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Healthcare Business System Analyst Resume

Minneapolis, MN


  • Over 5 years of Experience as Business Analyst in Healthcare include understanding of Business Requirement Gathering, Business Analysis, Joint Application
  • Development JAD sessions with clients and referring to accessible documentation and procedure.
  • Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System MMIS.
  • Knowledge of data migration tools and interfaces - Integrity, (SharePoint),BizTalk.
  • Knowledge and Experience on Membership, Billing, Claims Payment Processing in relation to HIPAA, EDI 4010, 5010 X12, 834, 837,835, and 270, 271.
  • In dept. noledge of Software Development Life Cycle SDLC methodology such as Agile, Waterfall and RUP.
  • Experienced in providing Medicare Operations support, with a focus on leading configuration activities for Medicare Part D operations and also in Requirements Traceability Matrix (RTM) and test plan.
  • Involved in generation and execution ofSQLqueries to understand the processes used by the pharmacy department.
  • Efficient in writing Business Requirements Document, user cases, HIPAA, Use Case Specifications, Functional Specifications and Workflows.
  • Develop business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation and enterprise architecture.
  • Good noledge on EDI 900 series in GXS BizManager.
  • Strong noledge of Use Cases, MITA and Activity Diagram and profound noledge of EDI X12 standards in healthcare insurance.
  • Involved in Facet Implementation and conversion of 4.21 and also in TriZetto Facets and TriZetto HIPAA Gateway 4.11.
  • Extensive Experience in Functional, Integration, Regression, MMIS, HL7, FRD, User Acceptance UAT, MITA, System.
  • Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
  • Designed and implemented basic SQL queries for testing and report/data validation
  • Experienced in client interaction, deep understanding of business systems functionality and technicality.
  • Strong Knowledge and experience of EDI transactions, HIPAA, ASC X12 Transaction sets: 834 (Benefit Enrolment and Maintenance), 835 (Claim Payment/Advice, 837 (Claims and Encounters), 820 (Payroll Deducted and Other Group Premium Payment for Insurance Products) 270/271 (Explanation of Benefits (EOB) /Response to EOB), 276/277 (Claim Status/Claim Status Response).
  • Proficient in Developing and executing Test Plans, Test Case, FRD, TriZetto Facets 4.x and Medical Billing, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
  • Knowledgeable about preparing RTM documents and also Experience in conducting SWOT Analysis, MMIS, MITA, Cost Benefit and ROI Analysis.
  • Experience in developing project plan and estimating project timeline.
  • Excellent working noledge in Project Life Cycle and clear understanding of Project Management.
  • Experienced in performing Gap analysis by identifying existing technologies, documenting the enhancements to meet the end-state requirements.
  • Excellent business communication and presentation skills. Adapt at creating, editing, and coordinating extensive communication networks, to keep executive staff and team members apprised of goals, project status, and resolving issues and conflicts.
  • Knowledge of Life Insurance concepts including Adjustable death benefit and various flexibilities associated with it.
  • Conducted successful projects with the help of teams to achieve deadlines timely and proficiently AND Worked on FACET claim processing system.
  • Organized, goal-oriented, MITA, FRD, self-starter, and ability to master new technologies manage multiple tasks while following through from start to completion.
  • Experienced in analyzing business requirement at all stages of Software development of life cycle SDLC.


Confidential -Minneapolis, MN

Healthcare Business System Analyst


  • Conducted the role of Senior Business Analyst for the Cigna Health Insurance Marketplace Eligibility & Enrolment project.
  • Gatheird Business Requirements, interacted with the Users, Designers and Developers, Project Manager and SMEs to get a better understanding of the Business Processes.
  • Gatheird and analyzed the User Requirements from walkthroughs and interviews with the business groups and in-house stakeholders, and many other departments like accounting, fund management, human resource and thus converted User Requirements into Business Requirement Documents (BRD).
  • Manage company's EDI catalog for prospective EDI customers.
  • Gatheird the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA).
  • Implement new services and programs via MMIS for the Medicaid program by directly interfacing with the customer and the system engineers on a regular basis.
  • Developed a work plan that ensured RFP would meet federal prior approval requirements including use of modular project development, compliance with MECT, MITA, HIPAA and other federal guidelines
  • Involved inSSASCubes design by creating KPI, Actions and Perspective from huge dataset usingSQLServer 2008 Analysis Services (SSAS)
  • UsedSQLdeveloper tools to create data report from data warehouse
  • performing queries and generating reports.
  • Used Electronic Medical Record (EMR) to extract useful information regarding patients for claim submission to the insurance company.
  • Involved in various Facets Data models like Gateway, Claims, Membership, Provider, Billing, Capitation, Invoice Benefits, Product and Plan.
  • Created and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and Claim adjudication.
  • Facilitated Scrum meeting with technical/non-technical team, Accounts updating, data analysis and sharing with XML patterns, SME's to clarify business rules & solve impediments, rectifying the regulatory issues with SME's and translated Functional requirements into User stories using JIRA.
  • Prepared test data from user stories, write and execute test cases in JIRA
  • Created UML Diagrams including Use Cases Diagrams, Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams and Deployment Diagrams, using Rational Rose and MS Visio and thus defining the Business Process Model and Data Process Models.
  • Coordinate with Health Insurance Exchange (HIX) program staff and other stakeholders to define and develop requirements for correspondence generation across various business lines.
  • Worked with Source system Subject Matter Expert (SME) to ensure that the extracts are properlymapped. Used SQL for data mapping and querying.
  • Worked in Agile Methodology, worked on all phases of software development life cycle to build the different phases of Software development life cycle.
  • Performed Gap Analysis to check the compatibility of the existing system infrastructure, features and functionality with the new business design using the "As Is" and "To Be" methodology.
  • Developed business case which included results of the business-impact assessment, gaps identified, alternative solutions, risk assessment, preliminary work plans, resource requirements, and a budget for completing the initiative.

Confidential -Clarksboro, NJ

Healthcare Business System Analyst


  • Participated in Business Modelling by documenting the needs of the Business.
  • Designed a new matrix covering all the conceptual parameters of the new system.
  • Extensive noledge on relevant cross-industry data and messaging standard organizations and HIPPA/EDI industry-specific organizations to maintain a point of view as to the current applicability and risks associated in implementing standards or new technologies to client environment.
  • Developed applications to track risk exposure.
  • Created class diagrams, use case diagrams and sequence diagrams to view the system from different perspectives.
  • Conducted on-site/web conference presentations, data conversions, system implementations and end user training. Provided ongoing user assistance, enforcement of technical policies, software releases, system upgrades and resolved software related problems.
  • Leverage Risk experience and business judgment to plan initiatives and accomplish enterprise- wide goals.
  • Well versed in gap analysis in changing old MMIS mixed up with testing new MMIS.
  • Identified and analysed trends in EDI failures, collaborating with new EDI partners to develop innovative solutions.
  • Got involved in designing future state processes for HIPAA 5010 transaction processing EDI's 837,835, 270, and 271.
  • Used Microsoft Visio to document Use Cases, ad-hoc reports Activity Diagrams/State Chart Diagrams, Sequence Diagrams, Collaboration Diagrams.
  • Prepared Business Process Models that includes modelling of all the activities of the business from the conceptual to procedural level.
  • Analyzed the problem domain, specified features, established baseline architecture, developed the Project plan, and risk analysis.
  • Research and Implementation of Web Portal and Content Management Systems
  • Consulting with other departments on the management of content and design of pages.
  • Articulated UML through Use Cases, use case document by specifying actors, normal flow, sub flow, alternative flows for each and every use case.
  • Complying with the consistent development and maintenance of the healthcare industry databases, health care insurance and health care industry related aspects with adherence to HIPAA compliances.
  • Wrote SQL scripts for back-end testing.
  • Provide reporting to management via excel reports of workload and work completion on a daily, weekly, and monthly bases
  • Liaison and Coordinated in resolving HIPAA/EDI mapping issues arising from the third party systems.
  • After successful development and testing of the product, participated in product release and deployment to End-User.
  • Worked closely with the deployment team for roll out the project - external releases, packaging, distributing, installing, user assistance, beta testing, migration of software and data.
  • Created Project management plans for managing on-time delivery using MS Project along with writing test cases, unit and systems integration test plans in Test Director.
  • Conducted User Acceptance Testing (UAT).
  • Documentation of Training Material for the implementation and the maintenance of the application.

Confidential -Los Angeles, CA

Business System Analyst


  • Conducted user interviews, gatheird requirements in JAD sessions with Business team to help create Business Requirement Documentation & also created the System Design Documentation
  • Involved in translating the requirements into a design document after gaining the clear understanding of the requirements. Helped in the preparation of Functional Design document. Developed project plans and manages project scope.
  • Executed the project based on SDLC as per the project requirements.
  • Gatheird Business Requirements upon clearly analyzing the scope of the project.
  • Documented the AS-IS and TO-BE Business Process Management (BPMN) and presented in the form of Use Case scenarios.
  • Provided a consultative approach through the Concept to the Execution phase of the project.
  • Held Weekly Status meetings to track changes and respond to any project variables.
  • Worked closely with project manager during resource allocation and budget discussions to ensure the project timelines are taken care.
  • Coordinated for demo workshops to Business Managers, Business Users and demonstrated the entire functionality of the product.
  • Conducted user acceptance testing with key stakeholders and incorporated feedback in improving the functionality and aesthetics.
  • Used Agile with the help of RTM tracked progress of work in the form of User Stories, Epics, Themes on JIRA (Into product backlogs and sprint backlogs)
  • Completed validation, testing, and Implementation with the defined scheduled timelines.

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