Business Analyst Resume Profile


  • 6 years experience in identifying business needs and determining solutions to business problems for complex software projects, including system development, business process modeling and solution design.
  • Proficient in Healthcare Domain projects such as ICD-10 Remediation. , ANSI X12 5010 and ANSI X12 4010 for EDI medical transactions like 837, 835, 270 eligibility inquiry , 271 eligibility response , 276 claim status , 277 claim status response , 820 enrollment , and 834 premium payments .
  • Elicit, Analyze, Create and Review of Business Requirement Documents BRDs , Functional Specification Documents FSDs , Use Case Documents, and Business Rules Spreadsheets BRS , Standard Operating Procedures SOPs using Rational Requisite Pro.
  • Interviewed SMEs and Stakeholders for business process modeling to create use cases, functional design specifications, activity diagrams, process flow diagrams and data flow diagrams using MS Visio.
  • Lead Role in UAT testing of the ICD 9 to ICD 10 codes including RTM Requirements Traceability Matrix creation, defect tracking and management responsibilities using Quality Center
  • Prepared Test Plans, Test Scenarios and Test Cases using SQL.
  • Experienced in Medicare Part A, B, C and D and Medicaid Benefit Design and regulatory policies.
  • Thorough understanding of CPT coding, HCFA-1500 and CMS-1500 claim forms and reimbursement forms.
  • Strong understanding of the project life cycle and SDLC methodologies including RUP, Waterfall and Agile.
  • Conducted JAD sessions and worked with users to gather requirements, analyzing them and subsequently using the Rational project and design tools to model the requirements.
  • Performed System testing, Regression testing and UAT for several claim types and test scenarios.
  • Used Rational ClearQuest for tracking and prioritizing defects.
  • Conducted feasibility studies, Impact Analysis and organized the software requirements in a structured way by using Rational RequisitePro to track development.
  • Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment.


Methodologies and Technologies

Agile, Waterfall, SDLC, RUP, UML, Microsoft Office Sharepoint 2007

Change Management Tools

Rational Clear Quest

Business Modeling Versioning Tools

MS VISIO, Rational Requisite Pro, Rational Rose

MS Office

MS Project, MS Word, MS Excel, MS PowerPoint, MS Access

Operating System

MS-DOS, Windows NT/98/2000/XP/7


MS Access, Oracle, MS SQL Server

Testing tools

Rational Clear Quest Test Manager, HP Quality Center, Quick Test Professional, LoadRunner, WinRunner, QTP Test Director



Lead Business Analyst ICD-10 Remediation


  • Interacted with stakeholders and SMEs to gain a better understanding of client business processes and gathered requirements for the provider web portal.
  • Performed Web Portal to downstream systems data mapping, interface requirements and testing.
  • Conducted formal interviews, Live Meetings and JAD sessions with business users and Subject Matter Experts SME's .
  • Documented, organized and tracked the requirements using Rational Requisite Pro.
  • Developed Requirement Traceability Matrix RTM to map BRD and UAT plan.
  • Developed UA Test Plan to guide end-users in testing the business processes on the application.
  • Entered Pre-Authorizations and Referrals in the system for validating ICD-9 and ICD-10 Diagnoses Codes.
  • Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using MS Viso.
  • Performed Web Portal to downstream systems data mapping, interface requirements and testing.
  • Worked on changes for HIPAA Transaction from version 4010 to 5010.
  • Propose strategies to implement HIPAA 4010 in the new MMIS system eventually move to HIPAA 5010.
  • Conducted Gap Analysis 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.
  • Participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
  • Incorporated and implemented all the HIPAA standards, Electronic Data Interchange EDI , transaction syntax like ANSI X12, ICD-9, ICD-10 coding.
  • Worked on different EDI scenarios for batch processing and ensured day-to-day EDI transmission, Reject tracking and Reconciliation.
  • Assisted with user testing of systems and maintained quality procedures and ensured appropriate documentation is in place.
  • Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests.
  • Designed use cases and sequence diagrams using Rational Rose.
  • Data mapping, logical data modeling, used SQL queries to filter data within the Oracle and Sybase.

Environment: Rational Rose, Rational Requisite Pro, UML, MS Project, MS Visio, MS Office Suite, , SQL, Test Director,


Sr. Business Analyst


  • Involved in Business Analysis for Inbound and Outbound Transactions.
  • Provided day-to-day EDI translator support.
  • Performed gap analysis between partner specs and internal system requirements by matching HIPAA 4010 to 5010 implementation techniques.
  • Tested HIPAA Transactions and Code Sets Standards such as 837/835, 270/271, 276/277 transactions.
  • Ensured the following EDI medical transactions 837 Claims and Encounters , 834 Benefit Enrollment and Maintenance 835 Claim Payment/Advice , 270/271 Eligibility Benefit Inquiry and Response , 277/275 Claim Request for additional Information and Response , 276/277 Claim Status Request / Response followed HIPPA guidelines.
  • Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.
  • Monitored revenue cycle process and implemented ICD 9 ICD-10 mapping and crosswalk analysis.
  • Converted X12 data to XML using DI and verify the data by performing schema validations.
  • Created Use Case Diagrams and Test Cases for federal employee program.
  • Gathered and documented doctor company's business requirements and developed, entered and verified test cases.
  • Rendered X12 Syntax Integrated Testing, Balancing Testing, Code Testing, Specialty Testing and Trading Partner Specific Testing when environment is upgraded.
  • Performed re-testing in order to verify resolution of defects.
  • Collaborated with project team, project leads, and project managers and fostered with them to review plans, systems testing and overall testing of software.
  • Provided support during the integration and UAT.

Environment: NPS, EDIFECS, Requisite Pro, Rational Rose, Clear Case MS Office, MS-Visio, XML, Java, TOAD, Quality Center, MS Project


Sr. Business Analyst


  • Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.
  • Responsible for writing Functional Requirement Specifications FRS and User Requirement Specification URS .
  • Analyzed Business Requirements and segregated them into high level and low level Use Cases, Activity Diagrams / State Chart Diagrams using Rational Rose according to UML methodology thus defining the Data Process Models.
  • Designed a claim processing system for the healthcare management client system. It allowed the user to inexpensively capture information regarding patient, summary of medical history, symptoms ICD-9 codes , and treatment CPT .
  • 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. It also assisted in identify the business and further guidelines of HIPAA.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 270, 271, 834, 835, and 837.
  • Identify Member, Provider, Coverage, Medicare, and Medicaid.
  • Defined Functional Test Cases, documented, executed test script in Facets system.
  • Coordinating and Developing QA activities.
  • Assigned tasks among development team, monitored and tracked progress of project following Agile methodology.
  • Created Process Flow diagrams, Use Case Diagrams using Microsoft Visio and Rational Rose.
  • Wrote Test Cases and performed User Acceptance Testing, documented the in detail defects using the Defect Tracking report.
  • Used Test Case distribution and development reports to track the progress of test case planning, implementation and execution results.
  • Created Use cases, activity report, logical components and deployment views to extract business process flows and workflows involved in the project. Carried out defect tracking using Clear Quest.
  • Maintained proper communication with the developers ensuring that the modifications and requirements were addressed and also monitored these revisions.
  • Involved in compatibility testing with other software programs, hardware, Operating systems and network environments.

Environment: Requisite Pro, Rational Rose, Agile, HL7Interfaces, PL/SQL, HTML, MS Office, MS Visio, EDI, Rational Clear Quest, UML,RUP, Microsoft Excel, Microsoft Word,


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 such as Waterfall.
  • Conducted Data Mapping to ensure that the data was flowing between the interfaces.
  • Managed changing requirements that 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.
  • Responsible for integration of data. Designing Test Scripts for testing of Claims in Development, Integration and production environment.
  • 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.
  • Wrote Training manuals and helped business with the Training.
  • Employed Rational Clear Quest for effective Change Management and bug tracking during the testing lifecycle.


Rational Rose and Requisite Pro, MS Visio, MS Project, UML, XML, Rational Clear Quest, Rational Clear Case, RUP, Microsoft Excel, Microsoft Word, Microsoft Power Point.

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