1. Zahi
Zaz01008@gmail.com
Summary:
 7+ years of experience as a Business Analyst in the field of information technology, specializing in
Business Analysis.
 Extensive experience in Business Intelligence, Database Administration, maintenance and coding in
SQL SERVER […] and data related technologies along with expertise in MS SQL Server […] suite
of products like SSIS, SSRS
 Understanding of HIPAA X12 EDI transaction 834 for enrollment and eligibility, X12 EDI
transaction 820 for Payment Order/Remittance Advice, Acknowledgement transactions 999 and
TA1.
 Experienced in design and optimization of OLTP, creating SSAS based OLAP cubes and Created
reports for the building maintenance department using Crystal Reports
 Having experience and good knowledge in data warehouse technologies like SQL server […]
Business intelligence studio, IBM DB2 OLAP server, Informatica, Business objects, and Cognos
 Extensive professional experience of Healthcare and Retail Domains on web based applications.
 Extensive knowledge of Healthcare Administration - Claims processing (auto adjudication),
EOB/Drafts, Claims pricing and testing, HIPAA, Enrolment, EDI, Medicare, Medicaid, HMO, POS,
PPO, Obamacare (Affordable Care Act).
 Knowledge of healthcare standards such as HIPAA 4010, 5010, ICD-9 and ICD 10 codes. Excellent
knowledge of EDI Transactions (270, 271, 278, 820, 834, 835, 837)
 Excellent knowledge of Medicare (Part A, B, C and D) and Medicaid Health Insurance Policies,
CPT coding.
 Data driven analysis using a wide variety of platforms including SQL, Hadoop, and Tableau and
Report building using Adobe Omniture report building technology.
 Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction
codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 470 (benefit
codes), 835 (payment or remittance advice), 837 (health care claim) and 834 (benefit enrollment).
 Expertise in end to end Data Warehouse ETL-Testing, functional testing projects.
 Experience in Requirements elicitation techniques like conducting user interviews, document
analysis, JAD sessions and managing the requirements.
 Comprehensive knowledge of Software Development methodologies (SDLC) such as Waterfall,
Agile, Spiral and Scrum.
 Create various documents like the Software Requirement Specifications (SRS), Business
requirements document (BRD), Use Case Specifications, Functional Specifications (FSD), Systems
Design Specification (SDS)
 Good Knowledge of software and applications designing tools for the preview of the project at the
very beginning.
 Very good hands-on experience in using SQL assistance, OBIEE reporting tool, Mainframe
applications, Data stage ETL tool.
 Thoroughly research, review and respond to appeal request submitted by, attorneys, providers, CMS,
Treasury and Medicare contractors.
 Experience in performing Gap Analysis using AS-IS and TO-BE business processes.
 Exposure to evaluation of system performance and defects tracking.
 Excellent Written and Verbal communication skill and being able to relate technical and non-
technical terms for better understanding between the end users and development team members.

2. Technical Skills:
 Database: Oracle, DB2, Teradata, IMS, Informix, Green Plum, SQL Server
 Languages: C, C++, SQL, PL/SQL, COBOL, Eztrieve, Rexx, Coolgen, JCL
 Healthcare: EDI X12, 834, 837, […] 278, 820, 835, HIPPAA 4010, 5010
 BPM Tools: IBM BPM 7.5
 ETL Tools: Data Stage, Informatica HF 9.5.2, DAC11g
 Process Tools: IBM Blue works Live Process Modelling Tool, IBM Blueprint Design
 Tool, Master Craft
 Reporting Tools: OBIEE […] SAP Business Objects
 Other Tools: JIRA, HP QC/ALM, SQL Developer, SQL Assistance, SPUFI, DB2
 Softtech, QMF, Endeavour, Platinum, JMR, Expeditor, SCLM,
 Librarian, File-Aid, CA7, QMF, Master Control, Confluence
 Operating Systems: UNIX, IBM Z/OS, Linux, and Windows […] MS-DOS
 Others: MS Office, HTML, BMC Remedy Tool
 Methodologies: Agile, Scrum, Waterfall, RUP
Work Experience:
Sr. Healthcare Business Analyst
Health Alliance plan - Detroit , MIDec April 2014 to Present
Responsibilities:
 Participated in gathering Business Requirements from State, Users and Internal Offices and assisted
to quality control teams to develop test plans and test cases.
 Coordinated with the developers and IT architects to design the interface of the new system
according to the X12 (270, 276, 278, 834, 835, 837 (I, P, D) and 820) standards
 Created different type of reports including Conditional, Drill-down, OLAP and Sub reports using
SQL Server Reporting Services (SSRS).
 Demonstrated superior reporting skills while incorporating Crystal Reports with MS SQL Server
database to provide hard copies of EDI transactions per customers’ requests
 Created SSIS Packages to handle the SSRS subscriptions from SSIS and to log all the results and
error to the Sql server tables.
 Exposure in Designing, Administration, Analysis, Management in the Business Intelligence Data
warehousing, Client Server Technologies, Web-based Applications and Databases
 Got involved in designing future state processes for HIPAA 5010 transaction processing EDI 820,
834, 835and 999.
 Created and maintain advanced Power Pivot solutions, and integrate with SharePoint Business
Intelligence features and functions
 Analysed the client's applications to determine the impact of the Enhancements on EDI Transactions
Set and Code List implementation and defined the changes to bring the affected systems into
compliance.
 Create and maintain high level executive reports in Xcelsius and low level management reports in
Excel, Web Intelligence and plain SQL using TOAD.
 Worked on Migration data from SQL Server and create the same report from source (Oracle and
SQL Server)
 Consolidated data stored in different databases (SQL, Oracle, DB2) into one single source
 Participated in JAD sessions to identify the business needs and determine the impact on current and

3. proposed systems.
 Worked as a back end tester by writing SQL Queries on large data warehouse systems involving
huge datasets.
 Worked on projects related to Health Information Exchange (HIE), Interoperability, Medicare,
Medicaid, EDI transactions (inbound and outbound: 837, 820, 834, […] HL7, Eligibility and Benefit
systems, ICD9, ICD 10, HCPCS, CPT, HIPAA […] and Claims Adjudication.
 Created business requirements documents, functional design document, requirement traceability
matrix, source to target ETL mapping document, unified functional design document.
 Worked in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and
testing for processing of Medicaid Claims.
 Prepared needs assessments for ICD9 To ICD10 Conversion project
 Reviewed CMS data to assist in ICD9 to ICD 10 Conversion Project and creating reports
 Interacted with Claims, Payments and Enrolment teams, hence analysing and documenting related
business processes.
 Handled escalated inquiries related to the resolution of Medicare Secondary Payer and Recovery
issues
 Analysed legacy systems, file and record formats, system flow charts and other information to
develop a comprehensive depiction of the existing environment.
 Developed Business Crosswalks for 837 I/P, 835, 270/271 and 276/277 transactions per CMS -
HIPAA implementation rules.
 Research, analyze, and define the business requirements for Minnesota's Health Insurance programs
using IBM-Curam HCR.
 Review Test Cases & SQL queries developed by the team and ensure 100% traceability with
requirements and standards followed in the project.
 Analyzed and defined the clearinghouse specific information needed for inclusion in new HIPAA
5010 companion guides, including the usage of the 999 Functional Acknowledgment
 Create Tableau dashboard for higher management
 Analyze Change Requests (CR) and Defects that arise during implementation of IBM-Curam HCR
solution for providing business requirements and expected behavior.
 Validate EDI Claim Process according to HIPAA compliance
 Develop EDI X12 850, 855, 860, 865, 856, 810 mapping Master specifications
 Analyzed HIPAA Privacy and Security regulations to determine system and procedural changes
required to ensure compliancy with federal regulations.
 Produced Gap Analysis documents for both HIPAA 5010 and ICD 10 Enhancements.
 Worked on EDI transactions, submitting and tracking claims until adjudication and Remittance
Advice.
 Walkthrough of unified ETL functional design document, source to target ETL mapping document
 Wrote SQL Statements to extract Data from Date warehouse (Teradata) to verify the output Data of
the reports.
 Worked with multiple teams to improve the overall reporting of the Claims, payments, Real-time
adjudication information.
 Analyzed business and user needs, and documented for Unemployment, Medicaid, Case
Management (Curam).
 Designed and implemented comples SQL queries for report.
 Developed test cases based on the crosswalks and compliance guidelines for 837 Professional and
Institutional claims and for 270/271 Eligibility inquiry and response.

4.  Assisted in designing and developing Use Cases, Activity Diagrams, Sequence Diagrams, Object
Oriented Design (OOD)
 Throughly research, review and respond to appeal request submitted by, attorneys, providers, CMS,
Treasury and Medicare contractors.
 Provide state-wide oversight, coordination and monitoring federal recovery programs for Medicare
NGHP
 mpact analysis for existing data flow & migration from Mainframe ETL process to Data Stage ETL
process.
 Participated in Forward Mapping and analysis of ICD 9 - ICD 10 Conversion, for CM (Diagnosis
Codes) and PCS (Procedure Codes)
Sr. Business Analyst
Cigna Healthcare - Minneapolis, MN Jan 2012 to Feb 2014
Responsibilities:
 Responsible for gathering and developing business requirements, writing user stories, documentation
and test plans.
 Involved in creating mappings for the conversion of EDI ANSI (ASC) - X12 transactions 820, 834,
835 and 837 (I, P and D) code sets version 4010 to 5010.
 Deployed and scheduled Report subscriptions using SSRS to generate all daily, weekly, monthly and
quarterly Reports
 Develop test plans to perform testing on Business Intelligence platform, on Web Applications and on
databases.
 Experienced in X12 transactions 835/837/834/820/271 of medical claims/underwriting for support
and point of reference for the vendor in business issues.
 Used Agile methodology with extensive training in Rally tool. Conducted sprint planning and sprint
review meetings.
 Develop test plans to perform testing on Business Intelligence platform, on Web Applications and on
databases.
 Conducted every day scrum calls and review of developed product.
 Responsible for planning sprints for application development. Grooming, developing and assigning
planned epics and user stories for new sprint.
 Produced/lead the team in creation of integrated process modules needed to replicate end to end
business process flows of the Curam solution.
 Functioned as a subject matter expert on Utilization of ICD9, CPT, HCPCS and Revenue Codes for
reporting and validating healthcare data
 Analyzed the complete IT landscape of the client understanding the multiple applications and their
functionalities such as EDIFECS, HIPAA gateway and EDI process
 Closely involved with software development team in assigning tasks and understanding technical
needs and providing documentation.
 Worked on CPT, ICD 9, ICD 10, HCPCS, and RVS codes.
 Created and supported the key documents for the system , including, but not limited to, system user
guides, operations manuals , interface control documents (ICDs),and onboarding documentation
 Document and define test case scenarios and test cases to make the products compliant to Patient
Health Information confidentiality, CCHIT, HL7 and HIPAA s
 Designed and implemented basic SQL queries for QA testing and report / data validation.

5.  Worked on testing ETL interfaces which included a physical test to map source to target components
and a one to one mapping source to target mapping of data fields.
 Co-ordinated with Business and development team to convey business needs and end user
sentiments.
 Developed schemas for extraction, transaction, and loading (ETL) to expedite data integration
between systems.
 Designed state processes for HIPAA 5010 transaction processing EDI's 837 Inbound
 Developed many X12, EDI FACT maps using GIS Map Editor tool.
 Follow HIPAA compliance and other security issues to safe guard patient information.
 Performed Mapping, Gap analysis and feasibility studies for web service call response and UI
display.
 Used ICD9, CPT, HCPCS and Revenue Codes for reporting
 Developed PRDs, SRDS and traceability matrices
 esting of the data migration using PL/SQL scripts and validation of stored procedures
 Perform extensive quality assurance testing with talented ETL/data warehousing team
 Developed and maintained flow diagrams for understanding the newly developed application.
 Involved in writing and reviewing test cases during application development based on user stories.
Used Quality center as a testing tool.
 Defined the product enhancements required to support the HIPAA transaction and code set editing
requirements
 Worked with cross functional teams such as Architects, ETL Data Warehouse, DBA, MyAccount,
Web services team on system integration and ensured client experience.
 Created User acceptance testing (UAT) plan and detail documentation for the Claim Management
application.
Business Analyst
Aetna Health Services, Nashville, TN Oct 2008 to Dec 2011
Responsibilities:
 Provided production and project support for various EDI transactions in maintaining HIPAA
compliance
 Followed a systematic approach to eliciting, organizing, and documenting requirements of the
system.
 Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the
High Level Requirements.
 Used Query Analyzer, Execution Plan to optimize SQL Queries.
 Interacted with client and the Technical Team for requirement gathering and translation of Business
Requirement to Technical specifications.
 Worked closely with the development team to make sure that the system is in compliance with
HIPAA Guidelines.
 Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
 Planned and documented procedures for data processing and prepared data flow diagrams for the
application.
 Used Argo UML to draw the UML diagrams when required.
 Analyzed trading partner specifications and created EDI mapping guidelines
 Execute test plans and test cases to verify actual results against the expected results. And making

6. sure that the functionality meets business requirements.
 Designed and developed project document templates based on SDLC methodology
 esigned workflows and allocated permissions within SharePoint.
 Performed Unit Testing and User Acceptance testing and documented detailed results.
 Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning
and control.
Rich from contecticare – payer in connecticut, individual smal and mdeium group and #1 and exchange in
mdeicarte, #1 in individual persepctive. Healthare in target membership. Moving medicare business, emblem
health back to conectinct in farmington, replatform to new system, business preocess, removing from parent
company. Elebility, entrollment, vendor feeds, claims,. Financiate and revenue raps, edps, finance
mangement
Qcare – main frame
Auto aducate, amisys – comercial business
Amisys
1/1/2017
FEB – 2017
Conecticare – emblem – coffrece – edge server risk adjustment. Medicare and submission. Reading the
manuls etc.
Document are there but in different place – Business Requirement – Source to Target Mapping.
CMS – vendor file and vendor process for mental patient is different regular claims. Internal claims.
Different data for different type of claims
Conditnal drill down, OLAP Manage rejections, dispute
Claims Submited, rejcted to talmedo. Fix the data or supicate submission.
Let us know source system and check the data map,
Verify the void the claim in our system, void need to send to cms.
SQL and SAS to find what is rejected, risk score assigned to claims, Work rejectedion, fix the code
submitted to CMS.
Commercial side – large data submissison and commecial is bigger than medicare.
Go through the companion or training guide. Need medicare expert and do the documentions.