SUMMARY:

• Experienced in enterprise quality assurance processes and testing (manual and automated) of business and web application software for compliance to business and or regulatory requirements based on technical understanding of their architecture and cross functional business process.
• Skillful at interpreting and analyzing complex data from a variety of sources including claims and clinical data to discover patterns or identify root causes for problem resolution or present for referrals.
• Business knowledge in private and government health insurance payer space (legislation and regulations, health plans, eligibility and enrollment, benefit coverage and high risk claims adjudication, coordination of benefits and Medicare secondary payer, overpayment recovery and tracking, fraud prevention, medical coding, etc.).
• With strong background knowledge of provider types, coding and payment structures and claims and clinical data, had supported development and implementation of claims auditing and business logic.
• Supported teams of application developers, business end - users, stakeholders and project managers as subject matter (domain) expert and liaison during enhancement, maintenance and new implementation of complex business application projects.

TECHNICAL SKILLS:

Requirements Management/ Automated Testing Tools: HP Quality Center (HP ALM), WebDriver (Selenium2.0), IBM Rational Dynamic Object Oriented Requirements System, (DOORS), HP WinRunner (HP Quick Test Professional, QTP, HPE Unified Functional Testing, UTF), IBM COGNOS, INFOMAN (Information Management System), Endevor.

Computers: IBM computers and compatibles. IBM Mainframe computer

Languages: Java and J2EE, C#, HTML5, CSS3, XML, JSON, SQL (for MS Access and SQL Server, Oracle MySQL, IBM DB2, IMS and Hibernate), COBOL and JCL

Operating Systems: IBM - OS/390 (MVS, z/OS), CICS and MS Windows 2010

Applications and Utilities: Emulation Software Rumba, EXTRA & Reflection (Attachmate), Mainframe Utilities (TSO/ ISPF, QMF, SPUFI, File-Aid, CA MAX IMS/UTIL etc.), AT&T global network client, Citrix supported virtual private network (VPN), MS Office 2013 (including Project, Visio, SharePoint), HIPAA compliant, HL7 (Health Level 7) and ANSI X12N ver. 5010, Web Services (SOAP, REST) and Data Warehouse (SSIS)

PROFESSIONAL EXPERIENCE:

Teacher and Consulting

Confidential

Responsibilities:

• Ongoing self-education through studying, online tutorials and testing programs to refresh and extend skill sets in software development and engineering, and testing frameworks: Java SE (and J2EE), JavaScript, AJAX, AngularJS, JSON, XML (including XQuery), Web services (SOAP, WSDL, UDDI, REST), NoSQL (using Mongo Db)
• Extend proficiency in writing and executing automated tests using WebDriver (Selenium 2.0), Protractor, JUnit, Cucumber, TestNG, Maven, Jenkins, in IDEs (Eclipse, IntelliJ, Visual Studio, etc.) for web (including cross-browser, parallel execution, page object model) and enterprise applications
• Applied analysis, test design methods and procedures to verify and conduct API validation of web service implementation in a Service Oriented Architecture (SOA) environment using SOAPUI test automation tool
• Diploma in Statistics through Confidential, an online education facility.
• Attending health information technology and software testing based webinars to maintain industry knowledge and identify new trends and best practices.
• Read publications to stay current on trends in healthcare payment reform, cost containment strategies, ICD-9/ICD-10 updates, fraud prevention and more.
• Providing full-time care and pre-school education for children while managing household finances, scheduling transportation and travel arrangements.
• Volunteering in various capacities including assortment of projects in my church (community).

Confidential

Responsibilities:

• Analyzed customer’s requirements to identify impact on established business requirements/ rules and tracked new changes. Developed and documented functional requirements, test design and test cases conforming to the requirement traceability matrix (RTM) and stored in test project’s repository.
• Researched test data specifications for selecting or creating matching transactions to fulfill test cases. Manipulated and reformatted test sets for integration into repeatable process. Participated in code reviews.
• Conducted user acceptance testing (UAT) in compliance to quarterly mandate releases, business rules, government regulations and confirm fixes for previously identified defects.
• Performed end-to-end test executions using test items formatted in HIPAA compliant ANSI X12N EDI transaction code sets, i.e. 837, 835, 276/277 etc., for institution providers transmitted through mix of secured messaging protocols.
• Reviewed systems’ release notes to update and perform test procedures in the test regions prior to test executions.
• Mentored and supported business analysts (BA) and quality assurance (QA) testers in resolving business and related technical issues during test executions.
• Researched and documented test results and triaged and tracked test defects until fixed using issue tracking (a proprietary knowledge/information management system) and test management tools. Developed and submitted anomaly information about unresolved issues for customer’s review and directives.
• Reviewed key deliverable documents for input and or feedback to ensure project objectives have been addressed.
• Used TSO/ISPF to review mainframe data sets (flat and VSAM files), ran and viewed query results. Analyzed reports and other JOB outputs in SDSF. Submitted batch input files and downloaded output files and or reports using secure FTP.
• Business travels and test site visits included participation in program training for implementation of new rules, courtesy meeting and presentation of testing methodology among business partners.

Confidential

Senior Business Analyst (Technical)

Responsibilities:

• Participated in early involvement, walkthrough and data center meetings between the stake-holder, system maintainer and end-users. Coordinated and maintained database of new customer’s requirements and distributed and tracked them for analysis among team members.
• Conducted integration, application programing interface (API) and beta testing of the modified software for compliance to changes authorized by the stake holder(s) and confirm fixes for defects previously identified in test and production environment.
• Participated in joint application development (JAD) sessions and technical Work Groups meetings for conversion of all EDI X12N code sets from version 40 10 to 501 0 including updates to implementation guide (IG) in preparation for transitioning of ICD-9-CM to ICD-10-CM/PCS.

Confidential

Technical Business Analyst

Responsibilities:

• Researched and supported management at level appropriate in development of test plan and strategy, and provided time estimates and test justification information for business cases as needed. Supported process improvement and change management processes.
• Participated in establishing documentation templates, testing practices and model (project management) office that have since evolved into the current national standard adopted by CMS.
• Researched data requirements and presented information that completes claim life cycle for each institution provider type to support development of data selection program for seeding test regions which CMS has since adopted for its national beta, regression and UAT environment.
• Researched and supported development team to create and maintain automated test scripts for all business functional areas. Supported maintenance of object repositories and performed data mapping of the testing tool to that of application under test.
• Provided business and technical support in the implementation and execution of proof of concept (PoC) which lead to the award of the Regression testing contract.
• Provided business and technical support, during kickoff implementation of new policies that constituted significant software changes, to community of business analysts and QA testers for institution providers with commendation for excellent customer service experience by CMS.