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Senior Business Analyst Resume

Franklin Lakes, NJ

SUMMARY

  • 9 years of industry experience as a Business Analyst with solid understanding of Business Requirements Gathering, Business Process Flow, Business Process Modeling and Business Analysis.
  • Advanced level knowledge in software development life cycles followed in CMMI Level 5 Company. Performed Requirement Gathering/Analysis, System analysis, Design & Data Modeling, Development, Testing, Performance tuning and Functional Consulting.
  • Good knowledge of the claims process and how that process is related to the FACETS system.
  • Proficient in conducting JAD sessions with management, SME’s, vendors, users and other stakeholders.
  • Worked on the conversion of existing legacy system to the FACETS 4.7 in accordance to HIPAA 5010 upgraded version from the HIPAA 4010.
  • Performed Cataloging method and procedure development for managing files/data.
  • Performed Data restructuring to convert data into different formats.
  • Experience in HIPAA EDI transactions 837 (Institutional/Professional), 835(Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims Status Inquiry Response), 834(Benefit Enrollment and Maintenance Transaction), 278 (Prior Authorization), 997/999 (Transaction Acknowledgement) and 824, 277CA reports.
  • Knowledge of ICD-9 and ICD-10 systems implementations and upgrades.
  • Good experience in performing GAP analysis.
  • Good knowledge of Business Process Monitor and Map Editor to work with X12 files.
  • Strong expertise in using EDI Tools like Edifices (Ramp Management).
  • Excellent Business writing skills in developing Business Requirements Document (BRD), Use Case Specifications, Functional Specifications Document (FSD), Systems Design Specification (SDS), Systems Requirements Specification (SRS), Workflows and Project Plan.
  • Developed, maintained test plans and executed test Script from Quality Center.
  • Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre. Systematized Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare and proficient in CPT and HCPCS revised coding convention.
  • Understanding of Data validation and warehouse concept.
  • Worked on pharmacy benefit management systems to make use of our existing web applications that provide pharmacy/Rx related member functionality.
  • Strong communicator and creative problem-solver skilled at analyzing business needs and transforming them into technical designs, applying technical skills and business knowledge to achieve sound results.
  • Developed, maintained test plans and executed test Script from Quality Center.
  • Participate and contribute to lessons learned sessions and prepare the documents Logged and reviewed Defects, documented the whole Bug life cycle using Quality Centre.

AREAS OF EXPERTISE

Methodoloes

Agile, Waterfall, RUP, UML, SDLC, Scrum, RUP, V-shape modeling, Reverse Engineering.

Change Management Tools

Rational Clear Quest, Rational Clear Case.

Business Modeling Tools

Microsoft VISIO, Visual Paradigm.

MS Office

MS Project, Microsoft Word, Microsoft Excel, Microsoft PowerPoint.

Programming Languages

Structured Query Language (SQL).

Operating System

Windows NT/98/2000/XP.

Databases

Access, Oracle 8i/9i/10g, Teradata V2R5.1, DB2, MS SQL Server 7.0/2000

Other known tools

Informatica, Load Runner, Win Runner, Crystal Ball, Expert Choice, Core, Caliber, Rational Rose; Rational Requisite Pro.

OLAP Tools

Business Objects XI, Cognos .

Testing tools

Rational Robot, Test Manager, HP Quality Center, Quick Test Test Professional, LoadRunner, WinRunner.

P R O F E S S I O N A L E X P E R I E N C E

Confidential, Franklin Lakes, NJ

System Analyst

Responsibilities:-

  • Facilitated the JAR sessions with business users for understanding and capturing the requirements for Front End Order Processing of Prescription Claims.
  • Responsible for creating requirement deliverables - High Level and Detailed Level Functional Requirements.
  • Conducted requirement sessions and design reviews with the offshore / onsite technical team.
  • Reviewed test cases and co-ordinated the defect triage sessions with development and QA team.
  • Conducted regular demos to users and responsible for getting the necessary Signoffs from the Stakeholders.
  • Handled the requirement churn for different projects through a formal Change Request process.
  • Created User manuals for the end users and support the post production changes or enhancements.

Confidential
Business Analysis

Responsibilities:

  • Analyzed and studied the different Business Processes across various Business Units.
  • Analyzed impacts and recommendations to current business processes for Topaz.
  • Evaluated solution alternatives and developed HLDs (High Level Documentation).
  • Facilitated business users and technical resources in business, requirement gathering, documenting requirements and obtaining sign off on the business requirements.
  • Conducting JAD sessions with the client BCBSKC and BCBSNC for gathering requirement for Topaz.
  • Gathered detailed Technical requirements and participated in the defining of business rules and data standards.
  • Worked on scope of the project by creating scope item inventory.
  • Created the Technical Specifications for the Extensions, Extracts, Interfaces, Boundary applications.
  • Created the Process flow diagrams for the extracts that will be made from the FACETS 5.0 databases by the vendors who will require information for their roles as a third party.
  • Created Technical specification documentation for interfaces, Extensions, Extracts, GAP HLDs and boundaries.
  • Created Custom Development Functional Specification documentation (FSD) & obtained approvals.
  • Created process flow diagrams/activity diagrams/use cases using MS-Visio.
  • Analyzed and converted the stored Procedures into the Pseudo codes for the extensions provided by the client for better understanding of business logics behind the extensions.
  • Worked on PBMS oriented requirements/analysis/design.
  • Coordinated with Project Managers to resolve risk issues.
  • Completed the HIPAA/HITECH compliance training for the Project.
  • Analyzed and assessed the SOW 1(align and confirm phase) for the Project.
  • Reviewed, analyzed & participated in the meetings for the System Architecture Development work for the project.
  • Conducted brainstorming sessions with the onsite team and remote resources via teleconferences.
  • Documented the TriZetto assumed inventories and compared with clients MKS repository of assumed inventories by creating a traceability matrix.
  • Conducted GAP analysis that is realized from the inventory of the client in the form of Spreadsheet.
  • Updated the inventory list, SOW as per the updates from the clients and the Project Manager.
  • Extracted the information from the company’s earlier documents that involved the relevant work for different clients using the customer exchange.
  • Extracted the information required from the FACETS DATA Model (5.0), Data dictionary for the documentation involving the data and documented it.

Environment: Factes5.0, Oracle, MS Office, MS-Visio, TIBCO,, Outlook, MS Project 2010 (Work Engine), Agile (Scrum), MS Outlook, Office Communicator, MS Excel 2010, MS Visio 2010, Sql Server 2008, Facets Extensibility Guide, Customer Exchange, MKS Repository, PVCS.
Confidential
Lead Business Analyst

Responsibilities:

  • Participated in CO-MMIS (Colorado - Medicaid Management Information System) knowledge transfer in preparation for Implementation and Operation of the 5010 standards.
  • Analyzed business processes and performed needs assessment to align CO-MMIS information technology solutions with DHCPF business initiatives.
  • Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.
  • Performed Cataloging method and procedure development for managing files/data.
  • Performed Data restructuring to convert data into different formats
  • Performed data editing/manipulation to remove errors for further processing.
  • Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System related to the HIPAA.
  • Performed System testing, Regression testing and UAT for several claim types and test scenarios.
  • Compared and validated 5010 system test results with 4010 results for the same test scenarios.
  • Performed system testing and validation on ACS third party web-based solution, EDIFECS, through step down process to validate conversion process by confirming Medicaid claim was process correctly from 5010 to 4010 standard
  • Created X12’s for 4010 and 5010 standards to meet test scenarios.
  • Configured, set up and managed the automated build servers for EDI Gateway.
  • Worked with developers to generate builds, merge code, and resolve merge conflicts.
  • Frequently resolved the issues with EDIFECS and ACTTNow, primarily the generation of 997, 999, 824, 277CA reports.
  • Worked with the system administration team, technical leads, and project managers to release builds to production through EDI Gateway.
  • Good knowledge Business Process Monitor and Map Editor to work with X12 files.
  • Hands-on experience in the design, development, implementation, and production activities associated with X12 transaction sets (278,270 / 271, 276 / 277, 834, 837, and 835), and other proprietary data standards.
  • Provided support for the critical EDI Gateway translation software environment.
  • Converted Business specifications into Functional Specifications.
  • Lead the impact analysis, scope lockdown, and requirements gathering phases of the company's transition from ICD-9 to ICD-10. Also monitored revenue cycle process and implemented ICD 9 & ICD-10 mapping and crosswalk analysis.
  • Provided business analysis, testing, and system documentation for the 5010 updates for 837I transaction sets for Institutional claims for Adjudication in ACS’s Medicaid Management Information System (MMIS).
  • Performed Web Portal testing and Web Portal Post Implementation testing for 278,270/271,276/277,837PID.
  • Created system documentation for 278, 270/271,276/277,837I. Review and updated the System documentation based on team.
  • Gathered and documented Denver State client business requirements and developed, entered and verified test cases for ANSI 5010 / ICD 10 implementation.
  • Created mapping documents and also updated Companion Guides for 278, 270/271,276/277,837I.
  • Created 837I paper claim in the MMIS system.
  • Performed system and regression testing for 5010 278, 270/271,276/277,837I transaction.
  • Verified and documented HIPAA regulator changes found when moving from 4010 to 5010.
  • Analyzed results and EDI ANSI X12 file mapping and reported on standard analysis spreadsheet.
  • Involved in Business System Analysis for Inbound and Outbound Transactions.
  • Provided day-to-day EDI translator support.
  • Proposed strategies to implement HIPAA 5010 in the new MMIS system.

Environment: MMIS portal, EDIFECS(Ramp-management), FileZilla Grabit, HIPAA, Oracle, QTP, Caliber, MS Office, MS-Visio, Outlook .
Confidential
Business /Benefit Analyst

Responsibilities:

  • Performed source data analysis for claims system business unit and performed GAP analysis for current claim system and NPS.
  • Worked with data creation team to fetch data for Benefit SIT Testing.
  • Facilitated meetings with different Business unit to identify and complete data requirements for Benefit SIT Testing.
  • Prepared Test Plan for Benefit SIT Testing to identify the scope, approach, resources and schedule of the Benefit testing activities for Benefits Migration from BCBSMN STAR system to NASCO.
  • Conducted meeting with NASCO and BCBSMN team for Benefit SIT test plan review and updated the test plan based on team input.
  • Created Test Scenarios for Benefit SIT Testing, and review with NASCO and BCBSMN team.
  • Conducted meeting with NASCO and BCBSMN team for Benefit SIT test scenarios review and updated the scenarios based on team input.
  • Experience in MembersEdge and Metavance.
  • Provide direct support and input to different Technical teams during various phases of the Project.
  • Created strategy and design steps provided with the high level technical specification details for the process of preparing and integrating Claims system data to NPS.
  • Involved in reviewing the Statement of Work (SOW).
  • Performed and created impact analysis before deriving an integration roadmap.
  • Performed data analysis and conducted root cause analysis.
  • Gather information needed for business reporting requests and establish the business requirements needed to properly extract data.
  • Developed Business Requirements Document (BRD), , High level Functional Specifications Document (FSD), technical mapping documents and Workflows
  • Created and reviewed Test scenarios and Test cases for Benefit SIT Testing with BCBSMN and NASCO team.
  • Followed and provided input in regards to Agile SDLC methodology and keep aligned all aspects of the Project.
  • Identified issues and worked with application and data team to resolve any issues.

Environment: NPS, EDIFECS, Requisite Pro, Rational Rose, ClearCase MS Office, MS-Visio, Lotus Notes.
Confidential
Senior Business System Analyst

Responsibilities:

  • Analyzed and studied the different Business Processes across various Business Units.
  • Gathered detailed business and technical requirements and participated in the defining of business rules and data standards.
  • Created SRS (system required specifications) document and analysis document explaining all the aspect of 5010 837.
  • Participate in regular FACET patches weekly meeting and work with FACET SA’s to find the solution for proposed fixes.
  • Assist testers to perform mock up test for patch fixes.
  • Worked on Business Process Monitor and Map Editor to work with X12 files.
  • Work with Data Validation team and assist testing and validation.
  • Participate in regular ODS team meeting for updates coming up for the project.
  • Worked extensively for 837 Multiplan Inbound and outbound transactions for 5010 migration.
  • Responsible for requirement input in Caliber.
  • Created S.R.S (system required specifications) document and analysis document explaining all the aspect of 5010 834.
  • Created maps & layouts for HIPAA as imposed during Electronic Data Interchange (EDI): 837 Claims and Encounters, 834 Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice, 270/271 - Eligibility Benefit Inquiry and Response, 277/275 - Claim Request for additional Information and Response, 276/277 Claim Status Request / Response.
  • Worked on Claim processing and Configuring COB (Coordination of Benefits)
  • Wrote and Enhanced test cases and test scripts to meet new functional requirements as per the new business requirements for Data validation.
  • Worked with the Business Users through interviews and (Joint Application Development) JAD sessions.
  • Prepared test plan for Data validation team and Confirm that all test scripts and results have been documented and presented to internal project personnel.
  • Involved in Regression Testing every new build in UAT, QA and Pre-Production Environments.
  • Participated in writing data mapping documents and performing gap analysis on the systems.

Environment: TriZetto FACETS 4.X,Oracle,TIBCO,Onyx, Caliber, Clarity, Mercury Quality center ,TOAD, SQL, ANSI X12, XML, JavaScript, HTML ,MS office and Outlook.
Confidential Buffalo, NY
Lead Business Analyst

Responsibilities:

  • Involved in Business Analysis for Inbound and Outbound Transactions.
  • Provided day-to-day EDI translator support.
  • Served as primary point of contact to bring new trading partner onboard.
  • Performed gap analysis between partner specs and internal system requirements by matching HIPAA 4010 to 5010 implementation techniques.
  • Tested HIPAA Transactions and Code Sets Standards such as 837/835, 270/271, 276/277 transactions.
  • Created maps & layouts for HIPAA as imposed during Electronic Data Interchange (EDI): 837 – Claims and Encounters, 834 – Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice, 270/271 - Eligibility Benefit Inquiry and Response, 277/275 - Claim Request for additional Information and Response, 276/277 – Claim Status Request / Response.
  • Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.
  • Monitored revenue cycle process and implemented ICD 9 & ICD-10 mapping and crosswalk analysis.
  • Converted X12 data to XML (using DI) and verify the data by performing schema validations.
  • Created Use Case Diagrams and Test Cases for federal employee program.
  • Gathered and documented doctor company's business requirements and developed, entered and verified test cases for ANSI 5010 / ICD 10 implementation.
  • Rendered X12 Syntax Integrated Testing, Balancing Testing, Code Testing, Specialty Testing and Trading Partner Specific Testing when environment is upgraded.
  • Extensive experience in writing business documents such as Business Requirements Documents (BRDs) and Functional Specification Documents (FSDs) and Business Process Blueprint and Process Flow Diagrams (PFDs) and Data Flow Diagrams (DFDs).
  • Created Use Case Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS Visio.
  • Extensive Analysis of HIPPA rules to incorporate in the Development of Utility application which is not HIPAA compliant.
  • Collaborated with project team, project leads, and project managers and fostered with them to review plans, systems testing and overall testing of software.
  • Provided support during the integration and UAT.
  • Conducted Value Analysis, Regression Analysis, and Risk Management.
  • Prepared the Business Documentation for future reference.
  • Helped the project manager in project status reporting, ensuring that the project’s product delivers the benefits called for and resolution of conflicts within the project and between cross-functional teams.

Environment: EDIFECS, Requisite Pro, Rational Rose, Clear Case MS Office, MS-Visio
Confidential Atlanta, GA
Business Analyst

Responsibilities:

  • Identified and engaged the appropriate key stakeholders in working with the business requirements
  • Conducted and facilitated interviews Development sessions with the Subject Matter Experts to identify and prioritize all business processes impacted by migration.
  • Conducted and facilitated interviews, brainstorming, and Joint Application Development (JAD) sessions with the Subject Matter Experts to identify and prioritize all business processes impacted by migration.
  • Created Business Requirement Documents, updated Functional Specifications (TRD) for each Strategic Business Unit and critical Operation (Enrollment, Membership, Group Benefits, Claims, EDI Transactions, Customer Service)
  • Conducted Current – Desired State analysis (As-Is, To-Be process flows), GAP analysis, and documented Detailed Business Needs (file format, data mapping) compliance to HIPAA mandates (837, 835, 834)
  • Worked on data mapping, identified all data feeds generated by the legacy system to NASCO Processing Systems Claim Engines and EDI Gateways.
  • Created Business Requirement Documents, updated Functional Specifications (TRD) for each Strategic Business Unit and critical Operation (Enrollment, Membership, Group Benefits, Claims, EDI Transactions, Dental billing, Customer Service)
  • Enter professional and institutional claims using eFDE (Electronic Flexible Data Entry)
  • Adjudicate a claim, Work a claim, Reset claim lines, Adjust a claim and Read an Online Desk Level in EEC (Electronic Error Correction) HEHK
  • Perform a Hex Dump, View Pending and History Claims, View Suspended Claim Summary Screen (SCSS) in Online Inquiry HIQK
  • View/Update CSR logs in PDM (Project Data Manager)
  • Access carrier information, View/update COB Comments File Maintenance records HROK
  • Participated in weekly status meetings, daily production reviews and conducted walkthroughs for team members, and documented the proceedings
  • Completed testing for member and provider reject codes
  • Regression Testing for Provider and Member reject Codes, Coverage and Benefits.
  • Participated in the bug review meetings, Updated requirement document as per business user feedback and change in functionality of the application
  • Assisted client in developing content and training materials; recommended enhancements and identified new business requirements ensuring appropriate documentation
  • Provided Post-Go-Live Support to users, and helped end-users in solving their problems in live environment.

ConfidentialHoboken,NJ
Business Analyst
Market Master

Responsibilities:

  • Validated business requirements by facilitate JAD sessions.
  • Managed requirements by using priority matrix.
  • Performed data editing/manipulation to remove errors for further processing.
  • Worked on digitizing the geographical data.
  • Performed Cataloging method and procedure development for managing files/data.
  • Performed Data restructuring to convert data into different formats.
  • Prepared business requirement documents using Rational Requisite Pro.
  • Worked closely with ETL developers and business to incorporate the requested changes.
  • Performed data analysis using TOAD and conducted root cause analysis.
  • Facilitated meetings with users for requirement collection, design changes and feedbacks.
  • Performed GAP analysis and differentiated “must have” and “good to have” functionalities.
  • Prepared and implemented communication plan for business and internal team.
  • Prepared data comparison report (Worldwide Insurance Monitor vs. Market Master) and migration statistics report.
  • Analyzed, validated ratings data of various rating agencies (S&P, AMBEST and Moody’s).
  • Escalated issues as appropriate to management for support and guidance.
  • Prepared user instructions and use cases to conduct User acceptance testing (UAT).
  • Managed, maintained UAT defect log and conducted review meetings for defect resolutions.
  • Identified issues and worked with application and data team to resolve.
  • Process/workflow analysis.
  • Performed sanity test in different stages of software development life cycle (SDLC).
  • Prepared Playbook, Project Plan and Production deployment schedule using MS office tools.
  • Followed UML based methods using Rational Rose to develop use cases and activity diagrams; assisted developers in creating sequence diagrams and collaboration diagrams
  • Worked closely with release management to manage the requirement changes and fixes.

Environment: Java, JSP/Servlet, Oracle 9i, MS Office Tools, Windows XP, MS Project, RequisitePro, Rational Rose, ClearCase, MS Powerpoint, MS-SharePoint, MS-Word, MS-Excel, Business Objects 5.1/6.5, Informatica 7.1.
Confidential Atlanta, GA

Responsibilities:

  • Involved in requirement gathering phase (Provider, Claim components and HIPAA)
  • Utilized Rational Unified Process (RUP) to configure and develop process, standards and procedures.
  • Met with report users and stakeholders to understand the problem domain, gathered customer requirements through surveys, interviews (group and one-on-one) along with JAD sessions.
  • Involved in understanding the current business process, defining scope of the project along with position statement.
  • Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional requirement.
  • Implemented automated COB processing of Medicare claims into Facets
  • Validated business rules and all artifacts with users, got approval and sign off.
  • Followed Unified Modeling Language (UML) methodology using Requisite Pro and Rational Rose to create/maintain: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams.
  • Tested and delivered Inbound/Outbound Facets interfaces.
  • Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 837 and proprietary format files and Reports development.
  • Assisted Design Team in preparing SSR, Software Design Document (SDD), User Interface Design, Application Architecture and Database Modeling.
  • Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.
  • Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables.
  • Documented the dimensional models of ETL system.
  • Led the testing efforts of the datamarts in development, coordinated moving/setting up of processes in Dev/QA/production. Worked with QA team and UAT team to go over the various test scenarios for different types of loads in the datamarts.

Environment: Java, JSP/Servlet, Oracle 9i, MS Office Tools, Windows XP, MS Project, Requisite Pro, Rational Rose, Clear Case, MS Power point, MS-SharePoint, MS-Word, MS-Excel.
Confidential Philadelphia, PA
Business System/ Analyst

Responsibilities:

  • Acted as primary liaison between the Business unite and development team department; performed analysis, review, and estimation of client requests; prepared and reviewed system requirements, and client documentation; prepared and executed detailed test plans.
  • Prepared questionnaire and conducted personal user interviews to gather requirements.
  • Prepared business requirement (BRD) and functional requirement documents (FRD) using Rational Requisite Pro.
  • Developed test cases and participated in QA and UAT testing.
  • Worked with outsourced team to resolve application issues.
  • Provided training to users and resolved day to day issues.
  • Prepared user manual and reference guide.
  • Conducted user training in cross functional departments.
  • Developed standard operating procedures for IT tasks.
  • Maintained, analyzed and resolved IT issue log.
  • On the basis of customer feedback analyzed the report and identified vital areas to fix.
  • Provided data for reporting to internal pharmaceutical research groups and sales for enhancement purposes.
  • Created use case with UML for product functionality.

Environment: MS Office Tools, Windows XP, MS Project, RequisitePro, Rational Rose, ClearCase, MS Powerpoint, MS-SharePoint, MS-Word, MS-Excel, Business Objects 5.1/6.5.
Confidential NJ
Jr. Business Analyst

Responsibilities:

  • Analyzed business process workflows and worked in the development of Data Base procedures for moving data from source to target systems.
  • Represented Master Solution IT for various on site Client Projects and served as QA and Business analyst.
  • Analyze business requests for feasibility and collaborate with key business personnel based upon processes, procedures and workflow and the ability to make solid recommendations based upon findings
  • Created new database objects and maintain HR and reporting database.
  • Created use case with UML for product functionality using Rational Rose.
  • Strategized implementation of RUP effort throughout SDLC.
  • Created and analyzed Use Cases ,Test Plans, Test Cases and Scenarios
  • Wrote SQL scripts to verify and test business functionalities for aggregation and summation.
  • Scheduled and performed weekly and month end reports for management.
  • Designed Mapping Specifications on the basis of Functional Requirements to create the data migration Mappings.
  • Integrated several components of newly created business units.
  • Provided technical support to clients and support projects.

Environment: PVCS, SDLC, MS Office, Unified Modeling Language, Java, TOAD, Windows NT, Test Directo

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