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Sr. Business System Analyst Resume

San Diego, CA

SUMMARY

  • Sr. System Analyst with 6+ years of hands on experience in business consulting and application development with excellent skills in 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.
  • Knowledge of Health exchanges: off marketplace exchange and on marketplace exchange. Federally Facilitated marketplace, state partnership Marketplace, State based marketplace.
  • Proficient in identifying, documenting and analyzing Business Requirements Specifications (BRS), System Design Specifications (SDS) and Software Requirement Specification (SRS).
  • Strong working experience in the Data Analysis, Design, Development, Implementation and Testing of Data Warehousing, DataMarts and ODS using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL).
  • Very good understanding of Data Warehousing concepts, Data Analysis, Data Warehouse Architecture and Designing
  • Extensive knowledge of Medicaid, Medicare, Procedural and Diagnostic codes, Claims Process, Health information Exchange (HIE), Electronic Health Record (EHR) and Electronic Medical Record (EMR).
  • Specialized experience in healthcare insurance domain including Medicare and Medicaid. Profound experience with HIPPA X12 EDI transaction codes such as 270/271(inquire/response health care benefits), 276/277(Claim - status), 834(Benefit-enrollment), 835(Payment/remittance advice), 837(Health care claim).
  • Experienced in gathering requirements for HIPAA EDI Transactions (837,834, 835,270,271) in various phases of implementation.
  • M edi cal Cl aims e xp er ien ce in P ro ces s D o cu m enta tio n, An alysis and I m p le m entati o n in 8 3 5 / 8 3 7 / 8 3 4/ 2 7 0 / 2 7 1 / 2 7 7 / 9 9 7 (X 1 2 Stand ard s) p r o c esse s o f M edi c al Cla i m s Ind u stry fr o m t h e P r o v id er/ P a y er sid e.
  • Experience in conversion and mapping of HIPAA X12 4010 codes to X12 5010 codes and 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.
  • 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 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.
  • Effectively used various elicitation techniques to gather requirements like JAD sessions, brainstorming, prototyping, one and one sessions, workshops, surveys, interviews and conferences.
  • 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.
  • Experienced in writing SQL queries to extract data using complex inner joins, outer joins, constraints etc.
  • Worked with PMO to review time line and schedule for the implementation and discussing the milestone.
  • 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.

TECHNICAL SKILLS

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

Business Modeling Tools: Rational Rose, MS Visio, Rational Clear Case

Requirement Management Tools: Rational Requisite Pro

Defect Tracking Tools: Rational Clear Quest, Quick Test Professional, Quality Center

RDBMS: Oracle, SQL Server, IBM DB2

Languages: Visual Basic, XML

Business Applications: FACETS, MS Access, Excel, Outlook, PowerPoint, Visio and SharePoint

Version Control Systems: Rational Clear Case

Operating System: Windows, UNIX/Linux

PROFESSIONAL EXPERIENCE

Confidential, San Diego CA

Sr. Business System Analyst

Responsibilities:

  • Acted as a primary contact in all the phases of Software Development Life Cycle SDLC, including Quality Assurance Testing, Performance & User Acceptance testing.
  • Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/ Medicaid claims processing.
  • Worked with the data architecture and data analyst team in designing the model and in creation of the data mapping documents
  • Used Data warehousing for Data Profiling to examine the data available (Data Analysis) in an existing database
  • Performed GAP analysis for ICD-9 and ICD-10 and EDI 5010 X12 Message Structure with the 4010 Structure. Developed End-to-End Business Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrollment and Maintenance), 835 (ERN-Electronic Remittance Notification) and 837 (Claims Submission) Transactions.
  • Worked in the analysis of the ICD 9 - ICD 10 codes conversion Project using GEM (general Equivalence mapping) processes and concepts. Worked in a project involving Miami Systems to create Drug Cards and created Test files to be sent to drug card vendors for approval.
  • Involved in end-to-end testing of Facets Billing, Claim Processing and Subscriber/Member module.
  • Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations
  • Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management.
  • Worked on a Paid without prejudice project for various States. Performed UAT tests using the (MORAE) Usability Testing Tool using the Observer and the Manager Mode.
  • Experience in writing SQL queries, Stored Procedures and Triggers.
  • Worked extensively with Tableau and MS Excel for the generating of reports.
  • Responsible for architecting integrated HIPAA, Medicare solutions, and Facets EDI 834.
  • Worked with FACETS, eBilling and EDI HIPAA Claims(837/835/834) processing .
  • Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet. Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts. Acted as a liaison between client and payer/intermediary.
  • Developed test Scripts using Quality Center and coordinated with developers to quickly resolve the defects associated with them.
  • Worked with SSIS for data transformation and defining To-Be processes.
  • Experience in Data Validation, Data Modeling, Data Flows, Data Profiling, Data Mining, Data Quality, Data Integration, Data Verification, and Data loading
  • Developed several detail and summary reports including line and pie charts, trend analysis reports and sub-reports according to business requirements using SQL Server Reporting Services (SSRS).
  • Created source table definitions in the Data Stage Repository by studying the data sources.
  • Developed Database packages, procedures, functions, triggers using SQL.
  • Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
  • Conducted JAD sessions with the management, users and other stakeholders for open and pending issues to develop specifications. Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions to test the performance of the application from various dimensions.
  • Helped create the 'Business Glossary' to facilitate efficient understanding of the business process amongst the other teams. Assisted in creation of the Functional Design Document from the Business Requirements Document which was used as the reference by the development team while preparing the design and held the responsibility of the required data setup for unit testing.
  • Validate transaction records using SQL queries.
  • Extracted data from Teradata and Oracle and created pivot tables in Excel
  • Developed new reports using Business Objects/Crystal Enterprises on SQL Server, Oracle and Teradata databases utilizing T-SQL and DTS, focusing on data verification and query performance.
  • Interpret and analyze data to determine appropriate configuration changes
  • Worked extensively in the executing of SQL queries on the database to verify data integrity.

Environment: IDX, MS Visio, Word, Excel, PowerPoint, CMMI, Rational Rose, Requisite Pro, Clear Case, Clear QuestSQL, Oracle, J2EE technology.

Confidential, Bronx, NY

Business Data Analyst

Responsibilities:

  • Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process
  • Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process.
  • Developed Test Plans and Test Cases to test the GUI and workflow for Quality Assurance.
  • Used Quality Center to plan tests, manages test assets, create and run manual and external scripts to check GUI and functional features of the AUT
  • Involved with requirement gathering and analysis for the data marts focusing on data analysis, data quality, data mapping between ODS, staging tables and data warehouses/data
  • Involved in developing and maintaining Test Matrix and Traceability Matrix, and performing Gap Analysis.
  • Maintaining knowledge of Medicare and Medicaid rules and regulations and evaluating the impact of proposed changes in rules and regulations.
  • Created Process Work Flows and responsible for preparing Functional Requirement Specifications Involved in gathering and prioritizing requirements using 1 to 1 interviews, job shadowing, brainstorming & developing questionnaires
  • Performed extensive task which include Data Quality Analysis, Data lineage and Data Standardization data structures, data base design, data warehouses, business intelligence/analytic tools, SQL, ETL tools, and data integration methods
  • Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data mining, data cleansing, data mapping, data dictionary and data analysis.
  • Develop, design & implement department plan to configure new Facets integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
  • Translated business requirements into functional specifications and documented the work processes and information flows of the organization
  • Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
  • Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) and 820) standards
  • Contributed in the build and design of organizational Wiki that provided comprehensive knowledge of workflows, policies and procedures, patient care objectives, regulatory requirements, and industry best practices for membership management
  • Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010 and ICD-9-CM to ICD-10.
  • Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers. Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
  • Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
  • Involved in identifying and studying the ACES and Facets system data and field-by-field analysis of Facets system for the attribute mapping purpose.
  • Analyzed EDI X12 - 837I/P, 835 and 834 transactions consistency related to providers, payers, subscribers and other related entities
  • Analyzed the data in the Facets source system to map into the correct field and attribute in the target storage
  • Owner of the business rules document, which documented the business rules across different systems.
  • 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
  • Created detailed use cases, use case diagrams, and activity diagrams using MS Visio.
  • 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
  • Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan.
  • Worked with Source system Subject Matter Experts (SMEs) to ensure that the extracts are properly mapped. Used SQL for data mapping and querying
  • Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.
  • Executed advanced level SQL queries to verify data integrity of the databases.
  • Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
  • Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports.
  • Performed Data Analysis, Data profiling and Data validation by writing SQL queries using TOAD
  • Worked extensively with Tableau and MS Excel for the generating of reports.
  • Resolved data issues and updates for multiple applications using SQL queries/scripts
  • Responsible for unit testing and working with System/Integration testing team in debugging/resolving any issues raised during testing.
  • Created Data Flow Diagrams and Process flow diagrams for various load components like FTP Load, SQL Loader Load, ETL process and various other processes that required transformation.
  • Conducted user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters)

Environment: MS-Project, Visio, MS Word, Rational Rose, clear case, Requisite Pro, Clear Quest, Test Director, HP QTP, Oracle, EC Map, Facets, HIPAA.

Confidential, Sterling, VA

Business System Analyst

Responsibilities:

  • 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).
  • Implemented automated COB processing of Medicare claims into Facets
  • Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process.
  • Created Process Work Flows and responsible for preparing Functional Requirement Specifications
  • Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
  • Experienced in data warehouses and data marts for business intelligence reporting and data mining along with developing and documenting process flows for business processes.
  • Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
  • Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions
  • Involved in creating test scripts and test data files for the HIPAA transaction based on the ANSI X12N HIPAA standards.
  • Involved in claims and record data mapping and data modeling with technical teams.
  • Followed up with the SME in every module to ensure that HIPPA guidelines are being followed.
  • Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets.
  • Worked with the development team to make sure that they understood the user requirements and that the system developed met those requirements.
  • Involved in back end testing using SQL Queries on Microsoft SQL Server 2005/2008.
  • Performed backend testing to check the system data integrity for insert, update, delete and retrieve transactions by writing complex SQL queries including joins, group by, having clause etc.
  • Generated reports for various projects using HP Quality Center and Rational Clear Quest
  • Participated in developing test plans and test procedure templates and guidelines to be used by the project team with detailed screen layouts with regards to various types of corporate actions.
  • Was involved in User Acceptance Test using the test cases given by the client before releasing the application.
  • Involved in the development of Test Plans, Test Cases and Expected Results, and coordinated the tests with the QA team to verify implementation of new features and enhancements.
  • Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Windows XP, SQL, MS-Visio, MS Word, Rational Rose, HTML, HIPPA, JSP, Oracle, Requisite Pro.

Confidential

Business System Analyst

Responsibilities:

  • Involved in business analysis and project management, coordinating between the team members, addressing budget issues and creating test plans according to the business requirements.
  • 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.
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Involved with the business partners to define requirements, determine solution alternatives, and develop high-level designs and estimates.
  • Defined and documented the vision and scope of the project.
  • Met with various groups, including business owners, SMEs (subject matter experts) and marketing team, for requirements gathering in definition Stage.
  • Gathered requirements, developed Process Model and detailed Business Policies.
  • Designed Use Cases using UML and managed the entire functional requirements life cycle using RUP.
  • Managed multiple vendors in the project (Issue & Risk management and timely project deliverables).
  • Followed the RUP methodology for the entire SDLC.
  • Involved in developing and maintaining Test Matrix and Traceability Matrix, and performing Gap Analysis.
  • Performed Data Validation using SQL Queries.
  • Designed SSIS Packages to extract, transfer, load (ETL) existing data into SQL Server from different environments for the SSAS cubes.
  • Expertise in problem solving and bug tracking using Quality Center.
  • Involved in writing and implementation of the test plan, and various test cases.
  • Initiated, proposed and implemented critical analytical and technical turnkey solutions extensively increasing the quantitative and qualitative value of the application.
  • Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
  • Build and managed a cohesive team to meet deliverables per project / track assigned.
  • Provided customer support as required to meet service level agreements.
  • Created and maintained SQL scripts and Unix as a part for back-end testing on the oracle database.
  • Executed SQL statements to check if the data integrity has been maintained.
  • Create internal reports using Dashboard and basic SQL queries in the tool to track activities of the teams.
  • Involved in Data Flow/Business Process Diagrams to illustrate the flow, input and output of data.
  • Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions.
  • Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
  • Defect Tracking and Bug Reporting was performed using Test Director.
  • Involved in the testing of web portal of new MMIS system.
  • Worked with the clients on the final signing process in the User Acceptance stages.

Environment: Rational Rose, Rational Requisite Pro, MS Word, Rational Clear Quest, MS Visio, MS Project, Java, HTML, Windows XP, Oracle

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