Gunja Soni

gunjasoni93@gmail.com (732)-318-8614

SUMMARY

 Technical Healthcare Business Analyst with 3 years of experience.

 Possesses strong experience with gathering requirements, working with stakeholders, creating
documentation/technical process flows, working with Facets, writing SQL Queries, working in an Agile
environment, utilizing Balsalmiq/Visio/Mockingbird, and extensive data mapping/analysis.

PROFESSIONAL OVERVIEW

 Highly motivated team player with excellent communication, presentation and interpersonal skills, always
willing to work in challenging and cross-platform environment.
 Developed and maintained Confluence page in JIRA through the scope of the project. Documented Process
flows in approved VZ tools, Word, Excel, Power Point, Access and Outlook.
 In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical,
component and deployment views to extract business process flow.
 Strong understanding of project life cycle and SDLC methodologies including RUP, RAD, Waterfall and Agile.
 Expertise in broad range of technologies, including business process tools such as Microsoft Project,
Primavera, MS Access, MS Visio, technical assessment tools, Data Warehousing concepts and web design and
development.
 Analyze market proposals received to verify benefits, premium rates and competitiveness.
 Wrote Use Cases, prepared use case diagrams (using Rational Rose & UML) and followed Agile at every
stage of the processes.
 Participated in the initial Impact Analysis (ICD-10) for all the critical functions, i.e., Membership &
Enrollment, Claims Processing, Utilization Management, Medical Policy, Reporting, Vendor Management,
etc. 
 Highly skilled in data handling / visualization, statistical analysis, and application / web development. 
 Used Teradata to write scripts to analyze and formulate data into logical segments and graphs, analyze
behavioral, healthcare.
 Good understanding of HL7, claims processing platforms like ClaimsXten.
 Experience in writing SQL queries and optimizing the queries in Sybase, Oracle and SQL Server 2000.
 Extensive experience in Strategic development of a Data Warehouse and in Performing Data Analysis and
Data Mapping from a Operational Data Store to a Enterprise Data Warehouse.
 Strong experience in data validation and manipulation in SQL Server databases using SQL queries for
integration between various systems like mapping and converting of Provider data to FHIR format.
 Conducting requirement gathering sessions, feasibility studies and Impact Analysis and organizing the
software requirements in a structured way using Rational RequisitePro to track development.
 Performed UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT).
 Experienced with Java tools like Junit, IBM WebSphere App Server, Oracle Web Logic Application 
Business Process Re-engineering (BPR), Business process streamlining, Process optimization, Process
mapping, Resource allocation, and utilization. 
 Expertise in understanding and supporting the client with Project Planning, Project Definition,
Requirements Definition, Analysis, Design, Testing , System documentation and user training.
 Good knowledge of Workflows and Content Management Tools.
 Having good knowledge of Enterprise management system and its Modules.
 Experience in Change Management Process (Identify, Analyze, Evaluate, Plan, Implement, Review and
Close).
TECHNICAL SKILLS

Programming Languages: C, C++, HTML, XML, SQL.

Data Base: MS Access, Oracle (SQL Series), DB2 ,
Reporting Tools: Crystal Reports 8.0
Clinical Exchange Documents (CCD, Consolidated CDA, IHE Standards for
Exchange), Confluence, TFS, JIRA
Software: MS Office Suite(Word, Excel, Access, PowerPoint & Outlook), MS Visio, Rational
Rose, Rational Requisite Pro, Adobe Acrobat, MS Office FrontPage, Lotus Notes,
ERP System Software , MSSQL Server(2016) , SSMS(2018)
Methodologies: Agile(Scrum), Software Development lifecycle, SDLC,

Processes/Technologies: Rational Unified Process (RUP), Waterfall, UML & Microsoft Office SharePoint
2013
Automation Tools: Requisite Pro, Win runner, QTP, Test Director, HP Quality Center/ALM, Junit

EDUCATION

 Bachelors in Computer Technology, NJIT, USA

PROFESSIONAL EXPERIENCE

Dean Health System; Madison, WI

Business Analyst
June 2018 – March 2020
Dean Health System is multi-specialty integrated healthcare delivery system which provides medical and health
services, health insurance and services, and clinical research. The goal of the maintenance release project was
focused on dealing with data cleansing, resolving data inconsistencies, and improvement of query and load
performance issues. Administrative Services Only (ASO) project was implemented as Dean Health Plan (DHP)
identified the market opportunity to broaden its services. DHP was offering customized medical management
services in conjunction with a third party administrative service for claims processing.

Responsibilities:
 Facilitate communication between developers and business units to implement reporting solutions.
 Elicit and document requirements using interviews, document analysis, business process description, use
cases, task and work flow analysis.
 Develop requirement specifications according to standard templates.
 Create detailed design specifications and facilitate design sessions and peer reviews.
 Develop design concepts for applications, including operational features, user interface and interactions
with other systems.
 Involved understanding the current business process, defining scope of the project along with position
statement.
 Having good knowledge of Enterprise management system and its Modules.
 Responsibilities include researching a quicker and more efficient way to implement HL7 interfaces by
using FHIR.
 Present information and updates to the Open Enrollment Department regarding any topics or problems
affecting operations in the Healthcare Insurance Marketplace. 
 Develop DAOs for Subscription Monitor, Subscription Manager modules using Hibernate API; write JUnit
test cases for this module. 
  Working knowledge of healthcare Technology standards such as HL7, ANSI ASC X12, IHE XDS/ XDM, HITSP,
CCR(continuity of Care Record), CCD(Continuity of Care Document).
 Converted various SQL statements into stored procedures thereby reducing the Number of database
accesses.

 Provided management support to the off-shore End to End Integration / Regression Test Team.
 Prepared UAT Materials UAT Test Cases to include various steps involved for UAT and to have proper
coverage of requirements.
 Experience in EDI automated first-pass claim adjudication, requiring thorough understanding of claim
processing, both front and backend operations.
 Involved in editing claims in the workflow using ClaimsXten. 
 Created and documented processes during entire software development life cycle using lBM RequisitePro.
 Assisted JAD sessions to identify the business flows and determine whether any current or proposed
systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
 Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for
processing of Medicaid Claims.
 A specific description of all of the major Medicaid and CHIP-related provisions of the Affordable Care Act as
well as related policy guidance can be found under ACA Provisions.
 Prepared test Data sets and performed data testing using the PL/SQL scripts. Also used MS excel for data
mining, data cleansing, data mapping, data dictionary and data analysis.
 Obtained Data requirements, identified data sources, determined the content of data fields and created Data
Mapping Documents and performed Data Extraction and Data Compilation using SQL queries.
 Data mapping, logical data modeling, created class diagrams and ER diagrams and used SQL queries to filter
data within the Oracle database.
 Designed workflows and allocated permissions within SharePoint.
 Adhered to latest industry standards like Agile Business Rules Development (ABRD) & deliver high quality
ABRD documents. 
 Performed Unit Testing and User Acceptance testing (UAT) and documented detailed results.
 Foster Agile principles and methods for requirement gathering. 
 Facilitate Agile rapid and meaningful releases.
 Provided input (scope, goals, risks, constraints, timelines and interfaces) to PM for project planning and
control.

United Health Care; Minneapolis, MN

Business Systems Analyst
Apr 2017 – May 2018
United Healthcare has a history of developing innovative programs to facilitate a better, more positive health care
experience for everyone. We combine our strength and stability with nearly three decades experience serving
customers of all sizes. This system permits the registered members with United Healthcare, to get the details of the
long term care insurance schemes and benefits.

Responsibilities:
 Gathered business requirements by driving user-group meetings and working with various global, cross-
functional and virtual teams.
 Involved in transforming business requirements into functional specifications; focused on workflow
analysis & design, business process reengineering, user interface design & process flow modeling.
 Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally
load into the Data Marts.
 Apply UML notations and methodology in developing models that accurately represent the business process
reengineering and workflows and clearly communicate them to the stakeholders.
 Performed the requirement analysis and documented the requirements using Rational Requisite Pro.
 Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.
 Analyzed the existing claims process and specific business rule logic will be applied in the ACP model.
 Responsible for business system analysis of customizing the BPS Risk Management product with
involvement through the whole SDLC.
 Incorporated Rational Unified Process (RUP) to create Business Requirement Document Specifications
using MS Visio and MS Word.
 Responsible for producing process flow diagrams for TO-BE process flows and AS-IS process Flows using
Microsoft Visio.
 Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata,
and ETL teams.

 Extensively interacted with the stakeholders and the IT Department in finalizing the requirements
according to the CMS Compliances/Regulations and HIPAA Regulations.
 Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data
migration in to the CI System Knowledge Data Base in Microsoft SharePoint Designed and developed Use
Cases, Activity Diagrams, Sequence Diagrams, OOD using UML.
 Involved in all phases of software development life cycle in RUP framework.
 Used Rational Rose to model the process using UML to create behavioral and structural diagrams.
 Developed detailed Developer specification to reflect technical details of the business requirements.
 Performed data analysis by using SQL queries using the DB Artisan tool.
 Performed GAP analysis for the modules in production, conducted feasibility study and performed impact
analysis for proposed enhancements.
 Used Query Analyzer, Execution Plan to optimize SQL Queries.
 Conducted status report meetings with the business and the IT team on a weekly basis, as the most
important aspect of the project is Data Mapping.
 Extensive experience in using collaborative tools like Mercury Quality Center to facilitate development
across disparate teams.
 Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOAD using UML and Business
Process Modeling.
 Interacted with the users and logged any defects, enhancements from the UAT and communicated them to
the development team.