICD-10 conversion.
  • Got involved in designing future state processes for HIPAA 5010 transaction processing EDI 820, 834, 835 and 999.
  • Analyzed HIPAA 5010 related to EDI 837 (I, P and D), 270, 271, 276 and 277 transactions (both inbound and outbound) and performed gap analysis between the 4010 and 5010.
  • Join tables by employing SQL INNER JOIN, INTERSECT, UNION ALL and UNION syntax.
  • Created various SQL Schema, Triggers, views, index/keys and stored procedures along with compiling them in SQL server and troubleshoot errors.
  • Responsible for installation of SQL Server, database design, and create schema objects like tables, views and indexes.
  • Involved in creating Basic SQL, worked with the application developers and provide necessary SQL Scripts using T-SQL, Create joins and sub-queries for complex queries involving multiple tables.
  • Designed and created SQL Databases tables, indexes, and views, User Defined Functions, Stored Procedures and Triggers based on user requirements.
  • Participated in Agile Planning Sessions and assumed the Product Owner role for the Agile initiative.
  • Created and explained the User Stories to the Scrum Team under Agile - Scrum methodology and helped them design the Tasks.
  • Designed acceptance criteria under Agile - Scrum methodology for validating the output of each Sprint.
  • Reviewed Team Velocity under Agile - Scrum methodology on a frequent basis and advised Scrum Master at various stages.
  • Participated in Sprint Planning and Sprint review meetings under Agile - Scrum methodology for finalizing the Sprint Backlogs and Verifying the Sprint outputs respectively.
  • Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
  • Help the product owners to come up with set of User stories for better understanding for estimate and development.
  • Conduct User Story estimation meetings on epic level as well as story level.
  • Manage iterations using JIRA/ Grasshopper plugins for Agile Sprint management.
  • Create Epics, Stories and sub-tasks.
  • Mapped the collected data with the existing data provided by the hospital departments.
  • Experience in working and conducting requirement engineering process and Business process Modelling.
  • Used Microsoft Word, Excel, Access, Project and Visio as working tools.
  • Analyzed existing reports in order to respond to Change Requests (CR) coming from client side in the form of new business requirements.
  • Identified the impacts of the Change Requests on the basis of their specifications given in the CR Reports, number of changes required, and number of hours required for code changes and testing, and creating a document with all these details to be shared with the client.
  • Assisted the QA team and worked on Quality Center.
  • Interacted with developers to report software bugs and re-tested the fixed issues.
  • Hands-on experience and good understanding of the hospital working system including Registration, Scheduling, Radiology, Laboratory, Pharmacy, Patient Accounting, HIM, Claim Processing etc.
  • Met the deadlines and scheduled day to day meeting sessions.

Environment: Java, SQL, Windows XP, MS Project, RUP, JIRA, .Net, Grasshopper, Rational Rose, Requisite Pro, UML, MS Visio, Waterfall.

Confidential, Atlanta, GA

Business Analyst


  • Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
  • Prepared the Business Requirement Document (BRD) and System Requirement Document (SRD).
  • Facilitated Provider Enrollment, Setting up Provider profile & Trading Partner Agreement.
  • Set up Provider's Access to the System. (Security Setup).
  • Helped creating Provider Reports i.e. Financial, Claims processing.
  • Prepared the Business requirement Document for the enhancement of the existing services.
  • Wrote FRDs for the defects and enhancements and got approval from business for the developers.
  • Worked on Technical Design Documentation (TDD) of the claims processing system.
  • Performed task estimations and documentation of procedures.
  • Designed, prepared and implemented test cases for system testing as well as for User Acceptance testing.
  • Involved in the testing of web portal of New MMIS system.
  • Conducted integration testing and regression testing with developers in development and QA, also conducted user acceptance testing with UAT team. Safety reporting on system-based projects, acted as a liaison, writing documentation and increased project coordination.
  • Analyzed and documented system release/deployment issues according to version management, backward compatibility, load balancing of components in production environment.
  • Did impact analysis for changing requirements and coordinated with business users for prioritizing the testing/release of the changes.
  • Maintained a very close interaction between business users and developers to avoid any gaps in understanding or implementation of requirements.
  • Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
  • Performed Risk Analysis based on defect severity and priority.
  • Tested User Interface inconsistency and application functionality.
  • Developed Reports and Graphs to present the Stress Test results to the management.
  • Created BPR charts for AS IS and TO BE processes of different business functionalities.

Environment: Windows XP, SQL, MS-Visio, Rational Rose, Requisite Pro, Clear Quest, UML, Axure, Java, Agile.

Confidential, New York City, NY

Business Analyst


  • Performed Requirements Gathering and Analysis, interviewed the SME (Subject Matter Experts), and ensured that contributors and all key stakeholders were motivated to complete assigned tasks.
  • Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
  • Manage the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios. Modeling of the business and application using Rational Unified Processing (RUP) and Unified Modeling Language (UML).
  • Performed Gap analysis and assessed risks of the project.
  • Gathered Requirements through interviews and JAD sessions with business owners.
  • Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 270, 271, 276, 277 and 999.
  • Observed extensive troubleshooting for the failures in mapping systems for outbound claim payment transactions (835).
  • Involved in up gradation of HIPAA ANSI (ASC) - X12 4010 transactions to HIPAA ANSI (ASC) - X12 5010.
  • Ensured that application was created and maintained in a manner that supports the departmental, user and overall business objectives in coordination with other system vendor products.
  • Performed System Integration and Regression Testing for the Microsoft BizTalk 2002 applications. These are developed to perform Electronic Data Interchange (EDI) translation from ANSI (ASC) (American National Standards Committee) ASC(Accredited Standards Committee) ANSI (ASC) - X12 layout to MMIS fixed-width record format.
  • Worked as liaison between software developers and users of Electronic Medical Record (EMR) systems to create better electronic medical record systems.
  • Involved in creating mappings for the conversion of EDI ANSI (ASC) - X12 transactions 820, 834, 835 and 837 (I, P and D) code sets version .
  • Worked on changes for HIPAA Transaction and proposed changes to be made in the current system for an easy transaction from version .
  • Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
  • Created test scenarios for EMR systems executed those tests cases and evaluated the results.
  • Translated and transferred requirements from Business Requirements Document (BRD) to Functional Requirements Document (FRD).
  • Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
  • Extensively worked with HIPAA Privacy Facets application groups.
  • Enabled successful implementation and usage of the FTP(File Transfer Protocol) for the extract submission to the corresponding vendor.
  • Was involved in User Acceptance Test using the test cases given by the client before releasing the application.
  • Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Rational Requisite Pro, Rational Clear Quest, MS Visio, SQL, MS Project, Java, Windows XP, Oracle, Axure, Facets, Waterfall.

Confidential, Long Island, NY

Business Analyst


  • Part of the team for migration of HIPAA - EDI ANSI (ASC) - X12 4010 series to ANSI (ASC) - X12 5010 series for EDI Transaction code sets: 820, 834, 835 and 999.
  • Performed GAP analysis of 4010 and 5010 EDI transactions 837 (I, P and D), 270, 271, 276 and 277 using implementation guide to identify the changes in the segments and data elements.
  • Developed Incident documents and portrayed the as-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
  • Identified the scope, business objective and documented the functional requirements for each release.
  • Worked on analysis of Facets claims processing system and to gathered requirements to comply with HIPAA 5010 requirements.
  • Directly involved in process improvement Plans and implementing business change.
  • Documented the Business Requirements Document (BRD) and the Functional Specification Document (FSD).
  • Coordinated with the different teams distributed at different geographic locations for various releases.
  • Identified Actors, Activities, Artifacts and Workflows and developed use case diagrams using Rational Rose.
  • Prepared and performed to Client and Internal staff as a result of system changes.
  • Produced clear user manuals & guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions and appropriate GUI screenshots.
  • Interacted with the development team on regular basis to ensure and balance practicalities with innovative and efficient business systems solutions.
  • Created use cases specifications, use case diagrams, swim lane diagrams, component diagram and context diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
  • Conducted and Participated JAD sessions to gain consensus on various issues related to the project. Acted as a facilitator on different occasions.
  • Held regular meetings with the Business users and SME’S to priorities the business Requirements.
  • Conducted walkthroughs and code reviews with developers, project managers and stakeholders and users to comprehend business workflow of applications.

Environment: Rational Requisite Pro, Clear Quest, UML, MS Visio, Axure, Quality Center, SQL, MS Office, Java, Facets, Waterfall.

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