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Sr. Business Systems Analyst Resume

3.00 Rating

Eagan, MN


  • Over seven years of experience as a Business System Analyst in Healthcare Domain.
  • Experience on HIPAA 5010, ICD10, HCR, Medicaid, MMIS, Medicare, claim processing, Claim adjudications.
  • Excellent understanding of Business Requirements Gathering, Evaluating Database Sources, Translating Requirements into Specifications and Application Design.
  • Proficient in Technical and Business writing, Business Process Flow, Business ProcessModeling and Testing.
  • Experience working in all phases of Software Development Life Cycle (SDLC).
  • Experience in facilitating Joint Requirement Planning (JRP) sessions with Business User Groups, conducting Joint Application Development (JAD) sessions with IT Groups and Conflict Management with Project team members.
  • Profound Knowledge of Rational Unified Process (RUP) methodology, Use Cases,Object Oriented Analysis and Design (OOAD).
  • Competent in Creating Unified Modeling Language (UML) diagrams such as Use Case Diagrams,Activity Diagrams, Flow Chart, and Class diagram.
  • Extensive experience in developing Use Cases, creating Screen Mockups, conducting GapAnalysis and Impact Analysis, SWOT analysis, Cost Benefit Analysis, Risk Analysis.
  • Expert in Tracking and Managing theRequirementsusing Requirement Traceability Matrix (RTM) that controls numerous artifacts produced by the teams across the deliverables for a project.
  • Involved in Test Planning,Test Preparation,Test Executionand Issue Resolution and Report Generation to assure that all aspects of a Project are in Compliance with the Business Requirements.
  • Experience with HIPAA 4010 - HIPAA 5010 conversion implementation.
  • Experience with ICD9-ICD10 conversion implementation.
  • Strong Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases. Expertise in designing and developingTest Plans and Test Scripts.
  • Involved in training of end users. Documented Training Manuals for new product release. And suggested screen design to the developer in Visio 2007
  • Excellent analytical & problem solving skills and a team player with strong interpersonal and communication proficiency.
  • Experience in implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system.
  • Experienced working in Medicare and Medicaid projects.
  • Knowledgeable for gap analysis in changing old MMIS and Involved in testing new MMIS.
  • Excellent knowledge of (HIPAA) transaction and code set rules such as EDI 837,270,271,276,277,834,835.
  • Proficient inICD-9-CM and ICD -10-CM coding and claims processing.


Systems/Architectures: Web, VB Client/Server, Main Frame, Windows

Languages: SQL, JAVA, HTML, C++, C

Databases: MS SQL, Oracle, MS Access

Test Tools: Test Director, QualityCenter, Quick Test Pro (QTP), Win Runner, HP QualityCenter

Other Tools: Visio, Front Office, Rational Rose, Rational Requisite Pro, Software Modeler, Team Test, Doors, PROLOG, Clearcase, Clear quest, Win Runner, Load Runner, Web Sphere, Microsoft Office 2010 ( Project, Word, Excel PowerPoint, Access, Visio), Presentation Software, Share Point.

Standard Skills: Research Analysis, HIPAA, ICD, SOX, ISO, Six Sigma, MMIS


Confidential, Eagan, MN

Sr. Business Systems Analyst


  • Gathered requirement through interviews and JAD sessions.
  • Created Document like BRD, FRD, Test Plans, Test Scripts, Change request, System requirement document, Technical specification, Mapping document.
  • Responsible for designing future state processes forHIPAA 5010 transaction processing EDI’s 837 and 835.
  • Analyzed HIPAA 5010 related to 837,835, 276,277 and 834 Transactions and performed gap analysis between HIPAA 4010 and 5010.
  • Implemented mapping ofICD-9-CM to ICD -10-CM coding and used ICD 10 codes for claims processing.
  • Helped IV& V team understand our plan benefits and payments terms for our MCO plans.
  • Validated and tested ICD10 codes and HIPAA 5010 transactions..
  • Involved in the creation and maintenance of the Workflow plans and artifacts
  • Experience working with Epic software in an ambulatory healthcare environment.
  • Conducted SWOT Analysis and Demand Analysis for better market understanding and fool proof project implementation of HIPAA 5010.
  • Documented Requirement Traceability Matrix(RTM) for requirement elicitation and linkup to deliverables
  • Worked with the individual sub-project managers to translate these into PRDs (Product Requirement Documents) for the development teams
  • Examined, analyzed and model Test plans, Test cases, Use Case Model cases & Test procedures.
  • Designed and developed Quality Assurance standard and processes to all levels of project team
  • Performed Gap analysisfor HIPAA 5010 and ICD 10 implementation modules in production, conducted feasibility study and performed impact analysis for proposed enhancements and also worked on market opportunity, reporting skill set.
  • Verified the functional and technical aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the existing system
  • Involved in walkthroughs and meetings with development team to discuss related issues
  • Used Rational Rose to visually determine the proper structure, key elements and optimal design for database and to aid efficient creation of tables, stored procedures
  • Critically evaluated the information gathered from multiple sources during requirement gathering and analysis and responsible for tracking, tracing and managing requirements using Rational Requisite
  • Used MS Project for various planning and budgeting activities.
  • Performed UAT and loggedtest results according to the test plans using Quality Center.
  • Proficient in MS Office tools - particularly Excel (macro), Access, word, Visio, share point and PowerPoint.
  • Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance

Environment: Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MSAccess),Rational Requisite, RUP, XML, C#.net, Oracle, RUP, UML, SQL, Quality Center, MS sharepoint.

Confidential, Cary, NC

Sr. Business Systems Analyst


  • Responsible for coordinating with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
  • Studied the existing business process and created AS-IS-To BEworkflow to illustrate the existing system for HIPAA 5010.
  • Recorded requirements in the Requirement Traceability Matrix(RTM) defining each technical requirement in detail from areas like: main hardware, application software, networks, servers, internet and desktop configuration.
  • Created Data specification document, Business requirement document, Functional requirement document, technical specification, Test script, Test cases.
  • Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing forMedicaid Claims in MMIS.
  • Responsible for gap analysis in changing oldMMIS and Involved in testing new MMIS for HIPAA 5010.
  • Performed ICD9 to ICD10 analysis.
  • Strongly implemented analytical skills like business models, P&L, ROI, cost structure.
  • Assisting the project manager in creating the business case and project plan.
  • Served as a liaison between the internal and external business community (Claims, Processing, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
  • Actively analyzed current business processes (Claims, Recipient eligibility and enrollment etc.) and worked with management to improve and implement enterprise solutions to ensure compliance
  • Work with business representatives to understand data marts requirements and priorities and ensure that IT works is appropriately aligned.
  • Responsible for creating business work flows and processes and creating management reports based on the analysis.
  • Followed the UML based methods using Rational rose to create Use Cases, Activity Diagram, Sequence Diagram, Collaboration Diagram that include Functional and Non-Functional specifications to hand off to development teams.
  • Actively involved in updating internal processes (submit claims, check eligibility), updating data collection and data reporting
  • Defects and bug testing by using Rational Clear-Quest, Configuration management and Version control with Clear-Case.

Environment: Microsoft Office(MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access), RUP, MS Project, ANSI X12- EDI UML, Rational Requisite Pro, MS Word, Visio, SQL, MS Excel, Mercury Quality Center, SharePoint, MMIS.

Confidential, Parsippany, New Jersey

Business System Analyst


  • Propose strategies to implement HIPAA 4010 in the new MMIS system & eventually move to HIPAA 5010.
  • Involved in the creation of the Mockups and Use Cases for MACD quotes and Orders using MS Visio.
  • Documented business requirements, and communicated these requirements with the development team for design and implementation of business solutions.
  • Worked with Business Analysis team to prepare a detailed Business Requirement Document.
  • Analyzed Business Requirements to develop Functional and detail Design Specifications of the application.
  • Conducted Requirement Gathering Sessions with the stakeholders.
  • Interacted with the project team to help define the Business and System Objectives, confirmation of scope, identify constraints and the measures of success for the system to be developed.
  • Conducted the JAD sessions, daily meetings, brainstorming sessions to solve the problems and enhance the workflow.
  • Assisted in building a Business analysis process model using Rational Rose and Visio.
  • Gathered Functional Requirements from users and the management. Coordinated all the requirements in team based environment.
  • Acted as liaison between the senior management and different teams with effective presentations.
  • Monitored change requests and documented requirements, integrating them with Use Clear Cases.
  • Incorporated stakeholder feedback throughout project lifecycle to ensure project quality and customer satisfaction.
  • Did Technical documentation for the project using tools like Visio, Word, etc.
  • Used MS Project for managing schedules, resources and collaboration.

Environment: Microsoft Office( MS Word, MS Excel, MS PowerPoint, MS Visio, MS Access),RUP, MS Project, Toad, Visio, Oracle, HTML, Test Director, Rational Rose, UML 2.0, MS Project

Confidential, Lemoyne, PA

Business Analyst


  • Gathered Business Requirements, analyzed data/workflows, and defined the scope
  • Met with client groups to determine User Requirements and Goals, thus converting User Requirements into Business Requirements and User and Technical Requirement Specification
  • Facilitated collection of Functional Requirements from system users, and prepared Business Requirement documents
  • Responsible for claim adjudication like Medicare claims,professional claim, institutional claims.
  • Applied the RUP model throughout the entire development and testing process.
  • Involved in development of Business and Technical Requirements in preparation of Design and Functional Specifications for Business Needs and Processes.
  • Worked closely with Business users to determine the workflow of the product.
  • Performed walkthroughs of the prototype with end users to better understand user needs.
  • Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs, and ensured that critical requirements are not missed.
  • Followed the UML based methods using MS Visio to create Use Case Diagrams, State Chart Diagrams and Sequence Diagrams
  • Prepared Logical Process and Data Models that contained set of diagrams and supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the data elements to analyze and document Business Data Requirements.

Environment: Microsoft Office, Windows XP, Toad, SQL, Business Objects, Toad, Visio, Oracle, HTML, XML

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