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Sr. Business Analyst - Track Lead Resume

Plano, TX


  • Over 8 years of IT experience as a Senior Business Analyst with good understanding of business requirements elicitation, analysis, quality assurance and project management.
  • Experience in all phases of the Software Development Life Cycle (SDLC) including requirements gathering, analysis, design, implementation, testing and deployment as well as software engineering methods like Rational Unified Process (RUP), RAD, Waterfall, and Agile.
  • Excellent Knowledge in Electronic Medical Record (EMR)/Electronic Health Records (EHR) modules and process flow and Business Processes - Claims, Care management, Utilization Management, Provider network, Membership and Eligibility.
  • Successfully used Agile/Scrum Method for gathering requirements and facilitated user stories workshop.
  • Working closely with the scrum teams and larger organization on how to get the most out of Agile/Scrum practices
  • Documented Claims processing lifecycle and got good exposure of X12 837, 270 transactions for HIPAA 4010& 5010.
  • Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277.
  • Used Agile-testing methodology for achieving deadlines in UAT.
  • Extensive experience in the Medical Management, care management and Hospital based applications.
  • Knowledge of SDLC (Software Development Life Cycle) including Agile, Waterfall.
  • 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 HL7, HMO, PPO.
  • 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.
  • Expert in tuning the performance of SQL queries and ETL process.
  • Well versed in testing Enrolment, Billing and claims processing in FACETS.
  • Involved in testing Member, provider, Claims Processing and Utilization Management, Contracts and Benefits modules.
  • Strong healthcare system testing experience
  • Knowledge of PBM / Rx claims and associated data requirements
  • Experience in data mining, mapping and manipulation of healthcare data
  • Extensive experience in creating Business Requirement Documents (BRD), Use Cases, Software Requirements Specifications (SRS), Functional Requirements Specification (FRS), Project Plans, Requirements Traceability Matrix (RTM) throughout the Life Cycle of the project.
  • Implementation of the Rational Unified Process (RUP) in all four phases of a project: Inception, Elaboration, Construction and Transition. Expertise in requirements gathering using Water fall and agile methodology, root cause analysis, creating workflows, process map, activity flows.
  • Complete understanding of the AS-IS and TO-BE business processes and experience in converting these requirements into technical specifications for preparing test plans
  • Participate in the full lifecycle for multiple Data Mapping data project analysis, design, documentation, development and testing.
  • Managed meeting sessions with the SMEs to review business requirements.
  • Developed Use Case UML modelling using modelling tools like Rational Rose/MS Visio
  • Experience and skilled in creating and analysing Data flow diagrams, Entity Relationship diagrams, and Logical Data Flow Diagrams


Confidential, Plano, TX

Sr. Business Analyst - Track Lead


  • Conduct discovery sessions (requirement gathering session) with the SMEs, PSM/SREteam and the business team.
  • Creates detailed Business Discovery Design document with the data flow diagrams
  • Identify actors and use cases forDesign document using Protegrity data protection solution from the requirements and prepared future state diagrams, Business Process Flow, Activity Diagrams and Work Flow Diagrams to understand the interaction between actor and the system using MS Visio.
  • Walk through the document with the application team, business team and the Data protection engineering leadership.
  • Actively participating in Product Backlog/Refinement meeting, Sprint planning, Daily Scrum, Sprint review and Sprint retrospective meetings.
  • Taking ownership and apply time management skills to adhere to project timeline and deliverables.
  • Creates user stories and task on the Azure dev ops.
  • Utilize MS OneNote to update meeting notes and provide weekly status report to PM.
  • Utilize Power-point template to provide weekly project status report to POD director.
  • Collaborate with teams using MS Teams and Sharepoint services.

Confidential, Scranton, PA

Sr. Business Analyst


  • Created User Stories, UML Diagrams and Data Flow Diagrams to determine the data flow via various Systems.
  • Actively participated in Product Backlog/Refinement meeting, Sprint planning, Daily Scrum, Sprint review and Sprint retrospective meetings.
  • Elicited requirements, created As-Is and To-Be process, Cost Benefit analysis, Risk assessment and SWOT analysis for the project.
  • Worked on adding functionalities for payment processing system which allowed users to process payments to selected payees
  • Accomplished projects and design documents on HIPAA 835 and 837 calculations and EDI transactions, Health Statements and Explanation of Benefits, Healthcare Reform and 5010 CMS occurrence and field expansion for 835 and 837 EDI formats
  • Worked with UtilizationManagement,CareManagementwork stream to help Development, and Quality Assurance team to produce business efficient product by providing Product design and business understanding.
  • Facilitated Joint Application Development (JAD) sessions to focus on definingCareManagementand UtilizationManagementRequirements of the portal.
  • Worked with configuring the Business rules to automate many tasks associated with thecaremanagement, UtilizationManagementincluding auto referrals and auto generating education materials.
  • Identified actors and use cases forCaremanagementand utilizationmanagementfrom the requirements and prepared Use Cases Diagrams, Business Process Flow, Activity Diagrams and Work Flow Diagrams to understand the interaction between actor and the system using MS Visio.
  • Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set.
  • Involved in testing Member, provider, Claims Processing and Utilization Management, Contracts and Benefits modules.
  • Coordinated the upgrade of EDI Transaction Sets 837, 835 and 834 to HIPAA compliance.
  • Work on EDI 834-file load in Facets through MMS (Membership maintenance sub-system).
  • Experienced in software development life cycle such as Waterfall, Agile-SCRUM methodologies, Business Analysis and Modelling.
  • Updated Current internal systems to integrate New data and functionalities of the payment arrangement system.
  • Worked on securing all patient data that was exchanged within systems and made sure the exchanges fell within HIPAA guidelines and mandates.
  • Assisted QA team by reviewing Test plan and Test cases and clarifying requirements to ensure complete coverage of requirements

Confidential, Champaign, IL

Business Analyst


  • Attending various meetings such as project discovery session, review session, project health meeting, sprint meeting, daily scrum, CRB (Change Review Board) meetings, etc.
  • Preparing and updating IA (Interface Agreement) for the clients and working with operations team to review the requirements captured.
  • Working with the Project Manager, CME (Client Management Executive), ASM (Account Services Management), and business owner to document the business requirement.
  • Maintaining project’s timeline based on the requested release date along with next sprint release.
  • Prototype recommendations to facilitate meetings to derive business decisions for configuration.
  • Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
  • Designed and documented, code & test Facets Medical Plan, Product, Provider, Pricing, Subscriber/member, Claims, Utilization Management, Finance, Billing, Accounting, Customer service, workflow, security, etc. Application configurations to support new and existing business requirements for migration projects, new implementation and current production.
  • Extensive knowledge of the Managed care management process.
  • Worked on claim processing used EDI 837, 835 transaction set to process claims in Care Management System Audit project. Used EDI 835 transaction set to repay the over payments made by providers.
  • Responsible for validating the work performed within the various areas of the Configuration team
  • Involved in all SDLC stages under Agile process requirement analysis, implementation, testing (functional and use acceptance) and deployment.
  • Engaged on the loading EDI 834-file to Facets through Membership module.
  • Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837
  • Expertise in EDI files transferred to Trading Partners in HIPAA 5010 standards
  • Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837
  • Expertise in EDI files transferred to Trading Partners in HIPAA 5010 standards
  • Preparing and maintaining business requirements and/or functional requirements, identifying current client state, future state and changes required to address changing business needs.
  • Interface with external clients and internal programming staff to ensure requirements meet all parties’ needs.
  • Working with technical staff to ensure requirements will be incorporated into system design and testing.
  • Taking ownership and apply time management skills to adhere to project timeline and deliverables.

Confidential, Aurora, IL

Business Analyst


  • Gathered business requirements by driving user-group meetings and working with various global, cross-functional and virtual teams.
  • Prepared project deliverables through business workflow analysis, process analysis, user requirement documents (Use Cases & Use case diagrams) and managed the requirements.
  • Documenting artifacts including, but not limited to, Functional Specifications, and the Use Case Specifications.
  • Analysed HIPAA 4010 and 5010 standards for 837I/P and 835 EDI X12 transactions, related to providers, payers, subscribers and other related entities
  • Experience in configuration ofclaims processing applications, claim adjudication process, claims management process, real time claims adjudication, Electronic Medical Records / Electronic Health Records (EMR/EHR)andMedicaid Management Information System (MMIS), andMedicaid Information Technology System (MITS).
  • Worked on claims, Claim adjudication Membership, Eligibility, Accumulators.
  • Enhanced applications associated with Claim Numbers so that duplicate Claim Numbers could be allowed in the system. Updated the Electronic Claims, Patient Screen and Sales Administration processes.
  • Involved with the 837, 835, 270/271,277/275 and 276/277 HIPPA-EDI Transaction Code Sets.
  • Identified all use case components including basic, alternate and exception flows.
  • Worked on Health Level-7 or HL7 international standards for transfer of clinical and administrative data between software applications used by various healthcare providers.
  • Prepared Business Process Models, which included modeling of all activities of the business from conceptual to procedural level.

Confidential - Fort Worth, Texas

Business Analyst


  • Worked with waterfall Software development Life cycle (SDLC) and agile framework to carry out different phases of project including gathering and documenting business requirements.
  • Conducted user interviews, gathered requirements, analysed and documented business requirements based on the analysis of mortgage loan processing workflow model.
  • Drive and challenge business units on their assumptions of how they will successfully execute their plans.
  • Created user guides/run book for reference to be used by the downstream teams and the business users
  • Gained hands on experience on creating cases in Remedy STAR (case management System), Sales Originations and menu options of Loan Servicing System LSAMS
  • Collaborated with developers, architects, subject matter experts, and other IT team members to establish the technical vision and analyse trade-offs between usability and performance needs.
  • Assisted in the development of business cases, considering financial, resource, and technological constraints; developed cost estimates with consideration to business impacts and risks.
  • Performed analysis and created Source to target mapping document for incoming LOB and existing projects for process improvement.
  • Worked on creating Mock-ups/wireframes to give the visual representation of the requirements
  • Assisted PMs in preparing weekly/monthly project status reports to be provided out to senior level management/project stakeholders.
  • Interacted with business customers to define, analyse, and deliver customer testing requirements and complete Users acceptance testing (UAT).
  • Attended Change Control Board (CCB) meetings to seek approval or facilitate any pertinent changes including changed requirements, change timelines occurred during project phases.
  • Worked with Third Party Vendors (partners) including Hope Loan Portal and Venture as part of the project requirements. Dealing with Venture mainly included assisting on creation of NSM files and transmitting files to venture via Secured FTP server and creation/printing of letters or statements.
  • Extensive Creation and execution of SQL queries (using MS SQL and MS Access) and scripts to validate data movement perform data-based QA testing and validate UAT testing results.
  • Created product implementation documentation, including online help, Business communication document (BCD), printed user manual, and training materials.
  • Participated in closure activities or other quality initiatives including setting up realistic project scope and goals of project with Project managers.
  • Involved in production support inclusive of creating incident tickets and Incidents tickets resolution as part of 30 days warranty window frame.

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