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Business System Analyst Resume

Danville, PA

Dharmesh Shah


  • To obtain a challenging position as a Business Analyst and add value to a fast - paced technology company, by utilizing my proven Technical, Interpersonal, Analytical and Documentation skills, abilities and my diversified experience in software quality assurance, to ensure the company’s sustained growth and continued success.
  • 7 + years of experience in healthcare domain in EDI and Medicaid environment
  • Proficient understanding and demonstration knowledge of Medicaid, Medicare, EDI, ICD - 10, HIPAA 5010
  • Excellent communication and presentation skills
  • Performed data analysis, and data and software conversions, and led multiple system implementations.
  • Worked on data migration, reports implementation, and inbound/outbound interfaces and facets extensions. Implemented EDI transactions 835, 270/271, 276/277 and 834.
  • Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies and reimbursement forms.
  • Experienced in various Healthcare areas like enrollment, benefits, claims, Medicare, and implementation of HIPAA key EDI (ANSI X12) transactions.
  • Dealt with the complexity of migrating from the ICD-9 set of diagnostic codes to ICD-10.
  • Expert in all phases of requirement management, including gathering, analyzing and tracking requirements.
  • In depth knowledge Rational Unified Process (RUP) methodology, Use Cases, Software Development Life Cycle (SDLC) processes, Object Oriented Analysis and Design (OOA/D).
  • Facilitated Change Management across entire process from Project conceptualization to Testing through Project Delivery, Software Development and Implementation Management in diverse Business and Technical Environments.
  • Strong experience with different project methodologies including Agile-Scrum Methodology, Waterfall, Modified-Waterfall, Iterative, Incremental and RUP.
  • Experience in Manual, Automation & Performance testing tools like HP Quality center (QC)/Application Lifecycle Management (ALM), Quick Test Pro (QTP)/Unified Functional Testing (UFT), JIRA, Load Runner.
  • Worked closely with project managers, SMEs, and staff to understand and brief the requirements and specifications for new applications along with re-engineering the existing applications.
  • Experienced in complete AGILE, RUP, SDLC, client /server architecture, providing a well-balanced understanding of business relationships, business requirements
  • Worked for financial and technical solutions and help the team at all levels until final product release.
  • Practical knowledge of FACETS configuration principles and activities, including the FACETS data model
  • Experience with ICD 9 and ICD 10 analysis and validation
  • Experienced in writing and preparing business requirements documents (BRDs), system requirements specifications (SRS), system design specification (SDS), functional specifications, defining project plan and change request.
  • Extensive experience in requirement analysis, business modeling, defining business processes, sequence diagram, activity diagram, and Use Case using UML methodology.
  • Conducted JAD session, Gap analysis, and prioritized requirements using interviews, document analysis, and requirements workshops.
  • Communication with stakeholder, internal team, SME’s, peer group, Project Manager for follow up, update, requirement changes.
  • Assist the Project Manager in the development of SDLC methodology and documentation strategy and act on behalf of the Project Manager during the PMs Absence.
  • Facilitated UAT with stakeholders and business users
  • Excellent analytical skills for understanding the business requirements, business rules, business process and detailed design of the application.
  • Developed excellent professional skills, by working independently and as a team member in designing, developing, and implementing innovative business process and system solutions using new approaches, technology and training for Insurance Software applications.
  • Knowledge of SQL and experience of writing SQL commands.
  • Extensive process analysis, data analysis and analytics, data mapping and data modeling skills (ERM) to develop solutions to complex application, business and operational problems, and by performing business process re-engineering and process improvements where necessary.


Business Skills: Business Definition Requirements, Business Process Analysis & Research, Use Case Modeling & Analysis, JAD/RAD Sessions, Requirements Gathering, and Gap Analysis and Impact analysis

Languages:   C, C++, PL/SQP, Java, Oracle

Operating Systems:   Linux, Windows 95/2000/NT/XP, UNIX

BI Tools: Business Objects, Info view

Testing Tools: Mercury Suite, Rational Suite, Win Runner, Load Runner

Test Reporting Tools: Quality Center (Application Lifecycle Management) ALM 11, JIRA, Test Director, Clear-Quest

Office Tools: Microsoft Office

Modeling:   Agile, Rational Unified Process (RUP) and UML


Confidential, Danville, PA

Business System Analyst


  • Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.
  • Analyzed data and created reports using SQL queries for all issued Action Items. Performed the Gap Analysis to find the existing gap between the HIPAA 4010 and HIPAA 5010 EDI transactions.
  • Administered responsibilities and tasks of Functional Requirements Specifications and Non-Functional Requirements Specification (SRS) amongst Business Analysis Team, Development Team, Quality Assurance Team, and Deployment Team with the accessibility of HP Application Lifecycle Management (ALM).
  • Followed Business Process Modeling Notation (BPMN) for functional breakdown
  • Involved in UML diagrams and design of Use Case Diagram, Class Diagram, Sequence Diagram, and State Diagram for project documentation
  • Followed agile scrum methodology throughout the project.
  • Developed Data Mapping and Crosswalk documents.
  • Involved in preparing several Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio.
  • Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
  • Actively participated in creating Level I and Level II specifications including MS Visio data and program flow charts. These techno-commercial documents were presented for their approval for claims (837I / 837P / 837D), Service Review Request and Response or Prior Authorizations (278), Eligibility Verifications (270 / 271) and Claim Status Request/Notification (276 / 277). Outbound batch transactions included Claim Payment Advice (835).
  • Expertise in ICD-9 to ICD-10Conversion.
  • Develop, coordinate and support Information Technology Division on all operational requirements of FACETS claims processing system and production management.
  • Involved in developing database objects using FACETS database in SQL Server.
  • Worked on the existing mainframe system to understand the code written in COBOL, documented the system requirements from the COBOL code and came up with Use Cases from the analysis.
  • Wrote Test scenarios and test cases for testing the migration of EDI 4010 to 5010 and the processing of member enrollment and benefits, batch jobs corresponding to the claims (837) and real time transactions like 270/271/276/277.
  • Worked with multiple teams and coordinated with them to do various releases. Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9.
  • Performed Gap Analysis for HIPAA 4010 837P and 835 transactions and HIPAA 5010 837P and 835 transactions.
  • Involved in impact analysis of HIPAA 5010 835 and 837P transaction sets on different systems.
  • Re-engineering and capturing of EDI transactions with legacy systems Enrollment -834, Eligibility Transaction (270/271), Claims (837), Claim Status Request and Response (276/277), Remittance (835) .
  • Performed Migration and Validation per SDLC standards. Interacted with the Test Team and reviewed Test Plans and Cases.
  • Worked in testing the professional, institutional claims processing and adjudication and validate data with facets.
  • Assisted in Regression Test, System Test, and UAT.
  • Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.

Environment: Microsoft SharePoint, MS Visio, MS Office, HP Quality Center.

Confidential, Richardson, TX

Business System Analyst


  • Gathered analyzed, documented business and technical requirements from both formal and informal sessions and validate the needs of the business stakeholders.
  • Performed data mapping on the extracted data, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter data.
  • Followed Agile SCRUM methodology to lead the 6 people team right from the beginning of the project and reported to Project Manager on periodic basis.
  • Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Health Insurance Claims. Worked on HIPAA Standard/EDI standard transactions: 270, 271, 276, 277, 278, 834, 835, and 837 (P.I.D), 997 and 999 to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
  • Utilized HP Application Lifecycle Management (HP ALM), assigning deliverables to Quality Assurance Analyst to manage the traceability of requirements and anomalies.
  • Designed and developed Use Cases and Use Case scenarios, Activity Diagrams, Sequence Diagrams, High Level and Low Level Process Flow Diagrams, OOAD using UML and Business Process Modeling.
  • Created and maintained the Requirements Traceability Matrix (RTM).
  • Responsible for creating test case scenarios, creating test data plan and writing test scripts for the UAT using testing tool and defect management for Policy Management Systems, Payables/Receivables and Claims processing.
  • Conducted surveys, interviews, and JRP, JAR and JAD sessions and translated them into system Requirements. Suggested measures and recommendations to improve the current application performance of the system.
  • Assisted the team members to develop Service Oriented Architecture (SOA), and data warehouse system (EDW) to utilize data mining for data analysis.
  • Responsible for preparing Business Requirement Document (BRD), Functional Requirement Document (FRD) and then translating into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
  • Performed Gap Analysis in every phase and stages to check the compatibility of the existing system infrastructure with the new business requirements.
  • Interacted with DBA for the process of data extraction, data transformation, data load, data integration and conversion processes using business intelligence tools on the Benefit Plan functionality.
  • Served as a Peer review member to verify, validate and modify necessary changes made considering technical and business aspects, in the deliverable documents and thereby uploading it on SharePoint. Consolidated individual Statistical Summary from the team deliverables, various reports, jobs, files and Inventory documents to present it in weekly status meetings.
  • Lead requirements analysis and inspection, ensuring that requirement statements and business rules are complete, consistent, concise, comprehensible, traceable, feasible, unambiguous, and verifiable, and that they conform to standards.
  • Facilitated various brainstorming, requirement gathering sessions, and provided training
  • Managed requirements traceability information and tracked requirements status throughout the project. Also managed changes to baseline requirements through effective application of change control processes and change management tools.
  • Provided highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations.
  • Developed budget tools and templates, and prepared and analyzed highly complex financial and budget reports for management review.

Environment: MS Excel, MS Word, MS Access, MS Project, MS Visio.

Confidential, Montgomery AL

Business System Analyst


  • Gathering business requirements, documenting them, writing scope documents and uses cases.
  • Involved in meetings with Business process owners, SME (subject matter experts) and IT professionals for requirements gathering and definition.
  • Instrumental role in introducing and enforcing new Scrum methodology in MHS with the Express One methodology, a new approach to requirements gathering, software development life cycle (SDLC) process and software testing life cycle (STLC).
  • Worked closely with the project manager, business lead and technical lead to identify, research and escalate issues and risks to the appropriate work stream for resolution
  • Organized weekly and biweekly meetings with testers to discuss testing progress and address any major concerns with the testing effort.
  • Highly experienced with the Agile Methodology and Software Development Life Cycle.
  • Understand the overall business model of Medicare Part D products and the MMIS mechanized claims processing and information retrieval system and translate concepts into practice
  • Involved in preparing several Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio.
  • Extensively used ETL to load data from XML files, Flat files data also used import data.
  • Worked on requirements of the 835 HIPAA projects, 276/277, 278, 837, and HIPAA EDI Transactions across enterprise.
  • Sent weekly dashboard reports to management with updates of testing progress
  • Involved in planning and implementing both high-level and detailed system and integration test plans
  • Attended weekly testing status calls to update corporate on our testing progress and address any testing concerns
  • Responsible for understanding the “As Is” business process and defining the “To Be” business process.
  • Worked with the project manager to ensure project sign off closing procedures are adhered to
  • Utilized RUP (Rational Unified Process) to create use cases, activity, class diagrams and workflow process diagrams.
  • Performed overall Requirements Management and built the Requirements Traceability Matrix.

Environment: Microsoft SharePoint, MS Visio, MS Office, HP Quality Center, AGILE methodology

Confidential, Tampa, FL

Business Analyst


  • Creating BRD and FRD for conduction of tests and enhance business process cycles
  • Reviewed design documents & business requirements to learn the function and scope of the application.
  • Translated high level business / data requirements into Process, Workflow, and Data Flow Diagrams using Rational Rose / MS Visio / BPMN towards facilitating clear understanding of the business process
  • Involved in Test plan development, writing and implementation of the Test Cases.
  • Checked the data flow through the front end to backend and used SQL Queries to extract the data from database. UAT testing for HIPAA 4010 and 5010 projects including legacy testing and HIPAA requirements and compliance mandates.
  • Written multiple Test Cases (System, Integration) for multiple transactions include 837I, 837P, 835, (both inbound and outbound) transactions
  • Performed User Acceptance testing (UAT) with Business and Users.
  • Ran SQL queries to retrieve the data for data analysis and reporting.
  • Worked closely with the development team to make sure that the system is in compliance with HIPAA Guidelines.
  • Analyzed and evaluated the performance of the application from various dimension and conducted User Acceptance Test (UAT) with business users.
  • Worked on Scrub enhancement project related to Medicare Part D.
  • Clearly understood coding standards required for all Medicare Part D Users transactions involving electronic data interchange as provided by department of health and human services and incorporated at every stages of the project wherever found necessary
  • Performed Security Testing to ensure secure login and payment access.
  • Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
  • Integrated Requisite Pro with Rational Rose to provide all teams visibility and maintains tractability among requirements, use cases and change requests.
  • Compiled the Vision Document and composed detailed Use Case Specification Documents in Rational Requisite Pro.
  • Analyzed the results using online monitors and graphs to identify the server resources.
  • Performed Backend Testing using SQL queries.
  • Used Quality Center for reporting Bugs and Issue Management.
  • Used Quality Center for tracking and reporting defects found during the functional and regression testing.
  • Supported clients in all testing phases through UAT (User Acceptance Testing).
  • Participated in weekly meetings for reviewing progress and future testing efforts.

Environment: SQL, MS Word, Excel, EDI, SQL, Quality Center, MS Visio, Waterfall Methodology.

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