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Healthcare Business Analyst Resume


  • Over 8+ years of experienced professional with strong knowledge of the pharmaceutical and medical insurance fields, including clinical trials but not limited to customer service, claims processing, medical transcription and practice management.
  • Worked in all phases of project life cycle and in different SDLC methodologies such as Waterfall and Agile.
  • HealthCare management experience in projects involving the customization, design, development, implementation, and testing of automated systems to support the Medical Management Information System (MMIS) as well as day - to-day business operations.
  • Experience with HIPAA EDI Transactions 837, 835, 820, 276, 277, 278 code sets testing in Health Insurance.
  • Experience with EDI HIPAA 4010 - 5010 Project to convert EDI X12 Healthcare HIPAA 4010 transactions into HIPAA 5010 Complaint transactions.
  • Experience in analyzing requirements, design and review of various documents including the Software Requirement Specifications (SRS), Business requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems Design Specification (SDS), Requirement Traceability Matrix (RTM) and testing documents.
  • Experience in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis and working with different software methodologies like Agile, Waterfall.
  • Supporting all the documents with UML Diagrams such as Use Case Diagrams, Class Diagrams, Activity Diagrams, Data Flow Diagrams, Sequence Diagrams, Process Flows (Business and System) using UML modeling tools such as MS Visio and Rational Rose.
  • Knowledge of healthcare standard Health Level Seven (HL7).
  • Lead fit/gap sessions to map requirements to standard Business Application Suite features and functions and experience on SQL queries to check the integrity of data and Facilitating Project Discovery, Sprint Backlog and Sprint Planning meetings
  • Extensive experience in designing of Workflow Alerts and Actions, Workflow Approval, Profiles, Role based hierarchy, Sharing Rules, Validation Rules, Case Management, Custom Reports, Report Folders, Report Extractions to various formats, Dashboards, and Email generation according to application requirements.
  • Knowledge of Oracle, SharePoint, Visio, IBM Rational Clear Case, Requisite Pro., UML/XML models.
  • Experience in system conversions (Mapping) such as HIPAA, ICD-9 codes to ICD-10 & PCS codes and claims processing.
  • Strong knowledge of Word, Excel, VLOOKUP, Pivot table generation, Pivot Reporting and Flow Charts Monitored project execution/ change control/ release management.
  • Experienced in Preparation of Test plans, Test Strategy Document, Test cases, developing and maintaining Test scripts, Analyzing bugs, Test Summary Report etc.
  • Extensively used ETL methodology for supporting data extraction, transformations and loading processing, in corporate-wide-ETL Solutions using Data Stage, Informatica, and Oracle Data Integrator.
  • Very Good experience in using HP-Quality Center and testing
  • Sound proficiency in analyzing and creating, Use Case Diagrams, Sequence Diagram, Activity Diagram, Data Flow Diagrams, Business Flow Diagrams, Wire Frames and Mock-ups using MS Visio and Rational Rose to communicate business and functional requirements to clients and developers.
  • Managed platform deliverables including Study & DBTR estimates, Master Test Plans, Detailed Test Plan, Quality Assurance reports, Static Testing reports, RAID logs and Daily Status Reports.
  • Experienced in preparing test data and validating data using SQL Queries.
  • Experience in Data mapping, Data mining, Data warehouse concepts, OLAP and OLTP Technologies.
  • Experience in Rational Rose, Clear Case, Requisite Pro, Clear Quest and MS Visio.


Documentation: BRD, FSD, UIS, SRS, RSD, UML, Activity & Sequence diagrams, Business Process Flow

Requirement Elicitation: JAD, JRP, stand-up meetings, workshops

Analysis: As-is, To-be, GAP, Traceability and Impact Testing Unit, Regression, Functionality, Integration UAT, Win Runner, Load Runner, Test Director, Quick Test Pro, PR Tracker

Programming Languages: C, JAVA, Oracle

HIPAA: 5010, 4030, 4010, 3060

EDI Transaction Sets: 270, 271, 276, 277, 278, 820, 834, 835, 837, 997

Business Modelling Tools: MS Visio, MS PowerPoint, MS Project, MS Word, MS Excel, MS SharePoint

Methodologies: RUP, Agile, Waterfall, SDLC

Defect tracking: Mercury Quality center, HP Quality center/ ALM and Bugzilla




Healthcare Business Analyst


  • Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
  • Applied RUP methodology with its various workflows, artifacts and activities to manage life cycle from inspection to transition phase.
  • Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
  • Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence
  • Diagrams, State Diagrams, Activity Diagrams and business process and workflows.
  • Involved in implementing Six Sigma practices to systematically improve processes and standards and by eliminating defects
  • Coordination / Support for HL7 Interface testing (ADT Messaging)
  • Involved in HIPAA 5010 gap analysis of ANSI X12 4010 and ICD 10 initiatives.
  • Coordinated JAD sessions with all the stakeholders to understand the impact of HIPAA 5010 on the existing system.
  • Developed and updated HL7 interfaces for HIS and ancillary apps and involved in source mappings and translation tables. Supported EPIC message processing with Record Viewer functions.
  • Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
  • Involved in internal infrastructure team with QNXT schema questions/solutions.
  • Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 835, and 837 to identify key data set elements for designated record set.
  • Performed AS-IS and TO-BE analysis for EDIFECS Standards - HIPAA 5010 Database Setup for new version releases. Documented proposed changes and coordinated development, testing and production release environments, including end-to-end testing.
  • Used edifecs to quickly perform gap analysis and automate migration between guideline versions.
  • Assist configuration analysts with QNXT application functionality and testing.
  • Assist is team with QNXT infrastructure schema questions and solutions.
  • Planned, developed, scheduled and conducted systems acceptability tests of modernization and production systems; including Mainframe and web applications
  • Involved in testing the HL7 Version 2.5.1 to receive messages from HL7 version 2.3.
  • Gathered requirements for "Front End" and for "Core Adjudication System" by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requirement Traceability Matrix and later exporting them to HP Quality Center.
  • Involved in designing & determined 3-tier architecture for the claim processing system.
  • Assisted team lead in developing Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements to test cases.
  • Prepared and executed different Test Cases and Test Scripts.
  • Involved in conducting Functionality testing, Integration testing, Regression testing and User Acceptance testing (UAT). Provided analysis and insight to QA Team in defects and bugs tracking.
  • Gathered requirements for ICD 10 transition.
  • Maintained and controlled track of stakeholders' requests for enhancements and changes using Rational Clear Quest also shared knowledge on SAAS in brainstorming storming session.
  • Identified and documented issues, risks, gaps and their impact to the project life cycle.
  • Used JIRA for project tracking, bug tracking and reporting.
  • Create wireframes using Axure RP Pro based on collaboration with use cases and Visio flows
  • Exposed to using ICD 9/ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology.
  • Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications in Edifecs
  • Tracked the change requests.

Environment: MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, Mainframes, JIRA, COBOL, Rational Requisite Pro, Rational Rose, Rational Clear Case, Oracle, SQL, Toad, Java, Windows XP, HP Quality Center, UML, HIPAA.


Healthcare Business Analyst


  • Played an active and lead role in gathering, analyzing, and writing business requirements.
  • Project was implemented in phases, enabling system to deliver as many business requirements as early as possible.
  • Involved in Requirement Scoping and analysis of high priority requirements for implementation.
  • Worked on Transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
  • Involved in HIPAA EDI transactions such as 270, 271, 837 (P, D, I), 276, 277, 834, 820, 278, 999/TA1, and 277 CA.
  • Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.
  • Coordinated, implemented and provided on-going support of the Quality Performer as outlined in the Specifications Manual for Well Care Inpatient Quality Measures Centers for Medicare & Medicaid Services (CMS).
  • Used HP Quality Center for writing Test plans and Test Cases.
  • Worked on documenting business rules to be defined in the business rules management engine (IBM ODM).
  • Participated in requirements meetings, writing requirements in CaliberRM, converting requirements from Caliber RM to HP Quality Center.
  • Working knowledge of implementing software development projects using methodologies such as Waterfall, RUP, and Agile Scrum.
  • Used HIPAA guidelines and regulations to keep track of Healthcare transactions like Eligibility Request/ Response, Request and Response for Claims Status, Prior Authorization, Claims Vision and Claims Payment.
  • Worked closely with business team, and identified, analyzed the core requirements and key features of the ongoing project. Extracted, discussed, and refined business requirements and developed comprehensive business requirement document (BRD).
  • Developed Software Requirement Specification (SRS) document using Visio and MS Office.
  • Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team.
  • Executed Test Cases Manually, once the application is stable and documented the successful or unsuccessful completion of each test case in HP Quality Center (QC) for End-to-End Scenario based testing.
  • Worked on Agile SDLC during the project phase, performed the role of Product Owner and Team member in Scrum Meetings.
  • Participated in agile process - planned iterations, created tasks, assigned tasks to quality assurance team based on the priorities and estimated capabilities of quality assurance team for every iteration.
  • Involved in Testing Out-Bound Transactions (835 Health care claims Payment, 277 Claim Status Response).
  • Consulted with healthcare third-party administrator company to develop conversion specifications for member, enrollment, and authorizations.
  • Involved in Scrum development process and prepared Sprint burn down chart, product catalog and sprint backlog contain Business Requirements and supporting documents that contain the essential business elements and definitions as well as the tasks to be completed.
  • Responded to billing inquiries from patients and payers.
  • Analyzed and studied the technical, structural and data content changes for EDI transaction sets 834 (Enrollment and Maintenance), 837 (Professional, Institutional and Dental Claims) and 835 (Claim Payment/ Advice).

Environment: UML, SQL, Microsoft Office, HP, Agile, MS SharePoint, HTML, XML, DB2.


Business System Analyst


  • Developed data flow, workflow, process flow and entity relationship diagrams in MS Visio, and analyzed them to create "AS IS" and "TO BE" scenarios
  • Verified the functional aspect as per the business process and validated the interfaces with the other systems and data conversion from the existing systems
  • Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim processing, both front and backend operations.
  • Interacted closely with QA team in different phases of testing such as System testing, Functional testing, Regression testing and Integration testing for Quality Analysis using Quality Center and resolving the issue assigned on JIRA.
  • Validated 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response) and 834 (Enrolment/ Dis-enrolment to a health plan)
  • Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
  • Acted as a liaison between business area subject matter experts (SMEs) & developed teem throughout all the phases of SDLC, starting from inspection to transition phase of the life cycle.
  • The process involved performing gap analysis, compiling the results, impact assessment and designing new screens for portal
  • Run and analyze weekly and bi-weekly patients' encounter data and present to department Heads for data quality management and regulatory body (such as Joint Commissions) Standard Compliance.
  • Develop business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation and enterprise architecture.
  • Worked extensively with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential.
  • 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.
  • Conducted formal interviews and JAD sessions with business users and SME's
  • Designed and developed use cases diagrams activity diagrams and sequence diagrams
  • Also performed regression testing and created test scenarios for User Acceptance Testing (UAT)
  • Performed Ad-hoc SQL queries for the information to be retrieved and asked by the members of the team
  • Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and web-page mock-ups using MS Visio for acceptance from end users
  • Assisted in Change Management and Release Management by requesting, implementing and evaluating changes to the system using Rational Requisite Pro and recording defects using Quality Center.
  • Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyses the High-Level Requirements
  • Analyzed, manipulated and updated the database using SQL
  • Performed test cases for multiple transactions including 837, 835, 277, 270, 271 transactions
  • Created various artifacts such as BRD, Functional requirement documents (FRD), Requirements traceability matrix (RTM)

Environment: JAD, Microsoft office, rational clear quest, quality center, rational requisite pro, UML methodology, oracle, database


Business Analyst


  • Interfaced with the IT division and business to address ongoing business needs.
  • Prepared process flow documents capturing the defined SOP (Std Operating Procedures) for Application Outsourcing (AO) endeavors.
  • Delivered project overview and status presentations during committee’s meetings.
  • Aligned the AO processes for the team as per the business requirement.
  • Lead daily scrum meeting to review execution progress and identify changes if required. Participated in Agile Development Cycle. Experienced in Agile technology with Scrum.
  • Created and maintained project plan. Review the BRD, FRD, SRS, High level Design Documents, Detailed Design Documents and Requirement Matrix and prepare WBS.
  • Involved in Testing Outbound Transactions
  • Collaborate with SMEs from Regulatory, Clinical, Pharmacovigilance, and Quality to integrate data, including assessment of source and target properties and product dictionaries to align with Sanofi and FDA Regulations
  • Scheduled daily meeting with requirement managers and development managers to review issues identified during execution. Participates in the development of contingency plans.
  • Configured the standard SFDC objects and created custom components as per the requirement.
  • Created new custom objects, assigned fields, designed page layouts, custom tabs, components, custom reports.
  • Business / Functional Analysis of the Clinical Data Management Applications (EDM, RDC (TAO-Trial Access Online), SMT, I-Review, PRS, IBISecg, DLS, PC Imaging, EmBARC). The tools help to support the IT part of the Life Sciences (like Clinical Trail and Discovery)
  • Involved in Order Management and Inventory Modules.
  • Received training in HP Quality Center (ALM) for Application Lifecycle Management in accordance with Pfizer validation policy following regulatory policy aimed at FDA guidelines
  • Production support on OM, Advance Pricing, Inventory.
  • Prepared user acceptance criterion and testing strategy that will be utilized by QA team to validate the addressed functionality of all critical requirements. Developed and maintained Test Matrix and Traceability Matrix. Utilized Quality Center to plan and execute tests, track defects and create change alerts. Conducted User Acceptance Testing (UAT)
  • Testing the New functionality related to OM, Purchasing, Advance Pricing, Inventory.
  • Collaborated with ERP to align interfaces of Production Execution System to the Global Process Model of Supply Chain Operation of Pfizer Inc
  • Worked on Price Lists, Qualifiers, Modifiers, Pricing Attributes in Advanced Pricing.
  • Coded all adverse event terminology, other medical information, and drug information in Pharmacovigilance database utilizing MedRA and WHO-DD dictionaries.
  • Designed and deployed Custom tabs, Validation rules, for automating business logic.
  • Worked in an agile environment, during all iterations of system, and software development.
  • Author of AMPS (Agile Manufacturing Production System) BPML (business process master listing)
  • Developer and author of BIM (Business Integrated Model) for AMPs, IPL, PPRS, PES Serialization project
  • Created workflow rules and defined related tasks and email alerts.
  • Managed project review meeting and make sure all identified issues are discussed and scheduled properly without having any downtime.
  • Interfaced with third party suppliers and vendors for support, upgrades and implementations.
  • Worked on Change Management and change control on a pharmaceutical regulatory tracking system for change submissions
  • Extensively worked in Data Requirement Analysis and Data Mapping for ETL process.
  • Worked closely with Technical Architect and Business Owners to close out on the requirements.
  • Highly involved in build and design sessions, creating and modifying XML schema definitions.
  • Analyzed data with discrepancies through Error files and Log files further data processing and cleansing.
  • Developed user stories in EPC (Event Process Chain)
  • Used ARIS tool for Manufacturing Execution System and Production Management for Shop-floor production of pharmaceutical products

Environment: Salesforce.com / Veeva, SFDC, ARIS Business Architect suite, HP Quality Center (ALM), ARIS Business Designer and Publisher, Mercury Quality Centre, Peregrine, VMobile, Exploria, HP Quality Center, QTP 8.2,9.0, VB Script, Java, J2EE, Oracle, Visual Basic, MS-Office, Windows XP/2000/NT, Chrome, Quick book, EDI, HIPPA, .Net, TSD, SQL, CMMI, Oracle 9i, Oracle Seibel, Oracle OBIEE, Six Sigma, UAT.

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