Systems Analyst/Business Analyst

ANIRUDH Y

Lead Business Analyst /Systems Analyst

Email: ***.******@*****.*** Wellington, FL 33411 Phone: +1-651-***-****

PROFESSIONAL SUMMARY

Lead Business Analyst /Systems Analyst with over 11+ years of extensive experience performing Business Analysis, Systems Analysis, Business Modeling, Requirement Gathering and Technical Documentation and Expertise involving all stages of the Software Development Life Cycle SDLC and a business level understanding of the technologies, Excellent in facilitating Joint Application Development (JAD) sessions and interviewing Subject Matter Experts (SMEs) for eliciting functional requirements that support high-level business needs. Diverse experience working with various domains that include Federal, Healthcare, Insurance and Retail

Diversely experienced Professional with Around 11+ years' experience of in the IT Industry involved with Business Analysis, Project Coordination, Business Rules, Business Processes, Gap Analysis, Impact analysis and Prototyping, developing/creating business process related documents

Comprehensive work experience of SDLC methodologies including AGILE methodology and traditional methodologies like WATERFALL having thorough understanding of various phases like Requirements, Analysis/Design, Development and Testing.

Adept with SDLC methodologies- Agile (SCRUM), Skills in web development, systems analysis, database systems, server admin, data mapping, data pruning, data visualization, web frameworks, agile development and agile team building.

Highly skilled in writing Business Requirements Documents (BRDs), Functional Requirements Documents (FRD), Request for Proposals (RFP), Statement of Work (SOW).

Over 8+ years of experience in data analysis, data modeling, data mapping, batch data processing and capable of generating reports using reporting tools such as Business Objects, Tableau.

Proficient in documenting and conducting GAP Analysis, SWOT Analysis, Cost Benefit Analysis, Risk Analysis, Impact Analysis, Data Analysis, Status Report, Requirement Traceability Matrix RTM as well as expert use of Surveys and Questionnaires in gathering information and Sound understanding of the data governance principles and disciplines for the business line

Strong Experience & Expertise in US Healthcare Insurance Payer – EDI (X-12 EDI Transactions like 837 Claims, 835, 997 Acknowledgements, 834 - Member Eligibility, 270/271 Eligibility Inquiry, 276/277 - Claims inquiry)

Expertise in payer domain System Integration wif Health plans eligibility and claim information. Strong understanding and Claims Processing/adjudication, Membership, and other standards.

Thorough work experience and understanding of Business Requirement gathering, Business Process flows, Business Process Modeling and database/data warehouse, data governance, data dictionary, data modelling and Extract, Transform and Load (ETL).

In-depth understanding of Google Cloud Platform (GCP) services including Compute Engine, Cloud SQL, BigQuery, Cloud Storage, and Pub/Sub, applied to optimize business systems and operations.

Leveraged Google Cloud Machine Learning tools to support predictive analytics and enhance decision support systems for strategic initiatives.

Experience and strong proficiency in utilizing Tableau Visualizations like Dual Axis, Bar Graphs, Scatter Plots, Lines, Pie - Charts, Heat Maps, Bubble Charts, Donut Chart, Geographic Visualization and making use of actions, other local and global filters according to the end user requirement.

Advance experience in query databases, validate data; programing language: MS-SQL and Python. Experience in creating Product Backlog, sprint backlog and managed and updated Issues (Epics, Stories, and Tasks) onto Jira. Participated in Sprint Planning, Daily Scrum Stand up and Sprint Retrospective meetings

Great experience in creating Test Plans, Test Scripts and Test Cases for Functional, System, Integration and UAT

Expertise in creating Static Wire Frames using MS Visio and mock-up tools to assist UI/UX team in UI Prototype designing.

Experience with requesting and validating Web Services, SOAP and REST API using Soap UI and Web API technical writer documenting structured data in JSON and XML.

Competent in creating Narrative Use Cases, User Stories, Use Cases, Activity Flow Diagrams, and Data Flow Diagrams using UML Tools - MS Visio, Enterprise Architect.

Experience deploying enterprise workloads to Azure and AWS for highly integrated medium to large organizations.

Experience in creating Process flow diagrams, Business architecture diagrams, Develop Use Cases, Activity Diagrams using MS Visio and JIRA.

Extensive Claim experience for Provider, Payer, Clearinghouses, Pharmacy Expert level knowledge of healthcare industry applications and processing, EDI transaction sets and formats.

Experienced in the integration of Google Cloud Platform (GCP) solutions to streamline business operations, improving data accessibility and performance

Extensive experience in Gap analysis of HIPAA 4010 to HIPAA 5010 conversion using the implementation guide and companion guide of EDI transactions (EDI 837, EDI 835, EDI 834, EDI 820, EDI 270/271)

Proficient in SQL queries and data manipulation techniques for efficient EHR data extraction and analysis.

Worked on HIPAA standards, EDI Electronic data interchange Transaction syntax like ANSI X12, Implementation and HIPAA code sets, ICD-9, ICD-10 coding and HL7.

Successfully implemented a Generative AI (Gen AI) model to automate data analysis for system performance monitoring.

Designing and supporting integrated Azure and AWS environments, including IaaS and PaaS across production and non-production environments.

Hands on experience with Azure Portal, Cloud Shell, Azure DevOps, Terraform, PowerShell, Python, or other scripting languages.

Configured and maintained data governance tools (e.g., data lineage tools) to track data origin, transformation, and usage.

Good experience in configuring the APIs, Proxy endpoints and API analytics based on technical specifications with MuleSoft API Manager.

Used HealthEdge’s automated tools and algorithms to process claims quickly and accurately, identifying any discrepancies or errors in the claim data and Expertise in Claims adjudication and Rx Claims applications.

Experience in Visio Workflows, Micro Services, Data Warehouses, Data Center and Data Lakes

Experienced in bash scripting and developing small projects in Python, and R in writing SQL Queries to extract data and perform Data Analysis.

EDUCATION

Masters of Science in Information Technology Management (MIS) - Saint Mary’s University of Minnesota.

TECHNICAL SKILLS

Business Skills

Waterfall, Agile, Requirements Elicitation, User stories, Wireframes, BRD, workflows, API FRD, root-cause analysis, mapping documents, change management and workflow management.

Tools & Technologies

MS Office Suite, MS Project, RequisitePro, ClearQuest, MS Outlook, ClearCase, SAP Business Objects, DB Visualizer HP ALM (QC), Jira, Confluence, Azure DevOps, Rally, TFS INTELLIJ, IDEA, POSTMAN, Swagger UI, Soap UI, Service Now, TABLEAU, Business Objects,

Languages

Java, Python, SQL, R SQL (PL/SQL), JSON, XML API Testing & Integration: SOAP UI, REST API, FHIR API, Postman

Cloud/Analytic Technologies

GCP, AWS, Azure, Databricks

MS Office Tools

Outlook, MS Word, MS Excel, MS PowerPoint, MS Access

Databases

MYSQL, Oracle 9i / 10g, MS SQL Server, DB2, SOR

Operating Systems

Windows, LINUX, macOS, Android, iOS

Browsers

Internet Explorer, Mozilla Firefox, Google Chrome, Safari

PROFESSIONAL EXPERIENCE

Role: Lead Business Analyst /Systems Analyst

Client: State of Hawaii (E-World ES)

Duration: Apr 2023 — Present

Location: Honolulu, HI

Project Name & Description: Benefits Eligibility System for State of Hawaii, Developed and implemented an integrated Benefits Eligibility System (BES) for the State of Hawaii, designed to streamline eligibility determination, enrollment, and case management for state-sponsored health and human services programs. The project involved modernizing the existing legacy system by integrating it with state-of-the-art mainframe technology to enhance data processing accuracy, improve user accessibility, and meet regulatory compliance standards. The solution facilitated secure, efficient data sharing among multiple state agencies, resulting in faster, more accurate benefit determinations for Hawaii residents.

Responsibilities:

Led system integration for eligibility determination, automating workflows for benefits processing, case updates, and notifications.

Involved in Joint Application Development sessions (JAD) with SMEs and development teams and documented functional business requirements as product backlogs using JIRA

Worked to promote transparency across teams and stakeholders by preparing Project Documentation like Business Requirement Document (BRD), Functional Requirement Document (FRD), System Requirement Specification (SRS), Release Notes, minutes of meetings (MOM) utilizing MS office.

Managed data migration from legacy platforms, ensuring data integrity and compliance with HIPAA and state privacy regulations.

Responsible to access the legacy systems and do the High-Level Source System Analysis, Source to Target Mapping (S2T), Data Analysis, Data Flow, Logical flowcharts, Workflow, Master Data Management, Data Governance, Data Cleansing, Data Profiling and Data Mapping.

Collaborated with cross-functional teams to identify and assess AI-driven business opportunities, aligning AI solutions with strategic objectives.

Provided user training and support, enabling seamless transition to the new system.

Led the Design & Development of Interfaces for different State Entities Like SSA, SVES, DOH, PARIS, NDNH, SNAP, EBT

Performed database analysis writing SQL queries and followed data remediation practices for any fields being deleted or added.

Conducted Gap analysis, SWOT analysis, Communication Analysis, Business Rules Analysis, Document Analysis and other related analysis such as Scope creep assessments and Goal Orientation Assessments.

Assisted UI/UX team in translating client graphical requirements to reality by creating wireframes and Mockup Screens

Identified the gaps and collaborated with the SME’s and created/updated several data mapping documents.

Interpreted complex datasets to generate actionable insights, optimizing Artificial Intelligence AI product development and deployment.

Perform data analysis, create dashboards, worksheets using Tableau and Used filters, quick filters, sets, parameters and calculated fields on Tableau reports

Evaluated data elements in data dictionary and mapped into request and response elements for creating SOAP and REST APIs documents, SQL queries and processing logic.

Developed RESTful APIs to support data synchronization with external applications, increasing accessibility for state employees and providing external agencies with real-time data access.

Working with the development team to help translate the business requirements into technical specifications and assist with application development.

Managing the QA validation process (business requirements, functional specifications, and application bugs).

Extensive exposure to Microsoft Azure cloud computing concepts & fundamentals and Used Postman to test Web API. Also, validated JSON formatted data.

Experience in Azure DevOps release management, accepting release into QA and then approving across the pipeline for production deployment.

Integrated a user-friendly mainframe interface that allowed caseworkers to manage cases efficiently, with screens optimized for quick navigation and data entry.

Built custom reporting functions using SQL queries on DB2, enabling real-time data insights and reporting for agency administrators to monitor trends and case outcomes.

Monitor the ETL process daily and report and data correction before the daily report is sent to the stakeholder and business partner

Built and maintained a rules engine that applied complex eligibility criteria across multiple benefit programs (e.g., Medicaid, SNAP), automating calculations and decision-making processes.

Role: Lead Business Analyst /Systems Analyst

Client: Medica

Duration: Mar 2023 — Apr 2023

Location: Minnetonka, MN

Project Description: This role is a part of IT Enablement where our team runs the Proof Of Concept (POC) and Integration for any new systems/Tools Integrating with Medica’s Health Rules claims adjudication cluster of applications, the business division of Dean Health Plan was trying to enforce we Successfully integrated Mulesoft “Anypoint” Platform by Salesforce, to enforce API Governance to On prem and cloud APIs.

Responsibilities:

Resource Management, Resource Allocation, Scheduling - day-to-day claims operation and involved into Healthcare Payer System - Health Trio - Claims Processing and Monitoring of daily operation, Project Management - oversee the claims processing functions of outsourcing company.

Worked with Business, Product Managers, Security engineers and multiple Development teams to elicit API governance implementation and Data requirements.

Worked on projects that included the development and deployment of new Health Plan offerings and Evaluated Medicare requirements and benefits in Medicare Health Plans for member enrollment and management.

Translated Business requirements into System requirements by documenting Use Cases for front - end and REST APIs for SAM core, group portal contributions, member enrollment, and claims processing.

Facilitated Joint Application Development (JAD) sessions with SMEs and business analysts from other systems for a detailed analysis and a better understanding of the impact of various aspects on each other.

Configured and segregated numerous APIs based on the risk profile to onboard new industry standard governance rulesets and Governance Profiles

Applied Rulesets to Multiple API’s Across the Org to provide an overview of conformance for all of Medica’s Validated APIs to Monitor and notify developers to help improve conformance.

Worked on “Exchange” where the developers can view the conformance status details for published API specifications, discover rulesets, and publish custom rulesets and Implementers can view rulesets to determine how to fix API instance conformance issues.

Worked on Design center/API Designer where developers or architects can check API specification conformance in the API design phase by applying governance rulesets directly to API specifications as dependencies.

Utilized Generative AI (Gen AI) techniques to analyze system data, pinpointing critical bottlenecks and proposing successful optimizations that enhanced system stability.

Extensively involved in Data Governance process. Assisted in data grouping and defined relationship among the different tables.

Defined and documented detailed business requirements for critical EDI transactions, including claims submissions (837), eligibility verification (270/271), and member enrollment (834).

To find conformance issues, i validated the APIs against the set of rulesets to which APIs to conform. After validating the APIs, see the conformance badges in API Governance, Exchange, and API Manager and view detailed conformance information in API Governance, Exchange, API Manager, and Design Center.

After Anypoint API Governance identifies conformance issues in an API, I monitored the governance validation report to get information about the issues. Nonconformance messages give information about conformance issues and contextual links directed me to the best place to fix them.

Implemented a Generative AI (Gen AI)-powered test case generation system, leading to decrease in testing time and increased development velocity.

Understand and clarify complex business integration requirements and produce eloquent and scalable designs utilizing MuleSoft as an integration platform.

Fixed Specifications in Design center, API Manager, API Catalog Information in Exchange

Created custom rulesets, Rulesets Validation, and publishing Custom rulesets and enforced and supported the dev teams and managed Client Application, Client Contracts and Credentials

Prepped and maintained and extracted various API related Data Sets.

End-to-end experience in designing and deploying data visualization using Tableau and developing Tableau Data visualization reports and dashboards

Monitored the progress of the overall project, tracked individual issues such as user stories, defects and technical debt using Atlassian JIRA, allowing for improved visibility of project status and accurate forecasts.

Utilized MuleSoft AnyPoint platform features such as API designer, API Manager, Run Time Manager and Exchange

Secured REST API Web services using HTTPS, OAuth 2.0, IP whitelisting and Client ID enforcement and created and consumed the MuleSoft queues

Analyzed system data using Gen AI techniques, identifying critical bottlenecks and recommending successful optimizations.

Led the whole development lifecycle thus successfully integrating and testing the newly integrated Governance Application.

Role: Lead Business Analyst /Systems Analyst

Client: Optum Technology (United Health Group)

Duration: June 2020 — Mar 2023

Location: Eden Prairie, MN

Project Description: This role is a part of the Value based Risk/ Strategic Risk Enhancement a covid driven initiative that the organization has solutioned to build out / extend the functionality / Enhance the Capability of the Cirrus application(Claims Adjudication) to accommodate the Requirements coming out of the business for PMPM capitation contracts, DOFR- Division Of Financial Responsibility, DOMR- Division Of Medical Responsibility & DOAR- Division of Administrative Responsibility for determining the appropriate responsible amount, responsible entity and the risk determination of different Network contracts whenever an Institutional/Professional claim has been adjudicated.

Responsibilities:

Worked with Several teams supporting the CIRRUS Application, an application that supports the end-to-end claim Adjudication of UHG’s variety of health Insurance claims, which needed some new functionalities that needed to be added to the decision-making logic.

Planned and supervised target meetings with SME’s, Joint Application Development (JAD) sessions, direct interview sessions, conference calls and produced detailed artifacts such as Surveys/Questionnaires and minutes of meetings covering issues discussed.

Conduced GAP Analysis, Risk Analysis, Data Analysis between the current system and new requirements to be implemented, thereby mapping the business requirements of the application.

Extensive work in Claims data analysis, Root Cause issue Analysis and resolution, Advanced claims Analytics and dashboards generation using tableau, identification of issue related data by reverse engineering and identifying the similar issues related to claims adjudication.

Performed Data Mapping to map the source data from multiple systems across, in-house Applications, Middleware and third-party vendor system software through Web API, RESTful web services, FTP, SFTP protocols to destination system-though le transfers like XML, JSON, etc

Assisted in the design of a Rule Service Engine of the claims adjudication where the business can assign/Configure different rules in the claim adjudication process.

Participated in Creation of various RAML resources to implement REST Based APIs as a part of project implementation.

Integrating systems of record into conformed dimensions and fact tables. Involved in analyzing the claims on basis of Primary and Secondary Payers and performed Medicare subsidy eligibility check for employee group plans

Defined roles and responsibilities related to Data Governance and ensured clear accountability for stewardship of the company’s principal information assets.

Performed system integration and testing across various cloud services and on-premises systems, ensuring seamless interoperability and optimizing performance through GCP's API Gateway and Identity and Access Management (IAM) tools.

Assisted Joint Application Development (JAD) sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA

Used Atlassian JIRA to document Epics and User Stories, decomposed Functional Requirements into User Stories, conducted Storyboard reviews to senior management and worked with Agile team for Iterative Development.

Enhanced/Incorporated the finalized solution into the Decision-making claims Adjudication logic method/class level Workflow to incorporate the business logic as a part of the IT Application Solution.

Conducted comprehensive risk assessments using advanced Artificial Intelligence (AI) models, identifying vulnerabilities and recommending corrective actions.

Partnered with data scientists to explore the application of Generative AI (Gen AI) for system anomaly detection and proactive maintenance.

Resource Management, Resource Allocation, Scheduling - day-to-day claims operation. Healthcare Payer System - Health Trio - Claims Processing and Monitoring of daily operation Project Management - oversee the claims processing functions of an outsourcing company.

Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions.

Reviewed claims that are flagged by HealthEdge’s automated tools to verify their accuracy and ensure that they meet all the payments requirements.

Performed database analysis writing SQL Queries and followed data remediation practices for any fields being deleted or added.

Resolved the case ambiguities to the UX/UI team, front end, back-end developers and QA to ensure common understanding of the requirements and scope.

Used Databricks to perform validations of the migrated data if it has been migrated according to the design using Python SQL, Spark and also developed automated Testing framework using python and HQL (Hive).

Effectively maintained updated documentation for the JSON Payload using POSTMAN, SWAGGER UI to perform CRUD operations with respect to the CISL (Cirrus Integration Service Layer) with task specific Soap & Restful API’s on GET, PUT, POST, DELETE operations to successfully manage the member groups on the Cirrus application.

Drove continuous improvement and innovative Azure DevOps practices and tooling for administration, provisioning and deployment including lower environment self-service for developers and testing teams.

Used HealthEdge to process claims quickly and accurately, identifying any discrepancies or errors in the claim data.

Performed database analysis writing SQL queries and followed data remediation practices for any fields being deleted from the respective tables in the database

Prepared files and reports by performing ETL, data extraction, and data validation and data mapping documents for the claim’s solution Externalization, modernization and building it into a standalone application.

Role: Senior Business Analyst /Systems Analyst

Client: Prime Therapeutics

Duration: Feb 2019 — Jun 2020

Location: Eagan, MN

Project Description: This role is a part of Rx - Claims application & Surround Code Applications for Adjudication of commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, Primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims for various Prime Therapeutic’s existing and future clients.

Responsibilities:

Worked on System requirements for both the Rx-claims application as well as the supporting applications to onboard new clients, new features and new NCPDP code changes.

Provide technical and domain subject matter expertise within team to resolve technical and functional issues, involved in Joint Application Development (JAD) sessions with operations and business users.

Acted as the SME for a few data elements within Medicare, Medicaid, commercial, HIM & Formulary Workplace.

Gathered, analyzed, documented high level Business Requirement Documents (BRDs), Requirement Traceability Matrix (RTM) and all the affiliate artifacts like UML diagrams Use Case, Activity, and Sequence Diagrams.

Handled various data elements for different lines of businesses like Health Insurance Marketplace (HIM), Medicare, Medicaid and commercial.

Prepared Requirement Traceability Matrices RTM and managed every change request effectively throughout the software development life cycle.

Designed Mock-ups and wireframes using MS-Visio to get feedback from UI/UX team about the web form designed.

Implement UML to develop System Use Cases, associate them with actor hierarchies through Object Oriented (OO) Diagrams (Use Case Diagrams, Sequence diagrams) using MS Visio.

Extensively used Jira and Confluence for converting requirements to User stories by assisting the Product Manager.

Responsible for assisting the process of Data Governance like defining, monitoring, creating, and implementing standards.

Acted as the SME for various aspects of claim adjudication, Eligibility, Qualifiers, Provider Overrides, schedules, plans, reject codes, gender codes, service codes, patient residence codes, Additional Message qualifiers, GPI Lists, submission clarification codes, Transactional Benefit Override (TBO), Prior Authorization.

Determine primary, secondary and tertiary coverage on accounts for Managed care and Medicaid payers.

Involved in the brainstorming sessions and reviewed the TDD documentation with the development team.

Actively led System requirements brainstorming sessions and successfully identified several impacts on the Surround code data elements.

Analyze business requirements and document them appropriately in the form of user stories in Jira and/or Azure DevOps.

Performed database analysis writing SQL queries and followed data remediation practices for any fields being deleted from the respective tables in the database

Involved in defining the source to target (S2T) data mappings, business rules and data definitions

Prepared files and reports by performing ETL, data extraction, and data validation and data mapping documents for the ETL team.

Prepared screen mockups, wireframes and made mockups for adding, removing, modifying and alignment for various display data elements on the UI of the Rx - claim screens using macros in excel.

Worked on databases to run SQL queries to perform data analysis and provide sample claim examples and claim scenarios for the features being added.

Designed, developed, tested and maintained Tableau functional reports based on Business Requirements

Developed Tableau Data Visualization using Cross tabs, Heat maps, Whisker charts, Scatter Plots, Pie, Bar and Density Charts.

Role: Senior Business Systems Analyst /Systems Analyst

Client: Optum Technology (United Health Group)

Duration: Apr 2017 — Feb 2019

Location: Eden Prairie, MN

Project Description: This role is a part of Polaris Core Engineering, with an emphasis on the development of a Claims Processing and Management Application “CIRRUS”. A part of the Nighthawk team dealing with the Membership and Member Group segment of the United Health Group’s Claims management process. This application acts as a claims processing core to process the incoming data from various data migration entities from which the PHI data is mapped to the respective attributes using a CISL Layer consisting of a wide variety of API’s for performing the necessary functions.

Responsibilities:

Facilitated with different levels of business and technology teams and actively involved in the PI feature planning, scoping and work estimation with the Director, Product Owners, Architects and Managers.

Worked to promote transparency across teams and stakeholders by preparing Project Documentation like Business Requirement Document (BRDs), Functional Requirement Document (FRDs), System

Gathered Business Requirements by using techniques such as document analysis, system analysis, and one-to-one interview with Business Users, Stakeholders, and Subject Matter Experts (SMEs).

Worked on UI/UX stories, created UI mockups and wireframe models using Balsamiq working in conjunction with the business and UI/UX teams.

Performed database analysis writing SQL Queries and followed data remediation practices for any fields being deleted from the respective tables in RDBMS, created & analyzed the data models to determine the impacts of adding or removing of respective fields on dependent downstream systems consuming our data.

Developed Tableau visualizations and dashboards using Tableau Desktop.

Create and maintain product backlog items, bugs, features, etc. in JIRA and TFS / Azure DevOps for story tracking and documentation.

Identified the gaps and collaborated with the SME’s and created/updated several data mapping documents by mapping the fields from source to target (S2T) of the data being migrated from different applications like PULSE into CIRRUS.

Extensively involved in Data Governance process. Assisted in data grouping and defined relationship among the different tables.

Identified and documented Business Rules, created detailed Use Cases, and Conducted User Acceptance Testing (UAT).

Involved in Reviewing the API specification with different stakeholders like API provider team and business owner

Configured and maintained EDI transactions, including 837, 835, 270/271, 276/277, and 278, to ensure accurate data exchange.

Led the implementation of HL7, FHIR, and other interoperability standards, ensuring seamless data integration between EHR systems.

Worked on system

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