OPERATING SYSTEMS: Windows 7/8/ XP, OS390, AS400, Mainframe, Citrix, Client Server
DATABASES: SQL, Access, FoxPro, Oracle, DB2, RDBMS.UNIX
OTHER SKILLS: ANSI X12, 837/835 EDI, ICD - 9/ICD-10 Code Sets, Edifecs, Claredi HP Quality Center 10.0, Rational Tools, ClearQuest, MQ Series, HIPPA Clear Quest, Cognos, Crystal Reports, AS 400 Query, Visio,TSO/ISPF, CICS, COBOL, AS400, File-Aid, QMF MS Access, MS Excel, MS Project, MS Outlook, SharePoint
Lead Business Analyst\QA
- Participated in the Business Requirements gathering process for the Confidential Blue Chip and ITS Claim Adjudication Systems for the ICD - 10/ ANSI 5010 Projects.
- Analyze, define and document Business Requirements for Business Stakeholders and Development for ICD-10 Remediation and Conversion.
- Defined and analyzed system impacts and gaps related to government mandates such as ACA, ICD-10 and Healthcare Reform initiatives.
- Involved in testing activities and analysis of Medicaid Fee for Service, reimbursement payments and electronic billing for ICD-10 and integration with MMIS.
- Analysis of Benefit Administration for Medicaid, Medicare and, Managed Care products against contractual requirements.
- Analyzed 4010/5010 side by side document and 5010 changes and impacts to Blue Chip Application, ITS and NASCO Claims Functionality.
- Reviewed 837 P/I and 835 Implementation/TR3 Guides for electronic claims submissions during the analysis phase
- Created User Acceptance Claims and Billing Test and Use Cases based on Business Requirements
- Participating in testing support for ICD-10/ ANSI 5010 implementation and ICD-10 Pilot Testing
- Cross functionally coordination with various Corporate departments including Confidential, EFE, HCM, EPPO and ITG to mitigate risks and issues
- Help define and design future state processes for ICD-10/5010 transaction processing for 837, 835 and NCPDP electronic transactions.
- Participated in analysis of ICD-9 TO ICD-10 conversion to determine impacts on Claim Adjudication and electronic billing Systems.
- Participated in Requirements & Test Cases Walkthroughs with Development, Business and QA Staff members for 5010 and ICD-10 projects.
- Assisted QA team during the testing effort and to make sure coverage for the Requirements were captured in the Test Cases.
- Participated in the ICD-9 TO ICD-10 and ANSI 4010 to 5010 ICD-9 Gap Analysis studies.
- Utilized Edifecs and Claredi compliance checker tools to verify 837 ICD10/ANSI 5010 compliancy.
- Significant Exposure to 837I/837P Claims Submission Processing and 835 Remittance Advice electronic processing and structure.
- Participated in troubleshooting and analysis of ICD-10 defects found during testing.
- Familiarity with ICD-9/ICD-10 Diagnosis and Procedure Code Sets and mapping.
- Develop Test Strategy and Approach documentation and workflows.
- Participated in Requirements gathering implementation activities for Confidential Health Care Exchange and ACA initiatives.
- Familiar with Healthcare mandates, CMS guidelines and ACA.
- Participated in Requirements gathering activities for Healthcare Exchange initiatives.
Clinical Business Analyst
- Participated in the Implementation process for the Installation of Epic Software at three Network hospital sites.
- Collaborated with various departments to create process and system workflows.
- Gathered Business Requirements from various departments.
- Participate in re-engineering and validation sessions with users and SME’s.
- Participated in System Build of new application in be installed.
- Participated in software conversion activities.
- Provided Application support and served as liaison between IT and user community.
- Completed Epic training at Epic University in Wisconsin in Inpatient Modules.
- Responsible for creating and developing test plans and scripts and executing test scenarios on-line and in Batch for Claims System Enhancements, software bug fixes and updates.
- Analyzed User Requirements and Functional Specifications for ITS Claims Processing and PTS applications to indentify and evaluate Test Scripts and data needed and gaps.
- Participated in (UAT) User Acceptance Testing and coordination.
- Assisted with creation of Test Beds and created own test data and perform data manipulation through File-Aid.
- Utilized Rational Tools and in-house testing utilities for high volume data loads and testing.
- Assisted Automation Group with automating tests scripts for enhancements and Regression purposes.
- Identified, documented, reported and tracked software defects for Development Team through ClearQuest.
- Investigate and troubleshoot Production application problems. Participate in all phases of the Test Life Cycle including Integration, Regression, Conversion and Automation. Create Test Strategy documents.
- Participate in Development, Design meetings and workgroups for Enhancements and software releases.
- Interact closely with Business Analysts and User groups to resolve functionality discrepancies.
- Projects include those related to claim pricing, billing, Healthcare compliance, HIPAA, Medicare Advantage, Blues Plan Network changes and reporting.
- Utilized Cognos for querying and reporting off of large claim and provider databases and performed SQL queries.
- Assisted with the gathering, determination and update of Functional Requirements and Specifications.
- Created statistical and metrics reports related to performance indicators and utilization for Plan Data.
- Participated in multiple testing projects including testing enhancements, re-creating and investigating production defects/bugs and taking ad-hoc requests simultaneously.
- Used Quality Center to load test cases, link defects, reporting and test planning activities.
- Mentor junior staff and create training documentation.
Sr. Quality Assurance Specialist
- Principal responsibilities include the creation of Test Plans against Requirements and execution of Life and Health Insurance Products test scripts.
- System functionality tested includes Claims Processing, Billing, and Carrier Administration.
- Responsible for analyzing application specifications, gathering business requirements from users and UAT.
- Issue tracking and use of Reporting tools such as AS400 Query for querying were other tasks.
Technical Support Analyst
- Responsible for compiling, analyzing and validating the accuracy of provider data in BCBSIL networks.
- Extracts data from several large databases and use various report development and analytical techniques to perform statistical data comparisons and tracking.
- Perform routine monthly and quarterly processes for quality checks and to ensure organizational compliance to set guidelines.
- Maintained, created databases and queried with use of MS Access.
- Participate in audit preparation activities and table maintenance.
Sr. User Support Analyst
- Responsible for providing application support to end-users of McKesson HBOC proprietary and third party Healthcare & Managed Care software at Hospitals, Clinics, Medical Groups and TPA’s.
- Troubleshoot application errors on multiple platforms including client server and IBM mainframe environments.
- Assisted in User Acceptance (UAT), Regression and Performance testing.
- Participated in Managed Care software implementations, upgrades and conversions.
- Responsibilities include system testing, training, and analyzing claim payment errors.
- Required development of procedural documentation. Involved table maintenance, plan/provider contract load setup and custom reports development.
- Heavy exposure to diverse applications utilized in a hospital, managed care and physician practice settings with exposure to claims, EDI batch processes, patient care, physician billing, eligibility and credentialing software.
- Performed system maintenance and application issue tracking. Maintain communications with vendors and administrative personnel within user groups on projects and system or software related concerns.
- Served as lead Analyst in requirements gathering and testing EDI claims conversion project.
- Coordinated hardware and equipment upgrades and performed software application installations.
- Participated in Performance and Stress testing.
- Responsible for database reporting utilizing Crystal Reports.