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Senior Business Systems Analyst Resume

Atlanta, GA

Professional Summary

  • Considerable experience and understanding of Software Development Life Cycle.
  • Knowledge of Health Information and Health Care Services Regulatory Environment including EDI, HIPAA,HL7, Medicare & Medicaid.
  • Worked in Agile and Waterfall Software Development Environments.
  • Expertise in Functional Testing of Client / Server and Web Applications.
  • Strong experience with NPS ( Confidential Processing System ).
  • Experience with National Provider Identifier (NPI), MMIS, MITS, Medicare, Medicaid and Commercial Insurances in HIPAA ANSI X12 formats including 270 / 271, 276 / 277, 834, 835, 837 and NSF formats.
  • Performed Validation of the EDI 837 Claim Billing ( Professional and Institutional ) and
  • 835 (Remittance advice or payment) claims adjudications.
  • Validating 270 and 271 messages (Coverage Verification ).
  • Strong knowledge of EDI formats and HIPAA 4010 to HIPAA 5010 changes to these formats.
  • Created Test Plans and Test Cases for HIPAA 5010 standards.
  • Knowledge in HIPAA Implementation. Involved in various HIPAA related projects.
  • Performed GUI testing, Functional testing, Regression testing, End to End testing, User Acceptance testing and Database testing.
  • Performed Backend testing of the SQL Database and verified the EDI data transactions.
  • Strong experience in data validation and manipulation in SQL server databases using SQL queries.
  • EDI Testing with good understanding of Quality Assurance Tools and Methodologies.
  • Writing Test Plans, Test Cases / Scenarios, Test Strategy and Analyzing test results.
  • Knowledge and experience in EDI Data Mapping and Migration.
  • Familiar with FDA Regulations like 21 CFR Part 11 and ICD Diagnosis Codes.
  • Good understanding of web technologies like CSS, XML, HTML, .NET and Java Script.
  • Experience and Strong knowledge with Medicare, Medicaid, insurance and claims processing for the EDI Transactions sets, HIPAA ANSI X12 4010, 5010X222, 5010X222A1, 5010X223A1, 5010X223A2 formats including 835, 837I, 837P, ICD 9, ICD 10, DRG, CPT, NCPDP codes for interfaces, enveloping of transactions and NPI requirements for 5010.
  • Strong experience in Healthcare Systems (HIPAA 5010 Compliance Confidential , FACETS, ENTERPRICE, EDIFECS, SPECBUILDER, RAMP MANAGEMENT FOR 5010 MIGRATION), Health insurance plans – Indemnity plans, Claims processing, Managed Care plans (HMO, PPO & POS) and C Codes for the business of claims processing.
  • Strong knowledge of Unified Modeling Language (UML), Software Development Life Cycle (SDLC), Waterfall, Rational Unified Process (RUP) and Agile Methodologies.
  • Extensive experience in handling Requirements Management, Business Requirements Document (BRD), Functional Requirements Specification(FRS), System Requirement Specifications (SRS), Use Case Specifications and Requirements Traceability Matrix.
  • Extensive experience in eliciting, structuring, documenting and validating (ESDV approach) requirements based on Joint Application Development (JAD), Joint Requirement Planning (JRP) and Rapid Application Development (RAD) sessions with stakeholders, end- users and technical teams.
  • Involved in Business Process Reengineering and GAP analysis.
  • Proficient in creating Use Case Diagrams, Activity Diagrams, Sequence Diagrams and Process Flows using Rational Rose, MS Visio and Enterprise Architect.
  • Experience in creating Test Plans, Test Cases and Quality Assurance Testing
  • Excellent written and verbal communication, decision making and leadership skills.
  • Strong questioning, observational, facilitation and Coordination skills.


Testing tools: Quality center 9.2, QuickTestPro 9.2/9.5, LoadRunner 9.1, Rational Robot, Test Manager

Defect Tracking Tools: Rational ClearQuest, Quality Center

Database: Oracle 9i, 10g and MS Access

Programming Language: Java c, C++, Visual Basic, SQL, PL/SQL

Web Technologies: Java Servlets, XML, JavaScript, HTML

Other Products and Tools: MS Office, Rational Rose 2000, Visio, RequisitePro, TOAD, Cognos

IDE Tools: Eclipse 3.0, Net Beans

Operating System: Windows 9x/XP/NT/2000, Unix, Linux


Confidential, Atlanta, GA

Senior Business Systems Analyst


  • Received financial vouchers from providers and filed them in database ledgers after they were tested and validated.
  • Practiced the financial transactions on the NPS System with accounting principles.
  • Created COB comment files for COB testing.
  • Validated creation of EOB’s and mapping of dollars and Messages on the Ledger.
  • Validating Different kinds of financial reports like 100 SERIES REPORST, 200 SERIES REPORTS generated by financial system in NPS.
  • Validated creation of subscriber and provider checks.
  • Validated creation of ANSI 835 and performed transaction, claim and line level balancing.
  • Responsible for testing coding changes made on Confidential system.
  • Completed knowledge of claims processing on Confidential system.
  • Prepared Test Scenarios and Test grids in Confidential .
  • Used SQL and Ad-Hoc querying to pull and also validate claims data from database.
  • Responsible for Vouchers inside of the Confidential system.
  • TSO application to view copy and edit 834/837 datasets.
  • Confidential ’s HIQK was used to view claims.
  • Helping the team in Day-to-Day activities, problem resolving.
  • Supported teams in Implementation and Post Implementation activities.
  • Part of many successful projects from analysis through implementation phase.
  • Performed SIT (System Integration testing) to check compatibility of new changes with current system.
  • Regression Testing was performed to check the adverse impacts of new technical changes that were made.
  • As part of UAT(User Acceptance Testing), integrated with users(Providers) to validate the tested results with requirements.
  • Impact Assessment for ICD 10 Implementation – Field Expansion for Codes, ICD Indicator, 25 Occurences, Code Mapping from ICD -9 to ICD -10 and vice versa.
  • Identified and reported all testing issues including data and process.
  • Performed end to end testing by sending claims on 837.
  • Complete knowledge of loops and elements present in 837,835 and 834.
  • Complete knowledge of validating 837 and 835’s based on HIPPA compliance.
  • In-depth knowledge of downloading 837 files from PROD and editing as per requirements specified.
  • EEC (HEHK) was used to adjudicate claims.
  • Used HSSK application to downloaded claims into Model Office for Testing.
  • Worked on all applications in Confidential like HIQK, HURK, HRSK, HZMK etc.
  • In- depth knowledge of analyzing claim process in the NPS system.
  • Performed writing CSR’s in PDM.
  • Viewed and modified GENO tables using TPOL application.
  • Extensive knowledge of GENO tables usage in claim processing.
  • Worked on Confidential membership, eligibility and benefit sub system.
  • Extensive knowledge of using eFDE application to create claims.
  • In-depth knowledge of Confidential system from end to end.

ENVIORNMENT: HIPAA, Windows 200/2003/XP, MS Office, Confidential , TSO, EDI, SQL, Ad- Hoc, Sybase.

Confidential, Hartford, CT

Senior Business Analyst


  • Interacted with business managers and other stakeholders to determine project scope thus defining key challenges, risks and project deliverables.
  • Involved in PMO activities to make sure proper documentation and standards are being followed.
  • Creating project plan and communicating to the team with ongoing project activities.
  • Performed GAP Analysis for HIPAA 4010 to 5010 Migration
  • Created process flow diagrams for all “As Is” and “To Be” scenarios using MS Visio
  • Generated requirements through JAD sessions, discussions and one-on-one interviews with stakeholders.
  • Exposed to extensive use of MS Visio and UML for generating class object, component, deploying, use-case, sequence, collaboration, state and activity diagrams.
  • Worked on EDI X 12 transaction set 837 I/P/D, 834,276/277 feeds to allow for change in the claim number.
  • Understood and analyzed project requirements and specifications and provided estimates on effort and duration of test assignments.
  • Reviewed and Validated Requirements and technical specification and developed and executed test strategies.
  • Used standard test plan templates, wrote components of the Test Plan document.
  • Independently wrote and executed test cases utilizing standard test methods and tools.
  • Executed testing, recorded and tracked test case execution and benchmarks.
  • Recorded, tracked defects using standard test tools.
  • Analyzed the FACETS(claim engine) data and discussed with the Business team regarding the requirement.
  • Working knowledge of the data mode, data fields of the FACETS system and worked on FACETS tables such as Provider, Contract, Benefit, Claim details and Member.
  • Worked on Claims attributes, Provider attributes, enabling EOB & Remit rules associated with Provider configuration process in FACETS.
  • Provided basic metrics reporting on test execution and defects.
  • Communicated status, issues and risks on a timely basis.
  • Consulted with development engineers to resolve project related technical questions and issues.
  • Identified and reported project issues and risk.
  • Provided test execution results and analyzed test results to ensure existing functionality.
  • Conducted User Acceptance Testing (UAT) and after interacting with the end users and collecting their feedback: documented the changes/enhancements required.
  • Worked on generating the companion guide for the various trading partners depending on the SNIP WEDI edits from level 1 through 7 and generating Business edits for the 5010 837P and 837I Transactions sets for the HCFA and UB ( Inbound and Outbound).
  • Performed the gap analysis for the various loop, segments, elements like ICD 9, ICD 10 diagnostic codes, mapping of NPIs under the NM108 segment and removal of REF*IG segment were performed under the latest addenda versions of 5010X223A2 and 5010X222A1 and documenting the BRD for the same.

ENVIORNMENT: HIPAA, UNIX, PL/SQL, Quality center, QTP, Oracle, SQL Server, SQL Query Analyzer, SQL Enterprise manager, SQL server Compare, PVCS, FACETS 4.71.

Confidential, NJ

Business Systems Analyst


  • Involved in gathering user requirements and preparing following documents: Functional Requirement Specification (FRS), System requirement Specification (SRS), Business Requirement document (BRD) nad Product Configuration Specifications.
  • Involve in documenting the development and implementation of Business Data Catalog.
  • Identified the scenarios based on business requirement and HIPPA compliance for each transaction such as 837(Claim) and 276/277 (Claim status).
  • Worked on 837 files and validated the claims in Confidential processing system.
  • Created Use Cases for Confidential claims processing system.
  • Working knowledge of benefits and claims processing on Confidential processing system.
  • Used MS Visio and UML for generating class diagrams and activity diagrams. Used standard Business Analysis methodology centered on RUP (Rational Unified Process).
  • Followed Scrum development process using agile methodology.
  • Used Sprint backlog and User stories in the process.
  • Performed Integration testing between WGS system and Confidential application.
  • Worked on provider, subscriber information and claim enquiry through HIQK platform.
  • Entered professional and institutional claims in eFDE and mapping of claims.
  • Participated in multiple team JAD sessions.
  • Involved in reviewing the Test cases and Test Plans and identifying the gaps to make them more effective and relevant according the requirements.
  • Good documentations skills.
  • Provided support during the integration and UAT.
  • Worked on the HIPAA 5010 Transaction and NPI Implementation Phase.
  • Directly dealt with the SMEs for the Medicare Claims for Crosswalk, Provider Audit Reports for Claims, DRG pricing, NPI Maintenance using Taxonomy and Zip+4 and documented the BRD and FRD and impact screens.
  • Analyzed the existing 4010 transactions, performed Gap Analysis and documented the BRD and FRD for 5010 ANSI X12 835 and 837 set of transactions.
  • Developed test cases and completed the entire System Testing of the Provider Enrollment Screen for NPI Implementation, prioritized the defects and raised to the Mainframe developer. Defect tracking was done using MS Excel.

ENVIORNMENT: HIPAA, NPS, MS Office, Windows, TSO/ISPF, Clear Quest, RTM, Visio, XPEDITER, HTML, XML, SQL Server.

Confidential, Danville, PA

Business Analyst

  • Responsible to ensure that EDI Process is HIPPA (Health Insurance Portability and Accountability) complaint and worked on ANSI X12 standards.
  • Analyzed URS & Functional Requirements Specifications to understand business rules of application.
  • Identified the scenarios based on business requirement and HIPPA compliance for each transaction such as 837 (Claims) and 276/277 (Claim Status).
  • Developed all operational and technical flows using MS Visio and involved in the creation of business Architecture Document to provide an overview of different aspects of the application.
  • Actively participated in creating requirements traceability matrices, test scenarios, test scripts and test cases.
  • Documented test cases corresponding to business requirements and other operating conditions.
  • Used RUP methodology.
  • Wrote Test cases and Test scripts for functional testing.
  • Responsible for back end testing/database testing, which was done using SQL queries.
  • Maintained and executed test cases and test scripts using Rational Clear Quest.
  • Reported the bugs, Email notifications to the developers using the Rational Clear quest.
  • Provided Support services for centers for Medicare and Medicaid services (CMS).
  • Performed Data mapping, logical data modeling.
  • Used SQL queries to filter data within the database tablets.
  • Involved in Data selection for testing the EDI Load Process: backend process for loading and processing the data received through EDI and manual process as per Business Rules.
  • Preparation of Traceability matrix.
  • Participated in testing using SQL queries on SQL Server tables and generating reports to ensure data integrity.
  • Performed UAT testing with client an supported all phases of testing with QA team and managers.
  • Facilitating and co-coordinated all User Acceptance Testing activities.
  • Worked on the HIPAA 5010 Transaction and NPI Implementation Phase.
  • Directly dealt with the SMEs for the Medicare Claims for Crosswalk, Provider Audit Reports for Claims, DRG pricing, NPI Maintenance using Taxonomy and Zip+4 and documented the BRD and FRD and impact screens.
  • Analyzed the existing 4010 transactions, performed Gap Analysis and documented the BRD and FRD for 5010 ANSI X12 835 and 837 set of transactions.
  • Conducted GAP Analysis to determine the AS IN and TO BE case flow scenarios.

ENVIORNMENT: SQL, Quality Center, rational Clear Quest, Windows, Excel, Outlook, PowerPoint and word, MS Office, MS Visio, Rational Unified Process, UML, Use Case Diagrams.

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