jessica claire resumesampleexamplecom 555 4321000 montgomery street san 9 francisco ca 94105 summary qualified professional 6 years extensive experience business analyst system analyst healthcare industry strong understanding project life cycle sdlc methodologies including waterfall agile edi files successfully verified processed respective database indepth knowledge hipaa compliance medical plans hmo ppo pos epo medicaremedicaid successfully produced business requirement document brd approvals knowledge sitecore use web content management strong skills conducting jad sessions uat test plans scripts creation coordination execution experience change management process identify analyze evaluate plan implement review close experienced preparing business process reengineering models single point contract communicate business technical requirements tools methodologies tools ms sql server rational rose msexcel mspowerpoint msvisio jira msoffice rational requisitepro rational clearquest methodologies agilescrum hybrid agile waterfall rad waterfall requisite pro rational rose agile plsql html ms office ms visio edi uml education 2011 mba business administration 2008 business administration experience sofi business analyst 012015 present la care health plan process upgrading enhancing existing user interface organizations web portal internal claim billing systems improve performance user interface user experience responsibilities conducted weekly meetings deciding policies procedures followed upgrading systems performed requirement analysis impact analysis documented requirements documented requirements billing system cash management module enhanced encrypting standards required application documented current business flows utilization management um case management cm disease management dm created managed business requirement document use cases upgraded functionality worked mainframe environment used sql query various reporting databases analyzed system performance initiated process improvement measures mainframe webbased applications followed owed systematic approach eliciting organizing documenting requirements system reviewed joint requirement documents jrd cross functional team analyze high level requirements part architecture modeling team used soa service oriented architecture interacted client technical team requirement gathering translation business requirement technical specifications planned documented procedures data processing prepared data flow diagrams application analyzed translated business requirements system specifications utilizing uml methodology interacted line business managers coordinated transition security database ensure business compliance hippa collaborated testing teams running detailed uat tests roll documented traceability matrix tracing test cases requirements related developed uml use cases using rational rose developed detailed project plan emphasis deliverables designed developed project document templates based sdlc methodology performed unit testing user acceptance testing documented detailed results provided input scope goals risks constraints timelines interfaces pm project planning control environment windows 2000xp microsoft office sharepoint 2007 rational requisite pro ms office sql server agile ms project ms frontpage 2003 ms access edi documentum 20 uml sofi business analyst ca 011 122014 prime healthcare services holding company owns operates 43 hospitals united states project develop application hospitals use central repository storing reports different departments hospital major modules included enrolmentregistration billing reports system developed using hipaa guidelines regulations keeps track healthcare transactions like eligibility requestresponse request response claims status prior authorization claimencounter responsibilities gathered business system functional requirements conducting detailed interviews business users stakeholders subject matter experts smes conducted group jad sessions business units stakeholders define project scope deliverables validate businesstobusiness data exchanges data exchange partners validate internal processing mmis transaction processing system provide technical support minimum data set mds outcome assessment information set set oasis systems enable electronic transmission patient data purpose payment quality care analyses medicare medicaid programs responsible e creating use cases system architecture document supplemental requirements document architecture documen diagrams verifying technical production infrastructure designing executing performance tests documentation worked medicare advantage b c medicare part mapd medicaid options 65 65 managed care care disease case management also insurance regulations claims processing claim scrubbing hmo ppo medicare medicaid assisted loading managed care contract rates managed care contracting information systems also worked departments provide managed care information identify improvement opportunities also performed complete reconciliation explanation payments eop check remittances received managed care contracts entered minimum data set mds computer database transmitted medicare website designed maintained managed care contract databases streamline collection analysis dissemination contract information performed requirement analysis impact analysis documented requirements using rational requisite pro prepared client process maps consumer broker employer provider transactions facets process developed wrote test script walkthroughs developers quality analyst set continually managed project expectations team members stakeholders analyzed documented business requirement document brd functional specification documentation system requirement documentation using uml methodologies conducted meetings understand workflow processes assisted gap analysis derive requirements existing systems enhancements environment windows 2000xp microsoft office sharepoint 2007 rational requisite pro ms office sql server agile ms project ms frontpage 2003 ms access edi 20 uml highmark inc business systems analyst meadville 122010 092012 uniprise technologies part presbyterian healthcare system fortune 500 company leading player health insurance services market uhci specializes network based care coordination health care services small groups government specialized groups commercial employers system streamlined patient registration patient scheduling medical insurance checking claims processing reporting purpose project involves population enterprise data warehouse edw used critical reporting analysis data pulled together multiple disparate systems also involved certain modifications claims processing system responsibilities gathered analyzed documented business technical requirements formal informal sessions validated needs business stakeholders ional sessi conducted user interviews documented business functional requirements performed requirement analysis developed use cases activity diagrams using rational rose developed uml use cases using rational rose developed detailed project plan emphasis den deliverables defined developed specs federal reporting specific medicare advantage performed data data mapping logical data modeling created class diagrams er diagrams used sql queries filter data maintained ongoing technical assistance provided help desk support customers mainframe systems software included problem determination resolution completed documentation claims scenarios source system analyzed existing claims process specific business rule logic applied acp model documented medicare claims processing designed high level design new process integrating legacy facets documented requirements associated change requests requirements connected requirements use cases environment windows xp professional oracle9i ms access 2000 ms excel rup oracle uml rational rose requisite pro clear case 2002 rational clear quest 2002 ms office suite ms visio 2003 aetna health services business analystdata analyst city state 022007102010 project involved creating medical claims processing system aetna consisted different modules like provider enrollment member enrollment programs coverage project also involved maintenance claims workstation automatically handles entire claims life cycle responsibilities responsible defining scope implementing business rules project gathering business requirements documentation responsible writing functional requirement specifications frs user requirement specification urs analyzed business requirements segregated high level low level use cases activity diagrams state chart diagrams using rational rose according uml methodology thus defining data process models responsible architecting integrated hipaa medicare solutions facets identify member provider coverage medicare medicaid involved gather requirement claims processing system successfully conducted jad sessions helped synchronize different stakeholders objectives helped developers clearcut picture project created process flow diagrams use case diagrams interaction diagrams using microsoft visio national nuse rational rose wrote test cases performed user acceptance testing documented detail defects using perect nach defect tracking report used test case distribution development reports track progress test case planning implementation execution results wrote plsql statement stored procedures oracle extracting well writing data created use cases activity report logical components deployment views extract business process flows workflows involved project carried defect tracking using clear quest maintained proper communication developers ensuring modifications requirements addressed also monitored revisions skills streamline agile analyst approach billing billing system billing systems business process c case management cash management clear case contracts client data processing data modeling data warehouse databases database designing disease management documentation documentum 20 edi ms frontpage functional government help desk support html information systems insurance logic mainframe mainframe systems market meetings ms access ms access 2000 ms excel msexcel exchange microsoft office ms office ms office suite msoffice ms powerpoint ms project sharepoint microsoft visio windows 2000 windows xp modeling enterprise network oracle9 oracle plsql organizing policies prime processes process improvement progress project planning quality quest rad rational rose reporting requirement rup scheduling scrum sdlc script specification ms sql server sql sql server system architecture technical support technical assistance transaction processing translation transmission uml upgrading user interface visio web portal website workflow