- Accomplished Business Analyst offering 7+ years of cross - functional experience including progressive roles in world’s leading Healthcare companies
- Worked on both BA/QA activities in Software Development Life Cycle for insurance and Healthcare clients.
- Proven ability of BA experience and analyzing the business requirements and capable of establishing the best methodologies to break software builds.
- Extensive knowledge of Software Development Life Cycle (SDLC) and experience in all phases of Software Testing Life Cycle (STLC).
- Experience in preparing and analyzing Business Requirement Document (BRD) and Functional Requirement Document (FRD).
- Experience in software development methodologies like Agile-Scrum, RUP and Waterfall.
- Performed Integration Testing, Regression Testing, Smoke Testing, Business Functionality Testing, System Testing, Load Testing, Performance Testing, Security and Usability Testing.
- Expertise in developing Test Plans, Test Cases, designing Test Strategies and executing Test Cases.
- Experience in logging and monitoring Bugs/Defects to ensure Quality Management Plan is maintained.
- Experience working on various EDI X12 transaction sets such as EDI 820 (premium payments), 834 (enrollment), 835 (medical claims payments), 837 (medical claims), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status) and 277 (claim status response).
- Experience in HIPAA 4010 to 5010 migration, ICD 9 to ICD 10 codes conversions and upgrading FACETS.
- Experience in testing ICD-10 Diagnosis Codes and Procedural Codes.
- Experience with premium payment transactions and reconciliation of enrollment transactions.
- Tested the following modules of the FACETS application as part of an upgrade from version 4.71 to version 5.01: Subscriber/ Member, Group/ Subgroup and Subscriber/Family, Claims processing, Medical Claims / Hospital Claims and Dental Claims, Customer Service, Billing.
- Experience with ICD 10 Migration.
- Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle.
- Experience in using Automated Tools Quick Test Professional, Quality Center, Web and Database Applications.
- Detail-oriented and outstanding communication, organizational and leadership skills.
- Maintained the Requirements Traceability Matrix (RTM) across deliverables of a project
- Experienced in planning, delegating and tracking the test activities to meet the project schedule.
- Strong Analytical skills, excellent communication and interpersonal skills, team player and self-Starter.
- Liaison between Project Manager, QA Manager and Testing Team. Created Data Mapping documents to migrate the Data from existing system to the New System.
Testing Software: QTP, HP ALM, Quality Center, JIRA, Bugzilla
Programming languages: C, C++, JAVA, .NET, Visual Basic, HTML,XML,DHTML
Databases: MS SQL Server, Oracle, Sybase, MS Access, DB2
Operating System: Windows NT, Windows 98/2000/XP, Windows 7, Linux, UNIX.
Methodologies: Agile, Scrum, Waterfall
Confidential, NYC, NY
Business System Analyst
- Involved in preparing detailed Business Requirements document in accordance to SDLC deliverables.
- Conducted business requirement meetings with business unit teams to determine project goals and elicit requirements.
- Responsible for conducting Business Impact Analysis.
- Developed Business Requirements, User Requirements and upload into HP Quality Center 10.0
- Managed Requirement Traceability Matrix (RTM) to trace and map Business requirements, Functional requirements and Technical requirements.
- Developed use case Designed process flow diagrams using MS-Visio and also Business Context Diagrams
- Identify, analyze, document and implement all changes necessary to ensure that the vendor transactions and the related business processes are successfully accepted, processed, loaded, generated, transmitted and converted to handle ICD-10 compliance readiness as outlined in the capable strategy adopted by EH.
- Created Activity Diagrams & Sequence diagrams describing carrying out of actions in MS Visio.
- Performed Gap Analysis to assess the “AS IS “and “TO BE” scenarios.
- Documented the meeting minutes from the JAD's and stored the artifacts in the appropriate place holders in SharePoint for both the teams to review.
- Established Peer Review committee to conduct inspections of current processes, peer documentation, review, suggest and agree on best methods for ensuring the highest quality and consistent project artifacts output.
- Participated in testing strategy and document it in a test plan which contains purpose test types, schedule, scope, roles, entry and exit criteria, defect workflow, test deliverables, risks, assumptions, constraints & dependencies.
- Collaborated with business, and developers to finalize the scope of testing.
- Used Quality Center for defect tracking and maintained the trailing history of the bugs.
- Created data (837 I and P) for 5010 testing using Specbuilder.
- Tested Inbound 837 I and 837 P, 835’s (Out bounds) claims processing systems.
- Responsible for validating the 835 with Correct Outbound NPI.
- Tested the pricing and adjudication of 5010 institutional and Professional Claims
- Created and managed change requests alongside with updated scope and new changes.
- Worked with Benefit-focus staff to ensure requirements will be incorporated into system design and testing.
- Interacted with Development Team to fix the defects raised during the testing period.
- Prepared Traceability matrix, bug matrices, weekly and daily status reports and sent to management.
- Participated in weekly status report and defects review meetings.
- Performed/Participated in UAT testing of the application to test the system for both functional and business requirements.
Environment: HTML, MS Visio, MS Project, MS Office Suite, HP Quality Center, Java, MS SQL Server
Confidential, Hartford, CT
Business System Analyst
- Interacted with Key stake holder, Business and Business managers on daily basis
- Involved in gathering & documenting the business requirements.
- Initiated & managed business and technical requirements gathering sessions (JAD sessions)
- Facilitated JAD sessions with Business and IT Matrix partners to support all the business needs and requirements.
- Functioned as a primary liaison between the business line, operations and technical areas throughout the project cycle.
- Validated EDI Claim Process according to HIPAA compliance.
- Worked with other team members and conducted weekly status meeting to make sure all team members are on the same page.
- Experience conducting Walkthrough Meetings with developers and BAs as well as internal meetings with QA Lead for efficient testing.
- Wrote Test Cases and Test Scenarios based on Technical and Functional Specifications and uploaded them in Mercury Quality Center.
- Maintained Requirement Traceability Matrix (RTM) to make sure that test plans were written for all requirements.
- Attended Test Case Review Meeting with development team and QA manager.
- Modified and updated Test Cases and uploaded them in Testing Tool to execute tests .
- Performed data validation according to data mapping document with data conversion logics from source system and target system.
- Worked on EDI 820, 834, 835,837, 276/277, 278 as per HIPPA guidelines.
- Familiarized with Health Exchange Plan Management (HIX) in regards to Affordable Care Act (ACA).
- Extensively used SQL queries and procedures for data validation in both source system and target system.
- Created and maintained SQL Queries for back-end testing.
- Executed test cases, detected defects, reported defects, coordinated with developers and business analyst to determine repair priorities.
- Performed Regression Testing after defect was resolved and closed defect in Mercury Quality Center (QC).
Environment: HP ALM 11.00, Visio 2010, Toad, HTML, XML, Bugzilla, Oracle 11, HTML, Agile Testing/Scrum, MS Project, SharePoint
Confidential, Hartford, CT
Business Analyst/QA Analyst
- Interacted with business managers and other stakeholders to determine project scope thus defining key challenges, risks and project deliverables.
- Conducted JAD sessions with SMEs and Stakeholders to discuss architectural solution that meets the business requirements, resolve open issues, and change requirements.
- Performed GAP analysis to assess “AS IS” and “TO BE” scenarios.
- Performed gap analysis between partner specs and internal system requirements by matching HIPAA 4010 to 5010 implementation techniques.
- Created process flows diagrams for all “As Is” and “To Be” scenarios using MS Visio
- Involved in Business Analysis for Inbound and Outbound Transactions.
- Working with all Healthcare EDI Transactions for processing various files including Enrollment, Provider, Encounters & Regulatory under HIPAA compliance include all enrollment 834 and Played major role in 24/7 production support for transactions like 834, 837I, 837D, 837P, 276, 277, 820 .
- Created maps & layouts for HIPAA as imposed during Electronic Data Interchange (EDI): 837 - Claims and Encounters, 834 - Benefit Enrollment and Maintenance, 835 - Claim Payment/Advice, 270/271 - Eligibility Benefit Inquiry and Response, 277/275 - Claim Request for additional Information and Response, 276/277 - Claim Status Request / Response.
- Analyzed and identified gaps/issues in claims, encounters and remittance advice process flow.
- Converted X12 data to XML (using DI) and verify the data by performing schema validations.
- Created Use Case Diagrams and Test Cases for federal employee program.
- Collaborated with project team, project leads, and project managers and fostered with them to review plans, systems testing and overall testing of software.
- Provided support during the integration and UAT.
- Performing the Onsite-Offshore Coordination for the SIT team and is a single point of contact for offshore testing team to execute the test team activities.
- Developed Test Cases bases on Functional Specifications and Design Documents.
- Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
- Interacted with Business users and Technical team in providing clear solutions to requirements.
- Involved in testing Medical claims, Hospital claims, and Dental claims.
- Involved in testing the efficiency of healthcare delivery by using HIPAA
- Involved in testing HIPAA EDI Transactions and mainly focused on 837 and 835.
- Involved in preparing 837 HIPAA Format files.
- Involved in writing SQL queries in SQL Navigator to validate the payment files.
- Followed the Mapping documents and HIPAA implementation guides for HIPAA Transaction Mapping.
- Involved in processing claims in Diamond and validating the full cycle process to make sure the checks are generated and 835’s are generated.
- Responsible for QA status in release meetings.
- Used Quality Center for preparing the test case and for tracking defects.
Environment: HP Quality Center, SQL, JAVA, Oracle9i,TOAD, Clear Case, UNIX, Windows NT/2000