SUMMARY:

• A result oriented professional with over 8 years of diversified experience.
• Expertise in Project Planning, Project Design, creating functional specifications and data flow diagrams.
• Expertise in translating user requirements into technical specifications and mapping the process design, work flows for SDLC with documenting and managing business requirements using RUP, waterfall and Agile methodology.
• Defining change control processes, risk management, wealth management, cash management processes. Maintained the Requirements Traceability Matrix (RTM).
• Experienced Business Analyst in a role of responsibility encompassing Requirement Gathering, Decomposition and Analysis besides Quality Assurance.

KEY COMPETENCIES:

• Affordable Care Act ( Confidential )
• Project Management
• Developing Reports
• Process Development
• Structured Analysis
• Eliciting Requirements
• Document Management
• Confidential - Confidential
• Confidential & DHS Expertise
• Confidential Expertise
• Team Leadership
• Change Management
• Complex Problem Solving
• Training/Development
• FFM/ FFE & HIX experience

TECHNICAL SKILLS:

• SharePoint
• SDLC
• Agile
• Waterfall
• Pipkins
• MS Office Suite
• MS Access
• MS Visio
• MS Project
• Snag IT
• MS Dynamics CRM
• SharePoint
• Doors
• SQL Server
• Deltek

PROFESSIONAL EXPERIENCE:

Confidential

Business/EDI Analyst, Nashville, TN

Responsibilities:

• Took part in development, documentation and implementation of the Test Strategy and End to End Pilot.
• Extensive knowledge and experience of 1095A project and mentoring new analysts.
• QA’d different projects; Payment & Enrollment Disputes and BUU Remediation & BUU Validation Project.
• Researched and collaborated to meet escalated assigned objectives with CMS, Congressional Offices, Federal Agency Leadership & The White House via CMS ROs.
• Identifying and solving customer information and processing problems and Creating design specifications for new reports.
• Developed and lead complete claims review process, from investigation through resolution, while working alongside both internal and external parties (hospitals, insurance groups, CMS, Confidential etc.).
• Applying triage, research, collaboration, technical knowledge to resolve transaction and processing issues.
• Experience with enrollment & payment transactions with the Affordable Care Act ( Confidential ).
• Work with technical and development team to resolve identified issues in a timely manner.
• Reviewing Foundation System reports and identifying advanced analytics needs with report consumers.
• Reviewing upgrade documentation and determining how to implement those changes.
• Extensive experience with Healthcare related Confidential i.e. Confidential, Confidential, Confidential .
• Coordinated meetings, presented on specific topics and performed duties as described by the manager.
• Serving as a SME for the whole 1095A project and acknowledged as the top performer & a great asset.
• Provide day to day guidance to assigned team members when appropriate.
• Experience in creating and validating federal reports forwarded to CMS® from Medicaid programs.
• Extensive escalation experience with CMS, Congressional Offices, Federal Agency Leadership, The White House, State Health Insurance Programs, Local Federal/State/Town Agencies.
• Managing team(s) onsite and offsite workforce while achieving or exceeding productivity and quality.
• Identifying and reviewing the appropriate technological solutions for various reporting needs.
• Meeting with Application Reporting Leads and requestors to understand their data needs.
• Problem solving, analysis and performance improvement, identification and implementation.
• Review documented training material for accuracy and assist with end user training and support.
• Responsible for continuous process improvement of the reconciliation process.
• Refers claims appropriately and timely that require clinical assistance, and maintains tracking system to ensure timely claims outcomes.
• Participate in planning, report on project progress, and identify potential risks and issues.
• Serving as Subject Matter Expertise in the following projects; 1095A, Confidential, Enrollment & Payment Disputes, Issuer Orphan, SharePoint, ER&R, CEDAR, CERRS-NG, Pre-Escalation and BUU Remediation & Validation Project.

Environment: SharePoint, Lync, MS Office, Confidential FFM, HICS, CERRS NG, CEDARS, Issuer Orphan, Enrollment Disputes, Microsoft Dynamics CRM and 1095A.

Confidential

Sr. QA LEAD / Sr. EDI LEAD, Columbia, MD

Responsibilities:

• Tested multiple scenarios CHIP, Medicaid, APTC, CSR, Premium, Catastrophic Coverage and QHP etc.
• Developed and maintained Test & Traceability Matrices.
• Managed a team of 14 for 2 tracks, coordinated in Defect Triage and Validated EDI 834, EDI 820 files.
• Performed root cause analysis regarding any bugs/issues.
• Created test plans and wrote test cases and developed Requirement Traceability Matrix (RTM).
• Created Test Plan & wrote Test Cases based on business requirements and functional specifications.
• Processed and adjudicated claims as assigned in accordance with specialty assignment, organizational policies, contractual parameters, health plan requirements, and state and federal regulations.
• Conducted root - cause analysis for 1095A XML (content file) send to IRS on monthly and annual basis.
• Worked on 1095A monthly and annual eligibility with CMS® and IRS.
• Developed and lead complete claims review process, from investigation through resolution, while working alongside both internal and external parties (hospitals, insurance groups, CMS, Confidential etc.).
• Analyzed claims and ensured all pertinent information is organized and prepared, to assist with efficient processing.
• Provided modification & enhancement as needed to correct the defect & make the software more useable.
• Used agile systems and strategies to provide quick and feasible solutions to the organization.
• Gave Knowledge Transfer to UAT, Production and Business team on applications with End-to-End flow.
• Manually tested the web application to ensure the flow of the application functionality.
• Participated in walkthroughs and meetings with analysts, developers, team leads and managers on regular basis.
• Attended weekly defect report meetings and presented progress update status.
• Involved in preparing Test Plan and Test Cases based on business requirements.
• Took part in development, documentation and implementation of the Test Strategy.

Environment: Quality Center, Deltek, Pipkins, SharePoint, Alfresco, SQL, MS Office, Confidential FFM, Confidential .

Confidential

Sr. QA LEAD / Sr. EDI LEAD, Greenwood Village, CO

Responsibilities:

• Took part in development, documentation and implementation of the Test Strategy.
• Involved in writing Traceability Matrix.
• Created Test Plan and wrote Test Cases based on business requirements and functional specifications.
• Exposed to GAP Analysis significantly.
• Provided guidance and support to facilitate accurate and timely billing and prompt collection.
• Performed monthly reconciliations of billed/unbilled vs. revenue activity.
• Identified potential problems or areas for improvement and suggest solutions.
• Manually tested the web application to ensure the flow of the application functionality.
• Involved in writing SQL queries to check for the data validation.
• Understands the basic contract document(s) as it relates to billing and revenue.
• Input invoices into web based invoicing systems.
• Ensure the project set up/structure supports the billing requirements as specified in the contract.
• Researched and resolved unexplained reconciling items.
• Identified billable costs vs non-billable costs and creates appropriate invoices.
• Established a business relationship with internal and external customers.
• Notified the Manager of significant, reconciling items that remain unresolved for extended periods.
• Developed and maintained Test & Traceability Matrices.
• Aided with system builds to make enhancements and to provide programming support.
• Created/Processed EDI 834 and EDI 820 files.
• Processed claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements
• Entered claims data into system and resolved problems resulting from claim settlement
• Performed audit of randomly selected claims to ensure quality processing and researched claim overpayments and requests funds
• Followed adjudication policies and procedures to make sure proper payment of claims and provided timely customer service to members, providers, billing departments and other insurance companies on the subject of claims
• Invoiced customers in a timely and accurate manner. Ensured more complex invoices are in compliance with appropriate contracts, guidelines and regulations. Identified issues, researches same & remedies as appropriate.
• Confirmed invoicing requirements with Project Finance, Contract Administrator & Program/Project Manager.

Environment: Quality Center, Java, J2EE, Oracle, TOAD, MS Office (MS Excel, MS Word, MS PowerPoint), MS Project.

Confidential

Business Analyst / UAT EDI Analyst, Boston, MA

Responsibilities:

• Wrote Test Plan and Test Cases per business requirement.
• Conduct testing and compared EDI 834 vs. XML files.
• Performed data driven testing by data driver wizard and parameterization.
• Created and updated test cases based on new and/or /updated functional or interface requirements.
• Performed RTM by setting automatic alerts for tracing changes in the requirements and system maintenance.
• Manually performed functional testing based on the specification documents.
• Imported test cases from MS Excel, MS Word to Test Director.
• Provided modification & enhancement request needed to correct the defect & make the software more useable.
• Developed ‘as is’ & ‘to be’ documentation including process flows, requirements, narratives & related info.
• Constantly tested SQL for joins and contexts for new object creation.
• Used shell scripting to run the scripts as a part of creation of test environment and then validate the data.
• Participated in weekly meeting with the management team and walkthroughs.
• Tested applications, documented results & bugs including documentation of info useful in the debugging.
• Generated the test execution report in Test Director to be reviewed by the QA Manager & development team.
• Attended weekly defect report meetings and presented progress update status.
• Participated in walkthroughs and meetings with analysts, developers, team lead & managers on regular basis.
• Proficiency and demonstrated experience with report writing.
• Experienced in various testing mediums including Sanity, Smoke, Functionality, Performance, Volume, UAT, Integrated, System, Positive & Negative, Security, Stress, Load, Web Based & Client Server application testing.

Environment: Test Director, Manual Testing, Oracle, MS Office, SQL, IBM Rational Clear Quest, MS Visio.