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Business Systems Analyst Resume

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Baton Rouge, LA

SUMMARY

  • Facilitator between Business Systems and Information Technology with over 7+ years of extensive Business Analyst skills - Understanding of Software Development Life Cycle (SDLC), Rational Unified Process (RUP), Agile/Scrum methodology, Unified Modeling Language (UML), Object Oriented Analysis and Design Concepts (OOAD), Business Process Re-engineering (BPR), Test Lifecycle, Data Modeling.
  • Extensive experience in writing Business Requirements Documents (BRD), System Requirement Document (SRD), Use Case Specifications, Functional Specifications, Technical Specifications across the Deliverables of a project.
  • Understanding of pharmacy benefit management.
  • Good experience in Relationship Database Management System (RDBM).
  • Experience in handling Change Management and Release Management.
  • Extensive Experience in UML and Process modeling using Use Case Diagrams, Activity Diagrams and Sequence Diagrams.
  • Good experience in conducting Joint Application Development (JAD) sessions through interviews and workshops with subject matter experts and business users.
  • Good experience with Rational Rose, Rational Requite Pro, Rational Clear Quest, Rational Clear Case, MS Project, MS Visio, Crystal Reports.
  • Experienced in conducting GAP analysis, User Acceptance Testing (UAT), Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
  • Well versed with Medicaid Management Information Systems (MMIS), National Provider Identification (NPI) and familiar with Patient Protection and Affordable Care Act (PPACA).
  • Experienced in various MS Windows platforms, OS, Office Suite, etc.
  • Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD9-ICD10.
  • Extensive knowledge of Medical Management Information Systems (MMIS), Medicaid, Medicare, Procedural and Diagnostic codes and Claims Process
  • Strong knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), Implementation and knowledge of HIPAA code sets, ICD-9, ICD-10 coding, HL7, HMO, PPO.
  • Presented several documents and Use Cases for multiple transactions and worked with ANSI X12 5010 and ANSI X12 4010 including the standards for medical transactions like 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 membership eligibility, billing experience within life and disability in health plans. Excellent knowledge of HIPAA standards, EDI (Electronic data interchange), transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
  • Experience with Business Process Management.
  • A motivated, committed, quick learning, detail-oriented team player with good communication, analytical, leadership, interpersonal and problem solving skills.

TECHNICAL SKILLS

Operating Systems: Windows, UNIX, LINUX, Mac

Languages: SQL, C, C++, Java, XML, C#, VB, ASP, .Net, Assembly, VHDL

Databases: Oracle, MS SQL server, MS Access, IBM DB2

Tools: MS Office: Word, Excel, Access, Power point, Project, Visio, Front Office, Rational Rose, SoDA, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clear Quest,, Web Sphere, Business Modeler, HP Quality Centre, Ultra Edit, TOAD.

Industry Standards: HIPAA, SOX, ISO, Six Sigma, CMM

PROFESSIONAL EXPERIENCE

Confidential, Baton Rouge, LA

Business Systems Analyst

Responsibilities:

  • Gathered requirements by conducting meetings and brainstorming sessions with end users and Subject Matter Experts (SMEs) and documented them using Requisite Pro.
  • Prepared Business Requirement Documents (BRDs) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Gathered requirements and modeled the data warehouse and the underlying transactional database.
  • Performed Gap Analysis of the processes to identify and validate requirements.
  • Identified/documented data sources and transformation rules required populating and maintaining data warehouse content.
  • Make changes for HIPAA 277, 278, 835, 837 may also be receiving an (ORU) HL7 message.
  • Defined and analyzed test cases, test scripts, bugs, interacted with QA/ development teams in fixing errors and conducted User Acceptance Test (UAT).
  • Organized requirements into High level Use Cases and Low level Use Case Specifications and modeled them into UC, Activity and Sequence Diagrams using Rational Rose and MS Visio.
  • Created Business requirement document (BRD), Functional Requirement Specification (FRS), Technical Requirement Specification for application development following the Agile methodology.
  • Apply UML notations and methodology in developing models that accurately represent the business process and workflows and clearly communicate them to the stakeholders.
  • Conducted JAD sessions involving the management, development and user teams for clarifying requirements and facilitating better communication.
  • Analyzed the laws and regulations (HIPAA, HL7) before implementing the electronic medical record software
  • Involved in data modeling process for designing the data warehouse.
  • Analyzed and prepared Risk Analysis and Impact Analysis reports.
  • Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements, allowing sufficient time frame to ensure accuracy and consider deadlines
  • Reviewed Test Plans developed by the testing team for testing the application.
  • Assisted the QA personnel in the creation of Test Cases using Rational Test Manager.
  • Involved in performing version control and defect tracking activities using Rational Clear Case and Rational Clear Quest.

Environment: UML, MS Visio, MS Project, Ms Office, C++, Java, SQL, RDBMS, XML, Windows

Confidential, Buffalo, NY

Sr. Business Analyst

Responsibilities:

  • Gathered requirements from stakeholders for provider management and member management.
  • Identified and validated business rules and data elements.
  • Propose strategies to implement HIPAA 4010 in the new Medicaid (MMIS) system & eventually move to HIPAA 5010.
  • Created 837(P, I, D) claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837(P, I, D), 835, 270/271, 276/277 and 278.
  • Modeled the ‘as-is’ process flow and the ‘to-be’ process flow and analyzed the gap and developed the action steps to fill the gaps.
  • Analyze EDI - X12 data elements captured by the existing system to validate it against the data elements required for new system.
  • Worked with legacy team in developing BRD for multiple system change requests and participated in system testing.
  • Worked within project team to identify and interpret state Medicaid policies as applicable to customer defined algorithm research as well as assist with internal development of new healthcare analytics.
  • Conducted Impact analysis when there is any change in the requirements and updated the Business Requirements Document (BRD) and Systems Requirements Specification (SRS).
  • Facilitated meetings with the technical team and client team to analyze the current process and gather requirements for the proposed process.
  • Created functional requirement specification documents such as UML diagram, use case diagram, scenarios, activity diagrams and mapping.
  • Developed the User Interface (UI) prototypes to capture and validate requirements and spike solutions to the current problem.
  • Analyzed requirements for developing a cross-walk for understanding major changes fromICD-9toICD-10 with the help of SME’s.
  • Facilitated JAD sessions for Requirement Validation with Dept. of Cleveland clinic to gather requirements for the new MMIS.
  • Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
  • Examine the system design deliverables & validating it against the SLA.
  • Developed UAT test cases associated with the functional requirements.

Environment: MS Office, Windows, .NET, Agile, MS Visio, MS SharePoint, TFS, MS Project, MS Visio, SQL, Oracle, SOA, HTML.

Confidential, Little Rock, AR

Business Analyst

Responsibilities:

  • Requirements gathering from various insurance companies to develop a system to check for the outstanding balance from various accounts using highly efficient RUP process of software development.
  • Liaison between the Business needs (business users and sponsor) and the Technical solutions (development and testing staff), ensuring technical solutions satisfied business requirements.
  • Web Page Mock-Ups using MS Visio and thus defining the Business Process Model and Data Process Model.
  • Experienced in RUP software development cycle methodology with four consecutive phases - Inception, Elaboration, Construction and Transition.
  • Ensured that the claims processing is strictly under the HIPAA compliance regulatory document to safe guard patient information.
  • Authored Business and Functional requirements with supporting diagram, use cases, traceability matrices, and training manuals for Provider Portal web-based application.
  • Developed training material and trained the users on newly developed application.
  • Analyzed and wrote technical documentation for risk analysis on customer support issues.
  • Part of the team assisting in documentation involved in this project such as RFP, proposal, evaluation criteria, proposal approval, design document, project plan, project scheduling, project report, release document.
  • Prepared and presented monthly collection reports.
  • Involved in training and quality of the overall workflow process.
  • Documenting workflow and results of analysis for the aging accounts.

Environment: RUP, Rational Requisite Pro, UML Use Cases, VB.NET, SQL Server, Rational Rose, XML, Use Case Documentation.

Confidential, Nashville, TN

Business Analyst

Responsibilities:

  • Gathered Requirements from various Business Areas like Claims, Provider Relations, Enrollment, Finance and Benefits Administration for their updates to the Claim Processing Engine.
  • Developed Use Cases using MS Visio, and a detailed project plan with emphasis on deliverables.
  • Monitored Change Requests and documented requirements, integrating them with Use Cases.
  • Developed and Implemented Test Strategies using the Test Director.
  • Assisted QA team in testing phase by creating Test Plans and Test Cases documents.
  • Followed the RUP methodology for the entire Software Development Cycles.
  • Assisted the development team during the second and third iteration using the RUP model.
  • Checked the data flow through the front end to backend and used SQL queries to extract the data from the database.
  • Involved in project planning, coordination and implemented QA methodology.
  • Developed the Requirements Traceability Matrix, prioritized and determined Impact of all applications.
  • Identified the all applications and interviewed the application owners to recommend the process improvements.
  • Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
  • Defect Tracking and Bug Reporting was performed.

Environment: Oracle, SQL, PL/SQL, ASP.NET, Rational Requisite Pro, Microsoft Visio, HTML.

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