PROFESSIONAL SUMMARY:

*+ years of extensive experience as a Business Systems Analyst within Healthcare and Banking Industries. Worked in business and functional requirements gathering, analysing requirements, data analysis, data mapping, business process re-engineering, object-oriented designing, unified modeling language (UML), SDLC methodology (Agile, SCRUM) and very good team player with excellent communication and presentation skills.

Experienced in conducting joint application development (JAD) and Rapid application development (RAD) sessions.

Experienced in full cycle implementation of Workday Modules, including HCM, Finance, Payrolls, and Benefits, underscores my comprehensive understanding of end-to-end system deployments.

Expertise in Data Modeling, Data Analysis, GAP Analysis, Requirement Analysis, Business Modeling, Data Migration, Data profiling, and Dimensional Modeling.

Experience with project management tools like MS-Project, JIRA for status reporting, planning and error tracking and correcting.

Worked in full life cycle implementations Workday HCM using modules such as HR, Benefits, and Total.

Experienced in EDI transaction 835, 837I, 837P, 278 and proprietary conversions utilizing Facets extensions and development of new scripts and extensions to meet proprietary origination formats and reformat them into HIPAA standardized formats.

Worked on Business Process, Compensation and Custom Reports in Workday HCM and generate simple report-based Outbound Integrations.

Well experienced in working with Billing Provider, Rendering Provider, member subscriber, and NetworX modules of FACETS as well as in validation of subsequent loops and segments of the EDI files.

Extensively worked with FACETS Implementation, FACETS Billing, Claim Processing and Subscriber/Member module.

Highly proficient in developing and managing MS access and SQL server database for data entry, storage and generation of reports to facilitate management decision making processes.

Accomplished at UAT (user acceptance testing), Functionality Testing, Unit testing, System Testing, Integration Testing and Regression Testing.

Excellent verbal and written communication skills combined with interpersonal and conflict resolution skills with strong analytical skills.

TECHNICAL SKILLS:

Project Methodologies: Waterfall, Agile

Business Modeling Tools: Rational Rose, MS Visio

Requirement Management/Tools: Rational Requisite Pro, Wire Frame, MS Visio, SharePoint

Defect Tracking Tools: Rational ClearQuest, Quality Center/ALM

Operating Systems: Windows 10, 11 and UNIX

ERP Module: Workday HCM (Pay roll, Time Tracking, Benefits and Compensation), PeopleSoft

RDBMS: MS Access, MS Excel, Sybase, Teradata, Data warehouse, Oracle, SQL Server, DB2

Languages: Visual Basic, COBOL, Java, HTML, XML

PROFESSIONAL EXPERIENCE:

Client: Blue Cross Blue Shield, Helena, MT Jan 2022 - Present

Position: Business System Analyst

The project was based on the coding and testing for the enrollment products including all contracts, booklets, Insurance Medical Cards, Explanation of Benefits (EOBs), and Explanation of payments (EOPs), Claims Recovery Invoices and Premium invoices. The primary responsibility was to design a test plan based upon requirements, develop test scripts and execute test plans and test cases for all these products and assist in the training of the end users. These were all validated against a QNXT database that adhered to the strict compliance, policies and regulations that met the ACA (Affordable Care Act) compliance standards.

Responsibilities:

Gathered requirements on QNXT EDI 834 Benefit Enrollment and Maintenance subsystems.

When new clients are added, worked on creating technical specifications and BRD for claims submission.

Worked to verify and validate requirements for Medicare/Medicaid eligibility.

As a BAs worked with data architects to define dimensional models, entity-relationship diagrams, and other data modeling artifacts.

Managed changed requests and assessing their impact on data integration and warehousing solutions

Coordinate with QNXT implementation analyst on validating provider rates and reimbursement methodologies

Processed 837P, 837I & 837D transactions, verified those 837 transactions converted correctly to XML file format & XC keyword file format and verified the claims data loaded to QNXT for further processing.

Work closely with Product Team to create and maintain a product backlog in line with Business value/ROI, utilizing Azure DevOps.

As a BA monitored the performance of data integration and warehousing solutions and identify opportunities for optimization and enhancement.

Gathered demographic information about users such as age, disability, and income level from EDI 834(Enrolment and Benefits) to determine eligibility for Medicare and Medicaid benefits and conducted validation tests.

Created data mapping documents from source to target systems.

Worked on developing the business requirement and use cases for QNXT batch process, automating the billing entities and commission process.

Troubleshoot any problems found within QNXT and when testing the SQL data database while validating the business rule.

Implemented Agile approach for requirement gathering continuously prioritized requirements as per needs.

Processed claims in QNXT and verified they are generated and sent to Provider.

Involved in QNXT Implementation, end-to-end testing of QNXT Billing, Claim Processing and Subscriber/Member, UM module.

Worked with provider relations team in creating provider records file from scratch, and analyze provider response file to make appropriate changes to the provider file.

Mapped data from various sources to the target data warehouse schema to ensure data consistency, integrity, and accuracy.

Created Specification Document and designed mockups and interface design using MS Visio to make it visually easier for the users to understand business needs.

Involved in configuration of Member and Provider Module in QNXT.

Worked to verify and match the claim amount for each of specific procedural codes in EDI 837 (Claim) with the amount for that procedure in the issuer/insurer’s books.

Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 820, 834 and 837 transactions.

Configured Medicaid/Medicare Contracts, Benefits and Fee Tables modules in QNXT system on a daily basis, and other multiple modules such as, Sponsors, Carriers/Programs and Reference table modules as needed.

Set up capitation and payable providers in QNXT

Submitted EDI X12 initial submission transactions and verified the claim information is correctly populated in the Member services application.

Involved in writing extensive SQL queries for back end testing oracle database and Retrieved data using SQL statements.

Analysis and deployment of reports in SSRS, Power BI, Tableau or SSAS analysis from OLAP tables from data warehouse

Created Rich dashboards using Power BI, Tableau Dashboard, and prepared user stories to create compelling dashboards to deliver actionable insights

Analysed system requirements and developed detailed test plan for testing.

Tracked and reported defects using Quality Center/ALM.

Client: Health New England, Springfield, MA Feb 2019 – Nov 2021

Position: Business System Analyst

Health New England provides consumers directed healthcare products, including medical, pharmacy, dental, behavioural health, GIC, long-term care and disability plans, and medical management capabilities. This is an Enterprise Reporting Conversion Project for Government Business Division (GBD). Also, worked on another project to implement and provide support for HIPAA ANSI X12 standard transactions 277, 278 and support 834, 835 and 837 (Encounters) HIPAA EDI transactions and integrating the functionalities to the web portal for Electronic Claim Submission process.

Responsibilities:

Supporting all phases of the design, development and implementation of an enrollment resolution and reconciliation processes for health insurance exchanges.

Involved in gathering business requirements, JAD Sessions, Gap Analysis, UML diagrams, Process Flows, Business Documentation, Claims Processing & Testing and Claims Adjudication for Medicare and Medicaid, Data Mapping/Modeling, Facets and Medical Billing

Validated the HIPAA/ EDI transactions, tested the claims processing and Adjudication (EDI 837 & EDI 835).

Worked on EDI transactions: 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set.

Worked on Agile methodology developed by client for the web based system / product development.

Interacted with Claims, Payments and Enrollment hence analysing and documenting related business processes.

Worked extensively on the EDI Transactions via EDI 270, EDI 271, EDI 276, EDI 835, EDI 837

Worked on Encounter Data Processing System (EDPS) and MassHealth Encounter data flow and works within key regulator guidelines for acceptable data submission.

Monitor daily administrative duties of Encounter Data. This includes direct response to internal and external customers’ issues ensuring resolution

Assisted in building a business analysis process model using MS Visio.

Analyze and verify the onboarding, off boarding reports to ensure the Workday feed is properly correlated.

Worked on different modules of Facets such as Members/subscriber, commissions, provider, billing.

Membership/enrolment and billing-entered information on Facets to ensure correct eligibility, etc

Developed requirements integrating Use Case diagrams and designed the testing process flows.

Worked in a global implementation project with multiple Workday modules.

Done claims processing, benefits, provider reimbursement, provider set, billing and accounts receivable.

Designing the Business Requirements Document and working with system developers to ensure that the requirements are effectively communicated and well understood.

Directly work with HR/Workday team on any failed new onboarding, off boarding requests.

Coordinated User Acceptance and Quality Assurance testing of mainframe and GUI applications, identified test data, prepared user manual and conducted training seminars, installed applications on users.

Troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges and performing root cause analysis.

Wrote SQL queries to extract data from databases and connecting live/dynamic and static datasets to tableau desktop.

Created action filters, parameters and calculated sets for preparing dashboards and worksheets in Tableau and Converted metric insight reports to tableau reports.

Analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continuous process improvement of the reconciliation process.

Worked in mainframe environment and used SQL to query various reporting databases

Providing content and training to and for collaboration with training staff on training stakeholders on the transactions and the reconciliation process.

Participation in all phases of testing.

Perform testing and thoroughly document issues.

Work with the technical and development team to resolve identified issues in a timely manner.

Client: Santander Bank, Boston, MA Nov 2017 – Dec 2018

Position: Business System Analyst

Santander Bank offers wide range of consumer and lending products including basic checking and savings accounts to comprehensive financial solutions. Santander currently serves nearly 2 million retail customers and 5.2% of the 2.7 million small businesses in the US. I have worked in wide range of projects which includes outsourcing third party provider and oversight for the collection and recoveries for certain consumer portfolios, Customer onboarding and database system enhancements to reduce the gaps in Foreign Account Tax Compliance Act end to end processes, Deposit Account Controls and Reporting enhancements, Fair Credit Reporting Act and project related to Consumer Financial Protection Bureau.

Responsibilities:

Worked with a cross functional and diverse team of business users and developers to enable accurate communication of requirements and ensure consensus.

Facilitated workshops with business stakeholders in gathering and documenting business and system requirements (BRD).

Gathered requirements for sourcing and delivering the data and Interface requirements between various Partner Systems for Payments Processing for Corporate Banking purposes which involved a detailed understanding of Payments and Processing Standards like SWIFT, and ACH etc.

Coordinated and hosted meetings with multiple cross-functional groups involving Users and Product Owners (PO) from distinct Business Groups to understand business requirements formulate a solution and discuss timelines.

Analyzed business requirements and segregated them into high level and low level Use Cases and activity diagrams by using MS Visio according to UML methodology, thus defining the Data Process Models.

Extensive data validation on the back end using SQL queries to verify the data been loaded in the correct tables.

Used SQL queries to validate the load of the data to the correct column in an existing table and the newly added tables.

System covers all aspects of loan servicing including ACH payments, Charge-offs, Lockbox payments and Delinquent loans.

Implemented automation and enhanced business processes in HR (hiring, job change, recruiting, time tracking, security etc.) by adding features, validations, improving routing, and consolidating various legacy systems into Workday HCM.

Involved in writing and developing epics, user stories and acceptance criteria.

Obtained Data requirements, identified data sources, determined the content of data fields and created Data Mapping Documents and performed Data Extraction and Data Compilation using SQL queries

Proficient in TABLEAU forecasting modeling, and using TABLEAU to access, extract, modify, merge, and analyze financial data and other TABLEAU application for data update, data cleansing, and reporting

Involved in conducting the Functional, Regression and Integration testing on TABLEAU reports.

Created several API/web services as per business needs.

Responsible for reporting, query development and maintenance in Workday HCM.

Participated in gathering requirements for the integration of various credit cards application functionalities like account boarding, payment processing and collections

Regularly communicate ACH rules/regulations to stakeholders to ensure proper compliance.

Documented functional specifications for multiple components for achieving the ability to send and receive currency or cash via various Electronic Funds Transfer System (EFT) such as CHIPS

Worked to implement Workday Core HCM, Benefits and Payroll modules, and integrate with customer vendor systems.

Collected business requirements to set rules for proper data transfer from Data Source to Data Target in Data Mapping

Analyzed “AS IS” and “TO BE” scenarios, designed new process flows and documented the business process and various business scenarios

Involved in detailed discussions for End-to-End Process for various business processes like Account Level Reporting, Balance Transaction Reporting, Payments and Statements Processing.

Performed Data Profiling of current state of data in the Data Warehouse by doing Data Analysis using advanced SQL Queries and Microsoft Excel, finding Gaps in Data and formulating solutions for the same.

Generated ad-hoc SQL queries using joins, database connections and transformation rules to fetch data from Data warehouse.

Build the content strategy and then create, edit, and organize API documentation that helps our internal and external customers do their work.

Maintained projects story spreadsheet and reporting priority and status spreadsheet throughout the project and regularly updated on current state in JIRA.

Client: Arvest Bank, Springfield, Missouri June 2016 – Aug 2017

Position: Business Analyst

Arvest Bank Group (Arvest) provides commercial banking and financial services. The company offers personal banking, home loans, retirement planning, investments, commercial loans, and credit cards services. The main goal of the project was to redefine the automation of Wealth Management. The project was web based application that performed all the business functions related to wealth management- portfolio analysis, fixed income, stocks and bonds and different loan processing applications. I was involved with the team that worked with the modules of investment banking and loan processing.

Responsibilities:

Interacted with the stakeholders and end users in order to define the purpose and scope of application and gather User Requirements.

Prepared the Business Requirement Document (BRD) and Functional Requirement Document (FRD) for the enhancement of the existing services

Participated in Daily Agile Scrum “Stand-up”, Biweekly Sprint Planning and Retrospective Sessions and update the team on status of upcoming User Stories.

Conducted interviews with key business users to collect requirement and business process information for the loan process including set-up Account Information, New Loan set-up, Escrow Analysis, the Appraisal, Credit, income and Title functionalities

Performed Gap Analysis by identifying existing technologies, documenting the enhancements to meet end state requirements

Configure and provide support for core Workday HCM functionalities including Talent Management, Benefits, and Compensation, Recruiting/On boarding, Performance Management, Absence Management and Security based on change request.

Assisted the Product Owner for prioritizing User Stories, Epics, and Features created for the various releases through-out the year

Followed the Unified Modeling Language (UML) based methods using MS Visio to create Use Case, Activity/State Chart, Sequence, and Collaboration Diagrams.

Gathered requirements in excel based templates for configuration for rating, underwriting, claims and billing configuration

Worked with stakeholders, subject matter experts, process owners and users to elicit and document needs, expectations, constraints and external interfaces using various methods

Created Data mapping, logical data modeling coordinating with data architects, created class diagrams and ER diagrams and used SQL queries to filter data within the database

Assisted Scrum Master to facilitate scrum meetings such as Sprint Planning meeting, Daily Scrum meeting, Sprint Review meeting, Sprint Retrospective meeting, and Backlog Refinement meeting

Captured business requirements in the form of user stories using JAD sessions, brain storming sessions, focus groups and personal interviews and ensured coverage on business values, story points and acceptance criteria

Worked with User Interface simulations tools like iRise to depict the exact User experience (end-end) on all web application projects.

Developed requirements integrating E-R diagrams and designed the testing process flows.

Designed data models, swimlanes, dataflow diagrams & data dependencies for the system

Performed Walkthroughs of business requirements and functional requirements with the development and testing teams

Created and executed SQL queries and scripts to validate data movement and generate expected results for UAT.

Set up definitions and process for Scoping, document test cases, test phases included integration testing, end to end testing and user acceptance test (UAT) and documenting the results

Education:

Bachelor of Pharmacy from Rajeev Gandhi University- India

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