SUMMARY

• Extensively worked for 7+ years as Business System Analyst, Quality Assurance and Test Engineer in healthcare domain.
• Strong analytical and problem solving skills.
• Strong requirement gathering skills with JAD sessions, Workshops, interviews.
• Excellent oral and written communication skills. Have written technical and user manuals for computer applications.
• Experience in writing requirements and specification like Business Requirements Document (BRD), Use Case Realization Document, Functional Requirements Specifications (FRS), Systems Design Specification (SDS), Systems Requirements Specification (SRS), Data Dictionary, Requirements Traceability Matrix (RTM), User stories, Defect Traceability Matrix (DTM), User Guides, and Release Notes.
• Experienced with GAP Analysis, SWOT analysis, Product analysis.
• Good understanding of health insurance policies like HMO and PPO and proven experience with HIPAA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim), EDI 820( Payment order and remittance advice and 999(Acknowledge form).
• Strong business knowledge of Healthcare sector and very good knowledge about Faucets, HIX and proven experience with ICD9 - ICD10 conversion.
• Good working experience in analyzing changes and identifying areas of applications to be regression tested.
• Expertise in writing and reviewing requirements, functional and design specifications.
• Strong experience in working in Windows and UNIX environments.
• Expertise in creating Bug Reports using tools like Test Director/Quality Center.
• Hands on experience with Databases Mysql, MS Access, SQL Server and writing SQL Statements.
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the membership eligibility, billing experience within life and disability in health plans.
• A motivated, sincere, committed, quick learner, detail-oriented team player with good communication, analytical, leadership, interpersonal and problem solving skills
• Knowledge of MMIS (Medicaid Management Information System), MITA ( Medicaid Information Technology Architecture
• Have attended seminars/webinars and gained lot of knowledge on HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) and healthcare reforms like the Patient Protection and Affordable Care Act (PPACA), Emergency Medical Treatment and Active Labor Act (EMTALA)
• Well-versed with all stages of Software Development Life Cycle (SDLC) and Software Testing Life Cycle (STLC).
• Expertise in working with Agile, RUP, SCRUM and Waterfall testing methodologies.
• Well- skilled with various testing methodologies, testing types, testing techniques and Quality Work Products.
• Proficient in formulating test plan and Requirement Traceability Matrix.
• Hands on experience in writing test plans, test cases, developing and maintaining test scripts. Experienced in documenting requirement using Unified Modeling Language (Use Case and Activity Diagrams) also building business Process Flow, Activity Diagrams, Sequence Diagram using tools such as Visio.
• Experience in developing Software Test Plans, Test Case Design, Test Scripts, System Integration Testing, Functional, Regression Testing, GUI, and database testing.
• Extensively used Blackbox testing Techniques.
• Excellent Experience in Defects Tracking in the Application.

TECHNICAL SKILLS

Testing Tools: ALM/QTP, Test Director, Quality Center, Selenium, RQM, CQ

Databases: Oracle, MS Access, SQL Server, Mysql

Operating Systems: Windows, UNIX

Languages: C/C++, Java, SQL

Browsers: Internet Explorer, Google Chrome, Mozilla Firefox, Safari

Tools: MS office, MS Project, Visio, Rational Rose, Rational Requisite pro, Epic, Meditech.

PROFESSIONAL EXPERIENCE

Confidential, Madison, WI

Sr. Business System Analyst

Responsibilities:

• Worked with client to gather Business/Technical Requirements, Approval of CR (Change request), Design and Implementations for State MMIS.
• Responsible for designing future state processes forICD 9-10 Crosswalk Table and drafted High Level Business Requirements for ICD 9-10 conversion mapping.
• Worked extensively on the Procedure and Diagnosis Pricing and worked on the Reimbursement processing.
• Gained extensive experience in designing and modifying system for areas such as Enrollment, Billing, Provider Record and Reimbursement Status in MMIS.
• Analyzed HIPAA 5010 related to 837 (I/P), 835, 834, 270,271 transactions and performed gap analysis between HIPAA 4010 and 5010.
• Wrote clear, concise detailed System Requirements Specification(SRS) documents and user documentation in accordance to guidelines and standards of a level where developers can interpret, design and develop the application with minimum guidance
• Experience in implementation of ICD-9-CM codes and ICD-10-CM codes changes in the current claim processing modules in MMIS.
• Worked on HP Quality Center 10.0 which include Defects Management, Test Plan and Dashboard.
• Talking to the client based on requirements of that particular defect, uploading document required, checking history, status notes, setting up resources to handle and fix it.
• Worked on IBM caliber to handle various requirements including Functional requirements, High-level requirements, Non-functional requirements, Scope statement and User requirements.
• Provided online support to users for various applications such as IPCS (Internet Professional Claims Submission).

Environment: HP Quality Center 10.0, IBM Caliber RM, MS Office, Windows XP, MS Visio, SharePoint, MS Project, MS Visio, SQL, SOA Infra, XML, MMIS.

Confidential,Franklin Lakes, NJ

Sr. BA/QA Analyst

Responsibilities:

• Preparation of Requirements traceability matrix for each legacy systems to ensure the data migration is achieved with accuracy.
• Extensively involved in implementation of effective requirements practices, including gathering User Requirements, and analyzing User Requirement Document (URD), and functional specification document (FSD), use and continuous improvement of a requirement gathering processes.
• Validated Medicare Part A and Medicare Part B eligible claims.
• Worked on Mapping for Medicare claims data from source system to target system.
• Created GAP analysis and mapping document for ICD9 to ICD10.
• Preparation of Requirements traceability matrix for HIPAA compliance, various business rules depending on the state and ensuring the MetaVance functionalities are in compliance.
• Responsible for validating and testing clear ICD-9 to ICD-10 conversion.
• Developed test cases and test documents used for configuring software to meet needs of ICD-10 readiness.
• Worked on EDI 820 for testing payment orders and validating remittance advice from finance organizations.
• Worked as liaison between external clients and SMEs to generate and standardize product requirements specification documents such as URS/FRS/Use Cases.
• Knowledge of 837, 835, 276,277, 270, 271, 834, HIPAA EDI and X12 transactions.
• Writing system test plans, test scripts, check lists and its review.
• Extensively performed Manual testing process to ensure the quality of the software.
• Involved in Manual testing using Quality Center to develop test cases, test scripts, executing the scripts and logging the defects.
• Develop scripts and test cases for Integration Testing, Regression Testing and Stress Testing.
• Designed data for interpreting negative/positive results.
• Extensively used SQL scripts/queries for data verification at the backend.
• Interaction with the legacy SME, business, IT team and HP for technical clarifications.
• Interaction with the QA Team, Business Analyst and Delta IT team for status reporting and tracking.
• Work with Release Management Team to ensure that the correct version of code is pulled from SCCS for the respective testing cycles.
• Familiar with SCCS and was involved in code review with the development team in certain cases to help facilitate troubleshooting and identify the root cause of the bugs reported.
• Worked closely with the legacy team and HP to ensure adequacy of testing through clear understanding of Design aspects and business requirement.
• The areas of online application testing I covered were Membership, Benefits, Claims processing and Billing.
• The Batch testing covered the membership, benefits validation, claims adjudication and processing, payment processing and billing batch jobs. This also covered the legacy data load for each of the functional areas.
• Prepared Robust Regression Test scripts to test each new release provided by MetaVance team.
• Conduct Critical performance tests for the claims adjudication and payment processing systems.

Environment: Oracle, PL/SQL, SQL Developer, UNIX, Windows XP, HP Quality Center, MS-Office, ALM/QTP.

Confidential, Madison, WI

BA Analyst

Responsibilities:

• Analyzed use-case document and functional requirement specification document.
• Prepared and maintained the Requirement Traceability Matrix to ensure completeness.
• Created test cases and test data from the functional requirement specifications.
• Primarily responsible for reviewing the approved Change in Requirements and analyzing and identifying the impact to existing test cases and scripts.
• Primarily responsible for reviewing the approved Change in Requirements and identifying and preparing the new test cases and test scripts.
• Involved in Black box, Manual Testing and prepared Test Suite for all the Test Cases.
• Created different document and matrices like test log, test incident report, test coverage matrix, tractability matrix etc.
• Validated if EDI 820 has been send to supplier or not after electronic fund transfer.
• Generated test reports and test cases using QC.
• Tested the system to verify the compliance with HIPAA in terms of privacy, security and standards
• Involved in detailed Functional and GUI testing and User acceptance testing (UAT).
• Involved in writing SQL queries for Backend data verification, retrieving data from related tables and Testing.
• Conducted End-to-End testing of the system manually.
• Detected bugs and reviewed them with business and developers and classified them based on the severity.
• Generated various Reports for PMO including Weekly Status Report and Open Defect Report using Excel.
• Conducted the Regression tests for already reported Bugs and change requests to test whether fix has been applied or not and to test and ensure the fix does not cause a new problem or break existing functionality.

Environment: Windows XP, HP Quality Center, UNIX, Oracle, Java, MS-Office.

Confidential

BA/QA Analyst

Responsibilities:

• Participated in full SDLC cycle from initiation to deployment with regards to testing (Requirements Gathering, Test Planning, Test Cases, Test Data Preparation, Test Script Development, Test Execution, Test Reporting, Test Result Analysis and Review, Defect Retesting).
• Involved in Initial Test Walkthroughs (ITA's) for business requirements and test plans.
• Analyzed the BRD (Business Requirement Documents), FRD (Functional Requirement Document) and HLD (High Level Design).
• Attended JAD Sessions with Business Analysts, SME’s and the Development Team Manager.
• Designed and Developed Test Cases and Test Scripts from FRDs, BRDs and documented them in Quality Center.
• Expert understanding of the business process and verified the functional aspect as per the Business Process and validated the interfaces with the other systems and data conversion from the legacy system.
• Developed and modified the testing related documents such as Test Plan, Test Case, Test Scenarios and Test Scripts throughout the project.
• Wrote several basic and complex SQL scripts to validate the data integrity in the application.
• Worked closely with the Business Analyst to perform UAT and to prepare test scenarios and test data.
• Used Quality Center to create, track and follow up to closure on defects, during various builds.
• Coordinate with the team and QA manager to generate the status report and test matrix for each release.

Environment: Windows XP, HP Quality Center, UNIX, SQL Developer, Test Director, MS-Office Suite.