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Business Analyst Resume

Newark, NJ

SUMMARY:

  • Facilitator between Business Systems and Information Technology with over 8+ years of various environment experiences in the field of business analysis and project management.
  • Several years of experience and advance knowledge of the Systems Development Life Cycle (SDLC), and project life cycles like Agile, Rapid Application Development (RAD), Extreme Programming (XP),Rational Unified Process (RUP)
  • Strong knowledge and working experience of industry standards such as HIPAA, HL7, Six Sigma, and SOX, ICD - 9, ICD-10 coding, EDI(Electronic data interchange), transaction syntax like ANSI X12
  • Participated and actively functioned in Joint Application Development (JAD)
  • Strong Experience in Test Plans development, Test Conditions and Test Cases, test data creation and analysis, interaction with the development team for error detection and correction.
  • Understanding the Business Intelligence concept using set of methodologies, processes, architectures, and technologies that transform raw data into meaningful and useful information used to enable more effective strategic, tactical, and operational insights and decision-making.
  • Hands on implementing Web, Portal, Web-Services and Enterprise Applications using Object Oriented Analysis and Design (OOAD) Methodology.
  • Experience in understanding database structures and write SQL/PLSQL.
  • Extensive experience in Data Analysis and ETL Techniques for loading high volumes of data and smooth structural flow of the data.
  • Worked on System Changed Requests Issue resolution related to Medicare and Medicaid.
  • Vast experience in requirement gathering for business and application requirements, business processes, identifying risks, impact analysis, UML modeling, Sequence and Activity Diagrams using Rational Rose and Microsoft Visio.
  • Have worked intensively on the PL/SQL for creating and working on the database for multiple projects.
  • Adapt at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary, Data Migration and Interface Requirements Documents.
  • Experienced in conducting requirement analysis, use case design, designing test plans and developed database schemas based on the logical models.
  • Developed crosswalk schema based on implementation and companion guides. Actively involved in a data mapping and data modeling.
  • Expertise in OLTP/OLAP System Study, Analysis and E-R modeling, developing Database Schemas like Star schema and Snowflake schemas.
  • Experienced in conducting requirement analysis, use case design, designing test plans and developed database schemas based on the logical models
  • In house experience with project management tools like MS-Project, JIRA, Creative Pro Office for status reporting, planning and error tracking and correcting.
  • Proficient in working with UML development tools like MS Visio, Eclipse, Enterprise architecture framework,UML2 Tools, and Power Designer etc.
  • Extensive management background within varied sectors of the healthcare industry including HMOs, PPOs, Integrated Hospital Systems, Out-Patient Surgery Centers, Dental and Vision
  • Experienced in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
  • Exposure to Healthcare, Insurance and Finance business domains.
  • Extensive experience with Business Process Management (BPM).
  • Extensively worked and presented several documents and Use Cases for multiple transactions include 837I, 837P, 835, 276, 277, 270, 271(both inbound and outbound) transactions for ongoing industry projects.
  • Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the eligibility, billing experience within life and disability in health plans.
  • A sincere, committed, quick learner, oriented, motivated team player with excellent communication, analytical, leadership, interpersonal and problem solving and management skills.
  • Exceptional Problem Solving and Sound Decision Making capabilities, along with the ability to resolve difficult situations.

TECHNICAL OVERVIEW:

Business Analysis: MS Visio, Test Manager, Test Director, Win Runner

Project Management: MS Project (Server), Creative Pro Office, JIRA

Operating System: Windows XP, Windows 7, UNIX, Linux, Mac OS

Languages: C++, Java, VB, HTML, XML, SQL, PLSQL, C#, JavaScript

Application: Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Access, Visual Studio, Eclipse, Share Point

Database: MS SQL Server, Oracle 8i, 9i, 10g, MS Access

Other Tools: SQL*Plus, Apache Tomcat, Business Objects, Net beans

PROFESSIONAL EXPERIENCE:

Confidential, Newark, NJ

Business Analyst

Responsibilities:

  • Interaction and gathering of all the necessary information from various companies and necessary Records to create and provide an error free software solution.
  • Efficiently handled claims processing as well as enrollment, medical-management and workflow processes involved during and for the project given.
  • Developed current and ‘to be’ business processes and use case documents in compliance with HIPAA policies and procedures using MS Visio.
  • Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
  • Documented business, functional and operational specifications of as-is and to-be system in the product business requirement Document/technical requirement document, and prepared corresponding requirement traceability matrix.
  • Created and maintained the Requirement Traceability Matrix (RTM) between the requirements and other products such as design documents and test plans.
  • Developed use-cases and workflow diagrams for effective plans of ASO Hybrid Product.
  • Created process flow diagrams using MS Visio. Extensively worked on Access, Excel, Word and PowerPoint.
  • Worked with the architect team on different tasks. (Process flows.)
  • Created a new mechanism to capture different types of information (Server count, Servers location, mapping machines to servers).
  • Worked on claim adjudication process with different clients applying different adjudication process and methodology
  • Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
  • Prepared project reports for management and assisted project managers in the development of weekly and monthly status reports, documented process flows, policies and procedures
  • Provided Helpdesk supports. Assisted with acceptance, installation and deployment.
  • Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
  • Developed current and ‘to be’ business processes and use case documents in compliance with HIPAA policies and procedures using MS Visio.
  • Worked with development and testing teams to accomplish timely release objectives.
  • Used detailed knowledge of application features and functions to assess the scope and impact of business needs throughout analysis.

Confidential, Lincoln, NE

Sr. Business Systems Analyst

Responsibilities:

  • Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
  • Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
  • Documented, identified, organized and tracked the requirements using Rational Requisite Pro.
  • Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
  • Defined project milestones, schedules, and monitored progress using MS-Project, creative pro office and modified, updated the project scheduled plans as required.
  • Analyzed and tested Data Interface needs.
  • Worked on System Change Request (SCR) sent by the clients to change the current work process and work methodology for some pre entered process using IBM Lotus Notes, Microsoft Access and Microsoft SharePoint.
  • Worked on IBM Mainframe dealing with different claim types, by adjusting, processing or entering new claims.
  • Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277
  • Worked on changes for HIPAA Transaction from version . Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
  • Got involved in designing future state processes forHIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
  • Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
  • Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
  • Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
  • Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
  • Worked on claim adjudication process with different clients applying different adjudication process and methodology.
  • Expertise in Logical Modeling, Physical Modeling, Dimensional Modeling, Star and Snow-Flake schema crosswalks.
  • Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
  • Maintained Requirement Traceability Matrix (RTM) and Utilized Clear Quest for change requests and defect tracking.
  • I also oversee the metadata schemas used in the department - which include METS, MODS, EAD, TEI, AMD, and MIX - and update as necessary.
  • Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
  • Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
  • Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, MS Share Point, MS Access, IBM Lotus Notes, IBM Main Frame, Rational RequisitePro, Star-Schema Modeling, Snowflake Modeling Schema crosswalk, Rational ClearQuest, Quality Center, SQL, FTP.

Confidential, Milwaukee, WI

Sr. Business Systems Analyst

Responsibilities:

  • Conducted formal interviews, Live Meetings and JAD sessions with business users and matter experts.
  • Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
  • Documented, identified, organized and tracked the requirements using Rational RequisitePro.
  • Created Data Flow Diagrams (DFDs), ER diagrams for data modeling and Web-page mock-ups using MS Visio for acceptance from end users.
  • Defined project milestones, schedules, and monitored progress using MS-Project, creative pro office and modified, updated the project scheduled plans as required.
  • Analyzed and tested Data Interface needs.
  • Conducted Asset Management, Risk Analysis of the Requirements and Traceability focus areas of the various projects and worked with the project team to help them identify the high-risk areas.
  • Worked extensively on both inbound and outbound transactions, creating test cases for multiple transaction types including 837, 835, 276, 277
  • Worked on changes for HIPAA Transaction from version .
  • Documented the detailed business as well as technical requirements to upgrade the current system to 5010 transactions.
  • Got involved in designing future state processes forHIPAA 5010 transaction processing EDI’s 837,835, 270, and 271.
  • Analyzed HIPAA 5010 related to 837,835, 270, and 271. Transactions and performed gap analysis between the 4010 and 5010.
  • Involved in Data Modeling of both Logical Design and Physical design of data warehouse and data marts in Star Schema and Snow Flake Schema methodology.
  • Intensive working on the current ICD code conversion from ICD 9 to ICD 10, assisting and leading various teams by complying with already going works in the health care domain and work with the conversion.
  • Gap Analysis: Analyzed the client’s applications programs to determine the impact of the HIPAA final rule on EDI Transaction Set and Code List implementation and defined the changes to bring the affected systems into HIPAA compliance.
  • Involved in jobs and analyzing scope of application, defining relationship within & between groups of data, Star Schema crosswalks etc
  • Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
  • Worked intensively on FACETS 4.6.1 for audit trails made on the used account and check and store information related to the HIPPA authorizations.
  • Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
  • Maintained Requirement Traceability Matrix (RTM) and Utilized ClearQuest for change requests and defect tracking.
  • Claim validation and Pend/Denied Claims Analysis for the Health plans Medicaid programs.
  • Worked closely with the technical team to look up for the best possible solution on requirements by keeping business needs and technical constraints in mind.
  • Updating, transferring and sharing Files using FTP between Windows and UNIX machines.

Environment: UML, MS Word, Rational RequisitePro, Rational ClearQuest, Quality Center, SQL, FTP, TelNet

Confidential, Hartford, CT

Business Systems Analyst

Responsibilities:

  • Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and the subject matter experts through meetings to understand needs of the system.
  • Completed a Business and Technical Requirement Document (BTRD).
  • Analyzed the laws and regulations (HIPAA, HL7) before implementing the electronic medical record software.
  • Developed current and ‘to be’ business processes and use case documents in compliance with HIPAA policies and procedures using MS Visio.
  • Involved with project management team in developing project plan.
  • Written business flow and work flow diagrams to develop software.
  • Involved in Blackbox testing using decision testing and use case testing.
  • Created Use case diagrams, Activity, Sequence and Collaboration diagrams using UML.
  • Defined Quality Assurance Checklist using Oracle Service Contract.
  • Coordinated with QA and user acceptance testing.
  • Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
  • Interacted with Subject Matter Experts (SME) and end users and established a business analysis around AGILE methodology.
  • Intensively involved in project testing efforts by doing Integration Testing, Regression Testing.
  • Dealt with HIPAA transactions.
  • Documented various key elements of HIPAA compliance and made sure that they are understood complied and followed by the development team members.
  • Worked on Application Change Request(ACR) by Creating HLR, DBR for the ACR and working with developer to develop the functionality, and working with UAT team for testing within the time and budget
  • Data mapping done using EDI Mercator team.
  • Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
  • Understood EMR capabilities, Created User manual, and provided one-on-one to end users.
  • Worked on ICD conversion from 9 to 10. Complete a review of existing documentation for orders, referrals, and reports and compare it to the clinical details needed for ICD-10
  • Performed General Equivalence Mapping (GEM) to assist in converting any ICD-9-CM-based application to ICD-10-CM/PCS. Involved with ICD10 implementation testing

Environment: Agile methodology, MS Visio, MS Project, UML, Win Runner, Microsoft Office, Microsoft Share point.

Confidential, St. Paul, MN

Systems Analyst

Responsibilities:

  • Worked on the MMIS (Medicaid Management Information Systems) for State government
  • Involved in Requirements Gathering from SMEs and Business Users like healthcare professionals.
  • Used JAR sessions, brainstorming, questionnaires, storyboarding techniques to derive ideas.
  • Used RUP methodology for the entire SDLC.
  • Researched on the medical disciplines and documented Business Requirement Document.(BRD)
  • Traced High level into Detailed Requirements in Functional Requirement Document (FRD).
  • Modeled functional requirements using UML and MS Visio to create Use Case Diagrams, Activity diagrams, Sequence Diagram and logical Class Diagram for interaction between the various actors and system and to supplicate the Workflow Models.
  • Analyzed SQL queries that validated and processed the patient data as entered by the nurses.
  • Cross-d the database through SQL for the reports that needed to be sent to doctor.
  • Implemented the ICD 9 codes for regulating Medical and Drug terminology.
  • Created Business Rules Document. Studied about the Claim components and HIPAA.
  • Incorporated HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12.
  • Conducting regular audits of EDI transactions to determine accuracy and areas for improvement and maintaining EDI maps and business rules for HIPAA validation software.
  • Managed requirements using tool Rational Requisite Pro for traceability and requirement relations.
  • Created screen prototypes using Power Point, HTML and CSS for RAD.
  • Carried out forward and backward tracing for verification and validation purposes.
  • Reviewed Functionality Test. Set up definitions and process for User Acceptance Test (UAT).
  • Prepared project reports for management and assisted project managers in the development of weekly and monthly status reports, documented process flows, policies and procedures.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
  • Responsible for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Responsible for Medicaid Claims Resolution/Reimbursement for peach state health plan using MMIS.
  • Developed materials and conducted sessions for the nurses.
  • Provided Helpdesk supports. Assisted with acceptance, installation and deployment.

Environment: Rational Requisite Pro, Rational Rose, Rational Clear Quest, Rational Test Manager, RUP, UML, SQL, MS Office, MS-Project, MS Visio

Confidential, St Louis, MO

Systems Analyst

Responsibilities:

  • Requirement gathering and preparation of business requirement documents (BRD).
  • Interaction and gathering of all the necessary information from various companies and necessary records to create and provide an error free software solution.
  • Responsible for translating BRD into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
  • Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
  • Conducted JAD sessions to define the project and to reduce the time frame required to complete deliverables.
  • Efficiently handled claims processing as well as enrollment, medical-management and workflow processes involved during and for the project given.
  • Developed and maintained all operational and technical flows using Visio and Power point.
  • Used Rational Rose/MS Office Suite for creating use cases, workflows and sequence diagrams according to UML methodology thus defining the Data Process Models.
  • Defined Use cases from requirements and helped convert them into software specifications
  • Helped in development and functioning in workflow analysis and process design.
  • Actively involved in Knowledge Transfer Phase.
  • Maintained Requirement Traceability Matrix (RTM).
  • Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation
  • Design, build and test maps to translate X.12 EDI to and from transaction formats such as EDIFACT, SAP IDOC, and other multiple formats
  • Analyze business requirements from Black Box testing:
  • Creation and maintenance of documents for change request and implemented procedures for testing changes.

Environment: Rational Rose, MS Office Suite, Oracle9i, Windows NT/XP, SAP, Business Objects, Java, J2EE, EJB2.0, JMS, Struts, Web Services, Tag Libraries, UML, CSS, MQ Series, WSAD, Web sphere 5.

Confidential, Jacksonville, FL

Systems Analyst

Responsibilities:

  • Prepared test cases/test scripts based on use cases, functional specs and requirements and design documents.
  • Extensive interactions with the client and the management teams to understand the requirements and report the status of the testing efforts on their applications.
  • Documented Test cases, test results, test procedure and reported to QA Manager and Developers.
  • Involved in Complete SDLC (Software Development Life Cycle).
  • Identified, researched, investigated, and documented business processes and Use Case Scenarios.
  • Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements
  • Assisted with user testing of systems (UAT), with developing and maintaining quality procedures, and with ensuring that appropriate documentation was in place.
  • Undertook responsibilities for identifying and documenting business rules and creating detailed Use Case and Conducted User Acceptance Testing.
  • Defining, Presenting and Documenting Test Plans and Test Strategies for each release of the application.
  • Worked with development and testing teams to accomplish timely release objectives.
  • Used detailed knowledge of application features and functions to assess the scope and impact of business needs throughout analysis.
  • Extensively worked, prepared and presented project documentations.
  • Extensively worked on Access, Excel, Word and PowerPoint.
  • Created the detailed test plan and test cases from the business requirements document and meetings with the business managers.
  • Involved in compatibility testing, integration testing and User Acceptance testing (UAT).
  • Determined test approaches for various testing strategies like Functional, System, Regression, UI, UAT, Usability testing, Alpha, Beta testing and executed using Win Runner.
  • Conducted data Driven tests in Win Runner by parameterization, worked with the data table, modified the script for data-driving, and wrote SQL statement in Script to retrieve data from database.
  • Regularly following up with Development Team to discuss discrepancies identified during testing and performance tuning.
  • Responsible for weekly status to show the Progress of the automation testing effort.

Environment: J2EE, Win Runner, Rational Clear Quest, Clear case, Web logic, SQL, UNIX, Microsoft Word, Microsoft Excel, Microsoft PowerPoint

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