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Sr. Business Analyst & Edi Project Coordinator Resume

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Chicago, IL


  • Over 9 years of extensive experience as a Business Analyst and EDI Analyst with strong experience in Healthcare Claims and Benefit Enrollment Process and Maintenance.
  • Experiences working with HIPAA ANSI X12 both 4010 and 5010 Versions.
  • Excellent understanding of ICD 9, ICD 10, CPT.
  • Solid Functional experience in health Care Industry with vast knowledge on Medicare and Medicaid, Claims/Billing, EDI transactions.
  • Medical Claims experience in Process Documentation, Analysis and Implementation in HL7, EDI X12, 835, 837, 271, 277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
  • Expertise in impact analysis on the key application systems (claims processing, reporting, payments) and business process of health insurance companies.
  • Knowledge on RCM (Revenue cycle management) and Revenue Cycle.
  • Extensive experience in Healthcare/Claimsadjudication with knowledge of industry compliance standards like HIPAA and HL7, EDI X12 transactions (834, 837, 835, 270/271, 276/277).
  • Experience with QNXT 3.4, QNXT 4.6, Facets 4.71, Inbound & Outbound interfaces, EDI configuration, and data mapping using ANSI X12 4010 and 4,835,837).
  • Exceptional ability to maintain and build client relationships with business owners to identify, prioritize and document business requirements.
  • Proficient in all phases of Requirement Management, including gathering, analyzing, detailing, and tracking requirements.
  • Expertise in creating prototypes and mock - ups for user interface designs.
  • Specialized in creating UML Diagrams like Use Case, Activity and data flow diagrams using Rational Rose and MS-Visio and consistently translate business requirement into IT solutions.
  • Expertise in RDBMS concepts and running SQL queries.
  • In-depth knowledge and experience in full SDLC with RUP, agile and waterfall methodologies.
  • Created Business and functional requirement documents for the conversion process.
  • Designed and developed scenarios based on business requirements.
  • Familiar with QA, QC, JAVA AND JIRA.
  • Involved in Functional System Testing, Integration Testing, Regression Testing, and UAT
  • Involved in project status meetings, QA review meeting, and System Test meeting.
  • Experience analyzing environments with multiple data sources and capture necessary data requirement
  • Extensive experience in claims adjudication with a solid understanding ofBusiness Processes Flows, BusinessAnalysis, Requirement Analysis and Business Modeling and Use Case development using UML methodology.


Modeling Tools: MS Visio, Rational Rose

Methodology: Agile, Waterfall.

Testing: Quality Center, Test Director, win runner.

Programming Languages: C++, Java, JIRA, XML, HTM

Platforms: Windows, NT/95/98/2000/XP/Vista/Window 7. Linux

Industry Standard: HIPAA, ISO, HL7.MS word, MS Excel, MS Access, MS Power point, MS Outlook, Adobe


Confidential, Chicago,IL

Sr. Business Analyst & EDI Project Coordinator


  • Gathered Requirements and created process flows for Premium Payments (Billing) and Member Services.
  • Performed Gap Analysis for Marketplace in regards with the Medicaid system in place.
  • Participated and facilitated JAD sessions to enhance requirements and create use cases and test cases.
  • Worked alongside Enrollment team to structure the premium payments based on the federal and state guidelines.
  • Performed Federal regulation sweepsand identified impacted areas and interdependencies.
  • Designed and documented Business Requirements (BRD) by using ASCI X12 EDIguides, reviewed and interviewed business process owners and companion guides.
  • Developed plan for data feeds and data mappings for integration between various systems, including XML, to followICD 10Code set andANSI X12 5010formats.
  • Involved in Processing QNXT 837, FACETSHealthcare Claims (Institutional and Professional) in PORTAL with valid TPI.
  • Involved in testing QNXT Member, Provider, Claims Processing, Utilization Management, Accumulators, Contracts and Benefits.
  • Great knowledge of EDI (Electronic data interchange), 834 and 837.
  • Worked through Agile framework with Iterative process and sprint cycles.
  • Identified various call types for member services based on the call volume for Medicaid system in place.(ID card request, Benefit clarification,PCP change, network adequacy and others).
  • Identified and created SOPs and training necessities for the CSRs.
  • Tested the HIPPA EDI 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data on different modules.
  • Worked on team support RCM (Revenue cycle management).
  • Created Inbound and Outbound call scripts for Member Services.
  • Creating a Work breakdown document (WBD) to identify specific tasks for the call center operations of the Marketplace project along with the management team.
  • Responsible for conducting and analyzing the impact analysis of the conversion from ICD-9 to ICD-10.
  • Good knowledge of HCPCS/CPT coding formats and modifiers.

Confidential, Phoenix AZ

Sr. Business Analyst


  • Gathered clinical data to perform workflow analysis and create system design
  • Designed and built Smart Sets, Smart Texts, Smart Lists, Preference Lists, Built Smart Phrases with embedded Smart Links
  • Created various labs/medication workflow rules, Content built/support charting tools for end users
  • Configured and maintained Epic model Securities, Profiles, Roles, created EMP and SER records
  • Troubleshoot daily PRD issues, in basket, charts and profiles
  • Used the Dark/Text side to build and maintain Profiles, roles, security, message types, reports, print groups
  • Worked with Chart review, results, encounters, programming points. etc.
  • Participate in multiple end user acceptance Testings’ and provided support for end users
  • Worked on XML / XSLT code writing and XML parsing.
  • Analyze, configure and test workflow engine rules
  • Assisted in the workflow analysis process to tailor functionality to departmental needs
  • Experienced with configuring Edifecs Map Builder, and worked on trouble shooting XEngine.
  • Worked with Edifecs (v 6.0 and higher) configuration
  • Ensure proper work flows through dress rehearsals and validation sessions
  • Lead and participated in continuous improvement initiatives and championed the effective implementation of process improvements.
  • Participated with all phases of implementation, workflow, curriculums and lesson plan development; practice scenarios, and testing.
  • Managing the development of a test plan
  • Involved in Regression Testing
  • Lead effort in writing and/or reviewing test scripts, identifying scenarios and executing test scripts, escalating issues to team leads and/or Manager
  • Provide application test support to the teams during unit, super user and systems integration testing
  • Provided system building in training environment
  • Set-up User Security Classifications and User Roles for “Go-Live”
  • Built Preference List, Smart Text, Letters with imbedded text and any Heat Ticket request from the end-users.


Business Analyst 


  • Presented clear and concise EPIC functionality:
  • Creating EMP and SER records, Navigator usage, Orders and Order sets, Smart list, Smart sets and Smart phrase usage, flow sheet functionality/ CPOE, Troubleshooting workflow problems
  • Participated in integrated system testing as assigned/ performed multi-level testing with responsibility for analysis of results and resolution of problems
  • Developed detailed procedural materials for users and operations to support effective use of the EPIC application
  • Was responsible for observing department workflow and data collection from the department to prepare for Ambulatory go-live
  • Creating detailed requirements from a Developer perspective, low level design at the component level for different healthcare HIPAA transactions
  • Was responsible for conducting system demonstrations for end-users and aid trainers during User training
  • Collaborated with user departments to ensure projects and requests are prioritized and completed in a timely and satisfactory manner
  • Participated in conducting Order transmittal mapping to ensure smooth work flow and efficient delivery
  • Assisted physicians and nurses in workflows and showed them how to use Smart Phrases, Smart Lists & SmartText,
  • Document Patient information, Placing orders, Entering back office Results, Telephone Encounters Using and building Smart Sets,
  • Managing Encounters, Smart links and Med Sig Smart Phrases / Trained the trainer sessions/ Troubleshooting workflow problems. Participated in Epic Ambulatory Go-Live
  • Educated and assisted the physicians on how to document encounters, manage their In-basket, orders, preference list and efficient use of Smart sets, and close encounters
  • Assisted Clinician on how to document orders results
  • Assisted cadence users to do the scheduling
  • Assisted floor super users on issue resolution such as adding more activities to their Navigator and sending ticket to the commander center
  • Lead effort in writing and/or reviewing test scripts, identifying scenarios and executing test scripts, escalating issues to team leads and/or Manager
  • Provide application test support to the teams during unit, super user and systems integration testing
  • Supported Physicians and Nurses during implementation and go-live
  • Elbow to elbow support of Physicians during their rounding time, provided guidance in resolving issues with Orders and procedure.
  • Assisted Physician and Nursing staff with patient list creation, unit support in entering vitals, review CPOE, Order and “Order set” functionality
  • One on one Physician support, escalated issues to analyst, assisted Patient vitals/ Smart set functionality support.

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