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senior business analyst resume example with 9+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Summary

A professional team player with over 9 years of IT project implementation and operational readiness experience. Experience in SDLC process for Health Care Individual and Group Products and specialized work with Finance, EMB, Contact and Customer Experience business processes. Excellent verbal and written communication and interpersonal skills with both business and IT stakeholders with proven documented forms such as business requirements specification, user stories, process flows and vendor change requests. Experience in review and assessment of enterprise level business cases for satisfying different segment market gaps. Strong institutional knowledge of Medicaid; including Medicaid Information Technology Architecture (MITA), and Medicaid Management Information Systems (MMIS) Development of 820, 834, 837 Claim billing, 276 Status, 834 Enrollment, 835 Claim Payments, 829, 270-278 and many other healthcare maps. Understanding of EDI business practice and the ability to understand the client's needs. Great attention to detail while understanding big-picture objectives and strategy Excellent experience in developing and executing Test Procedures, Test Cases, Test Scripts, Test Plans, performing Functional Testing, Compatibility Testing, Usability Testing, Stress Testing, UAT. Understanding of developing reports, dashboards, and processes to continuously monitor data quality and integrity on Salesforce. Strong understanding of management techniques intended to improve business processes like Six Sigma. Good knowledge on the different systems like policy admin, cash, print, and claims. Ability to resolve complex issues in a short time within the SLA. Highly motivated and initiative to learn new tools, and research new concepts, ideas, and technologies quickly. Strong systems/process orientation with demonstrated analytical thinking, organization skills, and problem-solving skills, willingness to train and teach others. Good interpersonal skills and ability to interact with clients.

Skills
  • Data Analysis
  • Business Analysis
  • Data Integrity
  • SQL
  • Business Process Mapping
  • Forecasting and Planning
  • Predictive Modeling
  • Root Cause Analysis
  • Data Mapping
  • Systems Integration
  • Data Migration
  • Jira/Rally
Work History
Senior Business Analyst, 04/2018 - 07/2022
Bgc Partners Arlington, VA,
  • Primary responsibilities were maintenance and development of payment application by communication with External Payment processing Vendor VIT responsible for SFTP between Company and External Vendors
  • Specialties: Project implementation, product owner role, operational readiness, process improvement, issue management, Adaptability to changing environment, managing multiple priorities Responsibilities:
  • Associated with full Compliance life cycle from gap analysis, mapping, implementation and testing for processing Payment Data
  • Scrum planning, MVP, SWOT analysis, Gap Analysis
  • Worked with team on EDIFEC processing system and gathered requirements to comply with HIPAA
  • Involved in integration with legacy and third-party vendor applications
  • Establish documentation for Agile methodology for implementation with very water-fall-centric development team
  • Performed analysis of enrollment and eligibility data in XML format to determine if data is compatible
  • Responsible for core activities of test team including creating and executing test cases, analyzing, and documenting results and drawing traceability matrix to match requirements with final test scenarios
  • Worked on report creation skills using Microsoft SQL Reporting Services (SSRS)
  • Participated in release cycles of software developed using Waterfall and Agile methodologies
  • Knowledge of health care services regulatory environment in compliance with HIPAA, ICD, MMIS
  • Proficient in writing SQL queries for testing and data validation
  • Develop, test, modify mapping using B2B mapping tool in Healthcare industry
  • Responsible for preparing Software Requirement Specification (SRS) and documenting them
  • Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, and State Diagrams, Activity Diagrams and business process and workflows
  • Strong experience working in Software Development Life Cycle (SDLC) using various methodologies including Agile, Waterfall
  • Involved in project planning, coordination, and QA methodology in implementation of change in Payroll Processing Vendor in Florida blue
  • Evaluated and performed testing within HP ALM for Rejected QA Scenarios.
EDI Business Analyst, 03/2015 - 12/2017
Unity Health Insurance Waukesha, WI,
  • INFOMC (AWS Claims Management System) (Remote)
  • Handled 10 plus project to address business inquiries
  • Medicaid and Healthcare partnership- United Health Care developed New MMIS system for centralizing the all-Healthcare related transactions all over the state
  • The New MMIS project is a large IT project replacing the Medicaid claims payment system
  • Participated in all aspects of testing the New MMIS; Primary responsibilities is to ensure that the system functions as designed, meets the requirements of the business community and conforms to all applicable Federal and state laws
  • Worked on the claims and provider modules of the New claims adjudication system
  • Performed SWOT and Gap analysis for the new functionality requirements
  • Worked with HIPAA rules and regulations to draft business rules and claim processes
  • Interacted with the client and the Technical Team for requirement gathering and translation of Business Requirements to Technical specifications
  • Responsible for validating claim processing transaction of MMIS
  • Worked on the ETL implementation using SQL Server Integration Services (SSIS)
  • Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims
  • Worked on different types of insurances such as, Group health insurance, individual health insurance, dental insurance, vision insurance, etc
  • Hosted the application online using Microsoft SharePoint excluding some functionality those were developed to use by employees only
  • Identified and documented the dependencies between the business processes
  • Created and executed Use cases for product and benefits testing for Medical and Dental
  • Documented the Use Cases and prepared the Use Case, Activity, Sequence diagrams and Logical views using MS Visio, MS Office and Rational Rose for a clear understanding of the requirements by the development team
  • Responsible for Medicaid Claims Resolution/Reimbursement for state health plan using MMIS
  • Conducted JAD sessions and Data modeling
  • Used SQL to test various reports and ETL load jobs in development, QA and production environment
  • Determine member benefits and priced claims according to individual provider's contract under Medicare CMS guidelines and Dental benefits
  • Facilitated daily scrum, sprint planning and sprint retrospectives meeting
  • Diverse experience in Information Technology with focus on Business Analysis, Business Modeling, Requirement Gathering, Documenting Requirements (BRDs/FRDs/Use Cases), and Software Validation
  • Worked with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence
  • Responsible in testing and analyzing data consolidation, organization, and presentation in MMIS
  • Create and maintain Use Cases, visual models including activity diagrams, logical Business process models, and sequence diagrams using UML
  • Well versed with HIPAA, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles
  • Documented all the aspects of Systems validation lifecycle in accordance with the FDA regulations, including Validation Plan and Protocol, Installation Qualification (IQ) Specifications, Operation Qualification (OQ) Specifications, Performance Qualification (PQ) Specification
  • Involved in preparing project plans and identifying major milestones for each stage as per the SDLC model (RUP Methodology)
  • Worked on Member Management, Eligibility, Claims and Billing modules within FACETS
  • Implemented the HIPAA privacy and security regulations to enhance the capabilities of the systems to process new products
  • Responsible for teaching sessions for end user to tell how to use tools
  • Used MS Project for various planning and budgeting activities
  • Involved in integration of FACETS with legacy and third-party vendor applications.
  • Learned new skills and applied to daily tasks to improve efficiency and productivity
Business Analyst, 03/2014 - 02/2015
Amerisourcebergen Corporation - Corporate Chesterbrook, PA,
  • Primary responsibilities were maintenance and development applications to process HIPAA x12 EDI files such as 834, 837, 271, 271, 277, 278
  • Implemented and administered turnover change management application along with enrollment and payment management
  • Associated with full HIPAA Compliance life cycle from gap analysis, mapping, implementation and testing for processing of Medicare claims
  • Involved in integration of Diamond claims management system with legacy and third-party vendor applications
  • Establish documentation for Agile methodology for implementation with very water-fall-centric development team
  • In depth Understanding of HIPAA X12 EDI transaction 834 for enrollment and eligibility, X12 EDI transaction 820 for Payment Order/Remittance Advice, Acknowledgement transactions 999 and TA1
  • Performed analysis of enrollment and eligibility data in XML format to determine if data is compatible with X12 data
  • Created 834 X12 format using Edifecs Spec-builder and Note Pad ++
  • Developed Schemas of EDI x12 Claims (837) and Eligibility forms in XML
  • Responsible for core activities of test team including creating and executing test cases, analyzing and documenting results and drawing traceability matrix to match requirements with final test scenarios
  • Worked on report creation skills using Microsoft SQL Reporting Services (SSRS)
  • Participated in release cycles of software developed using Waterfall and Agile methodologies
  • Integrated various systems with HEDIS and create design for HEDIS and other systems to pull data in HEDIS
  • Assists with TRR and MRR reconciliation, along with investigation, correction, and tracking of enrollment transaction
  • Knowledge of health care services regulatory environment in compliance with HIPAA, ICD, MITA, MMIS and EDI
  • Proficient in writing SQL queries for testing and data validation
  • Develop, test, modify and manage EDI (x12 standard) maps using B2B mapping tool in healthcare industry
  • Responsible for preparing Software Requirement Specification (SRS)
  • Employed UML methodology in creating UML Diagrams such as Use Cases, Sequence Diagrams, and State Diagrams, Activity Diagrams and business process and workflows
  • Strong experience working in Software Development Life Cycle (SDLC) using various methodologies including Agile, Waterfall
  • Involved in project planning, coordination, and QA methodology in implementation of EDI Gateway in EDI transaction of claims module.
Senior System Analyst, 09/2012 - 02/2014
Unity Technologies Corporation Fort Belvoir, VA,
  • Analyzed key aspects of business to evaluate factors driving results and summarized into presentations
  • Promoted enterprise-level risk management practices and helped instill strong culture focused on protective policies and procedures
  • Documented and executed detailed test plans and test cases and summarized and logged audit findings for reporting purposes
  • Inspected incoming products for adherence to labeling laws and company quality standards
  • Suggested improvements to designs and documentation to improve product reliability and manufacturability
  • Created and maintained several databases to track statistical data
  • Consulted literature to investigate software malfunctions
  • Implemented test scripts and recorded results
  • Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training
  • Developed and audited practices, programs and reporting system metrics for optimal efficiency
  • Conducted data review and followed standard practices to find solutions
  • Planned and implemented performance improvement and quality assurance programs
Education
Associate of Science: Computer Engineering, Expected in 06/2012
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MAHAMAYA TECHNICAL UNIVERSITY - Noida-Delhi,
GPA:
Status -
Additional Information
  • Strong Experience in Vendor relationships management and integration of new vendor . · Experienced with Federal contracts, X12 transactions, health care act, EDI transactions 270, 271, 834, 835, 837. · Wrote BRD, FRD, Mapping doc., test scenarios, test cases for testing the functional and non-functional aspects of both ETL and Reporting jobs. · Worked on different EDI healthcare transactions like 834-Benefit Enrollment and Maintenance and 820-Payment Order/Remittance Advice. · Upgrade mapping for new B2B and existing B2B clients , IBM Sterling B2B integration and IBM Connect Integration( Certification , Authentication and integration ) · Involved in Various application Implementation and conversion of 4.21 and also in TriZetto Facets and TriZetto HIPAA Gateway 4.11. · Conducted internal audits and prepared audit reports to ensure compliance with Medicare, Medicaid and other institutions. · Background of documenting HL7 and X12 interface specifications. · Knowledgeable for gap analysis in changing old MMIS data via ETL and testing new MMIS system integration for legacy data to new DB format. · Expertise in Membership Enrollment, Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets. · Proficient in conducting Business process modeling (BPM), feasibility studies, Impact Analysis, Cost/Benefit analysis, Gap Analysis and Risk analysis. · SQL application management, (added users, created backup and recovery plans, ran SQL scripts) · Through knowledge of ICD-9, ICD 10 codes and CPT codes for both Mental and Medical Health. · Exceptional knowledge in testing phases with state HIX projects. · Experience in implementation of HIPAA 4010 and HIPAA 5010 changes in the existing claim processing integrated system. · Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall, Scrum and Agile. · Operated Visual basic on different operating systems such as Windows and UNIX.

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Resume Overview

School Attended

  • MAHAMAYA TECHNICAL UNIVERSITY

Job Titles Held:

  • Senior Business Analyst
  • EDI Business Analyst
  • Business Analyst
  • Senior System Analyst

Degrees

  • Associate of Science

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