SUMMARY:

• Experienced Senior Business Analyst/QA Analyst with over 8 years of proven skills in requirement gathering, interacting with developers, documenting various business processes, executing test plans, coordinating various projects contributing 3 - Years of experience in Medicare D in region of Healthcare IT Industries.
• Proficient with EDI translators, EDI and FTP standards, ANSI X12/EFIDACT and XML, Claredi Ultra Edit & Trizetto Facets
• Excellent knowledge working on various Trizetto FACETS Modules.
• Comprehensive and proficient knowledge of EDI X12 Standards in Healthcare
• Concrete understanding of Business Requirement gathering, Business Process flow, Business Process Modelling and Analysis, design documentation.
• Excellent knowledge of ICD9/ICD10,Epic Build, Epic Clinical Workflows, Epic Implementation, Revenue Cycle, Provider, Professional, Facility, COB, Medicare/Medicaid Claims, HL7 Interface Messages, Split Claims, Medical Necessity, Dual Coding, 834,270/271,276/277, TA1 /835, 820 EDI Transactions, EOB, EOP, Claim Adjudication, FACETS & NASCO User Interface.
• Completed in Epic Bridges Interface module in Madison, WI.
• Very good working experience on Nasco and Facets Claims Processing system
• Functional knowledge in Creation of Professional and Institutional Claims by generating Flat files using NDM input/output folders.
• Extensively involved with the NASCO - HIQK, HEHK, and EFDE applications
• Operational experience in HealthCare Provider & Payer Industry - EPIC Implementation,, Eligibility, Claims, Billing and Reimbursement.
• Extensive experience working in all stages of System Development Life Cycle (SDLC). Extensive experience leading, facilitating conducting Joint Application Development (JAD) sessions among user community, stake holders and technical management, creating project plans and schedules and managing changes.
• Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).
• Solid working experience in Backend Testing using SQL Queries on various databases such as Oracle, MS SQL Server
• Around 2 years of experience in Test Automation using QTP (9.2 to 10.0 versions)
• Good exposure in using of QTP Integrated Environment (Step Generator, Synchronization, Actions, Recovery Scenarios and Methods etc...)
• Proficient working on Various EPIC Modules used in Hospital Organizations and Providers.
• Expertise in building ICD10 Test Scenarios and Test Scripts from Epic Workflows in all Epic
• Applications like ADT Prelude, Op Time, ASAP, Cadence, Epic Care Inpatient, Ambulatory, Beacon, Resolute Hospital (HB) & Professional Billing (PB), Anesthesia, Radiant, Patient’s My Chart Activation, Beaker, Stork, Willow, HIM Coding, Tapestry & Cupid.
• Involved actively and had experience with one complete Implementation Cycle of Epic EMR.
• In Depth Knowledge on Working of Cerner-McKesson Application which includes Surg Net(Surgery), PathNet (Lab/Pathology) & Rad Net (Imaging) Modules and Processing of
• Excellent knowledge in Software Development Life Cycle (SDLC) / Rational Unified Process (RUP) methodologies, Agile Methodology.
• Preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, Component-Based Diagrams, Collateral Diagrams, including the Business Workflow Chart.
• Experience using Rational Rose and MS Visio for business process modelling and designing data flow diagrams (DFD).
• Very sound knowledge in HP-ALM QC for Test Planning and Test Asset Management throughout the Software Development Life Cycle.
• Excellent knowledge working on Team Foundation Server (TFS) for creating Sprint User Stories, Queries, Bugs and maintaining overall project status
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 835/837,270/271,276/277,834 &820.
• Sound Knowledge in Processing of 834 EDI Transactions.
• Proficient inICD-9-CM and ICD -10-CM coding and Claims processing
• Expertise in Agile/Scrum methodology in Testing, including Sprints, Stand-ups, Story board, User Stories, Defect Tracking
• Proficient in working with testing tools like Rational Quality Manager, Clear Quest, HP-ALM/QC
• Involved in preparation of Defect Report and Weekly Status Reports
• Excellent Analytical, Organizational, Interpersonal, Communications, teamwork and leadership skills with proven skill to interact across multiple levels of organization.
• Good Team Player and a Self-starter with excellent verbal & written, analytical & documentation skills and Ability to quickly master new concepts and applications
• Thorough knowledge in Requirement analysis, Planning, Scheduling & Tracking projects.
• Hands on experience of using MS Office Suite, MS Project, MS Visio, Rational Tools.
• Enjoy working in a Collaborative, Fast Paced Environment

TECHNICAL SKILLS:

Testing Tools: Rational Quality Manager, Rational Clear Quest, HP-ALM(All Project Life Cycle management)/ Quality Center (QC),Team Foundation Server( TFS), Microsoft Test Manager(MTM), TriZetto Facets, Claredi, Ultra Edit

Methodologies: Rational Unified Process (RUP), SDLC, Agile/Scrum, EMR/EHR

Operating System: MS Windows XP/Vista/7

Database: Oracle, MS SQL Server, TOAD, SQL. DotNet

Languages: JAVA, .Net, Mainframe, NASCO, EPIC, HL7 Interface, Cerner-Mckesson, SQL, FACETS

Other Tools: Mainframe, MS Word, MS Excel, MS PowerPoint, MS Project, MS Outlook, MS Visio, MS Access

PROFESSIONAL EXPERIENCE:

Confidential - Beaverton, OR

Sr. Facets/EDI Business Analyst

Responsibilities:

• Responsible for business process analysis that includes requirements facilitation, definition & analysis, Business process design and data mapping.
• Involved in configuration of FACETS Subscriber/Member application
• Worked on Facets Data Tables like (MEES, MEME, BLEI, MESU, BLDF etc;) and created audit reports using queries.
• Performed Data mapping and data modelling and used Canonical data model to map data from X12 834 transactions
• Performed forward and backward data mapping between fields in Mainframe and Facets
• Tested the changes for the front end screens in FACETS related to, Benefit and Plan modules
• Extensively involved in testing of Facets Batches( )
• Analyzed the mainframe Reports for Member/Eligibility/Claims and mapped the fields with Facets batch jobs and reports.
• Manually loaded data in FACETS and have good knowledge of Facets Business rules
• Worked extensively on Claredi’s system to trace out the exact root cause of Errors in the 834 test files.
• Converted X12 834 files using Ultraedit tool in a readable format to understand the exact 834 file structure
• Involved extensively in writing Agile User Stories in Team Foundation Server (TFS) and reviewed with Business lead and project manager for Sign Off
• Extensively worked on creating Business Requirements Documents (BRD’s) and Technical Specification Documents.
• Participated in daily Scrum Meetings to review the Business, functional and Non-Functional Requirements and to discuss the status of Product/Sprint Backlogs.
• Participated Actively in Sprint Planning Meetings to discuss about the User Stories, Story Points and Product/Sprint Backlog created and had Brain Storming sessions with Product Owner, PMO’s, Developers and Business Users
• Extensive knowledge of Patient Protection and Affordable Care Act (PPACA)
• Trace and inform business requirement changes through the lifecycle of the project using Rational Requisite Pro while maintaining customer needs and maintain a Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.
• Understand and have the ability to configure, test, and resolve transmission set up for standard files (SFTP, FTP)
• Hands on experience with the 834 ANSI X12 transaction understanding loops, segments, elements and structure
• Extensively participated in verification of EDI file formats against HIPAA ANSI X12 Standards
• Maintained Excellent team collaboration with Developers, QA Team and tracking from time to time regarding the status of the bugs detected and updating them in TFS.
• Gathered detailed business and technical requirements and participated in the defining the business rules and data standards.
• Transform business requirements or policy documentation into Features, test plan, test cases and scenarios.
• Extensively worked on Data mapping of EDI Segments from 834 FFM (Federally Facilitated Marketplace) to Facets database and vice-versa.
• Copied 834 files received from FFM (Federally facilitated Marketplace) to a specific folder for further processing and finally installing enrollment data to Facets.
• Extensively involved in gathering Reconciliation files and sending them to FFM for further analysis for unpaid members.
• Analyzed and compared data present in HIX Middleware Canonical (BizTalk/Windows Service Bus) to Facets by writing SQL Queries.
• Excellent knowledge creating and working on Change In Circumstances (Cic834) and Reconciliation Scenarios and User Stories in TFS.
• Sound knowledge working on Facets UI in processing and validating Enrollment, Subscriber Eligibility, Claims and Data.
• Profound Knowledge working on Inbound (I834) and Outbound (IC 834) 834’s according to FFM (Federally Facilitated Marketplace) and Issuer perspective.
• Hands On experience working on 820 Payment order Remittance Files in order to validate the 834 Enrollment payment data to and from CMS.
• Excellent knowledge working on 834 Re-enrollments/Renewals and Reconciliation member data

Environment: FFM, HIX Middleware, TFS, Facets, Biz Talk, Dot Net, EDI, Microsoft Excel, Visio, One note, SQL, Windows Service Bus, Microsoft Test Manager (MTM).

Confidential - Englewood, CO

Sr. Business/QA Analyst

Responsibilities:

• Involved extensively and hands on experience in building ICD10 epic Test Scripts in both Inpatient and Ambulatory Settings and for Revenue Cycle Applications like 3M Coding, Professional, Hospital Billing and Claims portion by reviewing Epic clinical Workflows, visios and Epic User Web documents.
• Co-ordinated and assisted the Project team in executing the Test Scripts in EPIC Software.
• Had daily team meetings with Project Manager and updated the daily team status
• Created Test Plan, Test Scripts in Excel spreadsheet and uploaded them to HP-ALM/Quality Center Test Plan module using ALM Export Wizard.
• Built and Performed Scripts for Outpatient Registries, Scheduling Appointments, Check-In, Nurse Rooming, Ambulatory physician Orders, Check-out in Epic Care Ambulatory module.
• Moved Test Scripts from Test Plan to Test Lab module and performed them in EPIC System and updated the Test results in ALM Test Lab Module.
• Logged various Defects and conducted Defect Review meetings with SME’s and updated the Status of the defect from time to time in Defects Module in ALM
• Involved in automation infrastructure development in Quick Test Pro
• Extensively involved in Regression testing using QTP 11.0 Version.
• Generated Score Card Reports in ALM stating daily work progress and sent to Project Team
• Hands on Experience working in performing the scripts related to Patient Admit, Transport to a hospital, Discharge of a patient (ADT), Coding of a Patient Account, Billing of an account and finally generating and sending Claims to the Payer.
• Built Test Scripts for Patient Transport using AD/ Prelude, Oncology Department using Epic Beacon, Emergency Department using ASAP, Outpatient using Cadence and Epic Care Ambulatory, Surgery Scripts using Op Time, Patient Admission and Stay in hospital using Epic Care Inpatient and Bed time, Managing, Verifying & Dispensing Orders as a Pharmacist using Epic Care Willow, Verifying Patient’s Lab/Pathological Results using Beaker and Billing & Claims using Resolute/ Revenue Cycle Applications.
• Performed Test Scripts in Epic Test Environment for various Epic Applications to evaluate routine tasks of Charge Nurse (RN), Front Desk, Physician/Surgeon (MD), Central Scheduler, Unit Clerk, Registrar, Supervisor, Lab Technician, HIM Coder, OR Biller & Pharmacist using appropriate Log in Credentials
• Conducted Script Reviews with SME’s for various ICD 10 Impacted Scenarios for Epic ADT, Bridges, Ambulatory, Inpatient, Op time, Beacon, ASAP, Cadence, Stork, Anesthesia, Resolute PB&HB modules
• Validated DRG’s, Diagnoses and Procedure/CPT Codes to be compliant with ICD-10 version in Epic Test Environment in order to ensure proper Billing and Reimbursement from the Payer.
• Conducted Test Scripts Sign Off Meetings with SME’s to ensure all affected Epic areas related to ICD10 are included in the script for System, Interface and End to End Phases of Testing.
• Arranged meetings with Subject matter Experts (SME’s) and the development team regarding the defects found and their resolution in ALM QC Defect Module.
• Involved extensively in building epic ICD 10 test scripts and performing for System, Interface, User Acceptance (End to End) & Payer Testing.
• Extensively Validated various ICD 10 impacted HL7 Interface messages generated between 3rd party applications( Ensemble) and Epic Applications (ADT, ASAP, Outpatient, Inpatient, Pharmacy) and communicated effectively to ensure No loss of Data Integrity using Epic Bridges.
• Validated the Reports of the Patient’s Imaging Orders (Ultrasound, CT/MRI Scanning, EKG/PACS) placed by a Physician under Radiology Department using Epic Radiant Application
• Written and Executed Test Scripts in Epic Implementation Application for Diagnosis Calculator which is a newly implemented system in EPIC ICD 10 Application Software in order to validate the Specificity of ICD 10 Diagnosis (Dx) and CPT/Procedure (Px) Codes.
• Performed Admitting Labor & Delivery Patients logging as OB Nurse and documented C-Section Procedure Results logging as an Obstetrician in Epic Stork Test Application Environment.
• Functional knowledge in Signing up Patient’s My Chart Activation to access their Medical Records. Expertise in Coding a Discharged Patient Account using 3M Software and coded appropriate Diagnosis, Procedure and DRG associated with patient’s problem and verified charges posted using HIM (Health Information Management) Module.
• Efficient in creating Test Summary Reports at the end of each Testing phase of Validation.
• In Depth Work Knowledge in Revenue Cycle Billing Workflow to view required Charges posted to the patient’s Guarantor account and then to Payer (Insurance) on Charge Review Work queue.
• Very sound knowledge working on creating Professional & Hospital Electronic Claims and to verify accurate ICD 10 Diagnosis and Procedure Codes are filed in order to ensure proper Billing and Reimbursement from the payer perspective in Epic Tapestry module.
• Verified Diagnosis Calculator- a new ICD10 epic tool which is required to choose appropriate administrative details when a generic or Non-Billable diagnosis code is used for Billing.
• Excellent functional work knowledge on evaluating Medical Necessity for Medicare accounts and profound work experience on Split Claims for Inpatients, Outpatients, Observation and Emergency encounters i.e. Dual coding and Validating two separate claims generated for the encounter who admitted prior to 1st Oct 2015 billed with ICD9 Codes and who discharged after 1st Oct 2015 billed with ICD10 Codes for the accurate Billing & Reimbursement from the payer.
• Involved extensively in directing and escalating the issues/defects found during testing with Subject Matter Experts from Epic headquarters located in Madison and resolved them.
• Sound knowledge working on dual coding the accounts in ICD-9/10 to validate the specificity and accuracy of the system and its impacts from the Billing and Claims perspective.

Environment: EPIC, HP-ALM, HL7, Sql, .Java, Oracle 11g,, Use Case, Toad, SQL, MS Office Suite(Word, Excel, Power point)

Confidential

Sr. UAT Business Systems Analyst

Responsibilities:

• Involved in analyzing Business requirement documents, Claims Xten Use Cases and Conceptual System document (CSD) to identify specific requirements for In scope and Out of scope.
• Responsible for understanding and documenting requirements and translating them to functional and non-functional specifications and verifying that solutions meet the requirements.
• Created the Test Plan document which describes about the Test Strategy, In-Scope, Out of Scope, Assumptions, Risks, Dependencies and Timelines etc.
• Developed Test Plan, Test Scenarios and Test cases that reflects business requirements and reviewed with Test Lead and Business End users to get sign-off.
• Expertise in Creating Professional and Facility Claims required for Test Execution by generating Flat files using NDM input and output folders.
• Developed various UAT Test Scripts for testing HIPAA 835, 834, 837(I/P), 270/271, and 276/277 EDI transactions in order to generate a wide variety of Valid Claims.
• Expertise and In-depth knowledge of Claim Adjudication & Post Adjudication Process (Payment Order remittance, deductibles, Carry-over, etc.)
• Expertise in Adjudicating the claims and processing them through NASCO HEHK, HIQK & HZMK application
• Expertise on working various Loops, Segments of 834 Transaction set and verifying the ST & INS Segments.
• Highly involved in working on N1 Loop for identification of Payer and Sponsor Name and if sponsor details are associated for dependent.
• Proficient working on processing 834 Files upstream and downstream, identifying Enrollment Scenarios and deriving test scripts from the scenarios and adjudicating Claims effectively.
• Using Claims xten logic, proficient in Validating and adjudicating claims in a manner that is more efficient and cost effective.
• Using this logic, efficient in verifying and documenting the Incidental, Mutually Exclusive, Re bundling
• Edits identified by Claimsxten software under Test Results.
• Sound knowledge working with Explanation Of Benefits (EOB)/Coordination of Benefits (COB)/Check/EFT Transactions and Explanation Of payments (EOP).
• Analyzed the exact behavior of the ICD9/10 claim in the CXT UI Interface in order to verify that the Claim processed correctly in NASCO.
• Profound knowledge on various segments of the Claims i.e. Provider, Subscriber, HCPCS/CPT which are processed in NASCO.
• Developed the test cases for Claims xten rules and reviewed with Test Lead and Business Lead and Business End users to get sign off.
• Functional Experience in using IBM Rational Clear Quest for Defect Logging and tracking in IBM Clear quest
• Attended daily status meetings and prepared dashboard for daily status at the end of the day to the manager.
• Maintained the Requirements Traceability Matrix throughout the project life cycle.
• Verify the status of submitted defects, and participated in defects review/prioritization activities
• Provided detailed problem description for the issues to the development team to enable and facilitate them in proper analysis for the defects resolution.
• Worked very closely with Test Lead during entire Test Execution Phase until UAT sign off.
• Recorded and documented the Test Results for Test Cases.
• Involved extensively in discussion with Subject Matter Experts (SME’s) for Test Results Review Meetings and clarified their queries actively until getting sign off.
• Attended Quality Review process meeting to document the lessons learned.
• Very sound knowledge in processing Medicare, Medic aid and Coordination of Benefits Claims.
• Conducted Daily defect meetings with Business Subject matter expert have to review the defects resolution in End to end & UAT test Phase.

Environment: Java, Oracle 11g, Clear Quest, Use Case, Toad, SQL, MS Office Suite (Word, Excel, PowerPoint)

Confidential, Troy, MI

Candidate Experience

Responsibilities:

• Involved in analysing and gathering requirements and created the Product Backlog.
• Requirements were thoroughly analysed for developing the Test Scenarios
• Involved in writing Test Approach and assisted in the development of Test Plan
• Designed the Test Cases and responsible for executing them.
• Developing and execution of Regression, Integration Test cases.
• Participated in Test Plan and Test Case Walk through
• SQL Queries were written to query the database for the status of the records
• Performed smoke test to ensure that the right code is delivered
• Integration Testing between the different applications is tested for their stability
• Attended daily stand-up meetings and provided status by the end of the day to the manager
• Logged various defects and are followed up until their closure
• Defects reporting and tracking through Clear Quest
• Verify status of submitted defects, and participate in defects review/prioritization activities
• Provided detailed problem description for the issues to the development team to enable and facilitate them in proper analysis for the defects resolution
• Participated in various sprint review and design meetings.
• Recorded and documented Test Results for test cases and suites executed
• Created deliverables like support documents and evaluation summary reports.

Environment: .Net, Oracle 11g, ClearQuest, Toad, SQL, MS Office Suite (Word, Excel, PowerPoint)

Confidential, Milwaukee, WI

Sr. QA Tester

Responsibilities:

• Created Test Plan, that defines the test environment, phases of testing, entrance and exit criteria into different phases of testing and resources required.
• Identified, built and executed Test Cases for Functional, Regression and End to End Testing using Rational Quality Manager.
• Manually tested the entire application and updated the test results.
• Developed various test cases for testing HIPAA 837I/P 270/271 and 276/277.
• Validated the reports and files according to HIPAA X12 standards.
• Performed validation testing on the application navigation for various scenarios and reported the errors.
• Assisted EDI team with the testing of maps for HIPAA transactions 835 and 837.
• Involved in testing maps and translated data.
• Performed thin client testing for the remote users.
• Performed the Back-End testing to ensure data consistency on Front-end by writing and executing SQL statements on the Oracle database.
• Defect reporting and tracking through IBM ClearQuest
• Preparation of testing status reports and follow-up with the teams.
• Involved in the user acceptance testing (UAT)
• Analyzed test results for various tests and graphs.

Environment: Windows XP, Java, Oracle, Toad, ClearQuest, Rational Quality Manager, MS Office Suite (Word, Excel, PowerPoint), MS Project.

Confidential - Cypress, CA

Test Specialist

Responsibilities:

• Reviewed design documents and business requirement document (BRD) to learn the function and scope of the application in order to create a Test plan.
• Developed and executed test cases, test scenarios and defect tracking using ClearQuest.
• Worked with the developers to plan and implement the testing effort.
• Prepared Traceability Matrix to ensure the test case coverage
• Tested the system and applications for compliance with HIPAA
• Worked in Healthcare Claims Processing (837/835/834) includes facility claims and professional claims.
• Knowledge of Healthcare systems - Claims, Provider, etc.
• Created SQL queries for backend database validation.
• Validated the log files that were created
• Participated in Walkthroughs and Defect report meetings periodically
• Involved in UAT testing (User Acceptance Testing) and Implementation.
• Act as a liaison between the client and trading partners with the data intake and integration.
• Developed Test Metrics on a Daily basis and issues reported to Management.
• Participated in Team meetings for weekly QA Testing reviews.

Environment: Oracle, PL/SQL, Toad, MS Word, Excel, Windows NT/XP, Java, Rational ClearQuest

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Gathered requirements through interviews, meetings and existing documentation.
• Participated in JAD sessions (Joint Application Development).
• Involved in Risk Analysis.
• Communicating and conferencing with Leads and programmers for client requirements analysis and for accurate translations.
• Identified the deliverables at the end of the inception and elaboration phase of the Rational Unified Process (RUP) life cycle in terms of business modeling and requirements analysis.
• Developed Analysis Model that includes use case diagram that provide the development team a view of the requirements for construction phase activity.
• Reviewed the business Requirements with Business Lead.
• Define functional specifications from existing business requirements.
• Created use cases for business specifications.
• Develop elaborate test plan as per business specifications.
• Create and maintain test cases based on functionality and use cases.
• Created SQL queries for backend database validation.
• Scheduling and coordinating for meetings, seminars and conferences.
• Involved in preparing test plans for functionality tests by QA team.
• Defect reporting and tracking through IBM ClearQuest.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT).
• Attended QR (Quality Review) Process Meeting.
• Involved in conducting User s.

Environment: Windows NT, Java, Oracle, Toad, ClearQuest, MS Office Suite (Word, Excel, PowerPoint), MS Project.

Confidential

QA Analyst

Responsibilities:

• Analysis of the given requirements was performed and the estimation was prepared.
• Involved in documenting and implementing test plan, test case and test scripts
• Validated AUT for customizations, reports, labeling and barcode systems, and interfacing with laboratory instruments under CMM environment.
• Recorded and documented Test Results for Test Cases that are executed.
• Documented IQ, OQ and PQ protocols for new laboratory equipment.
• Developed SOP’s for operation of new laboratory equipment’s such as HPLC and GC etc.
• Developed Validation reports to summarize deviations from requirements, problems discovered and actions to be taken to fix them.
• Coordinated with the team members and the scientists for developing the SOPs for the equipment.
• Worked with a team in documenting the audit reports.
• Worked with Chemstation software used for analyzing of samples in HPLC.
• Developed Validation reports to summarize deviations from requirements, problems discovered and actions to be taken to fix them.

Environment: Java, HTML, Oracle, PL/SQL, Toad, MS Office Suite (Word, Excel, PowerPoint)