1. ANKHCHIMEG BYAMBASUREN
SUMMARY
 9 years of progressive working experience in software Business Analyst in Healthcare,
Pharmaceutical and Banking domains.
 Experience in deployment and maintainance of CRM/BPM.
 Excellent working knowledge on ITeleCenter (Siebel).
 Knowledge of HIPAA Compliance, HIPAA Insurance Regulations and Claims Processing
in EDI X12 transaction sets including 835/837/270/271
 Working knowledge about the HIPAA 4010/5010 implementation guidelines, ICD-9 and
ICD-10 code sets.
 Extensive experience gathering, defining, business requirements (BRD) translating them
into technical specifications and functional requirement (FRS) and Non functional
requirements.
 Strong knowledge of Provider Service and Member Delivery Systems, Provider
Information Management Systems.
 Extensive experience in business requirement elicitation/gathering techniques like
interviewing, questionnaires, brainstorming, focus groups; conducting Joint Application
Development (JAD) and Joint Requirement Planning (JRP).
 Adept in creating Business Process Models, Data Flow Diagram, State Diagram,
Sequence Diagram, Activity Diagrams and Flow Charts using Business Process Modeling
Notation and UML modeling tools such as Rational Rose and MS Visio.
 Excellent knowledge of Software Architecture and Business Architecture.
 Excellent knowledge of different Software Development Life Cycle (SDLC) methodologies
such as Waterfall methodology and Agile and project planning and scheduling and
experience in analysis of system specifications and business Iterative methodology.
 Experience in testing Client/Server and Web-Based Applications.
 Performed SOA / Web Service testing using SoapUI.
 Post Adjudication Claims Processing Regression Testing using SOATest 9.7 and Beyond
Compare.
 Maintained Requirement Traceability Matrix and Test Matrix.
 Assisted the project manager plan, coordinate and monitor project levels to ensure timely
completion along with satisfactory results.
 Experience in performing AS-IS, TO-BE analysis, GAP analysis and project planning and
scheduling and experience in analysis of system specifications and business
requirements.
 Worked extensively in HP Quality Center/ALM 10,11&12, JIRA and Zephyr to create test
plans, preparing test strategies, execution plan & tracking defects.
 Experience in testing Client/Server and Web-Based Applications.
 Excellent communication, documentation and organization skills with the ability to adapt
to new environment.
 Ability to quickly master new concepts, applications and open to learning new
technologies.
TECHNICAL SKILLS
Methodologies Agile,Waterfall, Iterative
Modeling Tools Rational Rose, MS Visio, BPMN
Requirement Management Rational Requisite Pro, Serena Business Manager
Testing/Defect Tracking Rational Tools, Quality Center 12 (ALM), IBM Data Studio,
Microsoft Reporting Services (SRSS), SOAP UI , SQL
Navigator 6.4, SOATest 9.7, Beyond Compare, Toad 12 and
Oracle SQL Developer, SQL Plus, Q-Dir 5.01, Altova XMLSpy,

2. TextPad, SharePoint
Project Management MS Project
Operating System Windows Vista/XP/2000/98/95
DBMS MS SQL Server 2005/2000, Oracle, MS Access 7.x, PL/SQL,
Data warehouse, Mainframe/COBOL, ETL, .Net
PROFESSIONAL EXPERIENCE
FEPOC, Washington, DC Feb 2016 – Present
Sr. Requirement Analyst
Working as a Requirements Analyst The NextGe, I am responsible for requirements
development and management providing requirements engineering expertise for the
implementation of new functionality and maintenance of existing FEP systems. The incumbent
will work with business domain analysts in a team capacity to ensure that both business and
technical considerations are addressed.
Responsibilities:
 Participate in the analysis of existing business processes and systems to recommend
process and system enhancements.
 Coordinate with or provide consulting services to other CareFirst departments and
external entities, such as vendors, consultants, auditors, other BCBS Plans, BCBSA, the
FEP Director’s Office, and government agencies such as the Office of Personnel
Management.
 Leads requirements discovery to document the needs of customers and potential
stakeholders.
 Work closely with internal and external customers to discover the root requirements.
Partners with business users to understand strategic goals, as the subject matter expert
to the customers’ needs as well as the systems functionalities.
 Assist to establish and follow industry standard requirements elicitation such as Joint
Application Development (JAD), interviews, prototyping, and user observation.
 Lead analysis of existing business process and systems.
 Use industry best practices and analytical techniques such as state charts, process
modeling, decision tree analysis, and data flow diagrams.
 Recommend process and system enhancements to improve business performance and
maximize the effectiveness of available technology.
 Create and analyze requirement models to increase understanding and uncover potential
issues.
 Conduct impact and gap analysis of systems and business process workflows.
 Contribute to building a knowledge base of business information using various types of
models.
 Lead in the development of complete, unambiguous description of the solution with use
cases, requirements, and business rules that are both verifiable and traceable.
 Translate business needs and functional requirements into technical requirements.
 Communicate with the development and testing experts using highly complex and
technical language.
 Lead the requirements validations by working closely with internal and external
customers to validate requirements against the needs of the customers.
 Develop and manage the requirements traceability such as tracing across the software
development lifecycle to ensure that each succinct requirement is met at each step of the
lifecycle. Additionally, trace up and down through the parent-child relationship within the
requirements.
 Define and documents complex requirements and develop business work papers and
specifications.

3.  Expand knowledge and skills of existing and new business processes, quality assurance,
and system development methodologies.
 Serve as a subject matter expert for business processes and related systems including
analyzing and researching complex system problems, as well as coordinating with
vendors and other parties as necessary.
 Perform business support responsibilities and consultation with internal and external
customers and any other projects as requested in support of management.
 Work effectively in a fast-paced environment with frequently changing priorities,
deadlines, and workloads that can be variable for long periods.
 Meet established deadlines and handle multiple customer service demands from internal
and external customers, within set expectations for service excellence.
 Effectively communicate and provide positive customer service to every internal and
external customer, including customers who may be demanding or otherwise challenging.
 Environment: Agile Scrum, User Stories, MS Office, Ms.Visio, Quality Center 12.0 (ALM)
for Requirements, TextPad, SharePoint
Covance (PMO), Gaithersburg, MD May 2015 – Jan 2016
Sr. Business Analyst
Covance is a global company that provides drug development services ranging from clinical
research and trials all the way through commercialization of a drug. The PMO in particular serves
as the key link between Covance’s business group and the technical team and ensures that the
client’s requirements are being met in the end product. Working as a Sr.Business Analyst, I lead
the formulation and definition of proposed solutions scope and objectives through research,
client interface, and fact-finding combined with an understanding of applicable business systems
and industry requirements.
Responsibilities:
 Lead development of functional and non functional business requirements and helps
users assess relative priorities for both business process and technology solutions.
 Drive the development business processes and priorities.
 Evaluate alternative business process and technology solutions, and participates in
making technology recommendations to enhance business operations.
 Worked on CRM/BPM deployment and mantainance.
 Lead the development of business requirements, functional designs, process maps, user
test plans, and training materials associated with business process and technology
solutions.
 Worked collaboratively with peers in PMO, the Application Management Organization,
and Global Applications, and with internal/external stakeholders to coordinate the overall
delivery of technology solutions to business groups.
 Developed strong working knowledge of the industry, CMA clients and technology trends;
use this information to support the continuous improvement of the CMA Process
Architecture.
 Provided recommendations to technology business requirements, business objectives,
budgets and timelines. Provided cost estimates for project related tasks.
 Partnered with senior leadership and the application development group or suppliers to
ensure a timely, accurate and cost effective solution to IT business needs.
 Interface with the application development test team to validate test results for new
applications verifying that they meet the requirements of their business group.
 Help partner with functional business unit members on how to work with IT. Facilitated
communication between IT and end users.
 Work in conjunction with senior leaders in other functional areas to ensure that program

4. launches, scope expansions and the development of new business capabilities are
supported and delivered within the business architecture.
 Utilize project management processes and tools to facilitate the delivery of business
process and technology solutions.
 Ensure that proposals and service offerings are in line with business architecture.
 Mentor and grooms business analysts and other staff in the above competencies.
Environment: Agile, Ms.Visio, Patient &Provider Services, InTeleCenter (Siebel),
Interfaces, Business Process, CRM/BPMN, MS Office
CareFirst BCBS, Owingmills, MD Jun 2014 – Apr 2015
Sr. EDI Analyst
As an EDI Analyst on the FEP Bridge Service Console and D2D FEP projects, worked closely
with the project team to identify user's business requirements, interpret complex business
needs and translate them into system requirements and performing System Integration testing
for day to day FEP Bridge Claims processing, claims error processing and to prepare the
auto- generated reports and On Demand reports correspondence using the Batch Cycle and
JReport.
Responsibilities:
 Effectively managed the requirements and requirement change requests during various
phases of the project life cycle. Facilitated Change Requests (CRs), assessed impacts of
changes to requirements resulting from proposed CRs.
 Created change summary for changes impacting FEP Bridge Console for Authorization,
Provider, Reports, Checks, Enrollment and Supplemental Claims for CareFirst and
Cambia Plans and D2D FEP Claims Processing.
 Analyzed business Requirements, performed gap analysis and segregated them into high
level and low level Use Cases.
 Conducted JAD sessions to resolve conflict arising from ambiguous requirements.
 Worked closely with the development team to clarify/understand functionality and ensure
that the developers clearly understood the business requirements that the system was
designed to fulfill.
 Researched and understood the claims adjudication and reimbursement systems based
on HIPAA X12 5010 standards.
 Managed Requirement Documents in Serena Business Manager.
 Created Functional and Non Functional Requirements by holding meetings with various
SME’s and Technical Architects.
 Acted as liaison between development team, business and testing team and standardize
product requirementsspecification documents such as PRD, FSD and Mapping
document.
 Created Ad-hoc reports by writing SQL queries in TOAD and SQL Plus.
 Worked on day-to-day claim processing and wrote the change summary for claim
processing error.
 Created Project Requirement Document and Change summary for ICD-10.
 Managed all the projects artifacts and reports in SharePoint.
 Designed and developed on the Flow diagrams in MS Visio using UML for various
modules of the project.
 Maintained and submitted periodic/monthly status reports to the Project Manager to serve
as the team’s assessment of the project and its schedule.
 Maintained a Traceability Matrix to ensure that all Functional Requirements are
addressed at the Use Case Level as well as the Test Case Level.
 Performed Claims Processing User Acceptance Testing for use cases and Packaging,
Split, Authorization, UCCF, Pricer and Dental Claims.

5.  Extensively used Waterfall Methodology in the process of the project management based
on SDLC.
 Used 837/835 EDI XML files in testing to generate valid claims and dropping claims
manually using SOATest 9.7
 Participated in Business Requirements reviews and work with systems analysts /
developers to fully test application changes.
 Validate the correct data on the electronic HIPAA transaction 837 or paper claim.
 Environment: Use cases, MS Office, Quality Center 12.0 (ALM), Toad for Oracle 12.0,
Oracle SQL Developer, SOATest 9.7, Altova XML Spy, TextPad, Serena Business
Manager, SharePoint
BlueCross BlueShield, Jacksonville, FL (Florida Blue) Mar 2013 – Jun 2014
Business Analyst
The BlueCross BlueShield Association (BCBSA) is a federation of 38 separate health insurance
organizations and companies in the United States. Combined, they directly or indirectly provide
health insurance to over 99 million Americans. I am working as a BA Analyst on the Provider
Data Conversion project, and working closely with project team to identify user's business
requirements, interpret complex business needs and translate them into system requirements,
write business specifications and forward to technical staff for system integration.
Responsibilities:
 Conducted meetings with users, gathering and analyzing requirements.
 Used gap analysis framework to identify AS-IS processes of claims transactions of
HIPAA X12 4010/4010A standard and TO-BE processes (ICD-10 codes compliance
requirements) of 5010 standard.
 Used Agile Methodology in the process of the project management based on SDLC.
 Designed and developed Process Flow Diagram, Use Cases, Activity Diagrams,
Sequence Diagrams, and Object Oriented Design (OOD) using UML and extensively
used MS Visio.
 Created Functional and Non Functional Requirements by holding meetings with various
SME’s and Technical Architects
 Gathered and documented Business Requirements, created Functional specifications
and translated them into Software Requirement Specifications.
 Created and Maintained Test Matrix and Traceability Matrix.
 Created monthly/weekly status reports to update the project schedules & deliverable
plan.
 Created mapping documents as per the requirement changes for HIPAA 5010.
 Worked on different EDI transactions like 837 for submitting claims, 835 for payments,
834 for benefit enrollment, and 820 for premium payments to insurance products,
270/271 for Eligibility inquiry, and 276/277 for claims status.
 Used 837/835 EDI XML files in testing to generate valid claims using in house tool Mojo.
 Supported the Multi Server Deployment Performance Testing Support for PIP and PIMS.
 Validate the correct data on the electronic HIPAA transaction 837 or paper claim.
 Have written detailed test plans based on Business Requirement Document (BRD);
System Requirement Specification (SRS).
 Create, deploy, and manage reports using SQL Server Reporting Services (SSRS) for
Provider Care Reporting.
 Wrote complex SQL queries in Oracle database using SQL Navigator and IBM Data
Studio to retrieve data from DB2.
 Have tested Provider Information (PIP) Database using IBM Data Studio 4.1 to retrieve
data in DB2.
 Involved in PIMS Conversion involved end-to-end testing of provider enrollment, member

6. services.
 Validate data according to the mapping document rules.
 Coordinated User Acceptance Testing with the UAT group to ensure the correct business
logic.
 Identified, analyzed, and documented defects, errors, and inconsistencies in the
application using Quality Center.
 Participate in various meetings and discussed Enhancement and Modification request.
 Environment:AGILE, Requisite Pro, Use cases, Visio UML, Rational Rose, MS Office,
QTP, Interfaces, IBM WebSphere, MS Project, Data warehouse, COBOL/Mainframe/JCL,
Test Director, DB2, SOAP UI, Diamond, HL7, SQL Navigator 6.4, IBM Data Studio 4.1,
Quality Center 11.0 (ALM)
Tenet Healthcare Corporation, Dallas, TX Apr 2011 – Feb 2013
Business Analyst
Tenet Healthcare Corporation is a healthcare services company whose subsidies and affiliates
own and operate acute care hospitals and related ancillary healthcare businesses. Tenet’s
hospitals aim at providing the best possible care to every patient who comes through their doors
with a clear focus on quality and service. Facets are a fully integrated CLAIMS data processing
and Medicaid and/or Medicare Management information system for managed healthcare. Facets
uses the data feed for the claims adjudication, claims error processing and to prepare the auto-
generated reports and correspondence using the Batch Cycle.
Responsibilities:
 Conducted JAD sessions to resolve conflict arising from ambiguous requirements.
 Worked closely with the development team to clarify/understand functionality and ensure
that the developers clearly understood the business requirements that the system was
designed to fulfill.
 Researched and understood the claims adjudication and reimbursement systems based
on HIPAA X12 5010 standards
 Created Functional and Non Functional Requirements by holding meetings with various
SME’s and Technical Architects.
 Acted as liaison between development team, business and testing team and standardize
product requirements specification documents such as PRD, FSD and Mapping
document.
 Worked on day-to-day claim processing and wrote the change summary for claim
processing error.
 Managed all the projects artifacts and reports in SharePoint.
 Designed and developed on the Flow diagrams in MS Visio using UML for various
modules of the project.
 Maintained and submitted periodic/monthly status reports to the Project Manager to serve
as the team’s assessment of the project and its schedule.
 Maintained a Traceability Matrix to ensure that all Functional Requirements are
addressed.
 Participated in Business Requirements reviews and work with systems
analysts/developers to fully test application changes.
 Validate the correct data on the electronic HIPAA transaction 837
 Involved in discussion with the Subject Matter Experts (SME) during creation of test plans
and updating of business requirements.
 Acting as liaison between end user and Facets for user problems, outstanding issues,
training needs and new software releases.
 Involved in new development, support, enhancement of application.
 Worked with business leaders to translate business requirements and processes into test

7. cases according to Facets package requirements and subsequent effective configuration.
 Conducted Claims and HIPAA Compliance training to run the test case.
 Responsible to work on Medicaid Management Information System which includes two
divisions: HIPAA compliance and Maintenance units division and Claim processing
division.
 Worked under HIPAA compliance standards.
 Environment: AGILE,HL7, Zephyr, FACETS, Java, Windows, Oracle, Requisite Pro, Uses
cases
United Health Group, Minnetonka, MN Jan 2010 – Apr 2011
Business Analyst
The US headquarters of a global giant offering healthcare services, Project Management
services in the Healthcare industry to clients all over USA. In addition to project management
services, other operations include providing affordable healthcare to clients. The requirement
was to develop a program that helps identify and fill gaps in health coverage and administration.
To develop an improved method of gathering and evaluating meaningful clinical data to improve
physician practices. We introduced data tapping to help improve quality and outcomes. Creation
of a program, which evaluates and identifies leading network physicians and hospitals using
quality and efficiency criteria based on evidence-based medicine across a broad spectrum of
care.
Responsibilities:
 Worked with the business community to define business requirements and analyze the
possible technical solutions.
 Performed requirement gathering, Business Process flow, Business Process Modeling
and Business Analysis.
 Worked with the Business community, Tech Lead and 3rd party vendors in gathering their
requirements and data transaction information.
 Co-authored business requirements document with project teams. Extract, discuss, and
refine business requirements from business users and team members.
 Developed and implemented processes and tools for requirements gathering, analysis,
planning, tracking and delivery.
 Analyzed user problems, including automated and manual business processes and
identified, researched, investigated, defined and documented business processes.
 Designed and developed project document templates based on SDLC methodology.
 Coordinated activities between business unit and technical staff, developing new
methods, policies, and procedures to meet the business needs, and will acted as primary
trainer in education of the business unit as it relates to business applications.
 Conducted workflow, process diagram and gap analyses to derive requirements for
existing systems enhancements.
 Collaborated with the QA team to develop the test plan, test conditions and test cases to
be used in testing based on business requirements, technical specifications and/or
product knowledge.
 Assisted in development of training materials for new technology and process
improvements.
 Developed timelines for project delivery, and managed projects and resources to
successful completion.
 Environment: AGILE, Quality Center, Interfaces, Requisite Pro, Uses cases, Rational
Rose, MS Office 2003 DB2, SQL
PacifiCare of Texas, San Antonio, TX Oct 2008 – Dec 2009
Business Analyst

8. EHR/EMR Data repository. The EHR/ EMR Data repository project was primarily responsible for
the Implementation of MPI (Master Patient Index) implementation at Hartford Life. This
implementation of MPI brought in the uniqueness among the Member’s within the various
products at HL to have a better and an efficient way of getting Diagnosed by their PCP’s, and
Providers. The basic functioning of this project was to get data from all our Primary Vendors/
Clients, Trading Partners, Direct Submitters and create a Data Warehouse/Repository.
Responsibilities:
 Worked closely with the development team to clarify/understand functionality and ensure
that the developers clearly understood the business requirements that the system was
designed to fulfill.
 Implemented RUP methodology for iterative and incremental development of the system.
 Researched and understood the claims adjudication and reimbursement systems based
on HIPAA X12 4010 standards.
 Performed gap analysis to identify AS-IS processes of claims transactions of 4010/4010A
standard and TO-BE processes (ICD-9 and ICD-10 compliance requirements) of 5010
standard.
 Assisted in X12 transactions 835/837/270/271 of medical claims/underwriting for support
and point of reference for the providers in business issues.
 Maintained and submitted periodic/monthly status reports to the Project Manager to serve
as the team’s assessment of the project and its schedule.
 Analyzed business Requirements, performed gap analysis and segregated them into high
level and low level Use Cases, Activity Diagrams using MS Visio.
 Reported progress against Development/Action Plan routinely to the Project Manager
with recommendations for corrective actions, where necessary.
 Maintained a Traceability Matrix to ensure that all Functional Requirements are
addressed.
 Acceptance Testing (UAT), functional and integration testing.
 Created User Manuals for the end users and customers, and assisted in user training.
 Conducted business impact analysis session to determine organization’s most critical
business function(s).
 Formalized a business analysis framework standard for all analysts to practice and follow,
standardized procedure in delivering documents required for the SDLC process.
 Environment: .NET MS-Visio, MS-Project, MS-Access, MS-Word, MS-Excel, Windows
XP, Microsoft SharePoint, Oracle 9i/10g
JPMorgan Chase, New York, NY Jun 2007 – Oct 2008
Business Analyst
JP Morgan Chase Bank, one of the most reputed and prestigious banks in America, provides
banking services to over 5.7 million customers. It professionally and personally delivers financial
solutions with every opportunity. The scope of the project was to upgrade their existing web-
based loan application system to include additional functionality features. This would provide a
user-friendly interface to customer while applying online loan.
Responsibilities:
 Conducted GAP analysis between two applications to understand the differences and
identifying the scope of the new product.
 Interacted with various members at the management level to understand business
processes, decision models and project scope.
 Used questionnaire, surveys, JAD sessions and Brainstorming sessions as requirement
elicitation techniques.
 Extensively used Rational Requisite Pro for maintaining requirements and Clear Quest

9. for tracking changes and defects in the development of the project.
 Worked with different phases of RUP starting from Inception through Transition.
 Generated and maintained multiple RUP artifacts including UML models.
 Wrote use cases and managed use cases that could be traced back to the functional
requirements as specified in the Requirement document.
 Developed sequence diagrams to show the interactions between objects in the sequential
order that those interactions occur.
 Defined business processes, identified gaps, evaluated requirements and change
requests, managed scope and transferred knowledge.
 Utilized technical tools to develop business, financial and system requirements analysis
with supporting variance reports, current and target business process flows and
traceability matrices.
 Worked closely with the Quality Assurance team and developed test cases, test scripts
using the developed use cases as the platform, and conducted User Acceptance Testing
(UAT).
 Worked with the project manager to develop a standard change management process to
continually improve the software processes used in the organization with the intent of
improving software quality, increasing productivity, and decreasing the cycle time for
product development.
 Environment: Rational Requisite Pro, Clear Quest, UML, MS Project, MS Visio, MS-Office
Suite, Windows 2000
EDUCATION
Master of Business Administration, Virginia International University
ICAgile Certified Professional