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Business System Analyst Resume

Blue Bell, PA


  • 6+ years of experience in Business/System/EDI Analyst in the field of healthcare with the strong ability to gather and document Business Requirements, experienced in writing Use Cases, proficiency in SDLC life cycle, understand the workflow concept, ability to gather and document the 'As - Is' and 'To-Be' processes.
  • Hands on experience in scripting Business Requirement Documents (BRDs), Functional Requirement Document (FRD), Systems Requirements Specification (SRS) Technical Requirement Documents (TRD’s).
  • Proficient in conducting Rapid Application Development (RAD) with Business Users, Joint Application Development (JAD) with developers, Joint Application Review (JAR) sessions with technical team including developers to develop and agree upon a system focusing on Business Requirements.
  • Experience in analyzing Business and Technical specifications, developing Use-Case diagrams, Activity Diagrams, Class Diagrams, Data Modeling, Data Mapping and Work-flow Diagrams to test requirements and procedures and formulate robust Business Model using Unified Modeling Language (UML) Techniques, Visio and Rose tools.
  • Proactively communicated and collaborated with internal customers to analyze information needs and functional requirements and delivered the following artifacts as needed, including: User Stories, Test Scripts, and Mockups for business review.
  • Experience in writing and reviewing test plans, test processors, defining test cases, reviewing and maintaining test scripts, analyzing bugs, interacting with team members in fixing errors and conducting User Acceptance Testing (UAT).
  • Strong knowledge on EDIFECS system configuration and management.
  • Extensive experience in healthcare products like HIPAA Transaction Processing EDIFECS Tools- Transaction Management, Edifecs SpecBuilder.
  • Used Edifecs, EDI tool, to identify syntactical errors in X12 formatted files.
  • Expertly organizes and manages all phases of application testing process using HP ALM/Quality Center and JIRA.
  • Experience in Data Transformation, Data Loading, Modeling and Performance Tuning.
  • Good Knowledge on Web Service Testing using SoapUI.
  • Experienced in building Data Integration and Workflow solutions and Extract, Transform, and Load (ETL) solutions for data warehousing using SQL Server Integration Services. SSIS/(Informatica)
  • Performed Gap Analysis, SWOT analysis, Risk Analysis, and Cost/Benefit Analysis.
  • Proficient in using testing tools like ALM/Quality Center, JIRA and Test Director.
  • Strong knowledge of Data Warehouse methodologies, including, Star Schema, Snowflake Schema, Fact and Dimension tables, worked with high volume databases with partitioned data.
  • Quick learner, responsible, hardworking and good team player.


Operating Systems: Windows, UNIX, Linux

Languages: T-SQL, PL/SQL, HTML

Databases: MS Access, MS SQL Server, TeraData, Oracle, Sybase

ETL Tools: Informatica, SSIS

BI Tools: Excel, SQL Server Reporting Services, Business Objects, Tableau, SAS, Cognos

Tools: JIRA, HP ALM/Quality Center, Test Director

Project Management Tools: MS Project, MS SharePoint Server

Methodologies: RUP, Agile, Waterfall


Confidential, Blue bell, PA

Business System Analyst


  • The project is based on Agile methodology.
  • Conducted Daily scrum meeting and involved handling the Jira dashboard.
  • Involved in Sprint planning session, Sprint retrospective meeting, Sprint review meeting.
  • Created user stories in Jira.
  • Involved in Conducting JAD session for the process of capturing of the requirement.
  • 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.
  • Managed the Requirements (Business as well as System requirements), performed requirements analysis along with the creation of Use Case Scenarios.
  • Responsible to streamline EDI Health Care Claim Payment/Advice Transaction Set (835) to make payments, send an explanation of benefits (EOB) remittance to the health care provider.
  • Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.
  • Processed at the various states requires the submission of encounter information using the EDI X12 standards as detailed in the HIPPA 837I and Implementation.
  • Created data flow diagrams, sequence diagrams, and business process models that describe how the EDI Health Care Claim Transaction set (837) is used to submit health care billing information and encounter.
  • Worked in creating X12 of, healthcare and claim Payment/Advice.
  • Analyzed, Troubleshoot, Maintained EDI Transactions 837,835, 834, 820, 276/277.
  • Worked closely with the business team in identifying project scope, to confirm to the regulatory compliance related to X12 837 (I/P), 835, 834, 820, 276/277.
  • Extensively worked with developing business rules engine enabling the business rules such as referral, prior authorization, eligibility, claims processing and billing essential for EDI transaction.
  • Wrote SQL Queries to validate the data integration between the various Database tables
  • Involved in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
  • Created and maintained SQL Scripts to perform back-end testing on the oracle database.
  • Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
  • Involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting.
  • Used MS SQL for extracting the claims report for ETL (Extraction, Transformation and Loading),imported the report in excel for analysis.
  • Involved in data cleansing and loading into the target system.
  • Prepared data mapping documents.
  • Created test case for UAT testing.
  • Created Test Scripts, Test Plans, validation Plans and Testing Metrics Reports.
  • Performed Functional, Integration and Regression Testing.
  • Involved in testing the CMS provider portal application
  • Involved in preparing Issue log for esMD (Electronic submission of medical document) work
  • Created Epic, Backlog, subtask in user stories in Jira.


Sr. Business System Analyst /EDI Analyst


  • The project was based on the waterfall method. So I have got good understanding of waterfall method of SDLC.
  • Gather high level business needs from the Source of Truth Documents.
  • Decompose the high level business needs into functional and detailed functional requirements.
  • Involved in change management and Gap Analysis.
  • Identified User Story points with the Developers and assigned user stories to Sprints in JIRA.
  • Helped the team to come up with user stories for our project and prioritizing the user stories.
  • Actively engaged in all aspects of the scrum Ceremonies, including Sprint-Planning Meeting, Backlog Grooming Meeting, Daily Stand Up Meeting, Sprint Review Meeting and Sprint Retrospective Meeting.
  • Gathered requirements on the Claims Package C and Claims Package D. The requirement topics included in Claims Package C and D are ClaimsXTEN, Member EOB, Provider EOB, EDI 837, EDI 999,EDI 835,Workflow(EXCD,Warning Message),Claims Timely Filing for the Medicare Advantage, Cal-Medi Connect, Medi-Cal(LA), Medi-Cal(Sandiego) line of business.
  • Extensively used Edifecs Enrollment Management tool to validate complete member enrollment cycle.
  • Experience working with CMS, Trading partners and direct submitters and setting them up in EDIFECS.
  • Used Spec Builder from Edifecs to analyze, generate and create guidelines for EDI files.
  • Decomposed high level business needs to Functional (FUNC) and Detailed Functional requirement (DFUNC) for the requirement topics of Claims Package C and D.
  • Once submitters are migrated check their 837 files and acknowledgement files 999 and 277CA on TM of Edifecs.
  • Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 834, 835, 820, 270, and 271.
  • Conducted JAD session and interviewed Subject Matter Expert (SME) for requirement gathering.
  • Conducting meeting with the stakeholders from IT and Configuration team, facilitating meeting for the purpose of requirement gathering.
  • Involved in writing use case, gathering and documenting “AS IS “,”TO BE” process.
  • Prepared BRD through the use of tools use of HPALM/Quality Center, REI and also used JIRA.
  • Gathered user stories (Requirements) for modules Enrollment/Registration, and medical billing and payments
  • Conduct JAD sessions to gather and document requirements that enhance a wide range of functionalities including claims processing, eligibility and enrollment, provider networks, and electronic data interchange for our Facets core application.
  • Worked on Claims, Customer services, Members, Billing-Enrolment interfaces and extensions for FACETS as a part of FACETS implementation team.
  • Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
  • Used SQL, Data Warehousing and Data Cleansing for the arrangement of customer data. Used Data mapping for collecting the data.
  • Development of source Data profiling and analysis - review of data content and metadata will facilitate data mapping, and validate assumptions that were made in the business requirements.
  • Performed analysis on enterprise data/report integration & provided functional specification to development team to build Enterprise Reporting Systems.
  • Conducted Data analysis using SQL on the backend databases for producing mapping documentation and transformation rules for developers.
  • Created and executed SQL queries to validate the data to verify the front end correctly displays data.
  • Assisted in designing test plans, test scenarios and test cases for integration, regression and UAT to improve overall quality of the Application.
  • Defect Tracking and Bug Reporting was performed using Quality Center.


Business System Analyst/EDI Analyst


  • Worked as a liaison between stakeholders and corporate staff and between IT and business units.
  • Documented Detail Business Requirements Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
  • Created Business Requirement Document (BRD) to document requirements and also created System Specification Documents (SSD).
  • Involved in correction and validation of errors in 837 encounters related to the eligibility of the patient/Member for date of service, member ID invalid, dependent not eligible for date of service.
  • Involved in correction and validation errors such as Invalid Procedure code, Invalid Diagnosis code, Patient date of Birth is Invalid, Admission Date missing, Discharge Date missing.
  • Involved in correction of error relating to Duplicate Claim, Service Facility NPI required, Service Facility Location required.
  • Used the tools such as IDX (Integrated Data Exchange) for validation and verification of data and also used Transunion for resubmitting the rejected claims after the correction of errors.
  • Tested EDI X12 format using optum tool and generating the error report showing the particular loop and segment where the error is.
  • Worked manually to find the error in EDI X12 format in the particular loop, segment and the line using the EDI companion guide.
  • Prepared error report for Institutional and Professional claims for the Prospect Medical Group and for the different child account such as Pomona Valley, Prospect Maverick, Prospect AMVI, Genesis, Corona, Starcare, Nuestra familia, Professional care, Healthsource, Upland Professional.
  • Used MS SQL SERVER in ETL (Extraction, Transformation and Loading) process of extracting the data from CLAIM HEADER (CLMHDR) data base, cleaning the unwanted data, removing the redundancy and then loading into the system.
  • Processed EDI 837P, 837I, 834, 820 and 837D transactions, verified 837 transactions were converted correctly to XML file format and verified the claims data for further processing.
  • Development of source Data profiling and analysis - review of data content and metadata will facilitate data mapping, and validate assumptions that were made in the business requirements.
  • Created Requirement Traceability Matrix (RTM) for end-to-end tracking of business requirements, from analysis to the implementation phase.
  • Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
  • Designed Use Case Diagrams, Activity Diagrams, and Data Flow Diagrams to define the Business Process.
  • Involved in loading the data from source to target data warehouse.
  • Involved in creating Adhoc reports related to the invoice backlog using SQL queries.
  • Executed SQL queries for data reconciliation, data cleansing, data validation, and ad-hoc reports.
  • Worked with the application development teams and QA teams to make sure they understand the business models and detailed user requirements and functional requirements.
  • Identified bugs during the test phase and reported them using HP Quality Center.
  • Responsible for Regression Test, System Test , and UAT project planning like creating testing scenario, test plans , and test scripts.
  • Performed Data Analysis, Data profiling and Data validation by writing SQL queries.
  • Designed and implemented complex SQL queries for QA testing and data validation.
  • Coordinated work plan between Project team and client, implemented & managed mitigation process.

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