SUMMARY:

• 10+ years of experience as a QA/BA Analyst in HealthCare IT Field.
• Diverse industry and functional expertise with success and accomplishments in all aspects of healthcare accounts receivable lifecycles, including health plan, clearinghouse and provider processing systems.
• Experienced in Research, Requirement analysis, gathering, detailing, documenting, validating in gathering business process information and data quality study, Use Cases, Functional Test Planning - preparation-execution, UML, Agile Methods, Application Maintenance and product Support
• Educated in HIPAA Health Information and Security & Privacy requirements
• Proficient in healthcare EDI systems and electronic claim transaction technology
• Experienced with VA Project Management Accountability System (PMAS) and ProPath processes/artifacts as well as Veterans Focused Integration processes (VIP)
• Excellent Mathematical, Analytical & Problem Solving skills and a good team player

TECHNICAL SKILLS:

Operating Systems: SQL Server, Windows 2000/Vista/ XP/NT, Unix

Training: SQL, DITSCAP, DOD Cyber Awareness Recertification, User and System Requirements for Successful Software Development and Agile Process, Scrum Master Certified

Software: MS Word, MS Access, MS Project, MS Visio, Visual Source Safe, WINMAP, Microsoft SharePoint Portal, Quality Center, Rational Tool, QMACS, Affinity, Test Track, TFS, etc.Languages: Turbo C, Assembler, Visual Basic Macro, Cobol, XML

PROFESSIONAL EXPERIENCE:

Business Systems Analyst

Confidential, VA

• Interfaced collaboratively with a diverse range of project staff, PMO support staff, technical analysts, system architects, etc.
• Facilitated requirements elicitation sessions to document and analyze VA requirements. Defined systems scope and objectives based on both user needs and a thorough understanding of business systems and industry requirements.
• Supported senior-level government clients at the Veterans Affairs Office of Information & Technology (OI&T), as well as, the Veterans Health.
• Wrote test plans documents and reviewed business documents for section 508 compliance.
• Developed GAP analysis, Requirements Traceability Matric (RTM), Business Requirements Document (BRD), and Requirements Specification Document (RSD) to assist the VA with decision making with cost effective business models according to agile.
• Managed communication and requirements meetings with the VA subject matter experts and development teams (including scheduling, facilitation, and preparation of agenda and meeting minutes).
• Assisted with the VA new and enhanced projects to formulate and define systems scope and objectives based on both user needs and thorough understanding of business systems and industry requirements.
• Reviewed business changes and ensures efficient and comprehensive translation into functional requirements.
• Gathered requirements, created process flow, and provided quality documentation to development for the design and development of systems.
• Identified user scenarios and generated new or modified process workflows as appropriate to solve complex problems and translated into proper agile environment.
• Reviewed project plans, identified risks and issues, resolved issues, and communicate status to appropriate internal and external team members.

Revenue Cycle QA

Confidential, Reston, VA

• Performed quality assurance and analysis responsibilities for developing EDI financial hospital software applications.
• Provided assessments and gap analysis documents on conversion of X12 4010 into 5010 version for 837 and 835 transactions and participated in ICD10 migration design meetings.
• Tested new developments of X12 837 claim, 835 payment files and HL7 documents to ensure timely and quality delivery of Revenue Cycle product releases.
• Reviewed, analized and tested State regulatory Data Discharge Reporting formats for a number of states.
• Performed quality assurance and testing on National Provider ID project for CMS requirement.
• Involved in testing of conversion of HCFA 1500 into new CMS1500 form.

Software Engineer IV

Confidential, Reston, VA

• Assisted with testing and implementation of X12 HIPAA standards for 837 and 270/271 using QCSI/QNXT software and tools.
• Assisted in testing and design of patient payment system by performing data analysis using SQL queries.
• Performed QA and unit testing on WV MMIS provider enrollment applications in Virtual Work flow web environment.
• Played a major role in integration team for WV MMIS claims processing system from legacy to HIPAA compliant system by researching, designing, modifying system components, identifying the required steps and recommended solutions for them to comply with HIPAA rules. The tool used was Instream HIPAA Validator, which provided WEDI level 1 through 7 edits and validations and produces functional acknowledgement 997.
• Maintained and supported Military Health System database for Tricare client.
• Contributed to the development and review of System Security Authorization Agreement documents, Physical Security, Audit Matrices and Risk Assessment Reports for MHS client.

Product Analyst

Confidential, Fairfax, VA

• Acted as the company's liaison with providers and electronic insurance carriers, and other "partners" in keeping up with their changing electronic submission and reporting requirements.
• Analyzed payer requirements for completeness and drive programming tasks.
• Reviewed payer billing manuals to recommend new changes and edits on client software.
• Identified root cause analysis on disruptions to production systems.
• Wrote tasks and supporting test cases derived from an analysis design and programming specifications.
• Tested software using these tasks, document results, defects and issue resolutions.
• Wrote VB script programs to automate claim-processing procedures for the clients.
• Quickly resolved problems. Worked directly with programming team and motivated them.
• Contributed to the development of timelines and managed work to meet the project schedule.
• Participated as reviewer, facilitator and problem solver to promote quality and consistency.
• Responsible for implementation of new payer edits (UB & NSF formats) into our software.
• Responsible for reviewing Medicare newsletters and WebMD customer service bulletins.
• Was instrumental in migration of CareFirst project from MHIN to Blue Cross DC through WebMD both as a research analyst and QA by obtaining business requirements for EDI claims from CareFirst, provided feedback on WebMd existing and discussed MHIN edit requirements with business analysts, communicated edits and changes with programming team and the management.

EDI Consultant

Confidential, Vienna, VA

• Performed quality assurance and testing on company mapping software (Winmap).
• Developed complex 837 institutional and Medical maps using ASC X12 (i.e. ANSI 4010) standards.