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Sr Business Analyst/edi Analyst Resume

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New York Ny, S


  • Qualified professional with 7+ years of extensive experience as a Business Analyst with solid understanding of Business Requirements Gathering, Data Warehousing, Evaluating Data Sources, Translating Requirements into Specifications and Application Design.
  • Highly skilled in Creating and Renovating Business Requirement Documents (BRD), Functional Specification Documents (FSD), and converting business requirement into Software Requirement Specifications (SRS) using MS Word and Rational Requisite Pro.
  • Extensive experience in working with different SDLC methodologies such as Agile, Waterfall, and Rational Unified Process (RUP).
  • Proficient in Requirements Elicitation Techniques - gathering and managing requirements, document analysis, conducting meetings and JAD sessions.
  • Expertise in UML (class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams) as a business analysis methodology for application functionality designs using IBM’s Rational Rose and Microsoft Visio.
  • Performed roles of Scrum Master following sprint sessions and used Rally software extensively to write User Stories, assign tasks to individual team members.
  • Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.
  • Good working knowledge of Claim Processing, HIPAA Regulations and EDI Transactions for health care industries such as 270/271(inquiry/response health care benefits), 276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim), 999(Functional Acknowledgment).
  • Worked extensively with 837I and 837P Transaction sets.
  • Solid experience in writing SQL Queries and executing them using TOAD and SQL editor.
  • Sound Knowledge in working with XML Format, reading XML files and using XMP parsing tools.
  • Used SOAP Webservice for sending files in XML format.
  • Used TOAD and SQL Developer to perform backend testing by writing SQL statements like Join, Inner Joins, Outer Joins and Self Joins.
  • Actively involved in developing, executing and managing User Acceptance Testing (UAT).
  • Good hands on experience in testing of inquiry screens to support EDI transactions.
  • Assisted Quality Assurance (QA) team in writing test plans, defining test cases, test scenario and data sets.
  • Extensively used HPALM, Rational Clear Quest and JIRA for Defect Logging and Tracking.
  • Team player and a self-starter with excellent communications skills, and interpersonal skills with exceptional ability to build productive relationships with colleagues, clients, and vendors across all functional and technical disciplines.
  • Ability to handle pressure and meet deadlines coordinating multiple tasks in project environment.


Documents & Processes: MS Projects, BRD, RTM, Use Cases, UML diagrams, UAT Test plans & cases, SharePoint

Programming Languages: C, C++, HTML, XML, SQL

Data Base: MS Access, Oracle (SQL Series), DB2

Tools Experience: JIRA, Rational Clear Quest, Quality Center/HPALM, MS VISIO, SQL Developer, TOAD, SOAP

Operating Systems: MS-DOS, Windows, Apple McIntosh, Linux

Software: MS Office Suite (Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage

Processes/Technologies: Rational Unified Process (RUP), Waterfall, Agile, UML & Microsoft Office SharePoint


Confidential, New York, NY S

Sr Business Analyst/EDI Analyst


  • Gathered Business Requirements from the Subject Matter Experts (SMEs) and documented the requirements in the BRD. Utilized data flow diagrams, user story/ use case diagrams and process flow diagrams to represent information provided by the Business Owners.
  • Involved in documenting changes to the Benefits Administration, Enrollment Processing and Claims Processing Systems based on the Medicare Plan Changes initiative.
  • Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS (Centers for Medicare and Medicaid Services) are met.
  • Worked with Business Owners of Market Prominence, the Enrollment Processing System, to ensure that the enrollment process for the new members is updated with changes.
  • Worked with the UAT and QA teams to conduct an assessment and determine how effective UAT and QA guidelines can help the company achieve timely completion of projects.
  • Worked with Business Owners of Quality Care, the Claims Adjudication Process, and documented updates and enhancements.
  • Professional working knowledge of X12 5010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
  • Effectively elaborated the current process and gave a clear picture of the proposed process for the projects in the organization. Worked aggressively towards timely completion of High Priority Tasks.
  • Vendors and Delegates - Worked with Business Owners and Relationship Managers for Vendors and Delegates, e.g. Davis Vision, Montefiore, HCP, to ensure that Eligibility and Membership File exchanged on daily and weekly basis is updated with the Medicare changes.
  • Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
  • Worked with Development Team to resolve issues and clarify Business Requirements from the Business Owners.
  • Documented the UAT Plan for the project and worked with the UAT Team to ensure every acceptance criteria for the requirements has been included in the UAT task plan.
  • Maintained the Traceability Matrix table to track the Business Requirements to the design to the testing keeping track of all requirements in the BRD.

Environment: QCARE, MS Access, ORACLE,MS Word, Excel, and PowerPoint.

Confidential, Bethesda, MD

System Analyst


  • 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.
  • Worked directly with software engineers to ensure clear communications on requirements and defect reports.
  • Used the guidelines and artifacts of the Rational Unified Process (RUP) to strategize the implementation of Rational Unified Process effort in different iterations and phases (Inception, Elaboration, Construction and Transition) of the Software Development Life Cycle.
  • Worked with the State of Maryland Medicaid office to oversee state task requests (STR) for enhancements to the Medicaid claims processing application.
  • Prepared the Prototype and mockup screens.
  • Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.
  • Responsible for Documentation in each phase of RUP Methodology, Risk Assessment, and Validation & Verification process. Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.
  • Analyzed and tested various Common Eligibility Outbound Interface Process and other Inbound/Outbound Facets interfaces.
  • Created Process Work Flows, Functional Specifications, and responsible for preparing Software Requirement Specifications (SRS), Functional Specification Document (FSD).
  • Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the proposed system.
  • Performed Defect Tracking and Change Control Procedures using Rational Clear Quest and Configuration Management and Version Control using Rational Clear Case.
  • Worked with the development team to make sure that they understood the user requirements and that the system developed met those requirements.
  • Followed the RUP methodology for the entire SDLC.
  • As a Business Analyst Trainee, prepared departmental reports, providing analytical framework related to the budget process
  • Assisted with the gathering Business Requirements based on the user requirements and specifications.
  • Worked with the technical and business staff to produce Test Scripts, Configuration and Management Plan documents.
  • Worked directly with developers, Project Managers and Business contacts to produce Data Flow Diagrams.
  • Followed established formats and procedures, created new formats, as well as researched, created, edited technical and business data documents.
  • Executed Budget/Measurement/Forecast processes, which provided accurate, timely and meaningful information to finance and line management.
  • Designed and executed performance and functional test scripts.
  • Worked with the Senior Business Analyst to develop test plan and test cases for (UAT).
  • Worked with the Project Manager on various Project Management activities like keeping track of Project Status, Deadlines, Environment Request, and Compliance Issues.

Environment: Windows, Rational Clear Quest, SQL, UML, Rational Clear Case, Microsoft office, Word, Excel, Power point.

Confidential, Marlton NJ

Sr. EDI/Business Analyst


  • Analyzed existing reports and defined business requirements and business process flows.
  • Conducted JAD sessions with PM, SMEs; facilitated interviews with end users and hospital administrators to collect business requirements
  • Built a business process model using Rational Rose and Visio.
  • Gather detailed business and technical requirements and participate in the definitions of business rules and data standards.
  • Facilitated SME interviews and assisted in identifying and analyzing the possible technical solutions.
  • The HIPAA component efforts included mapping and gap analysis of legacy claims formats, CMS 1500 and UB92 to 837P and 837 I.
  • Actively participated in load and extraction programs involving HIPPA 837 and proprietary format files and reports development.
  • Worked on converting ICD 9 to ICD 10 as per the HIPAA guidelines for new diagnosis coding system with help of GEMS.
  • Documented and coordinated activities related to the production of the Explanation of Benefits (EOB) document, a primary communication document.
  • Assisted DW data analyst in analyzing existing reports and identifying iteration metrics.
  • Performed requirement analysis, went through use cases according to the flow of patient data and rules of security sharing.
  • Conducted requirement sessions and successfully translated those requirements into Use Cases and GUI wireframes.
  • Documented business and system needs by preparing a variety of documents including Scope documents, Use Case Storyboards, GUI wireframes and Software Requirement Specifications.
  • Was responsible for Prior Authorization & Treatment Authorization Request forms.
  • Assisted in data mart design and prototyping.
  • Created test scripts for all the test cases in PL/SQL.
  • Wrote PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.
  • Assisted in mapping the requirements to the source systems, the DW and applicable data marts.
  • Assisted in designing and validating source target mappings and transformation logical data model required to support information requirements.
  • Assisted the project manager in preparing the project schedules, milestone tracking, resource allocation using Microsoft project.
  • Worked extensively with the QA team for designing Test Plan and Test Cases for the User Acceptance Testing.
  • Involved in manual testing and UAT with the development team and QA team.

Environment: Windows, MS Office suite, XML, Oracle Pl/SQL, MS Visio, RUP, Rational Rose, Rational Clear Quest, Rational Requisite Pro.

Confidential, Princeton, NJ

Business Analyst


  • Gathered Business Requirements, interacted with the Users, Designers and Developers, Project Manager and SMEs to get a better understanding of the Business Processes.
  • Used Rational Unified Process (RUP) as the Software Methodology.
  • Analyzed and optimized the process, Prepared Business Requirement Document (BRD) and then converted the business requirements into Functional Requirements Specification and Technical Specification using Rational Requisite pro.
  • Assisted in technology selection for the application, based on Cost-Effectiveness and Quality with an eye towards the future.
  • Working within a growing knowledge of X12 5010 HIPAA 837 I, P, D, 835, 834, 820, 270, 271, 276, 277, 278, EDI, Privacy, Security, and Medicaid.
  • Incorporated HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12.
  • Performed Feasibility, Adaptability and Risk Analysis to identify the business critical and high-risk areas of the application.
  • Communicated with design, development and test team using MS exchange Messaging and Defect Tracking System.
  • Participated in various testing related review meetings.
  • Used the Rational ClearQuest, to maintain and track the Stakeholders requested enhancements and changes.
  • Used Rational ClearCase, a Configuration Management tool to maintain different builds of the application with description about all changes and Versions.
  • Used MS Project to manage schedules, deadlines and resources and collaborate on the project.
  • Developed and implemented automated test scripts using Rational Robot.
  • Conducted regression testing and interacted with developers to resolve the issues.

Environment: Rational Rose, ClearCase, ClearQuest, Visio, MS Project, Visual Studio, SQL Server 2000.

Confidential, MO

Sr. Business Systems Analyst


  • Interacted with business heads to finalize the Business Requirements for the application.
  • Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
  • Used the requirement attributes (priority, effort, and risk) as the basis for negotiating the inclusion of the requirement, to manage the scope of the system efficiently.
  • Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
  • Successfully conducted JAD sessions, which helped synchronize the different stakeholders on their objectives and helped the developers to have a clear-cut picture of the project.
  • Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
  • Understand the As Is system and develop the To Be system concept and prepare the System Process Maps.
  • Managed changing requirements which included establishing a baseline, keeping track of the history, determining dependencies that are important to trace, tracing relationship between related requirements and maintaining version control.
  • Prepared and documented System Requirements and workflows for the Content Management Application tool.
  • Responsible for integrating with Facets. Designing test scripts for testing of Claims in Development, Integration and Production environment.
  • Checked Business Readiness and determined activities of flow.
  • Developed & executed several Optimized queries in SQL on this data.
  • Performed Unit Testing and User Acceptance Testing and documented detailed defects.
  • Wrote Procedure Manuals and was responsible for continuity preparedness.
  • Managed various tests, stored test information, reviewed and analyzed test results.
  • Conducted presentations of the Q/A test results with analysis to the stakeholders and users and documented modifications and requirements.
  • Helped in writing Training manuals and helped business with the Training on a one to one session.
  • Employed Rational Clear Quest for effective Change Management (Requirements Creep) and bug tracking during the testing lifecycle.

Environment: Requisite Pro, Rational Rose, Agile, PL/SQL, HTML, MS Office, MS Visio, EDI, UML.


Business Analyst


  • Interacted with stakeholders and gathered requirements as per the business needs.
  • Implemented RUP methodology for iterative and incremental development of the system.
  • Was involved in the planning of the RUP iterations and documenting of the artifacts throughout the various phases of the development process.
  • Conducted GAP analysis by understanding the AS-IS system and the TO-BE system requirements by having discussions with the SME's.
  • Created Process Flow Charts, Business Requirements Documents, Functional Specification Documents.
  • Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
  • Used UML to perform Use-Case analysis to capture the dynamic aspect of the application.
  • Ensured the accuracy and consistency of the data during the data loading process.
  • Developed State Diagrams, Activity diagrams and Class Diagrams in MS Visio using UML for various modules of the project.
  • Worked on Required Traceability Matrix (RTM) in Rational Requisite Pro for traceability of requirements through test cases.
  • Was involved in managing the Daily Standup meetings and ensured that quality standards were enforced as per the build-release schedule.
  • Developed Test Plan and Test cases based on the Use cases and Functional specifications and performed manual testing of the functionality of the application by inserting varying data on different test runs.
  • Developed Flowchart and process diagram using Microsoft Visio.
  • Was in regular contact with Business partners on the status of issues, action plans and timeframe for resolution throughout the development cycle.
  • Contributed in reviewing and editing of the test scripts.

Environment: Windows, MS Office (MS Word, MS Excel, MS PowerPoint, MS Visio), MS Access, MS Project, Rational Rose, SQL, Agile.

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