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Sr. Business Analyst Resume

3.00 Rating

New York, NY


  • Over 7 years of professional experience as EDI Analyst/Business Analyst in various Integration and Business Applications like Health Care.
  • Expertise in B2B standards, Implementation of Integrated EDI and XML applications and Enterprise Application Integration (EAI) for business processes across applications.
  • Created companion guides for EDI transactions for both 4010 and 5010 versions and also created crosswalks and also experience in using EDIFECS Specbuilder.
  • Strong knowledge on HIPAA standards, ICD9/ICD10, EDI transactions & 4010/5010 versions, Medicare and Medicaid Services.
  • Extensively used Facets 5.1/4.81 to test Medical and Hospital Claims.
  • Strong Knowledge on claim processing and EDI transactions i.e. Claims Inquiry and Response (276/277), Receipt and Verification of claim forms (837), Claim Payment and advice (835), Eligibility Inquiry and Response (270/271), Certification Request and Response (278), Benefit Enrollment (834), Order and Payment Remittance (820), Functional Acknowledgement (997/999).
  • Experience working on Healthcare Reform Projects such as Health Insurance Exchange (HIX), ICD - 10 Remediation and HIPAA 5010 Implementation.
  • Expertise in Datamart testing.
  • Extensively used Toad to validate backend data.
  • Used EDIFECS Step-up/Step-down to analyze and migrate from 4010 version to 5010 version.
  • Worked on Cognos Qual Environment to validate many Cognos reports.
  • Used various Cognos functionalities like Business Insight Advanced, Report Studio, Query Studio for Enterprise Quality Management purposes.
  • Expertise in Rational products like Rational Team Concert, Rational Quality Manager.
  • Experience in writing Test cases and Test plans based on use cases and involved in manual testing of EDI applications.
  • Extensively worked on HP Quality Center for tracking various defects that arise during submission of claims.
  • Performed various types of testing like Functional Testing, Unit testing, Integration Testing, System Testing, Performance Testing, Regression Testing, User Acceptance testing (UAT), End to End Testing and Smoke Testing.
  • Experience in working on Automation testing tools like HP Quality Center, Test Director, Quick Test Pro, Win Runner, Load Runner and Rational Suite.
  • Hands on experience in creating RTM, defect status report, Change requests form, test plans and Project Plans.
  • Experience in working on HIPAA Edits using EDIFECS Specbuilder.
  • Knowledge of HTTP, AS1, AS2, FTP, SFTP, FTPS, SSH protocols and connectivity.
  • Hands on experience using Oracle 8i/9i/10g and extensive experience in writing SQL Queries, PL/SQL, Procedures, Functions, Triggers, Exception Handling, and Cursors.
  • Good Knowledge in extraction, transformation and loading (ETL) process.
  • Design & development using Java, Oracle, JavaScript, XML, HTML, UML & Rational Rose


EDI/Middleware Tools: Gentran -6.0, 6.3 (Mainframe) & Gentran on Unix Server 5.3 & 6.1, IBM -DI, EDIFECS, EDISIM, Pervasive Map Designer, ODEX PLUS V3.0 -3.4 and MQ Series, Informatica Data Transformation and Power Center

EDIStandard: ANSIX12(110, 140, 141, 142, 210,214,810,820, 824, 850, 860, 865, 856, 861, 855, 866, 862, 830, 870, 997), EDIFACT(ORDERS, INOVIC, DELINS, DELJIT, DESADV),VDA(VDA4915, VDA4905, VDA4913, VDA 4906 and VDA4908) andHIPAA(270,271, 278,834,820, 835, 837 (P, I & D), 276,277, 277CA, 999 & 997).

Operating Systems: MVS/390, Z/OS, UNIX, Windows

Programming Language: VS-COBOL - II, JCL, CICS, Unix Shell Scripting, Window Scripting

Databases: ORACLE, DB2, VSAM,IMS

Domain Experience: Health Care, Insurance


Confidential, New York, NY

Sr. Business Analyst


  • Interacted with stakeholders to get a better understanding of client business processes and gathered requirements.
  • Involved profoundly in the GAP Analysis of Employer Rosters, Employee and Employer Application Fields focusing on changes required in existing COTS products to meet client business needs.
  • Conducted requirement gathering sessions with the purpose of creating and defining the Business Requirement Document (BRD).
  • Created Swim Lane Diagrams and business logic & calculation spreadsheets for various business processes.
  • Performed data mapping to define the Source data on 834 Benefit Enrollment and Employer Group File (EGF) EDI Transfers.
  • Created Process Models for (a) Initial Enrollment, First Billing and Payment and (b) Post Enrollment - Subsequent Recurring Billing and Payment.
  • Collaborated with vendors (CURAM, CONNECTURE & PWC) in order to ensure smooth transition of requirements from State to Vendors.
  • Involved in Small Business Health Option Plans (SHOP) activities across vendors -
  • CURAM - Emphasis on Employee Application and Case Worker Portal with customized triggers to send notices via EP Notify.
  • Notices by Email, Notices by Mail.
  • Integration Layer Activities - EGF, 834, Enrollment State Administration, etc.
  • Worked on streamlining SharePoint to meet project policies and processes.
  • Performed Data Mapping for State Administration Enrollment Management function to define the data elements, their source and read only/editable parameters.
  • Documented and Analyzed impact upstream and downstream when change in editable data elements in State Administration Enrollment Management function is recorded.
  • Documented the “Configure Billing Cycle” scenarios and billing rules for the employer.
  • Mapped Employer Subscription Service with Enrollment data from CONNECTURE and identified gaps.
  • As the processes and methodology moved from waterfall towards agile, wrote requirements in form of User Stories and Acceptance Criteria Documentation.

Environment: MS Project, MS Visio, MS Word, MS Excel, MS PowerPoint, MS SharePoint, JIRA, Windows XP, HIPAA


EDI Analyst


  • Defined the test criteria, project schedules and base lined the Test Plan with the help of project meetings and walkthroughs.
  • Involved in testing HIPAA EDI Transactions.
  • Completed 5010 Gap Analysis and Impact Assessments on Business process, Application and EDI Transaction process for upgrade from 4010A1 to new 5010 HIPAA EDI X12 electronic formats.
  • Analyzing 4010 and 5010 gaps and impacts across all transactions, system interfaces, applications and business processes.
  • Developed an implementation guide for Partners for EDI X12 transactions such as 834, 835,837,276,277,270 and 271
  • Work on Logical Data Requirements and Physical Data Mapping for the Forward Data Cache a new Data Model designed for EDI transactions (270/271,276/277, 834 and 837) to cater to the new 5010 federal govt. mandated regulations.
  • Adhered data transition of the enrollment process, COB, Claim Status and Eligibility as per the EDI standard 834, 835, 837, 277 and 271.
  • Worked in collaboration with the architects to perform the data mapping of the ACA-2 and SACA-2 application fields to the Database.
  • Tested the claims data and Billing.
  • Tested the Loading of Claims Data.
  • Tested the Members/Provider/Claims/Products.
  • Tested the COB, benefits, facilities and reports.
  • Worked with X12 /EDI transactions and validated the specifications/mapping for 837 transactions for Institutional and professional claims and 835 responses.
  • Tested and Analyzed ICD 9 and 10 codes
  • Tested ICD 10 codes (Procedure codes, Diagnosis Codes) for 837(Claims) Project.
  • Involved in ICD 10 Implementation and validated ICD 9 and ICD 10 reports
  • Developed Test Plan on Edit Changes for all Medicare & Medicaid Claims with help of Edifecs list for ICD-10
  • Developed Test Cases and Test Scripts on Reporting systems in different Roles of Diagnosis codes for ICD-10 Implementation
  • Test Case Management was done in HP ALM / Quality Center.
  • Involved in decision making of converting manual test cases into automated test scripts and analyzing their life time and time required to update the scripts.
  • Written smoke test cases in HP ALM/Quality Center and modified them when they are automated.
  • Experienced in Analyzing, designing, executing and reviewing new and old Test plans, Test cases, developing and maintaining Test scripts, analyzing bugs etc.
  • Used HP ALM / Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
  • Prepared documentation for all stages according to company standards.
  • Extensively involved in the automation of Regression Test Cases by scripting.
  • Involved in development and reporting of quality assurance project metrics.
  • All the test scenarios which have been satisfied with the functionality are moved to automation testing using QTP.
  • Tracked and Managed Defects using HP ALM / Quality Center.
  • Backend testing of the DB by writing PL/SQL queries to test the integrity of the application and Oracle databases using TOAD.
  • Used Visio for business analysis.
  • Responsible for collecting and analyzing the test metrics and then submitting the reports keeping track of the status and progress of the testing effort.

Environment: ICD-10, Web Logic, Java, Quick Test Pro 11.0, HP ALM 11.0 / Quality Center 11.0, Load Runner, UNIX, XML, SQL, PL/SQL, Oracle.

Confidential, NY

EDI Analyst


  • Worked on Facets extensively to validate products.
  • Created medical claims to test various services mentioned in the agreement configurator.
  • Created medical claims to test co-insurance and copay amount limits for both individual and family members.
  • Expertise in Corporate Analytics data mart testing.
  • Worked on Melissa Data Address Cleansing. Validated the cleansed addresses of the respective providers.
  • Validated Enhanced Primary Care performance management Cognos reports like Emergency Room Efficiency Utilization, Hospital Efficiency Utilization & Population Risk Reports.
  • Created hospital claims to test deductible limits for both individual and family members.
  • Validated Cognos reports that pull data from Facets and various data schemas like Enterprise Data Warehouse EDW and Analytical Data Warehouse ADW that are in house to CDPHP.
  • Worked as test lead for a Cognos project called Total Cost of Care. Tested Cognos Cube All three phases extensively.
  • Worked on Cognos Business Insight Advanced to test Cognos Cube.
  • Used Rational Team Concert RTC to log defects, track and close defects after resolution.
  • Worked with HIPAA compliant ANSI X12 834 formats.
  • Used Rational Quality Manager RQM to upload test cases, log and track testing process.
  • Tested and verified several Medical and Pharmacy Products in Facets.
  • Extensively tested 7 out of 12 ASO products for 2014 health plan renewals.
  • Experience in developing, implementing and testing EDI ANSI X12 applications.
  • Validated many source and target backend tables for data and dollar amount accuracy.
  • Performed regression testing to make sure any changes to the products did not impact any existing functionalities.
  • Expertise with HIPAA compliant ANSI X12 820 formats.
  • Validated In-Network and Out of Network Stoploss amount for various products.
  • Validated Out of Pocket Max limits for various products.
  • Extensive knowledge of diagnosis and procedure codes those are necessary to test several layers of insurance plans.
  • Created master test plan, test cases and created test scripts to successfully implement system integration testing in an effective and timely manner.
  • Interacted with Dev teams and Business Owners to have better understanding of Unit testing and User Acceptance Testing UAT .

Environment: Facets 5.1/4.81, Rational Team Concert (RTC), Rational Quality Manager RQM, IBM Cognos version 10.1, Microsoft Office, Oracle version 11g, Toad , Snag It 11, VMware Horizon View.

Confidential, Columbus, OH

Systems Analyst


  • Actively worked on Business requirement gathering, analysis and Data analysis
  • Facilitated JAD sessions to collect User Requirements, Business Requirements and Functional Requirements.
  • Created Business/User/Functional document using MS Project, MS Word and MS Visio that provided appropriate scope of work for technical team to develop prototype of the overall system.
  • Gathered requirements from the administrative staff and business rules for determining member eligibility and successfully converted them into functional requirements for the developments team.
  • Created Use Cases, various UML Diagrams and Data Flow Diagrams to determine the data flow via various systems
  • Developed and maintained the Requirement Traceability Matrix (RTM) for the project deliverables.
  • Proposed the change and reengineering of the ‘AS IS’ Business processes into the ‘TO BE’ process flow
  • Applied Master Data Management standards in data conversion, mapping and migration.
  • Involved in the day-to-day implementation of the agile methodology of application development with its various workflows, Artifacts and activities.
  • Created Business Rule Comparison (BRC) documents and Side-By-Side (SBS) comparison documents using 10 implementation guides for X12 transactions (i.e. 837 (I, P, D), 834, 835, 276,277,270, 271)
  • Coordinated the upgrade of Transaction Sets 837P, 835 and 834 to HIPAA compliance.
  • Created BRCs of EDI inbound and outbound transactions and mapped the provided data
  • Extensively involved in HIPAA 5010 User Acceptance Testing (UAT). Defined and maintained Test Cases for EDI transactions.
  • Thoroughly studied the inherent systems to have a clear understanding of the business processes and associated system workflow.
  • Did gap analysis for HIPAA P and 835 transactions and HIPAA P and 835 transactions
  • Worked with multiple clearinghouses to ensure smooth transition to 5010 standard for their day-to-day EDI X12 transactions.
  • Creation of a Gap/Impact Analysis Document for changes to Pharmacy Transactions (real time and batch) based on NCPDP 5.1 to NCPDP D 5.0 specifically concerning the data elements.
  • Manually read through the loops, segments and elements of individual test files from clearing houses using Notepad++ and compared them to Implementation Guide/ Companion Guide to ensure that they met 5010 standards. If errors were found on these, the same were communicated back to the clearinghouse and asked them to resubmit the file after making necessary changes.
  • Used HP Quality Centre for error reporting and communicating between developers, product support and test team members
  • Worked on various subsystems within the MMIS including but not limited to Recipient Payer, EDI etc
  • Re-engineering and capturing of transactions with legacy systems Enrolment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
  • Recommended corrective actions, if necessary, along with the progress against Development/Action Plan routinely to the Project Manager.
  • As part of the data mapping procedures, assisted in writing requirement document for ETL - Data Extraction, Data Analysis and Loading process of collected data.
  • Used MS Share point for sharing documents, calendars and other data between users in different locations.
  • Wrote test cases and test plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality centre.
  • Assisted in regression testing and did UAT to improve overall quality of the Application.

Environment: UML, Windows, Agile, Mainframe, SQL, ETL, Data warehouse, Microsoft Office, Test Director, MMIS, MS Access, HTML, XML, Java Script, Java, ASP, DB2.

Confidential, Little Rock, AR

Business/System Analyst


  • Managed and developed EDI specifications, for data feeds and mappings for integration between various systems, to follow ANSI X12 4010 formats including 270 Eligibility/Benefit Inquiry, 271 Eligibility/Benefit Information, 276 Claim Status Request, 277 Claim Status Response, 810 Invoice, 820 Payment Order/Remittance Advice, 834 Benefit Enrollment, 835 Remittance Advice and 837 Claims and Encounter, to meet and exceed HIPAA requirements set forth by the federal government.
  • Extracted the Business Requirements from the client and end users keeping in mind their need for the application (Internet, Claims, Provider, and Recipient) and documented it for the developers following the HIPAA Guidelines for an Individual functional area by conducting JAD sessions
  • Met with the Provider Communities and Trading Partners to ensure that HIPAA transactions pass the EDI gateway and interpret technical difficulties into simple language.
  • Worked Extensively with Inbound 837 I and 837 P, 835s (Out bounds) claims processing systems.
  • Involved in developing database objects using FACETS database in both SQL server and Sybase environments.
  • Conducted Web Meetings with Off-Shore team members to ensure that everybody is on the same page.
  • Collected weekly status reports to ensure that all deliverables are met on time and on schedule.
  • Met with the Provider Communities and Trading Partners to ensure that HIPAA transactions pass the EDI gateway and interpret technical difficulties into simple language.
  • Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
  • Created Use Cases from the list of requirements and prepared use case diagrams using Rational Rose.
  • Prepared Test plans and assisted the QA team in Unit testing and Integration testing.
  • Implemented the claim management system following the HIPAA guidelines of state and federal government ensuring HIPAA Compliance in claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions.

Environment: MS Visio, MS Project, UML Modeling tool, Microsoft office, Rational Requisite Pro, Rational Rose, Test Director, ETL, FACETS, SQL server, XML, gap analysis, traceability matrix, XML, Quality Center

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