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Sr. Business Systems Analyst Resume Profile

Dallas, TX


  • Over 7 years of experience as Business Systems Analyst in the Health Care domain with knowledge of Business Case Development, Development of IT Enabled Business Solutions and Business Analysis.
  • Strong knowledge of Software Development Life Cycle SDLC , waterfall, Agile/Scrum and Rational Unified Process RUP .
  • Extensive experience in gathering Business and Functional Requirements, Business Scope Vision Document, developing Business Requirement Document BRD , Functional Requirement Document FRD , and communication plan, Use Cases, conducting Gap Analysis and Risk Analysis.
  • Conducted JAD sessions and Interviews. Adapt in implementing requirements, creating project status reports and presentations.
  • Experienced in creating Sequence Diagrams, Collaboration diagrams, Activity Diagrams, Class Diagrams using rational tools and Microsoft Visio.
  • Worked with Software Development Life Cycle SDLC including Feasibility Study/Gathering Requirements, Analysis, Design, Development, Testing, User Acceptance Testing UAT , Implementation and Post-Implementation Validation.
  • Expertise in creating and executing Test plans, Test scripts, Test cases, for Manual and automated testing.
  • Experience creating Traceability matrix to better manage the requirement gathering process and keeping track of the milestones.
  • Experienced in Medicare and Health Care Insurance as well as Medical Standards HIPAA and HL7
  • Knowledgeable in Obama Care.
  • Knowledge of HIPAA compliance life cycle, HIPAA insurance regulations and claims processing.
  • Thorough understanding and experience in EDI transactions and Codes like: 837 Health care claims , 270/271 Inquire/response health care benefits , 276/277 Claim-status , 834 Benefit-enrollment , 835 Payment/remittance advice mainly Professional and Institutional Claims
  • Knowledge of ICD 9-CM Clinical modification to ICD-10-CM/PCS Clinical modification/procedure coding system and CPT codes for mental and medical health.
  • Experience in Conversion of HIPAA X12 4010 transactions to X12 5010 transactions.
  • Hands on experience in Claims Adjudication System and Complete Revenue Life Cycle.
  • Excellent understanding of Healthcare Jargons like HIX Health Insurance Exchange , EMR/EHR, HMO/PPO/POS, Health Care Reform and Patience Protection Affordable Care Act PPACA , Medicare Part A, B, C, D ,/ Medicaid, Medicaid Management Information Systems MMIS and Health Care Reform.
  • Worked with Claims NASCO , provider, enrollment, finance, benefits and Vendor Management Business Areas.
  • Knowledge of the current industry methodologies like SEI-Capability Maturity Model CMM , HIPAA, EDI and Foreign exchange.


Microsoft Technologies

MS Visio, Excel, Word, Outlook, PowerPoint, SharePoint

Requirements Management


Rational Requisite Pro, Rational Rose, ClearCase, ClearQuest

Operating System

Unix, Windows 2000/XP/Vista

Business Skills

Business Process Analysis Design, Process Improvement and Implementation Assessment, Requirement Gathering, Use Case Modelling, JAD Sessions, Gap Analysis, Impact Analysis


C, C , SQL, JAVA, .Net.


SQL, Oracle, SQL Server 2000


Rational Unified Process RUP , Agile, Waterfall, Joint Application Development JAD



Sr. Business Systems Analyst


  • Participated in Business Modeling by understanding the needs of the business, and also documenting Business Use Cases as well as System Use Cases.
  • Facilitated Joint Application Development JAD sessions with the Management, Mainframe and HIPAA team to make sure everyone are in synchronous with the business requirement processes.
  • Created and Maintained Requirement Traceability Matrix RTM .
  • Conducted meetings with different vendors in order to gather and document system requirements.
  • Worked with Data stage developer to extract data from Facets 5.01
  • Worked on ASC X12 Benefit Enrollment and Maintenance 834 transaction.
  • Extensively used MS Visio to create Use Cases and Sequence Diagrams.
  • Assisted development team to translate requirements into technical specifications.
  • Prepared mock-up for paper bill both for On Exchange and Off Exchange Members.
  • Gathered and documented business requirement for federally facilitated exchange FFE members.
  • Used HP Mercury Quality Center 11.0 to report any bugs found and communicate to the developers and product support team.
  • Interacted with Subject Matter Experts SME and end users to establish a business analysis around AGILE methodology.
  • Worked with HIPAA rules and regulations to draft business rules and claim processes.
  • Conducted User Acceptance Testing UAT sessions with business users and prepared document for enhancements and bug fixes.
  • Worked with Architect to developed High level system design.
  • Created technical specifications for new and existing members from on and off Exchange federal program.
  • Worked with Test Coordinator to prepared Test plan and test cases.
  • Actively participated in Change Board Meeting for any changes in the business requirements.
  • Updated BRD based on Change Request and manage Change Request Document using Microsoft Office.

Environment: MS Visio, MS Project, MS Outlook, Windows XP, HIPAA, Microsoft Office Suite, Microsoft SharePoint, Quality center, Rational Unified Process RUP , UML.


Sr. Business Systems Analyst


  • Test various change orders of Medicaid applications received from the System Engineer's
  • Regression Testing of Web applications and applications dealing with MEDICAID and MEDICARE Services
  • Conduct weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
  • Conduct complex documentation and user needs analysis. Interface with team and staff to develop HL7 integration
  • Assist JAD sessions to identify the business flows and determine the EDI X12 Transaction, Code set and Identifier aspects of HIPAA, impacts any current or proposed systems.
  • Develop the strategy for developing and implementing new EDI HL7 and X12 interfaces and converting historical clinical and data.
  • Conduct business-impact assessment and the results compared with the new HIPAA 5010 standards to determine the current level of compliance and develop an action plan for approval by the project steering committee
  • Develop plan for data feeds and data mappings for integration between various systems, including XML, to follow ICD 10 Code set and ANSI X12 5010 formats.
  • Prepare and maintain Business Rules Spreadsheets BRS identifying Rules, Triggers and corresponding data fields from Legacy to target CRM application.
  • Involve in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations.
  • Conduct Gap Analysis, and Gathered User Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions.
  • Utilize corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
  • Store stakeholder conversations as part of CRM Activities in detail using ACT 5.0.
  • Proven Strength in Creating guidelines and templates for designing developing CRM applications.
  • Involve in analyzing activities for a variety of major projects including Medicare Plan part D, Coordination of Benefits, New Client Implementations, Consumer driven and regularly scheduled system upgrades.
  • Extensively interact with the stakeholders and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations.
  • HIX enrollment for EDI 834 and 820 transactions.
  • Assist to develop the Test Plan, Test Cases and Test Scenarios to be used in testing based on Business Requirements, technical specifications and/or product knowledge.
  • Act as a Business Analyst for the CDS implementation the backbone for data integration among myriad systems, including ERP, CRM, Portal, Workflow Engine, Payroll and related interface
  • Prepare graphical depictions of Use Cases, Use Case Diagrams, State Diagrams, Activity Diagrams, Sequence Diagrams, Component Based Diagrams, and Collaboration Diagrams and creation of technical design UI screen using Microsoft Visio.
  • Analyze trading partner specifications and create EDI mapping guidelines.

Environment: HIPPA 5010, EDI X12, Rational Rose, Rational Requisite Pro, Microsoft Visio, Microsoft Excel, HTML EDI, XML, HIX, SDLC, .NET, MS SQL Server


Sr. Business Analyst


  • Defined a complete set of metrics report requirements including a framework that will meet the needs of regional and national business leaders
  • Provided analytical data to enable management to make informed decisions to drive continuous revenue cycle improvements by realizing gains in operational efficiency, cost savings and member experience
  • Performed GAP Analysis of EDI 837 transaction from HIPAA 4010 to HIPAA 5010.
  • Created drill down from the high level summary metrics to the supporting detail in the current report format
  • Identified performance indicators that provide reliable daily trend information as a primary input towards the monthly executive dashboard report.
  • Developed HIPAA EDI Transmissions. Work includes complete business cycle management and hands-on production as well. Create EDI Testing process, documentation, and performance matrices.
  • Technical Specification Creation for EDI. Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
  • Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837- I,P, D , 835 Remittances and others.
  • Drafted the existing and known requested list of metrics to the Revenue Cycle process context map
  • Analyzed and drafted a functional and technical features list for each vendors, thus identifying the best to send out a RFP
  • Created a prototype presentation in Visio for the SCAL region, thus showing a pictorial representation on the various drill downs from the report to the metrics to the database.
  • Identified and drafted the calculations used for various regions, using their source SQL's for standardization purpose.
  • Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
  • Prepared for GAP Analysis identified and documented improving areas to meet capital requirement regulations.
  • Developed UML Use Cases using Rational Rose and developed a detailed project plan with emphasis on deliverables.
  • Involved in interactions with Subject Matter Expert, Project Manager, Developers, and the end-users in more than one JAD sessions. MS Project proved useful in coordinating activities with project manager and various other team.
  • Modelled the information and then came up with the requirements prioritization. Eliminated false requirements by screening out multiple versions of user input. Final prioritization was based on both, product and process requirements.
  • Provided clear and concise documentation regarding requirements management plans, functional requirements, supplemental requirement
  • Performed GAP analysis for the modules in production, conducted feasibility study and performed impact analysis for proposed enhancements.
  • Coordinated JAD session with system analysts, development team, project manager for application development and Pre-validation specifications

Environment: Windows XP/2000, Oracle, PL/SQL, MS-Project, MS-Office Suite, MS Visio, Rational Requisite Pro, UML, Clear Case, Clear Quest, MS Visual Source Safe


Role: Business Analyst


  • Prepared Business and Technical Requirement Document BTRD .
  • Worked on HIPAA Transactions 270, 271, 276, 277, 834, 835 and 837.
  • Developed current and 'to be' business processes and use case documents in compliance with HIPAA policies and procedures using MS Visio.
  • Involved with project management team in developing project plan.
  • Written business flow and work flow diagrams to develop software.
  • Created Use case diagrams, Activity, Sequence and Collaboration diagrams using UML.
  • Worked directly with quality resources to ensure testing activities are in line with the defined business requirements.
  • Defined Quality Assurance Checklist using Oracle Service Contract.
  • Coordinated with QA and user acceptance testing.
  • Maintained a record of recommendations, communications, activities, and schedules to monitor the progress of project in real time using MS Project.
  • Interacted with Subject Matter Experts SME and end users and established a business analysis around AGILE methodology.
  • Gathered requirements from Business Managers, Supervisors, stakeholders, Data Governance Team and subject matter experts through meetings to understand needs of the system.
  • Intensively involved in project testing efforts by doing Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing.
  • Effectively communicated user acceptance test UAT results between users and development team and provided recommendations for Application change requests ACR .
  • Dealt with HIPAA 4010/HIPAA 5010 transactions.
  • Documented various key elements of HIPAA compliance and made sure that they are understood by the development teams. Test cases written for the project were HIPAA complaint.

Environment: Agile methodology, MS Visio, MS Project, UML, Win Runner, Microsoft Office, Microsoft Share point.


Business Systems Analyst


  • Gathered User and Business level Requirements from various departments and designed the functional specific requirement collection approach based on the project scope using RUP.
  • Conducted JAD Sessions periodically with various stakeholders at various phases of the Software Development Life Cycle SDLC to discuss open issues and resolve them.
  • Documented Business requirement documents, functional requirements documents based on User Requirement Specification and created non-functional requirement documents.
  • Prepared Use Case, Briefs Specifications for all of the functional requirements
  • Designed Use case diagrams, Design Models, Activity diagrams and sequence diagrams to analyze the system using UML.
  • Designed screens and visual charts during web system development.
  • Held regular meetings with business user groups, developers, database developers, quality testers during the entire project to keep track of project and explain future data modules.
  • Validated technical designs created by IT developers against functional specifications.
  • Worked with QA team to design the test plan and test cases to be implemented.
  • Facilitated UAT and test strategies with developers and testers and performed manual front-end testing to check all the functionalities incorporated with the different modules.
  • Trained Users on the new applications, using PowerPoint.

Environment: RUP, MS Word, MS Excel, MS outlook, HTML, CSS, MS PowerPoint, MS Project , MS Visio, Rational Rose, SQL Server, Quality Center 10.0


Business Analyst / UAT


  • Effectively used Rational tools for Requirements Management Practices.
  • Communicated extensively with the Subject Matter Experts SME to gain further knowledge in completing user requirements.
  • Planned and defined system requirements, Use Case Scenario and Use Case diagrams for web-based application based on HIPPA compliancy.
  • Prepared Test Plan and Test cases using Quality Center for all the User Stories.
  • Participated walkthroughs with the development team to make them understand the requirements and help them formulate test plans and test scripts on EDI 834 benefit enrollment.
  • Verification of EDI 834 raw data from different portals such as fax, mail or web-sites.
  • Performed and analyzed GAP Analysis of EDI 834 and EDI 835 transactions.
  • Participated in meetings with developers and business analysts and reviewed the test cases written, and made changes where necessary.
  • Had to make sure HIPAA norms were addressed along with specific transaction sets.
  • Set-up Sprint Planning with the Scrum Master.
  • Actively participated in Iteration Burn down Chart to accomplish the project in time.
  • Conducted daily Scrum Meetings.
  • Helped QA team execute test cases as per the user stories.
  • Executed Active Batch jobs to run Data Conversion procedures for moving data from old system to new system.
  • Verified the data on the destination database after conversion using SQL Queries.
  • Tested Image Now application by making changes at central
  • Used Quality Center for Defect reporting and tracking, attended daily defect review meetings.
  • Involved in Mock-go-Live procedures to analyze issues that may arise while going pilot and live.
  • Developed business cases and provided Use Case and Activity Diagrams in MS Visio.
  • Worked with the end users during the User Acceptance Testing.
  • Verification of EDI raw data as per the guidelines of implementation guide.

Environment: Quality Center, MS Excel, MS Word, Rational Requisite Pro, ClearCase, MS Visio, Gap Analysis, SCRUM

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