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Business Analyst Resume

Sacramento, CA

Professional Summary

Business Systems Analyst with 7 years of experience in all phases of Software Development Life Cycle: gathering requirements, analysis, coding, testing and implementation of projects. I am independent, motivated, sincere, committed, fast learner, detail-oriented team player with excellent communication, analytical, leadership, interpersonal and problem solving skills.

  • 7 years of diverse experience in Business Analysis, Quality Assurance (QA) and Software Development Lifecycle (SDLC).
  • Extensive knowledge of Object Oriented Analysis and Design (OOAD) using Unified Modeling Language (UML), Rational Unified Process (RUP), Waterfall model. Also worked using various methodologies such as Agile, RAD (Rapid Application Development), JAD (Joint Application Design) and Prototyping.
  • Participated in requirements Analysis reviews, Business reviews and working sessions to understand the requirements and system design.
  • Extensive experience with Rational Rose, Requisite Pro, Rational Clear Case and MS Visio.
  • Experience in negotiating with clients from diverse backgrounds and industries.
  • Worked on the MMIS (Medicaid Management Information Systems) for State governments.
  • Extensive experience with Property and Casualty Insurance.
  • Extensive experience with Business Process Management (BPM).
  • Responsible for multiple responsibilities during stint at Insurance co. such as requirements gathering and solution development across the full insurance life cycle from CRM (marketing, sales, service) to underwriting & quoting, policy administration, commissions & broker management, claims, financial reporting and analytics.
  • Experience in development of documents such as Functional Specification Document (FSD), Requirement Specifications (SRS), and Standard Operating Procedures (SOPs).
  • Extensive experience using tools such as Rational RequisitePro, Rational ClearQuest, MS Project, MS Visio, Rational Rose, Crystal reports.
  • Excellent knowledge of HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
  • Worked with ANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response) and 278
  • Extensive knowledge of gap between HIPAA 4010 and 5010.
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
  • Efficient and proven track record of handling Change Requests by the client.
  • Programming skills with Java, J2EE, C# and Vb.net.
  • Worked in various technologies such as XSLT, CSS, XML, BPEL and HTML.
  • Extensive experience in White Box, Black Box, Unit, Functional, Integration, Back End and System Level Load and Stress Testing for many type of applications including web and client/server applications.
  • Experience in estimation of test effort and coordinate test schedule with overall project schedule.
  • Experience in writing System test plans, defining test cases, developing and maintaining test scripts. Documented all phases of QA process. Experience in developing business based functional test scenarios.
  • Developed and maintained databases in SQL/PL-SQL, Oracle and MS Access.
  • Experience in estimation of test effort and coordinate test schedule with overall project schedule.
  • Expertise in Problem solving and Bug Tracking Reports using Bug tracking Tools.

Technical Skills

  • Programming Languages: Java,VB.NET, C#, XSLT, ColdFusion
  • Database: Oracle, SQL/PL-SQL, MS Access,
  • Web Technologies: HTML, DHTML, XML, CSS, XSLT
  • Scripting Language: JavaScript
  • Server: IBM Websphere
  • Methodologies: RUP, UML, Six Sigma, CMM
  • Change Management Tools: Rational Clear Quest, Test Director
  • Business Process Modeling Tools: MS Visio, MS Project, Rational Rose, UML, MS Office 2007
  • Version Control Systems: Rational Clear Case
  • Platforms: Windows 9x/NT/2000/XP.
  • Front End Tools: Visual Basic, MS Front Page, VB.NET, C#.NET
  • Testing Tools: Rational Quality Manager, Win Runner, Load Runner, Test Director , QTP, Quality Center


Work Experience

Confidential,Sacramento, CA July 2011-Present
Sr. Business Analyst/ QA Analyst

Confidential,is a leading software consulting firm actively developing the Healthcare mandates for the California Medicaid system. The project involved working on the HIPAA 4010 to 5010 conversion for the existing system. It included working on the major EDI transactions as per the current CA-MMIS architecture.

  • Responsible for EDI transactions such as 837 I, 837P, 837 Crossover, 835 and the NCPDP D.0.
  • Developed the Business requirements for all the major claims transactions such as 837I/P and 835.
  • Worked closely with the development team regarding the technical and design aspects of the HIPAA 5010 project.
  • Worked on the various systems such as HEATS (HIPAA EDI Activation Testing System) and SURGE. Also developed requirements and specifications for the same due to the HIPAA 5010 and D.0 Enhancement.
  • Developed Test Cases and Scenarios for the testing team based on the business and technical requirements.
  • Actively participated in the Test Execution phase for various EDI transactions.
  • Gained extensive experience with various tools and platforms such as Rational Quality Manager (RQM), Clear Quest (CQ) and DOORS among others.
  • Gained extensive experience with IBM Mainframe and all the major components of the system.
  • Worked on various new screens and reports for IBM Mainframe due to 5010 Enhancement.
  • Developed and designed various Mainframe Screens as part of the HIPAA 5010 Enhancement.
  • Worked actively with the developers and the QAs for the Defect Management during the testing phase using Quality Center.
  • Extensively developed User Manuals for various applications for Claim Submissions.
  • Actively participated in Change Management of the requirements and other specifications.
  • Worked extensively on Test Script Development on RQM.
  • Worked extensively on test data manipulation of X12 format on tools such as EDIFECS and Slick Edit.

Environment: Windows XP, Java, RQM, Quality Center, Clear Quest, Doors, Visio, MS Office

Confidential,Rochester, NY June 2010-July 2011
Requirements Analyst/ Business Systems Analyst

Confidential,is the leading healthcare insurer in upstate New York. The project Health Care Reform involved making all the changes within the corporation as per the legislation to be in compliance with HCR. Other responsibilities involved working on projects such as ICD 9 to ICD 10 transition and Medicaid Third Party Health Insurance Feed projects.

  • Read and analyzed the federal legislation to update the products as per the mandated provisions of HCR.
  • Interacted with senior business teams and legal firms to gather and analyze requirements.
  • Participated in various JAD sessions involving various business and technical teams.
  • Documented various Use Case scenarios, Process Flows and other diagrammatic representations in MS Visio pertaining to various provisions of HCR.
  • Performed Gap analysis for various existing product lines and operations with respect to HCR.
  • Worked extensively on all the mandated first phase of provisions of Health Care Reform.
  • Responsible for gathering and documenting Legislative, Business, Functional requirements for all the provisions and their impact on the existing products and systems.
  • Gathered and documented functional requirements pertaining to iFacets and other legacy systems such as LRSP, TOPPS and MABIL.
  • Extensively used Requisite Pro and other Rational tools for Requirements Management and their traceability.
  • Gained extensive experience related to various product lines and impact on the respective products due to HCR.
  • Worked on the modification of Pricing Modeler of the various systems.
  • Gained extensive experience with medical codes and the change of benefits regarding various products.
  • Gained extensive experience regarding all phases of Requirements Management and Change Control for various projects.
  • Ensured legal compliance of the corporation in regards to the mandates of the Federal and State regulations.
  • Worked with Customer Care department to document the User Guides and Corporate Communications regarding policies and products.
  • Attended training sessions for the latest versions of existing Rational tools such as Rational Requisite Pro 7.1.1, Rational Quality Manager and Rational ClearQuest 7.1.1.
  • Analyzed the structural and operational impact of ICD-10 on the current systems.
  • Worked for Provider & Quote to Bill team for requirements gathering and documentation phase.
  • Interacted with various departments and application admin regarding the impact of ICD 10 into the system.
  • Managed all the ICD 10 business and functional requirements and related attributes on the latest version of Requisite Pro 7.1.1
  • Worked on the ICD-9 to ICD-10 transformation project including the gap analysis.
  • Worked on the requirements Gathering and management of the Medicaid Third Party Health Insurance Feed project.

Environment: MS Visio, Rational Requisite Pro, MS Project, Rational Clear Case, UML, Oracle 9i, MS Office, SQL, Provision, Test Director.

Confidential,CO Dec 2009- May 2010
Business Systems Analyst

Confidential,offers a broad spectrum of products and services through seven operating businesses: United Healthcare, Ovations, AmeriChoice, Uniprise, OptumHealth, Ingenix, and Prescription Solutions. Through its family of subsidiaries and divisions, UnitedHealth Group serves approximately 70 million individuals nationwide.

  • Performed gap analysis ‘Effect on CMS-1500 by 837P HIPAA 5010’ and recommended the user interface changes.
  • Created test scenarios for various EDI transactions such as 270/271, 276/277 and 278 for future implementations in HIPAA 5010.
  • Performed testing of various EDI transactions related to HIPAA 5011 for future implementation.
  • Prepared structural difference report for transactions in regard to the affected elements of the transactions.
  • Worked extensively on the HL7 Messaging system covering many areas such as ADT (Admit Discharge Transfer) and CDA (Clinical Document Architecture).
  • Worked on ODBC compliant databases for HL7 data transfer.
  • Created multiple pro
  • Developed Process Flows, Data Flow Diagrams and Swim lanes for various clinical areas of the project.
  • Responsible for creating and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
  • Responsible for requirement and design documentation review, test plans, identifying and reporting software anomalies and test results.
  • Developed test scenarios and implemented test plan. Providing key input in working with users in defining project and system requirements.
  • SCRUM principle was used in acute functionalities to design, document and manage requirements throughout the lifecycle of the project, i.e. definition, design and testing phases.
  • Assist the PM in setting realistic project expectations and in evaluating the impact of changes on the organization and plans accordingly.

Environment: Rational Requisite Pro, Rational Rose, SCRUM, UML, SQL, Webportal V7, MS Office, MS-Project, MS Visio, Test Director.

Confidential,Milwaukee, WI June 2008-Nov 2009
Business Systems Analyst
Confidential,provides health insurance coverage for more than 1 million people in the United States. The assigned project was to build a Web Based system called EASE (Electronic Agent Sales Experience) in collaboration with Capgemini a consulting company to establish a competitive advantage by making it easier for independent agents and customers to obtain insurance quotes and submit policy applications. Other major functionality includes e-mail notifications for agents, detailed quotes and medical underwriting. Other projects include such as My Web Page which is a health insurance agent’s own personal Web site that can be easily set up with some technical help by the company.

Responsibilities:

  • Created Use Case diagrams using UML and Business Process Models using MS-Visio.
  • Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations and to discuss the different ways and means for the integration of Rational tools with the current system using an “adoption through execution” strategy.
  • Responsible for Business Process Management (BPM) for development of various projects.
  • Worked on Medicaid and other claims processing division of the company.
  • Participated in providing implementation assessment for Rational RequisitePro, Rational Rose and Rational ClearQuest using Unified Modeling Language (UML) and Rational Unified Process (RUP).
  • Developed Use Cases, Sequence Diagrams, Collaboration diagrams, Activity Diagrams and Class Diagrams.
  • Assisting the project manager in creating detailed project plans and scheduling and tracking project timelines.
  • Responsible for preparing the Software Requirement Specifications (SRS) document, Standard Operating Procedures (SOPs), Functional Specification Document (FSD).
  • Responsible for Business Process Management (BPM) for development of various projects.
  • Worked as the primary liaison between the business user and the developers through out the project cycle.
  • Incorporated FDA guidelines (21CFR) and HIPAA (Health Insurance Portability and Accountability Act).
  • Worked with ANSI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response), 820 (enrollment).
  • Incorporated HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
  • Worked with various Business Intelligence tools for reporting and decision making.
  • Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.
  • Handled changes at each stage of project development.
  • Documented Requirement Traceability Matrix in Requisite Pro for traceability of requirements.
  • Used Rational Test Manager for creating test plan, writing test scripts, execution of the test and analysis of results.
  • Worked with Object Oriented Programming (OOP) environments such as Java, VB.net and C#.
  • Worked in various other technologies such as XSLT, CSS, XML and HTML.
  • Developed various reports for user verification like Cross Tab Reports and Sub Reports, various charts and graphs like Bar chart, line graphs, and Pie charts by using Crystal Reports and exported reports into formats like PDF, HTML, Excel, Word and RTF.
  • Used SoDA and created product documentation including online help, printed user manual, and training materials.
  • Scheduled meetings with developers, System Analyst’s (SA) and testers to identify resource allocation and project completion using MS Project.

Environment: Rational Requisite Pro, Rational Rose, Rational ClearQuest, Rational TestManager, RUP, UML, SQL, Webportal V7, MS Office, MS-Project, MS Visio, Websphere Webportal V7, Crystal Reports, Test Director.

Confidential, June 2007-June 2008
Business Systems Analyst

This project at Nebraska Department of Health involved me helping to develop a Comprehensive Information Management System (CIMS) about workers injuries. The purpose of this project is to support all the forms processed against workers compensation claim(MMIS). This system was developed using client server technology and PowerBuilder 5 integrated with Visual Info for Claims and Adjudication Forms Management. I also had to work with SMEs on helping to develop this system. This involved a high level of interaction, which involved having effective communication skills (verbal and written), excellent interpersonal skills, as well as exceptional organization skills. I had to have excellent knowledge of the adjudication and claims process so that I could help make these changes and to help develop this system.

Responsibilities:

  • Responsible for creating and reviewing business requirements, functional specifications, project schedules, documentation and test plans.
  • Worked on the MMIS (Medicaid Management Information Systems) for State government.
  • Responsible for Business Process Management (BPM) for development of various projects.
  • Closely interacted with designers and software developers to understand application functionality, navigational flow and updated them about end-user sentiments
  • Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
  • Perform EDI activities that comply with government reporting requirements and standard.
  • Working with management to establish, document and maintain EDI procedures by identifying errors and taking corrective action, reconciling EDI transactions through coordination of information with internal and external customers, Accounting Department, IT Department and external vendors to maintain EDI integrity.
  • Overseeing and maintaining the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution.
  • Conducting regular audits of EDI transactions to determine accuracy and areas for improvement and maintaining EDI maps and business rules for HIPAA validation software.
  • Worked on the various web based projects for the department and responsible for updating the current system.
  • Further analysis of the requirements was performed using Rational Rose through the use of sequence, Entity relationship diagram and class diagrams.
  • Worked with Object Oriented Programming (OOP) environments such as Java, VB.net and C#.
  • Worked in various other technologies such as XSLT, CSS, XML and HTML.
  • Generated queries in Oracle and SQL Server.
  • Managed Version Control, each version of the application was stored in Clear case and necessary modifications, updates, analysis was done. Developed ER diagrams for depicting relationships between entities. Mapped ER Diagrams to relational database.
  • Worked extensively with Oracle and SQL Server.
  • Worked with Websphere Webportal V7 for the specific projects.
  • Worked closely with Developers, User Representatives and participated in the product design process including specifications and other document reviews.
  • Used SoDa and created product documentation including online help, printed user manual, and training materials.
  • Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
  • Familiar with User acceptance testing (UAT), System testing, Integration testing. Validated and helped verify defects to weed out cosmetic problems and keep the project on schedule.

Environment: MS Visio, Business Process Management (BPM), MS Project, Rational Requisite Pro, Rational Clear Case, MS Project, UML, Oracle 9i, MS Office, Windows 2000, Crystal Reports, Java, J2EE, C# Oracle, SQL, XSLT, XML, HTML, CSS, Lombardi, MS Visio, Websphere Webportal V7, Test Director.

Confidential,Deerfield, IL Feb 2006-May 2007
Business Systems Analyst

Confidential,is among the most respected health care companies in US. The web based project involved generating reports on billing exceptions, project planning, software and hardware requirements analysis, user requirements study, data analysis and business analysis, designing of data mart, development of database, scheduling of jobs, Developing Business intelligence reports using Business Objects Creation and development of universes and Objects.

Responsibilities:

  • Responsible for requirement and design documentation review, test plans, identifying and reporting software anomalies and test results.
  • Worked on the various phase for development of web based systems.
  • Responsible for Business Process Management (BPM) for development of various projects.
  • Rapid Application Development (RAD) principle was used in acute functionalities to design, document and manage requirements throughout the lifecycle of the project, i.e. definition, design and testing phases.
  • Attended and conducted meetings and workshops to discuss high level requirements and developed User Requirements Specification Document.
  • The URS contained detailed requirements, which were formatted such a way that a set of traceability could be matched from features to test cases.
  • Developed business use cases and also extensively worked on Rational Requisite Pro in gathering the requirements.
  • Responsible for implementing the Key process areas and Impact analysis. Generated Use Case diagrams, Sequence diagrams, Business Objects, Domain Object Model using Visio, to depict process flows and PowerPoint presentations.
  • Responsible for Business Process Management (BPM).
  • Managed Version Control, each version of the application was stored in Clear case and necessary modifications, updates, analysis was done. Developed ER diagrams for depicting relationships between entities. Mapped ER Diagrams to relational database.
  • Worked with Oriented Programming (OOP) environments such as Java, VB.net and C#.
  • Worked in various other technologies such as XSLT, CSS, XML and HTML.
  • Worked extensively with Oracle and SQL Server.
  • Worked with Websphere Webportal V6 for projects.
  • Catered to all kinds of user requests and played an active role in negotiation of Change Requests.
  • Worked closely with Developers, User Representatives and participated in the product design process including specifications and other document reviews.
  • Configured test environment for specific test cases, created test data, executed automated or manual tests, document results and updated defect-tracking systems.
  • Used Test Director to invoke the scripts, initially performed the baseline testing, organized all the scripts systematically and generated reports.
  • Queried Oracle Databases to verify test case results. Randomly executed test scripts developed by QA team to check main functionality of application. Interacting with Development and QA Team to ensure overall quality of the software.

Environment: MS Visio, MS Project, Rational Requisite Pro, MS Project, Rational Clear Case, UML, Oracle 9i, MS Office, Webportal V6, Crystal Reports, Java, J2EE, C# Oracle, SQL, XSLT, XML, HTML, CSS, Lombardi, MS Visio, Test Director.

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