Senior Business Systems Analyst with 10+ Years Experience

Junaid Ahmed

Senior Business System Analyst

Email id: ******.*********@*****.*** Leesburg, Virginia 20176 Contact no: +1-571-***-****

Professional Summary:

Results-driven Senior Business Systems Analyst with 10+ years of experience in Healthcare, Pharma, Banking and Retail industry. Expert in SDLC, EDI (834/835/837), FHIR, HL7 and HIPAA. Skilled at bridging business and technical teams to deliver scalable solutions. Proficient in requirements elicitation, BRD/FRD documentation, API integration, data migration, UAT and dashboard reporting (Power BI, Tableau). Strong collaborator with proven success optimizing claims, enrollment and provider systems.

SKILL SUMMARY

Experience in SDLC, EDI X12, FHIR, HL7, HIPAA, PBM, HEDIS, CMS, ERP, commercial payer.

Experience with Medical Imaging, EHR/EMR, Mobile Apps, Medicare and Medicaid systems.

Experience in CRM related applications such as MS CRM 365 and Salesforce.

Experienced in Gap Analysis, Impact Analysis, Risk Analysis, Traceability Matrices, SWOT Analysis, Document analysis, AS-IS & TO-BE analysis and Cost Benefit Analysis.

Experience with EDI HIPAA 834, 835, 837 (D, P, I), 277/278 and other Health Care Transactions.

Strong knowledge of ICD-9 and ICD-10 standards within healthcare.

Expert in Functional, Integration, Regression, UAT and System Testing.

Excellent in analyzing and creating use cases and UML diagrams such as use case, activity, ER and data flow diagrams using MS Visio, Balsamiq and mock-ups.

Expert on Elicitation, analyzing and prioritization of each sprint in product backlog according to end user perspective & design User Stories with design perspective.

Experienced in Anti - Money Laundering (AML)/KYC.

Experience in creating and modifying SQL reporting services reports for use inside and outside Dynamics CRM.

Extensively used SAS for data analysis in Clinical Trials and worked closely on Clinical Operations to provide specialized programming support.

Good understanding of risk analysis, risk management and business process flow

Strong project management skills from requirement analysis, process mapping and documentation. Hands-on experience on tools like Rally, JIRA, Azure DevOps, cloud, MS-Project, Confluence for collaboration and tracking

Respond and correct help desk issues related to SAP business user issues.

Knowledge in support engineer with strong XML skills.

Knowledge of ETL (Extract, Transform, Load) processes for loading data into data warehouses and data marts.

Excellent Business writing skills in developing Business Requirements Document (BRD), Use Case Specifications, Functional Specifications Document (FSD), Systems Design Specification (SDS), (SRS), Workflows and Project Plan.

Experience in performing Data Analysis, Data migration and Data Mapping from an Operational Data Store to an Enterprise Data Warehouse.

Supported enterprise-wide data migration and integration initiatives using Azure Data Factory, AWS S3, Redshift and Synapse Analytics, ensuring secure ETL pipelines and HIPAA-compliant data flows across healthcare and CRM platforms.

Experience on Structuring Metadata and Cognos Models using Framework Manager

Experience in creating workbooks and dashboards using Tableau that includes tools like Tableau Desktop, Tableau Server and Tableau Reader.

Experience developing SSIS/SSRS packages for data mining projects by changing the data flow and assigning data validity check points for process failure.

Experience querying databases and validating data using MySQL and Python.

Facilitated and participated in JAD/JAR sessions to gather and document requirements.

Knowledge in Data Modelling and Process Modelling using MS Visio and Enterprise Architect.

Experience in Oracle SQL, PL/SQL, SQL Plus, SQL Loader, Query performance tuning, Created DDL scripts and Created database objects like Tables, Views Indexes, Synonyms and Sequences.

Expert in writing detailed system use cases, developing business test cases and working with QA teams during testing phase, thereby facilitating acceptance testing with stakeholders and business users.

Outstanding written and verbal skills with explicit attention to detail during requirements elicitation.

Excellent interpersonal and analytical skills, with ability to handle challenges under pressure with ease.

Work Experience:

Devoted Health. Florida, United States Nov 2023- Present

Senior Business system Analyst

Responsibilities:

Conduct JAD sessions to define scope functional specifications and validate requirements with SMEs.

Collaborate with HEDIS and NCQA standards to analyze quality measure gaps and reporting compliance.

Analysis on the technical and functional requirements for FHIR (HL7) conversions to X12 files and electronic payments

Develop end-to-end data workflows involving EDI transactions 834 (enrollment), 835 (claims), 270/271 (eligibility).

Create data profiling and modeling strategies using SSIS and Azure DevOps pipelines for warehouse processing.

Use Crystal Reports and SSRS for on-demand and scheduled operational and compliance reporting.

Analyz business rules for claims adjudication workflows, including member eligibility, pricing and provider validation logic.

Provide data for HEDIS reporting for performance measuring of patient care.

Gather and documented business requirements (BRDs, FRDs) from stakeholders across payor and provider systems.

Design and validate dashboards, reports, and KPIs to support decision-making in D365.

Translated complex healthcare business requirements into Salesforce objects, Health Cloud data models and integration stories.

Develop Visio process maps to illustrate AS-IS and TO-BE workflows for enrollment, claims and payment cycles.

Participate with QNXT and QSI platforms for provider data integration and claims adjudication logic.

Configure Salesforce Health Cloud Care Plans, Patient 360 and Consent Management modules for improved care coordination.

Conduct Medicare & Medicaid state-level reporting, ensuring adherence to CMS guidelines.

Document business processes and workflow diagrams for HEDIS data handling.

Created low-fidelity wireframes and UI mockups to communicate functional expectations to design and development teams.

Designed BPMN diagrams to model complex healthcare business processes and system integrations.

Worked as liaison between software developers and users of EMR systems to create better electronic medical record systems.

Coordinate Medical Record Retrieval & Provider Engagement initiatives for risk adjustment accuracy.

Utilized Translator Tool to convert, validate and migrate business rule configurations between legacy and modern systems.

Support system upgrades or transitions from ICD-9 to ICD-10 by conducting impact analysis.

Analyzed payer workflows for member enrollment, premium billing and claims adjudication within Epic Payer.

Collaborate with QNXT and MMIS systems to automate Medicare and Medicaid claims adjudication and provider validation logic.

Gather and analyze business requirements to design SharePoint sites lists and libraries for collaboration and document management.

Assist in building a Business Analysis Process Model using Rational Rose and Visio

Collaborate on ERP data migration and cleansing using ETL tools (SSIS, SQL, ADF) to maintain data integrity during transition.

Led FHIR-to-X12 integration for claims data, improving EDI accuracy by 20%.

Support the automation of HEDIS measure calculations and reporting.

Create RTM reports for project managers and leadership to show requirement status, risks and dependencies

Provide advice to business SMEs to analyze, design and deliver SAP functionalities.

Collaborate with developers to embed HIPAA validation rules within ETL and EDI workflows to prevent data leakage.

Implement Agile methodology and developed Performance Test Strategy, Test Plan, Test Requirements.

Performed HEDIS/Star Ratings analysis to optimize performance metrics and improve quality scores.

Conduct stakeholder interviews to refine enrollment and claims processing logic.

Write and optimized SAS programs for statistical analysis, data validation and large dataset processing

Define and validate ETL data flow requirements from Oracle to AWS data lake environments (S3, Glue, Redshift)

Collaborate with development teams to integrate QNXT with external vendor platforms via API and EDI X12 transactions.

Analyzed KPIs and clinical metrics using Excel pivot tables and advanced formulas.

Supported EDM strategies by mapping legacy fields to new systems during data migration projects.

Apply RUP and Waterfall methodologies for long-term, structured implementations.

Support integration of trade data with downstream systems such as risk, compliance and reporting platforms.

Ensure compliance with data governance standards when handling datasets through SAS and Python frameworks

Maintained requirements documentation, user stories and functional specifications in Confluence.

Conduct root cause analysis of rejected X12 transactions and collaborated with EDI vendors for resolution.

Conduct requirements elaboration sessions on the Salesforce CRM platform to review and validate business requirements.

Conduct gap analysis between legacy HL7 interfaces and modern FHIR APIs to identify integration needs.

Manage product backlog and used JIRA for task tracking, story grooming and sprint execution.

Document SAAS integration recruitment with third party vendor via RESTful APIs and API Gateway ensuring secure interoperability.

Analyz impacts of data mapping changes on downstream reports, interfaces and analytics workflows.

Utilize tools like Facets, QNXT or Health Edge to support Payor system configurations and troubleshoot issues.

Support the implementation of QMS modules for quality assurance, defect tracking, and SOP enforcement.

Perform data warehouse validation and analysis to support clinical reporting and operational KPIs.

Translate user stories into test cases for UAT and regression test planning.

Write a business case in PowerPoint to explain the need for SharePoint to centralize reporting.

Led requirements sessions to gather UI/UX needs for internal applications.

Conduct training sessions for business users on CRM reporting features, dashboard usage and data interpretation.

Create confluence documentation for business logic, system configurations and project updates.

Provide SME-level support for Oracle, DB2, and SQL Server-based applications.

Support UAT by showing stakeholders how heir requirements are mapped and tested in the RTM.

Design reports using SAS to provide more comprehensive dimensional information.

Create dynamic Power BI dashboards and Tableau visualizations to present KPIs to leadership.

Develop SQL and PL/SQL scripts to extract, transform and analyze claims, enrollment and eligibility data.

Participate in testing and troubleshooting ETL workflows, ensuring alignment with business rules and compliance requirements.

Maintain traceability matrices to ensure alignment between requirements, development and testing.

Train end-users on Salesforce functionalities, enhancements and best practices for daily use in healthcare operations

create class diagrams and ER diagrams and used SQL queries to filter data within the Oracle database.

Write PL/SQL statement and stored procedures in Oracle for extracting as well as writing data.

Trinity Health, Michigan, United States May 2021- Oct 2023

Senior Business analyst / Business Consultant

Responsibilities:

Conducted requirements workshops, process mapping and stakeholder interviews for Medicaid and Medicare claims modules within Guiding Care and Edifecs platforms

Collaborated with SMEs PBMs and pharmacies to gather and document business requirement for pricing MAC and AWP strategy

Conducted GAP analysis to compare current business processes against RUP/Agile best practices and identify improvement areas.

Created BRDs and FRDs to capture functional, non-functional and integration requirements across pharmacy and claims systems.

Facilitated JAD sessions and workshops to align stakeholders on scope, timeline and dependencies.

Ensured adherence to GxP and SOX compliance standards throughout project lifecycle and change management.

Performed gap analysis between existing EHR/claims functionality and new business or regulatory requirements.

Designed end-to-end business process flows and optimized workflows using Microsoft Visio and Rational Rose.

Built and interpreted UML, Use Cases, Activity Diagrams and Sequence Diagrams to support system design.

Collaborated on defining and managing Electronic Health Record (EHR), Health Information Exchange (HIE), Health Exchange (HEX), Protected Healthcare Information (PHI) and Healthcare reform processes.

Led Salesforce Health Cloud implementations, gathering requirements and configuring workflows to support member, patient and provider data management.

Coordinated the integration of clinical applications and electronic health record (EHR) systems to the HIE.

Created quick reference guide for HIPAA EDI ASC X12 834 transaction set for HCR enrolment.

Supported the design of healthcare data pipelines integrating HL7 messages and FHIR APIs with downstream systems like claims, enrollment and analytics platforms.

Gathered and documented business requirements for Epic Payer modules including eligibility, enrollment, claims and billing.

Designed workflows to synchronize patient demographic and clinical data between EMR/EHR systems using FHIR endpoints.

Managed sprint planning, backlog grooming, and user story creation as part of an Agile delivery team using JIRA.

Captured and prioritized user stories with clear acceptance criteria and traceability to business goals.

Customized Health Cloud data model to align with payer and provider business processes such as member enrollment, provider management and case tracking.

Identify gaps or missing coverage in requirements, design or testing using the RTM.

Modeled member enrollment, eligibility, claims intake, prior authorization and care coordination processes using BPMN standards.

Analyzed and interpreted HL7 v2/v3 messages for integration between payer, EHR and billing systems.

Collaborated with QA teams to develop UAT strategies, review test plans and ensure alignment with business needs.

Participated in UAT execution and validation for pricing, claims and benefit adjudication features.

Ensured compliance with HIPAA, NCQA and CMS interoperability standards across Guiding Care integrations.

Worked with Facets Claims transactions, data model and structure as well as EDI Claims (HIPAA 837 I and P) standards.

Participated in the transition from ICD-9 to ICD-10, including mapping and crosswalk validation.

Designed interactive Power BI dashboards and Excel reports for KPI tracking and operational decision-making.

Validated and supported EDI transactions (837/835) for claims submission and remittance processes with TPAs.

Led pharmacy and claims data migration projects from legacy systems into EDM platforms and SAP backend.

Worked closely with developers to support REST API integrations with third-party vendor systems.

Performed UAT planning, test case development and defect triaging for D365 implementations

Defined and implemented workflows within Demand Management to streamline demand intake, prioritization and approvals

Developed and maintained SOPs and compliance documentation for Medicare/Medicaid data handling and reporting.

Facilitated data quality audits for CMS submissions, ensuring regulatory accuracy and timely remediation.

Ensured traceability between requirements, user stories, process flows and test cases.

Coordinated EDI 834/835/837 integrations with external vendors, reducing transaction errors by 20%.

Involved in designing business requirement collection approach based on the Agile SCRUM SDLC Methodology.

Designed wireframes and mockups for CRM UI enhancements to improve user adoption and navigation efficiency.

Worked with data engineering teams to define and validate ETL processes, ensuring correct transformations.

Conducted UAT and coordinated feedback sessions to ensure SharePoint solutions meet business expectations.

Translate business needs into detailed functional and non-functional requirements for ISMs and development teams.

Defined interoperability workflows for data exchange between EMR/EHR systems, payers and provider platforms using RESTful FHIR APIs.

Analyse data flows between Guiding Care, Facets and Claims Adjudication systems to ensure data accuracy and interoperability

Integrated Python and SAS outputs into business intelligence dashboards and KPI tracking reports.

Coordinated with technical teams to design and enhance Service Mapping for accurate visualization of service dependencies

Maintained and shared all documentation and outputs via SharePoint and Confluence for cross-team transparency.

Defined UI/UX wireframes and supported usability testing for pharmacy portals and claims intake screens.

Partnered with data engineers to implement row-level filters in BI tools

Reviewed and optimized business logic in claims adjudication, pharmacy pricing algorithms and reimbursement policies.

Coordinated with compliance and risk teams to ensure transparent and auditable trade data flows.

Define and enforced Data Governance frameworks to maintain data quality, lineage and stewardship across healthcare domains.

Translated business needs into AWS-based reporting and analytics pipelines with scalable data outputs.

Support BPO teams by documenting SLAs, KPIs and operational procedures that align with business expectations.

Led cross-functional planning sessions with business, QA and technical teams to align on sprint and release goals.

Supported SAP-integrated claims systems for data reconciliation, policy mapping and rule configurations.

Created and reviewed ETL test cases and validated output reports against expected pharmacy and claims data.

Wrote SQL queries to pull real-time or periodic data supporting SOP metrics.

Presented data findings in graphs, charts, pivot tables, pivot charts and PowerPoint presentations.

Mentored junior analysts in Agile methodology, requirement documentation and tool usage (JIRA, SharePoint, Power BI).

Used SQL, PLSQL and DB2 to perform deep data analysis, identify anomalies and validate ETL results.

Pfizer, New York United States Feb 2019- Apr 2021

Business analyst / Business Consultant

Responsibilities:

Led end-to-end data mapping efforts for pharmacy benefit, eligibility and claims systems using NCPDP and MCEF standards

Partnered with SMEs and stakeholders to gather and analyze business requirements for pharmacy and claims management systems.

Conducted GAP analysis to identify system enhancements aligning with CMS and ACA regulatory updates.

Conducted Root Cause Analysis on claim rejects and discrepancies across PBM and MMIS systems.

Ensured compliance with Medicare, Medicaid and commercial plan PBM requirements through thorough testing and validation of FACETS configurations.

Created end-to-end data lineage documents tracing NCPDP and MCEF data flows across member, provider and pharmacy systems.

Assisted in change management and release coordination via ServiceNow tickets to maintain ITSM best practices.

Facilitated JAD sessions to capture requirements and prioritize functionalities for payers and PBM operations.

Designed data mapping and data flow diagrams to support PBM data migration into FACETS and data warehouse environment.

Utilized JIRA for user story management, sprint tracking and defect lifecycle maintenance.

Supported Medicare and Medicaid enrollment workflows to ensure eligibility and regulatory compliance.

Supported NCPDP and EDI X12 (834, 835, 837, 270/271, 276/277) transaction standards via EDIFECS.

Conducted business impact assessments and identified KPIs for pharmacy and claims operations improvements.

Engaged with payers and PBMs to align business requirements and resolve cross-functional system issues.

Analyzed ETL data pipelines for claims, enrollment and provider feeds ensuring accurate data mapping and transformation.

Designed and optimized ServiceNow workflows for automating IT service requests and approvals.

Worked closely with SAP teams to integrate PBM data into enterprise financial and benefit modules.

Ensured compliance with HIPAA, GxP and SOX regulations across all pharmacy data processes.

Worked with FACETS and MMIS to validate claims adjudication and member enrollment data flows.

Designed and managed PBM workflows across HMO, PPO and Commercial plans for member and claim management

Documented system workflows, flow diagrams and UI requirements for CRM and pharmacy benefit modules.

Created and validated UML diagrams to communicate system behavior and integration points.

Maintained project documentation and version control using SharePoint for seamless team collaboration.

Collaborated with developers and architects for ServiceNow ITSM integrations ensuring alignment with SLA and compliance goal

Ensured GxP compliance in pharmacy claims adjudication logic and audit trails.

Created dashboard and KPI reports in Power BI and Tableau to track pharmacy claim volumes rejection and reimbursement trend.

Coordinated UAT with pharmacies, TPAs and health plans for EDI 835/837 transactions.

Customize SAP to integrate with other systems through middleware or APIs.

Designed interactive PowerPoint presentations to communicate analytical findings and recommendations to leadership.

Supported RUP methodology and Agile Scrum processes including Sprint Planning and Product Backlog refinement.

Created BRDs and FRDs, translating business needs into detailed technical specifications for development teams.

Collaborated with QA teams to define UAT scenarios, validate claims workflows and ensure compliance with GxP/SOX standards.

Created and executed test cases for Medicare and Medicaid claim validation in SAP and D365 environments.

Participated in sprint retrospectives to refine processes and improve team velocity in Agile projects.

Built and maintained data dictionaries and process documentation for pharmacy systems.

Generated ad-hoc reports using SQL and Excel for business insights.

Increased reporting accuracy by 35% using Power BI dashboards and KPI automation.

Supported CRM system enhancements to streamline member engagement and prescription workflows.

Delivered monthly executive dashboards summarizing operational KPIs, SLA adherence and compliance trends.

Designed and maintained Business Process Models, Use Cases, Activity Diagrams and Sequence Diagrams using Rational Rose and Visio.

Performed data mapping between multiple source systems using PL/SQL, PostgreSQL and DB2 queries.

Ally Financial, North Carolina, United States Mar-2017- Jan 2019

Business Analyst

Responsibilities:

Gathered and analyzed business requirements for AML/KYC and fraud detection systems from SMEs and stakeholders.

Conducted Gap Analysis and feasibility studies for new compliance tools integrated into core banking platforms.

Managed project planning, risk assessment and mitigation strategies for regulatory and fraud-prevention initiatives.

Created BRD, FRD and Use Case documentation in alignment with SDLC and regulatory frameworks.

Led JAD sessions with SMEs product owners and stakeholders to capture system enhancement needs.

Collaborated with complains teams to implement Anti-Money Laundering (AML) and Know customer KYC Workflows.

Utilized JIRA and Azure DevOps for backlog grooming, sprint planning and tracking deliverables under Agile/Scrum.

Applied SAFe and RUP methodologies to ensure scalable financial solution delivery across global banking units.

Coordinated with UI/UX designers to enhance online banking interfaces for fraud alert and user notification features.

Conducted UAT sessions prepared test cases and validated transaction monitoring and alert workflows.

Coordinated with the scrum development to understand building Java micro services in Microsoft Azure cloud.

Coordinated with CRM, SAP, D365 and NetSuite to streamline financial data management and customer profiling.

Designed UML diagrams (Activity, Sequence, Dataflow) and process maps using Microsoft Visio to visualize system interactions.

Participated in post-implementation reviews evaluating ROI performance and compliance adherence.

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

Ensured alignment of data governance policies across banking, investment and online payment systems.

Performed data extraction, data validation and data profiling for large-scale AML/KYC data sources.

Supported ETL and Data Warehouse processes ensuring accurate data transformation and mapping.

Managed clients contact management including monitoring and recording interactions and communications through CRM.

Collaborated with Azure cloud teams to migrate legacy risk management systems to Microsoft Azure environment.

Created Excel-based financial dashboards using VBA, Pivot Tables and VLOOKUP for KPI reporting.

Analyzed financial and operational data using SAS and SQL to identify anomalies and potential fraud trends.

Conducted root cause analysis for failed AML/KYC alerts and recommended corrective actions.

Participated with ETL teams to design and validate data flow from operational systems to risk data marts.

Involved in Data profiling, Data analysis, data mapping and Data architecture artifacts design.

Created dashboards and visual reports in Power BI and Excel for executives to track compliance metrics.

Used SharePoint for document versioning, workflow approvals and stakeholder communication.

Collaborated with project leadership on BABOK-aligned business analysis practices ensuring process standardization.

Migrated data from in-house sales systems into Dynamics 365 Sales entities.

Worked in SQL statements for product specific ETL specifications.

Best Buy, Texas, United States April-2014 -Feb-2017

Business Analyst

Responsibilities:

Worked in E-commerce testing Product Search, Payment System, Online transaction processing and Inventory management.

Participated in strategic Digital Marketing team meetings to help coordinate initiatives to improve our processes.

Worked in the system development life cycle using Agile and Waterfall models.

Understanding of key E-commerce functions like site browsing and navigation, checkout flow, order fulfillment, payment processing, order shipment, inventory management and order management.

Work cross-functionally with product management, designers, marketing, sales & engineering.

Documented and analyzed the business processes for receiving and processing customer sales based on "Opportunity to Order" and covers business-to-business (B2B) and business-to-consumer (B2C) sales.

Validated data flows between warehouse systems (WMS) and the online order management system (OMS).

Conducted JAD sessions with management, SME (Subject matter expert), stakeholders and developing team for critical issues.

Participated in E-commerce implementation strategy. SAP hybris platform functionalities of Shopping Cart, Catalogs, UI design, Integration of payment gateways, Data Integrations with CRM, and SAP.

Defined data mapping for product catalog synchronization between ERP and online storefronts.

Worked as Business Requirement Document (BRD) and Functional Requirement Document (FRD).

Worked as Project Management maintaining project documentation.

Planned and established Software Development Life Cycle (SDLC) from start to finish. Adopted SDLC methodology Waterfall for development of the project.

Provided initial assistance in the implementation of NetSuite to manage our client base using the CRM

Created SOPs on Document Migration, Change Control, System Security and several other topics.

Prepared PowerPoint presentations and managed sales databases.

Identified all required documentation, including all required SOPs and created templates for same

Worked with UI/UX designers to modernize UI designs and functional flows for existing products.

Used Jira, CA Rally and project management tools or track and monitor backlog status and delivery.

Used PL/SQL and Dynamic SQL to extract Data from Oracle databases.

Used SQL queries to extract the performance metrics and generate the performance reports of trainees and trainers.

Education:

Bachelor in Business Administration ‘2013 from Punjab University

Contact this candidate