Business Analyst Process

JANKI PATEL

210-***-**** *************@*****.***

IT BUSINESS ANALYST

PROFESSIONAL SUMMARY

Over 7 years of diverse experience in the Information Technology industry with a focus on Business System Analysis.

Experience in business process analysis, modeling and Business requirement gathering.

Ability to collaborate with peers in both business and technical areas to deliver system solutions.

Highly proficient in HL7 and EDI X12 analysis, implementation of interfaces using various SDLC methodologies, business tools and Integration engines such as Mirth, Cloverleaf, and IBM Integration Bus, working on various projects within the HL7 domain including migration projects from legacy systems, implementation of new interfaces and enhancement of existing interfaces.

Designed and developed Enterprise level applications supporting various business units.

Extensive experience in analyzing and requirements gathering and writing system functional specifications including use cases.

Experience in Identity and Access Management products like SailPoint.

Experienced in EDI and HIPAA with multiple transactions involving claims handling and processing, with payer and provider experience ( 270 & 271, 276 & 277, 820, 837 P/I/D, 834, 835 ) Proficiency in documenting Test Cases, Test Plans, Test

Functional experienced in Claim Life Cycle and Health Care Payer domain process along with various line of health insurance system like PPO, HMO, POS.

Experience in ServiceNow on implementing end - to-end Service Catalog.

Extensive Experience in Functional, Integration, Regression, User Acceptance UAT, System.

Utilized corporation developed Agile SDLC methodology.

Industrial experience includes Healthcare HIPAA and EDI, EHR clinical Systems.

Functional Knowledge of Medicaid Management Information System MMIS.

Excellent in Developing and evaluating business process Models.

Ability to support prototyping activities that will validate business requirements and solution definition.

Hands on experience in creating Use Cases, Activity Diagram, and Sequence Diagrams

Comprehensive knowledge of RUP, Waterfall and Agile (Scrum & Xp) methodology.

Expertise in creating Data flow diagrams, Entity Relation diagrams, Gap Analysis, Developing Business Process Re-Engineering and Process Modeling using MS Visio .

Work for support the application of the Scrum and SAFE Agile Methodologies in developing and managing the application development process.

Good knowledge and extensively used RDBMS, Oracle, SQL, PL/SQL.

Well versed with HIPAA, Facets, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.

Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).

Created Mock-ups, established Reporting Requirements and worked with DBAs to create reporting solution.

Prepared Business process documents, project management process Documents, Functional Specifications, project plans, methodology and scope documents, release plans, upgrade plans and production support documents.

SKILLS

Visual Modeling Tools: Rational Rose, Requisite Pro, Clear Quest, Clear Case and MS Visio.

Testing Tools: HP Quality Center

Business Skills: Business Process Analysis & Design, Requirement Gathering, Use Case Modeling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Methodology: RUP, Safe Agile, OOAD, SDLC, and Waterfall.

Operating Systems: UNIX, Windows 95/2000/NT/XP, and MS-DOS.

Office tools: MS Office 2003 (Word, Excel, Power Point, Outlook), MS Visio, MS Project, and MS FrontPage.

WORK HISTORY

Jan 2025 - Present

Data Analyst / Gainwell Technologies – Dallas TX

At Gainwell Technologies, I was embedded within the Data Transformation and Medicaid Operations team, supporting multiple state Medicaid encounter submissions with a core focus on the Texas MMIS environment. The initiative was part of Gainwell’s larger mandate to modernize Medicaid encounter data handling, ensuring compliance with state-specific adjudication and reporting frameworks. My work directly influenced how incoming raw claim and encounter data (primarily 837P, 837I, 837D, and 835 remittance formats) were validated, transformed, tested, and submitted through complex EDIFECS-driven pipelines.

Worked as a Data Analyst supporting Medicaid encounter data processing, validation, and transformation for multiple state implementations.

Extracted and analyzed large datasets using SQL to verify claim accuracy, validate transformation rules, and ensure MMIS compliance.

Identified discrepancies between source and transformed data for 837P/I/D and 835 transactions, supporting rule optimization.

Created and executed UAT test cases for encounter submissions, ensuring correct output based on state-specific Medicaid requirements.

Collaborated with business analysts, QA, and developers to debug transformation logic and improve field-level accuracy.

Maintained and updated mapping documents, data dictionaries, and ICD-10 code references used in ETL transformations.

Conducted root cause analysis of transformation errors, data rejections, and formatting issues using SQL and Excel.

Prepared traceability matrices, audit logs, and validation reports for internal QA and external stakeholder review.

Built Excel dashboards and summaries to track transformation coverage, error trends, and test execution status.

Participated in Agile sprint planning, defect triage meetings, and status reviews focused on data quality goals.

Supported validation and reconciliation of encounter submissions across test, pre-prod, and production MMIS environments.

Environment: SQL Server, Excel, RQMS, SharePoint, and EDIFECS for data mapping, rule tracking, and reporting.

Mar 2022 – Dec 2024

Business/HL7 Analyst / MedAmerica – Dallas TX

Managed HL7 environments, performed analysis, design, development, testing and implementation of new interfaces and applications along with providing maintenance, support, and coding enhancements for existing interfaces and applications.

Applied RUP methodology with its various workflows, artifacts, and activities to manage life cycle from Inception to Transition phase.

Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain an up-to-date list of payer contacts.

Experience on all phases of Software Development Life Cycle (SDLC) from project initiation to deployment. Experience in Agile and Scrum methodology.

Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems in SOA are impacted by the EDI X12 Transaction, XML, XSLT, Code set and Identifier aspects of HIPAA.

Involved in GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.

Involved in the User Acceptance testing UAT to check the reliability for end users.

Designed Test Plans and Test Cases for User Acceptance testing (UAT) with the help of QA teams.

Create Mapping documents, ETL technical specifications and various documents related to data migration.

Implemented & supported Identity Management, LDAP Directories, Provisioning/Identity Workflows.

Have proven business insight and the technical know-how to implement large-scale EMR and EHR engagements.

Worked on the EDI 834-file load to Facets through MMS (Membership maintenance sub-system)

Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.

Documented the Requirement Traceability Matrix (RTM) for tracing the Test Cases and requirements in Blueprint.

Modified and created vendor specific maps for the 850, 820, 834, 855 and 856 transactions (EDI to XML, XML to EDI and delimited to XML). Worked on XSLT, XML schemas and xpath.

Developed and prepared EDI documentation for 837 outbound EDS claim processing.

Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.

Coordinated with the EDI team in developing and documenting the detailed testing work plans and created the various testing documents for the assigned EDI transactions.

Responsible for attaining HIPAA EDI validation from Medicare, Medicaid, and other payers of government carriers.

Created Requirement Traceability Matrix (RTM), Defect Report and Weekly Status Report.

Tested the HIPPA EDI, 834, 270/271, 276/277, 820, 837/835 transactions according to test scenarios and verified the data with Facets on different modules.

Environment: MS SQL Server, Payer, SDLC, UAT, Rational Unified Process (RUP), EDI, Rational Rose Requisite Pro, Clear Quest, and MS Office Tools.

Aug 2021 - Feb 2022

Business System Analyst / Altus ACE - Houston TX

Nov 2019 - Jul 2021

Business Analyst / Navient - Herndon, VA

Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.

Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).

Acted as a Subject Matter Expert (SME) on many occasions to explain in brief to the business users about the internal systems.

Conducted walkthroughs with the end users and stakeholders to gather the modification requests from the user to upgrade or change the specifications for the product.

Performed GAP Analysis, designed new business process flows, and documented various business scenarios.

Followed RUP and AGILE development methodology and adhered to strict quality standards in requirement gathering.

Designed and implemented service-oriented architectures (SOA) suitable for secure, reliable, and high-performance systems.

Environment: Rational Rose, MS Office, MS Visio, UML, RUP, SCRUM, JIRA, Confluence, Agile, MS Office, SQL Server, MS Project

Mar 2017 - Oct 2019

Associate Business Analyst / Phoenix University

Responsible for defining the scope and implementing business rules of the project, gathering business requirements and documentation.

Responsible for writing Functional Requirement Specifications (FRS) and User Requirement Specification (URS).

Acted as a Subject Matter Expert (SME) on many occasions to explain in brief to the business users about the internal systems.

Facilitated JAD sessions with the management, developers, and analysts from all the dependent systems/applications and backlog.

Proficient in creation of source to target data mapping documents in a data warehouse environment and execute SQL queries in a data warehouse environment.

Experience managing requirements using JIRA, Remedy and HP Quality Center.

Worked with UI and UX designers to create prototypes and Website workflow.

Gathered requirements for the integration of Point-Of-Sale (POS) system with the supply chain system.

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

Environment: Rational Rose, MS Office, MS Visio, UML, RUP, SCRUM, JIRA, SQL Server, MS Project

EDUCATION

Bachelor of Engineering

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