Systems Analyst Business

RAJESH PAUDEL

Email: ad5lei@r.postjobfree.com

Phone: 469-***-****

PROFESSIONAL SUMMARY

● Experienced Agile Business Systems Analyst with over 6 years in IT development, crafting and quality testing deliverable products.

● Led the RTR project, overseeing system process enhancements and functionality improvements, resulting in significant reductions in system downtimes and user complaints.

● Applied enhanced knowledge of industry-standard SDLC methodologies, with extensive experience in RAD and RUP, including Joint Application Development (JAD) and Joint Requirement Planning (JRP).

● Conducted GAP analysis, mapping, implementation, and testing for Medicaid Claims processing.

● Participated in the design and development of REST/HTTP APIs, incorporating JSON data formats and API versioning strategies.

● Integrated Golang and .NET APIs, fostering seamless communication between disparate system components and enhancing system interoperability and data exchange.

● Gather/Report all relevant agile metricssuch as Burn down and Burn-up charts.

● Experienced in creating and maintaining artifacts such as Business Requirement

● Utilize Azure DevOps tools to investigate and resolve issues that occur during the setup or deployment process, ensuring smooth operations.

● Organize meetings within Azure DevOps to bring together the Core Switch Team and subject matter experts, ensuring alignment and effective communication.

● Utilize Azure DevOps analytics and feedback mechanisms to drive continuous improvement in the CI/CD pipeline and deployment process.

● Documents (BRD), Functional Requirement Documents (FRD), System Requirement

● Documents (SRD), and Requirement Traceability Matrix (RTM)

● Proficient in creating Structural and BehavioralUML diagrams using MS Visio.

● Ability to communicate technical designs, Plans, Progress, Issues, and Alternatives.

● Conducted comprehensive API testing using Postman, ensuring all endpoints met stringent business requirements and functioned as intended, resulting in a 25% reduction in post-deployment issues.

● Implemented GraphQL to streamline data querying processes, achieving a 30% improvement in data retrieval times and a more flexible data interaction model.

● Utilized Power Query in Power BI for pivoting and unpivoting the data model, ensuring effective data cleansing and massaging.

● Ensured strict adherence to HIPAA compliance across all project initiatives, conducting regular audits and implementing necessary security measures to safeguard patient data.

● Collaborated with the production support team to promptly address system issues, minimizing downtime and ensuring continuous system availability for critical healthcare operations.

● Developed a vision plan, including Use Case diagrams, business flow diagrams, Activity/State diagrams, and Sequence diagrams, leveraging UML for enhanced understanding of business processes.

● Extensively experienced in creating executive reports with BI Publisher integrated with OBIEE.

● Worked on FHIR conversion to provide a 360-patient view from Hospital Discharge to Long-term Care, Home Health, or Senior Living.

● Created reports using SSRS, Excel services, Power BI, and deployed them on SharePoint Server as per business requirements.

● Led end-to-end UAT processes for multiple projects, ensuring alignment with business requirements and user expectations.

● Facilitated workshops with stakeholders to gather and document detailed business requirements for system enhancements.

● Collaborated closely with business users to understand their needs, address concerns, and incorporate feedback into the testing process.

● Implemented an efficient defect tracking system, reducing resolution time by 20% and enhancing overall product quality.

● Spearheaded requirement gathering efforts, engaging with stakeholders to understand core business needs, resulting in a 20% increase in project alignment with business objectives.

● Responsible for regular monitoring and maintenance of file transfer applications to ensure optimal performance and security compliance. Duties include software updates, configuring FTP, SFTP, and HTTP protocols, and ensuring successful completion of all transfers according to schedules.

● Authored business system analysis reports based on state regulations, HIPAA compliance, and product business rules.

● Defined and maintained project plans, risk matrices, and schedules using Clarity PPM, ensuring compliance with project scope, timeliness, and deliverables.

● Wrote user acceptance testing (UAT) scripts and led testing/quality assurance for both HL7 ADT interfaces and applications.

● Developed a single application to process data from multiple integration points, converting data for reporting purposes and feeding data into the mainframe system to comply with reporting requirements.

● Executed the deployment of the HealthEdge HealthRules Payor system, customizing the software to fit specialized Rate, Term, and Renewal (RTR) project specifications, including the establishment of product lines, benefit configurations, and pricing structures.

● Managed the complete claims handling process from initial receipt through adjudication to payment disbursement.

SKILLS

Category Technologies

BI and Data Visualization

Tableau (Desktop/Server), Power BI, BI Publisher, SSRS, Cognos, Crystal Reports, Kibana

Data Analysis and ETL

Power Query, Python, Groovy, Apache Airflow, DataStage, Informatica, SSIS, Hadoop, Spark, SparkSQL

Databases

Teradata, Oracle, SQL Server, MS-SQL Server, Netezza, Sybase, MySQL, AWS RDS, AWS Redshift, MongoDB

Programming Languages Java, Python, Groovy, JavaScript Web Technologies HTML, CSS, JavaScript, REST/HTTP APIs, GraphQL, Node.JS Frameworks and Libraries .NET, Golang, Flask, Pandas, NumPy, Scikit-learn, XGboost Collaboration Tools JIRA, Confluence, MS Visio, SharePoint Healthcare Technologies

HL7, FHIR, HIPAA compliance, Community and State claims processes

Project Management MS Project, Clarity PPM

Middleware and

Integration

Web API, EDI (Electronic Data Interchange), GraphQL, Nginx, REST API

Content Management

Systems

AEM CMS

Version Control Git

PROFESSIONAL EXPERIENCE

American Express March 2020- Till data

Business System Analyst

Tech Stack and Environment

● Domain: Finance Payments

● Focus: Enhancing system efficiency and functionality to improve user experience and reduce downtime for critical operations.

● Collaboration: Heavy emphasis on working with various teams (development, operations, business users, stakeholders)

● Tools and Methodologies:

SDLC: Utilizes Agile methodologies (RAD, RUP) with tools like JAD/JRP for collaborative requirement gathering and planning.

Analysis & Design: UML diagrams for workflow visualization.

API Development & Testing: Experience with RESTful APIs, JSON, Postman for testing, and GraphQL for data querying.

Data Management: Power BI, Power Query for data cleansing and manipulation.

CICI & Automation : Jenkins, Azure DevOps, Ansible

Content Management: Experience with Adobe AEM CMS for web applications.

Reporting: SSRS, Excel Services, and Power BI.

Defect Management: Efficient tracking system implemented to improve resolution times.

User Acceptance Testing (UAT): Leading end-to-end UAT processes ensuring the system meets user expectations.

Job Responsibilities

● Led the RTR project, focusing on system process enhancements and functionality improvements, significantly reducing system downtimes and user complaints.

● Adopt enhanced knowledge of industry standard SDLC methodologies and having extensive experience working on RAD and RUP including Joint application development

(JAD), Joint requirement planning (JRP).

● Analyze payment application requirements and workflows using tools like UML diagrams.

● Partner with developers on a generalized router application for all payment transactions, utilizing user story creation and collaboration tools.

● Support the production environment and production support team by monitoring application performance, identifying and documenting defects in payment processing, and assigning them to the appropriate technical expertise.

● Participate in war rooms to troubleshoot on production issues, critical payment processing issues and identify solutions.

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

● Participated in Designed and development of REST/HTTP APIs, including JSON data formats and API versioning strategy sessions.

● Integrated Golang and .NET APIs, facilitating seamless communication between disparate system components, enhancing system interoperability, and data exchange.

● Conducted comprehensive API testing using Postman, ensuring all endpoints met stringent business requirements and functioned as intended, thereby reducing post-deployment issues by 25%.

● Collaborate with the Core Switch Team using Azure DevOps tools to understand and implement their CI/CD pipeline requirements effectively.

● Leverage Azure DevOps for deployment activities, ensuring that deployments are efficient, reliable, and well-documented.

● Implemented GraphQL to streamline data querying processes, resulting in a 30% improvement in data retrieval times and a more flexible data interaction model.

● Utilized Power Query in Power BI to Pivot and Unpivot the data model for data cleansing and data massaging

● Collaborated with the production support team to promptly address system issues, minimizing downtime and ensuring continuous system availability for critical healthcare operations.

● Tasked with the ongoing monitoring and upkeep of file transfer applications to maintain peak performance and adherence to security standards. Responsibilities encompass updating software, setting up FTP, SFTP, and HTTP protocols, and guaranteeing that all transfers are executed successfully as per the established schedules.

● Developed a vision plan that defined the primary goals and objectives of the project. Developed Use Case diagrams, business flow diagrams, Activity/State diagrams and Sequence diagrams so that developers and other stakeholders can understand the business process by using UML.

● Extensive experience in creating executive reports with BI Publisher integrated with OBIEE.

● Created reports utilizing SSRS, Excel services, Power BI and deployed them on SharePoint Server as per business requirements.

● Led end-to-end UAT processes for multiple projects, ensuring alignment with business requirements and user expectations.

● Facilitated workshops with stakeholders to gather and document detailed business requirements for system enhancements.

● Collaborated closely with business users to understand their needs, address concerns, and incorporate feedback into the testing process.

● Implemented an efficient defect tracking system, reducing the resolution time by 20% and enhancing overall product quality.

Centene Corporation April 2019- 2020 Feb

Business System Analyst

Tech Stack and Environment

● Domain: Healthcare

● Focus: Integrating data from various sources, processing it for reporting, and ensuring secure and efficient operations.

● Technical Skills: Proficient in diverse tools like Clarity PPM for project management, Ansible for automation, Kibana for data visualization, EDI protocols, and security measures like JWT and Cloud-based Enterprise Resource Planning Workday

● Collaboration: Working with stakeholders, product owners, developers, production support, and external clients.

● Compliance: Adherence to HIPAA regulations and state laws. Job Responsibilities

● Spearheaded requirement gathering efforts, engaging with stakeholders to understand core business needs, resulting in a 20% increase in project alignment with business objectives.

● Authored business system analysis reports based on state regulations, HIPAA compliance and product business rules.

● Define and maintain project plan, risk matrix and schedules using Clarity PPM ensuring compliance with project scope, timeliness and deliverables. Implemented BPR to eliminate non-value-added tasks, workflows and amplified focus on the critical processes.

● Developed a single application to process data from multiple integration points, convert the data for reporting purposes and feed data into the mainframe system to be compliant to reporting requirements.

● Developed a secure payment routing application, implementing advanced security measures such as JWT token generation, significantly enhancing transaction security.

● Built dashboards to identify business scopes, heatmaps of customers and fraud zones and others

● Troubleshoot minor Workday issues and escalate complex problems to the IT team.

● Perform basic system administration tasks such as managing user access, data backups, and system security settings on the workday.

● Managed Nginx server configurations and automated repetitive tasks using Ansible, improving system reliability and operational efficiency by 30%.

● 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.

● Maintained comprehensive project documentation on Confluence, ensuring all team members had access to up-to-date information, fostering a collaborative work environment.

● Enhanced data integration and reporting through SAP's analytics, improving decision-making and compliance with industry requirements. Streamlined claims processing using Guidewire, optimizing efficiency and customer satisfaction through Business Process Reengineering (BPR).

● Managed project lifecycles and compliance within SAP PPM for claim management enhancements, aligning with business goals and ensuring timely, quality delivery.

● Boosted data security in SAP environments with advanced measures like JWT token generation, safeguarding sensitive claim information and adhering to HIPAA and other regulations.

● Expanded SAP functionality to support end-to-end claim management workflows, including claim intake, assessment, and resolution, ensuring a seamless and user-friendly experience for both employees and clients.

● Integrated SAP HR and financial modules with Guidewire to automate compensation and expense tracking for claims, enhancing accuracy and reducing manual efforts.

● Played a key role in developing and refining CI/CD pipelines, streamlining code deployment processes, and reducing deployment times by 40%.

● Provided escalated support for higher environment issues, collaborating with the production support team to ensure swift resolution of complex issues and maintain high system performance.

● Played a pivotal role in translating business requirements into actionable user stories for development teams.

● Collaborated closely with stakeholders, product owners, and development teams to refine and prioritize user stories.

● Acted as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.

● Conducted risk assessments on proposed changes, evaluating potential impacts on financial processes and compliance.

● Designed, built, and tested business rules to support operations and business objectives for Community and State claims processes.

● Validated EDI X12 transactions like EDI 834 (Benefit Enrollment and Maintenance), 277/275(Health Care Claim Request for Additional Information and Response), 276/277(Health Care Claim Status Request and Response), 835(Health Care Claim Payment/Advice), 837 and (Health Care Claim: Professional, Institutional and Dental) as per HIPAA 5010

● Utilized Kibana for data visualization and monitoring, providing real-time insights into financial data trends and system performance.

● Mapped existing Rate, Term, and Renewal (RTR) processes to the HealthEdge platform, identifying and executing enhancements for process optimization and automation.

● Oversaw the migration of data from legacy systems to HealthEdge, managing the integration of diverse data sources to ensure uninterrupted data flow and maximum system efficiency.

● Developed and implemented strategies to minimize claim processing turnaround times and improve accuracy.

● Focused on upgrading the claims management system to boost efficiency and enhance user experience, which involved automating manual tasks and refining the interface for improved navigation and data entry.

● Resolved complex claims issues and disputes promptly and effectively. Client: Walgreens, IL Feb 2018 - April 2019

Role: Business Analyst

Responsibilities:

Tech Stack and Environment

● Focus: Improving business efficiency and user experience through data analysis, process optimization, and close collaboration across teams.

● Technical Skills: Proficient in SQL, UML, Excel (including advanced functions), AWS cloud technologies, JIRA, Visio, MS Office Suite.

● Project Management: Deep understanding of SDLC methodologies, ability to define project scope, goals, and timelines.

● Collaboration: Working effectively with various stakeholders (SMEs, designers, developers, project managers) to gather requirements, facilitate discussions, and reach consensus.

● Data Analysis: Extracting insights from data using SQL queries, Excel analysis tools, and creating insightful reports and visualizations (pivot tables, charts). Job Responsibilities

● Collaborated with various cross-functional stakeholders throughout the SDLC, elicited requirements, and communicated the same to both technical and non-technical stakeholders.

● Extracted data using SQL queries to evaluate market share for each policy type to develop promotional offers displayed using APIs.

● Conducted an in-depth analysis of the project and its life cycle by analyzing data flow and workflow models and diverse data on restrictions by collaborating with many SHs from various business units.

● Analyzed data by Creating Pivot tables and growth Charts, using various advanced Excel tools to identify areas of improving supply chain logistics, inventory cost, and overhead reduction.

● Interacted with the Users, SMEs, Designers, Developers, and Project managers to get a better understanding of the Business Processes.

● Deep understanding of all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.

● Developed models in UML notations and methodology that accurately represent the business process and workflows and communicate them to the stakeholders.

● Provided input (scope, goals, risks, constraints, timelines, and interfaces) to PM for project planning and control.

● Monitored and tracked department KPIs, Sales growth, search conversion, and other drivers to track the efficiency of the project.

● Provided support for Quality Assurance activities such as System Integration Testing

(SIT), User Acceptance Testing (UAT), and Regression Testing (as well as post-implementation support).

● Created automated workflows in the cloud (AWS) to ensure data pipelines are migrated from SAP-cloud commerce.

● Facilitated collaboration & and consensus among various Stakeholders to generate the most feasible technical solutions in line with the organization’s goals and targets.

● Identified gaps by analyzing various system workflows, processes, and data-flow diagrams to improve overall efficiency and reduce waste.

● Followed reverse engineering to document UI and Functionality.

● Created and maintained user stories in JIRA for a better understanding of the requirements of the development team, Used JIRA for bug tracking.

● Reviewed the Test Plan developed by the testing team for testing the application.

● Created Test Scripts and test Scenarios to check report content, layout, and parameters. Environment: SQL, UML, Excel, AWS, JIRA, Visio, MS Word, MS PowerPoint. EDUCATION

Master of Science in Health Informatics

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