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Sr. Business Analyst Resume



  • 7+ years of varied experience in Business Analysis across various domains including Health care, Medical Billing and Claims PROFESSIONAL Management
  • Domain expertise in Health care insurance and Claims Analysis and Management
  • Experienced in interacting with business users to identify their needs, gather requirements and author Business Requirement Documents (BRD) and, Functional Requirement Document (FRD).
  • Experience as a Data Analyst / ETL/ BA, with Progressive responsibilities in data analysis with focus on financial reporting, and Data warehouse (DW), business intelligence (BI).
  • Good working knowledge of HIPAA ICD10 and HIPAA transaction requirements.
  • Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, 837, 997, and NSF formats for interfaces and images to third part vendor applications.
  • Vast experience of working in the area of data management including data analysis, gap analysis and data mapping.
  • Strong understanding of medical coding and transition from ICD 9 ICD 10
  • Experience with claims process and adjudication in the Medicare, Medicaid and Private Insurance Sectors.
  • Adept at writing Data Mapping Documents, Data Transformation Rules and maintaining Data Dictionary.
  • Extensive experience in Data warehousing, creating Fact Tables, Dimension Tables, star and snowflake schema modeling.
  • Excellent experienced in data Extraction, Transformation and Loading (ETL)
  • Solid experience in Claims Processing 837 transactions and remittance 835 EDI files
  • Adept with different methodologies which include Agile, Waterfall and Rational Unified Process (RUP)
  • Well versed in Requirement Gathering through techniques such as JAD sessions, Interviews, Document analysis and Reviews
  • Expertise in documenting Non - functional requirements in a Traceability matrix (RTM), (Tracking and managing: that controls numerous artifacts produced by the teams across the deliverables for a project.
  • Use case Specifications, the complete System requirement specifications (SRS).
  • Experience in creating and running SQL queries.
  • Design and development of Use Cases, Activity Diagrams and Sequence Diagrams using UML
  • Experience in UML 2.0, MS Visio, Rational Rose, Rational Clear Case, Rational Requisite Pro, Rational Clear Quest, MS office Suite (MS Word, MS Excel, MS Visio, MS Project & MS SharePoint)
  • Involved in meetings for Test Planning, Test Preparation, Test Execution and Issue Resolution and Report Generation to ensure that all aspects of a Project are in Compliance with the Business Requirements
  • Reviewed Test plans to make sure all the requirements have been covered and corresponding test cases have been created


UML Tools: Rational Rose / Microsoft Visio

Rational Tools: Clear Case/ Clear Quest, Requisite Pro, SharePoint

Databases: Oracle, DB2, MS Access, SQL Server, Teradata

Methodology: Waterfall, RUP, SDLC, UML, Agile, JAD

Web Design: HTML, DHTML, XML

Front end tools: Microsoft Project, MS Visio, Informatica,Toad,Rally

MS Office Tools: MS Outlook, MS Word, Ms Excel, MS Access, MS PowerPoint

Operating Systems: Windows 98/2000/XP/Vista/7, Mac OSX


Confidential, Bloomfield

Sr. Business Analyst


  • Identify and document total data needs for strategic enterprise programs:. I worked closely with business stakeholders, portfolio project teams, and application SMEs to identify and document the total data needs of strategic programs for Enterprise Data Management processes
  • Develop business use cases, business and data requirements, and related documentation in support of Enterprise Data Management. I worked closely with business owners and stakeholders at multiple levels in the organization to understand, prioritize, synthesize, and document data needs for enterprise programs and MDM assets.
  • Understand and inventory the business processes and business decisions which are enabled by EDM
  • Provide data expertise: Partner with application SMEs to gain a deep understanding of source data as well as transformation, cleansing, or aggregation rules that impact MDM.
  • Acts as the liaison between business owners and IT:In addition to the partnership with business owners, also partner with other roles including Architects, Designers, Developers, and Testers to ensure enterprise data needs are met.
  • Worked closely with systems analysts to ensure functional specifications are properly accounting for business needs. Facilitated meetings, as necessary, to review captured business needs and obtain approvals.
  • Transferred knowledge to production support team and matrix partners - - provided documentation that can be referenced for cross-training and issue resolution.
  • Performed data Validation for Provider s with reference to business requirements and logic captured in STM (source to target Mapping) documents.
  • Maintain TDE(total data elements) and regularly update TDE with STM documents changes.
  • Maintaining the score card according to the data elements coming from different provider source

Confidential, NYC

Business Analyst


  • Gathered requirements from the Subject Matter Experts and documented the business requirements in the BRS and system requirements in SRS.
  • Participated in Stake holder discussions during initiation phase and assisted in preparing the preliminary scope statement.
  • Facilitated face to face, teleconference and web - conference meetings for requirement gathering and discussions.
  • Identified gaps in the business process and did extensive data mapping of EDI and paper claims for Executive Dashboard Reporting project.
  • Created Vitech workflows for Pension Application Process and Employer Inquiry Process in MS Visio and updated the Vitech specs.
  • Developed and designed Claims KPI matrix for discovering the performance and operational efficiency of claims adjudication process.
  • Acted as liaison between functional business units and application team managers to assist in defining objectives, requirements, functions, and priorities of applicable business system related projects.
  • Developed Requirements Traceability Matrix (RTM) to trace the relationship between business and functional requirements.
  • Developed and managed work plans, acted as the key client contact, handled scheduling, resource planning and allocation matters, ran status meetings and compiled various reports on the progress of the project.
  • Evaluated all the information gathered from multiple sources, reconciled conflicts, decomposed high-level information into details, abstracted up from low-level information to a more general understanding, distinguished user requests from the underlying true needs and distinguished solution ideas from requirements.
  • Coordinated and facilitated user acceptance testing (UAT). Reported and documented any issues occurred during UAT.

Confidential, San Jose, CA

Sr. Business Analyst


  • Assisted in identifying project scope, to conform to the regulatory compliance related to X12 837 (I/P) and 835.
  • Responsible for soliciting and eliciting requirements for conversions.
  • Carried out Risk Assessment, GAP analysis and Impact Analysis for the conversion project.
  • Involved in one - to-one interview sessions and JAD sessions with stakeholders, SME s and business owners to discuss the scope of the conversion.
  • Produced for transaction sets 835 and 837 (I/P) a full gap analysis 4010 vs. 5010 against the documented application 5010 enhancements ensuring the upgraded application included the required changes and additions for 5010 compliancy.
  • Involved in up-gradation of 4010 transaction to 5010 by conducting Impact Analysis and Risk Assessment and worked on the mitigation plan to avoid the risks.
  • Tracking and addressing the problems on timely manner encountered on Acknowledgement 997, Claim Status Inquiry/Response 276/277, Remittance Advice 835, Eligibility Inquiry/Response 270/271, and Prior Authorization 278 claims.
  • Worked as a liaison among stakeholders both business and IT side in order to elicit, analyze, communicate and validate requirements for changes to business processes.
  • Involved in creating Reports and Documents like Requirements Documents, and Management Plan, Issue/Alternatives documents, Project Summary and Plans with formats like PDF, HTML, Excel and Word.
  • Prepared UML diagrams (Activity diagrams, Sequence Diagrams, Use case diagrams) for Extensions.
  • Involved with reviewing defects reported from UAT efforts and analyzed for root cause and took actions based on the findings.
  • Identified the master file changes and builds needed to enable the 5010 format to be utilized.
  • Conducted Business Process (As Is/To Be) sessions with various department directors and staff to ensure the Testing Plan and Test Approach would meet the identified Business Requirements, and the Training Program covered all identified new and changed processes.
  • Gathered requirements for impacted system and business areas for ICD-10 and their needs to embrace the changes.

Environment: MS Visio, .NET, MS Office, MS Access, Mercury Quality Center, ARGUS, MedDRA,J2EE, HTML/XML

Confidential, Downers Grove, IL

Business/ Systems Analyst


  • Worked on analysis of the Facets claims processing application in order to gather requirements to comply with HIPAA 5010 requirements.
  • Analyzed HIPAA 4010 and HIPAA 5010 standards for 837P, 837I and 835 transactions and prepared gap analysis document for each transaction.
  • Utilized RUP methodology during the project life cycle and worked together with RUP mentors at the location.
  • Wrote high level and low level business requirements for the project.
  • Supported developers with creating database objects like Tables, Triggers, and Indexes using T - SQL Management Studio.
  • Analyzed the existing data model and provided suggestions and recommendations
  • Worked with the solution architect in order to understand the existing data model and modify the data model to accommodate the required 5010 changes.
  • Dealt with data mapping issues between various source systems and staging area and data marts
  • Worked with data mapping team to create data maps for data integration task i.e. transformations.
  • Utilized Mercator as an EDI mapping tool to map the claims data that passes through the EDI gateway to the Facets claims processing application.
  • Conducted meeting with the EDI team and other stakeholders team members to discuss the requirements
  • Responsible for transforming data from OLTP to OLAP data sources using SSIS.
  • Involved in meetings with product manager, project manager, onsite and offshore team members to resolve issues and roadblocks during the project.
  • Used Rational Requisite Pro for overall Requirements Management and to build the Requirements Traceability Matrix.
  • Involved in identifying the integration points within the organization as required for the project, involved in preparing test cases and UAT.
  • Provided business and technical suggestions and recommendations during the project life cycle.
  • Worked closely with the business team, development team and the quality assurance team to ensure that requirements are understood as intended in order to achieve the desired output.
  • Involved in performing several database tuning tasks and built reports using PL/SQL.
  • Extracted large volumes of data from legacy systems and uploaded into the Oracle database using SQL*Loader and PL/SQL.
  • Ran SQL queries to check the results of the involved database.

Environment: MS Visio, Excel, MS office, Rational Rose, Dreamweaver, Rational Unified Process (RUP), ETL, Agile, SQL Server, Informatica.

Confidential, Chicago, IL

Business Analyst


  • Obtained business requirements from business users and stakeholders using JAD sessions, brain storming sessions, focus groups and personal interviews to get a better understanding of the client s business process.
  • Worked with the business to document and develop formulas for the calculation of premiums and losses statistics in the marts (eg. Written Premium, Earned Premium, Unearned Premium)
  • Elicited, documented, modelled, validated and prioritized functional and non - functional requirements using interviews, data analysis, and different modelling tools.
  • Actively involved in preparing and writing the business requirement documents, functional requirement documents and data mapping documentation.
  • Performed in depth data analysis identifying data issues in legacy system and worked with business to develop resolutions to those issues.
  • Used MS Project for status reporting and planning.
  • Utilized MS Visio for designing Use Case Diagrams, Activity Diagrams and Sequence Diagrams, after accessing the status and scope of the project and understanding the business processes.
  • Analyzed the as-is and to-be state of the project and performed Gap analysis, Impact analysis and SWOT analysis.
  • Created data mapping documents for the movement of data from production databases to the warehouse and from the warehouse to the policy and claims marts.
  • Used the guidelines and artifacts of the SCRUM methodology for project implementation and development.
  • Assisted System Architects and Quality Assurance Analysts in creation of various tests.
  • Assured that all artifacts are in compliance with corporate SDLC policies and guidelines.
  • Assisted in deletion of defects and bugs, in order to meet specific requirements and deadlines for successful execution of the project.
  • Worked as an SME for identifying the scope of End-to-End testing with different teams
  • Coordinated UAT of the product with Business Users


Functional Analyst


  • Acted as liaison between Information Systems group and Business User group.
  • Conducted business requirements, functional and technical walk - through meetings.
  • Met with key business unit stakeholders to gather requirements and needs.
  • Coordinated with SME's to gather requirements and document Gaps in functionality.
  • Developed written requirements to clearly, define and detail the needs of the business unit. Requirements included screen design and process flow charts.
  • Created and updated use cases, use case diagrams and work flows.
  • I was Involved in the entire project life cycle from evaluation, installation, development, testing to production of end user reports.
  • Defined user and system requirements for existing and proposed system during existing system integration and new system development initiatives.
  • Worked with GUI team for designing the screens and assisted in developing mockup screens and prototyping of the user interface and usability testing.
  • Designed the System Flow, Data Flow diagrams, using these as the base to obtain requirements and wrote Use Cases.
  • Built catalog using Impromptu Administrator and created joins, custom folders for easy access and understanding.
  • Assisted the business unit and teammates with resolving production issues.
  • Used Flat Files at a very basic level for configuration of data storage.
  • Managed Portia report writing for trading and operations business units. Managed import and reconciliation of historical performance data.
  • Used MS SharePoint for the purpose of managing documents and for hosting websites which was used to access shared work spaces and documents.
  • Experienced in creating training materials, SOP and handling documentation.
  • Documented business processes and communicated potential business and systems impact based on analysis of the data.
  • Tasked with documenting, storing, and sharing the issues and documentation using Rational Clear Case.
  • Created Export Archives to deploy reports and packages from development to test environment.
  • Assisted QA Team in designing the Test Cases, and collecting the Test Metrics.
  • Documented functional and technical designs and user guides.

Environment: MS Office, MS Visio, MS Project, MS SharePoint, Rational Clear Case, UML, SQL, Rational Rose.

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