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Business System Analyst/mmis Iv&v Analyst Resume

Hamilton Township, NJ


  • Healthcare IV&V Analyst with experience in MMIS HealthCare Industry.
  • Healthcare Business/Quality Systems Analyst with experience in the HealthCare Industry.
  • Business Systems Analyst with hands on experience in business consulting in healthcare and application development with excellent skills in client interfacing, requirement gathering, user support, quality assurance, problem solving, and documentation.
  • Skilled in determining system requirements and specifications for complex application development projects. Current experiences of leading and interacting with business teams, programmers and technical staff at all levels.
  • Experience in creating and maintaining the Requirements definition documents that included Business, Functional and Technical requirements.
  • Expertise in all the phases of the Software Development Life Cycle (SDLC), Agile Development methodology.
  • Experienced in conducting brainstorming sessions, reviews, and walkthroughs and customer interviews (UAT) for various business processes.
  • Good understanding of healthcare industry - claims management process, Medicaid and Medicare Services and insurance sector.
  • Expert in HealthcarePayersystems - Claims, Billing with backend data mapping, data integration.
  • Expertise in Data Modeling, Data Analysis, GAP Analysis, Requirement Analysis, Business Modeling, Data Migration, Data profiling, and Dimensional Modeling.
  • Experience with project management tools like MS-Project, JIRA for status reporting, planning and error tracking and correcting.
  • Provided customer with best practice solutions as related to Salesforce.com and CRM.
  • Expertise in developing, deploying and integrating Salesforce.com CRM solutions.
  • Experience conducting User Acceptance testing (UAT).
  • Exposure in creating and analyzing Data Flow diagrams, and Entity Relationship diagrams (Visio).
  • Skills to track environment build release level at various point in the software building process.
  • Proficient in writing SQL queries to manage customer database, good knowledge ofData warehousing.
  • Possess Project management skills such as time estimation, task identification, risk analysis and scope management and resource management.
  • Good practical knowledge in understanding Medicare Concepts, detailed knowledge of the claim’s adjudication process within a healthcarepayer.
  • Using RI Healthcare Portal for various health insurance areas such as enrollment, eligibility, member opt out, Claims and other related modules.
  • Defining Test Cases, executing, analyzing bugs and interacting with team members to fix errors, Unit testing, System Testing and User Acceptance Testing (UAT).
  • Using Bugzilla/JIRA Application to log the bugs into the system and let the team work on the fix and retesting.
  • Attended testing status calls to update core team on our testing progress and address any testing concerns.
  • Experience with Provider Electronic Solution (PES) Application: Claims Processing, Recipient Eligibility, Medical Plan, Provider, Utilization Management.
  • Experience with POS Claims submission to test the real-time claim progress through the application.
  • Experience with TOAD, running multiple SQL queries on multiple environments for building, updating, testing and verifying.
  • Experience with FileZilla and UNIX - loading, transferring and retrieving files in sftp servers.
  • Good understanding of Testing processes.
  • Strong knowledge of Project management skills such as time estimation, task identification, and scope management.


Methodologies: SDLC, Agile, Waterfall

Business Modeling Tools: Microsoft Visio

Technical Tools: TOAD, UNIX, FileZilla, mRemote, PSPAD

Platforms: Windows

Testing tools: PES, POS, Bugzilla, HCP, IWS, HP ALM, MS Excel

Office Tools: MS Office, MS Visio

Version Control Systems: Scripting, Rational Clear Case

Database: MS SQL Server, TOAD and Oracle

Reporting Tools: Cognos BI, Tableau, JIRA


Confidential, Hamilton Township, NJ

Business System Analyst/MMIS IV&V Analyst


  • Provide support to certification of the New Jersey Replacement Medicaid Management Information System R-MMIS project. This includes reporting, finding of Risk identified, observations that may impact R-MMIS implementation, CMS MITA alignment, assessment of the business solution gap analysis reports;
  • Verify stability, portability and security of systems architecture;
  • Plan and identifycertification tasks and activities on UAT waves, resource allocation and risk identification, completion date estimation;
  • Represented and attended the State technical meetings to analyze the assessment on the project.
  • Involved in Salesforce.com Application Setup activities and customized the applications to match the functional needs of the organization.
  • Work with the state certification team on reviewing the evidence packets and providing solutions.
  • Understand thespecific system requirements, define and analyze objectives, scope, issues, or organizational impact ofthesystems for assessment; validate the functional,non-functional, informational requirementsin accordance with the project scope.
  • Managed and prioritized user stories using JIRA. Worked with the development team to identify blockers and provide resolution.
  • Used the reporting feature in Salesforce to develop and manage daily reports.
  • Participated in a large team to replace and consolidate multiple contentmanagementsystems to Salesforce.
  • Used JIRA to analyze & capture bugs, track and manage any type of updates.
  • Verified the claim edit mapping under mainframe system.
  • Conduct research and provide support for the resolution of issues/conflicts impacting certification and/or the overall project.
  • Perform Gap analysis for the new functionality requirements and draft business rules and claim processes using HIPPA rules and regulations;
  • Participate in weekly certification planning meetings and IV&V quarterly assessment report progress meetings.

Confidential, Warwick, RI

Business Systems Analyst/UAT Analyst


  • Assisted the project manager in the creation of the project charter & vision document during the inception phase of the project.
  • Interacted with the client and the Technical Team for requirement gathering and translation of Business requirements, Functional requirements to Technical specifications.
  • Performed Gap analysis for the new functionality requirements Worked with HIPPA rules and regulations to draft business rules and claim processes.
  • Documented the Business Design Documents with required Appendices for Core and Notices section of the project.
  • Translated business requirements into functional specifications and documented the work processes and information flows of the organization.
  • Derived Functional, Non-Functional, Informational Requirements and Business Rules in accordance with the project scope.
  • Gathering Requirements and design of technical specification documents. Document the business requirements for the Cognos BI reports. Derive Cognos report requirements from already existing report template.
  • Created high-level user stories (business requirement document), using MS Excel that provided appropriate scope of work for technical team to develop prototype and overall system.
  • Scheduled the Internal and External Walkthroughs for BDD and get it approved.
  • Reviewed the Technical Design Document to verify the Technical design based on the Business logistics.
  • Performed the role of Business Analyst and interacted with various business user groups to gather the requirements for salesforce.com CRM implementation.
  • Analyzes Eligibility for State Children’s Health Insurance Program (S-CHIP), Food Stamps (SNAP), Child Welfare and Temporary Assistance to Needy Families (TANF) (CHIP, SNAP, TANF).
  • Worked on Data mapping on Enrollment Module (EDI 834).
  • Performed User Acceptance Testing (UAT) for various web based and database related applications.
  • Provided support and worked closely in UAT and used SQL to test various reports and ETL load jobs in development, QA and production environment.
  • Analyzed the data warehouse project database requirements from the users in terms of the dimensions they want to measure and the facts for which the dimensions need to be analyzed.
  • Created Test strategy, Test Plan and Test Count Script based on the Excel Test plans (Macro).
  • Created the data dictionary for the entire data field and their location.
  • Created Test Cases that defined the role of users who receive claims, users who process claims, and users who adjudicate claims.
  • Tracked stories using JIRA software.
  • Used JIRA as ticket management tool and confluence for documentation.
  • Utilized JIRA to log and monitor any defects.
  • Used JIRA and Confluence to view, manage and report on “Work in Progress”.
  • Responsible for System Test execution and logging the Bugs and retesting and verification.
  • Assisted with various aspects of the project's needs including bug management and resolution, current state workflow assessments, assist with integration and script testing, downtime activities/testing.
  • Analyzed data and created reports using SQL queries for all issued Action Items.
  • Developed Data Mapping and Crosswalk documents.
  • Performedreport validationwriting SQL queries using TOAD on an Oracle database.
  • Extracted data by running SQL queries, and reviewed securities, financial and customer metadata that gets populated on the web application.
  • Created test plan, test data and conducted manual testing to validate functionality and performed regression testing.
  • Extracted Data from Teradata using Informatica Power Center ETL and DTS Packages to the target database including SQL Server and used the data for Reporting purposes.
  • Identified and documented data sources and transformation rules required to populate and maintain data warehouse content.
  • Performed User Acceptance Testing (UAT) to confirm the delivery of key requirements in the final release.
  • Designed and implemented complex SQL queries for QA testing and data validation.
  • Performed detailed business process assessment of the affected business areas.
  • Documented the Artifacts according to the Test plan strategy.
  • Scheduled the Internal and External Meetings to get the Artifacts Approved.
  • Involved in Testing the Healthcare Portal Web Screens from the Client perspective.
  • Involved in Testing the MMIS Power Builder Screens and POS claims for Pharmacy Projects.
  • Performed Regression Testing, UAT and Ad-hoc testing.
  • Perform gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Tested the RI Healthcare Portal for the new member eligibility, member enrollment, Voluntary and Passive Recipients, Recipient Opt Out screen, Recipient Notice Screen for MMP.
  • Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
  • Maintained Requirement Management Document to ensure the project conformed to the project charter.
  • Expert in Validating, Verifying, Testing the EDI x12 files.
  • Conducted requirement feasibility analysis with the developers to ensure the project was in scope with the timeline defined in the project plan.
  • Performed GAP analysis as pertains to membership management and claims processing to evaluate the adaptability of the new application with the existing process.
  • Performed GAP analysis on membership management and claims processing to evaluate the adaptability of the new application with existing processes.
  • Used and verified the EDI messages 837. Healthcare encounters claim and coordination of benefits (COB)-Claim payment and remittance advice 835 - Healthcare claim status 276/277, Eligibility for a health plan 270/271.
  • Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).
  • Tested EDI X12 transactions 837 (Claim for Institutional, Professional and Dental Claims), 835 (Claim Payment) (Claim status), 834 (Enrollment), 270/271 (Member eligibility).
  • Identified and documented the dependencies between the business processes.
  • Responsible for checking NPI and approval of claim payment.
  • Support the evaluation of progress and readiness towards performing certain key business functions using the EOHHS - CMS (PCUG) blueprint test scenarios.
  • Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams.

Environment: SQL, PL/SQL, XML, UNIX, POS, PES, HTML, Web Client, MS Office, Citrix, COGNOS, MS SharePoint.

Confidential, Olympia, WA

Business System Analyst


  • Performed GAP analysis on membership management and claims processing to evaluate the adaptability of the new application with existing processes.
  • Analyzed “TO BE” scenarios based on the data that are currently required to generate reports.
  • Performed detailed business process assessment of the affected business areas.
  • Elicited and prioritized requirements through interviews, job shadowing, brainstorming, and questionnaires.
  • Identified the key stakeholders and conducted stakeholder interview sessions to determine reports that were impacted due to the migration.
  • Maintained Requirement Management Document to ensure the project conformed to the project charter.
  • Completed Data Mapping for group and detailed product analysis and report writing.
  • Actively participated in defining scope of project, gathering business requirements, and documenting them.
  • Worked on the Data Warehouse team analyzing data files that had to be compiled from disparate non-production sources and readied them for production. Tasks included: comparing data to requirements documentation, creation of data layouts and data dictionary.
  • Worked closely with Child Care Administration Department to gain knowledge of procedures and laws.
  • Well-coordinated with the team and maintained independent workload of several Programs including Medicaid,SNAP, TANF, CHIP, Presumptive eligibility and ACA.
  • Worked on monthly TANF Loans Issued and Debt reports requested by I&R (Investigation and Recovery) and the Accounting department.
  • Using Product Life Cycle for implementing System requirement for Data Warehouse and Data Management and State Diagrams bases on UML methodology and process flow diagrams.
  • Gathered requirements from the users and analyzed the requirements.
  • Performed the role of Business Analyst, interacted with various business user groups for gathering the requirements for salesforce.com CRM implementation.
  • Worked on data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
  • Extensive involvement in Data Analysis Activities including Data Visualization, Data Profiling, Data Quality, Data Governance, Source to Target Data Mapping, Data Testing.
  • Authorized, scheduled, supervised and smoke-tested thin code and data migration from development to test environments.
  • Tracked stories using JIRA software.
  • Extracted data from excel/SQL and developed interactive dashboard and BI report using Tableau and SSRS for providing business insights.
  • Executed ETL mappings through data stage director and monitored status.
  • Createduser stories, use case diagrams and process diagrams based on business requirements.
  • Receives reviews and enters data and source documents into Medicaid billing system.
  • Involved inUser Acceptance Testingwith the end users.
  • Assisted with various aspects of the project's needs including bug management and resolution, current state workflow assessments, assist with integration and script testing, downtime activities/testing
  • Created the data dictionary for the entire data field and their location.

Environment: Quality center, MS Project, MS Office suite, SQL, Citrix, Tableau, MS SharePoint.

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