SUMMARY:

• Overall 8+ years of professional IT experience in Quality Analyst (Tester)/Business Analysts in US with in - depth knowledge of business process with expertise in Software Development Life Cycle (SDLC) and project lifecycle across industries primarily with health care clients. Worked directly with the client at onsite and remote.
• Expert in Requirement Gathering, detailing, analyzing, identifying, tracking, evaluating, and recommending systemic changes to enhance productivity and efficiency as well as the methods and procedures for system maintenance.
• Experienced in documenting requirement using JAD session, one on one interviews, group meetings, and questionnaires.
• I have worked closely with business teams in the area of business architecture, business process modeling and reengineering to create detailed Business Requirement Document (BRD), User stories and Use cases for the engineering team to build quality software solutions.
• Good knowledge in healthcare insurance domain including Medicare.
• Proven experience with HIPPA X12 EDI transactions such as 834(Benefit enrollment) 835(Payment/remittance advice), 837(Health care claim).
• Experience and strong understanding of ICD9-ICD10 Conversion Process.
• Expertise in performing GAP Analysis and Impact Analysis in several projects
• Extensive experience of writing and executing test cases/scripts. A proficient manual functional tester.
• Estimating, creating, assigning and managing set of subtasks and tracking/resolving issues/risks/dependencies at task and Project level
• Proven track record of being an excellent individual contributor as well as an indispensable and critical team player. Possess a positive, flexible & detail oriented attitude, strive to be the best with strong analytical, problem solving & organizational abilities.
• Exposure of using automated test scripts with Selenium.
• Have the motivation to take independent responsibility as well as ability to contribute and be a productive team member with excellent communication and Interpersonal skills.
• Quick learner, self-starter, can learn and adapt to new atmospheres and technologies with confidence and ease.

TECHNICAL SKILLS:

Methodologies: Waterfall, Agile, SDLC, JAD

Business Modeling Tools: MS Visio (BPMN)

Requirements Management: JIRA, HP Quality Center (ALM)

Office Productivity Tools: MS Office (Word, Excel, Access, PowerPoint, Project and Visio) and O365

Databases: SQL Server, Mainframe Content Management, SharePoint

Testing: HP Quality Centre, Jira, Jama

PROFESSIONAL EXPERIENCE:

Confidential, Hartford, CT

Business Analyst/QA Lead (Agile)

Responsibilities:

• BA to facilitate during special or open enrollment periods.
• Contribute to functional design for Scrum teams to work directly from
• Working closely with the Scrum teams to ensure technical solution meets requirements and functional solution
• Supporting UAT to ensure issues are addressed in a timely manner
• Working closely with BAs on other projects within the program to ensure integrity of the end-to-end solution
• Work closely with the development and product teams and clearly communicates with all stakeholders in the management and progress of projects
• Work closely with developers, quality analysts and product owners to validate development against work requirements
• Work closely with the assigned project managers / scrum masters and business to define the scope of a project
• Working closely with both IT development teams and business teams in an agile environment to ensure successful delivery and efficient use of resources
• Assist in the change management by updating data as per QA request to make sure QA/Testing phases runs smoothly in the project
• Managed project requirement lifecycle by conducted JAD sessions, user interviews, and detailed research and requirement meetings to gather requirements and fetch details for Business Requirements document (BRD).
• Use a common repository to utilize notice templates and business solution documents (BSDs)
• Conducted numerous requirements elicitation sessions (whiteboard sessions, requirements workshops, brainstorming sessions etc.) to understand the business requirements of the end users.
• Involved in gathering requirements for any change request within the Worker and Consumer Portal.
• Responsible in knowledge transfer to developers by communication the requirement for development purpose.
• Was involved in doing Gap Analysis to know where are we now and what needs to be changes.
• Providing support at the time of implementation.
• Responsible in getting the Sign off from the stakeholders.
• Delivered UAT documentation to the BA to make recommendations on changes to the applications
• Extensive experience as manual functional tester writing and executing test cases for wed based applications as well as web portals and mobile application on IOS and Android devices.
• Involved in write and execute test cases to find system bugs like UI and usability issues.
• Used Jama to create cases, or work upon assigned cases/tickets, and to follow the STLC.
• Used JIRA to write requirement with production issues/create/log/track defects progress and to follow the defect life cycle and to analyze production defects.
• Involved in requirement gathering for Mobile project for consumer portal, which got developed from scratch with our current consumer portal functionality.
• Tested mobile application using IOS devices, Android devices and browsers such as Edge, IE, Firefox, and Chrome.
• Used BrowerStack tool to test on different Android and IOS devices to see if application working same in all the browsers along with different versions and also to see the look and feel of the application.
• Expert in performing all types and phases of testing including SIT testing, Functional testing, Compatibility testing, Integration Testing and Regression testing.
• Expert in creating test data using MS Excel.
• Performs enhancement testing of AHCT’s consumer and worker portals
• Test external website behaviors
• Request batch jobs for multiple purposes
• Validate Federal & State rules to test the different types of Medicaid and Qualified Health Plan (QHP) renewals, 95-day terminations and EDI validations
• Stimulate termination and creation of plans and applications in the worker portal
• Develop test cases from business use cases, test data and test scripts
• Responsible to validate 1095A form and SBMI validations using XML format
• Perform Regression testing for Releases to guarantee the full functionality of the system
• To reports defects, took screen shots, wrote a step-by-step flow of actions taken to run the reports or tools.
• Involved in Go-Live call while the code is deployed in Production to see that the system is working as expected.

Environment: Window 2010, Jira V7.5, Jama 8.55.0, Consumer Portal, Worker Portal, SharePoint, MS Office, O365, MS-Project 2000/2007, CMS, PMP, 1095A, CRM.

Confidential, Farmington, CT

Business Analyst(Reports)/QA Analyst

Responsibilities:

• Responsible in updating process documents such as Doctor Add, Product Add & Verifying FL-TX Doctor Licensure Information for operations team. Expertise in adding new products, doctors as per CSR’s request.
• Involved in UAT testing along with business and documented detailed test cases while working in an agile software development cycle.
• Monitored incoming calls to ensure quality assurance for CSR department.
• Assisted users for user acceptance testing (UAT).
• Actively participated in project meetings and discussions to gather the business requirements from stakeholders.
• Experienced and strong understanding for ICD9-ICD10 Implementation using Fastrack system.
• Involved in gathering requirement for transferring our telephonic interpretation & written document translation services from one vendor to another vendor.
• Assisting QA/UAT team on test cases creation for telephonic interpretation & written document translation services.
• Expert in doing end-to-end testing for phone line switches for telephonic interpretation & written document translation services from one vendor to another. Responsible to report a bug or error while testing the phone lines for our new vendor.
• Expert in creating process document for change in phone call options for our main phone line and involved in giving training to our Customer Service Representative’s so that they can guide our patients correctly when they receive a call to make sure our operations run smoothly.
• Responsible in creating the document for all our vendors and involved in giving training for phone switches from one vendor to another so that they can guide to our patients.
• Involved in working closely with Director to create the planning process for the ICD9-ICD10 implementation to run smoothly.
• Expert in validating date from production system to test region for testing purpose.
• Involved in creating product id’s by setting up correct prices in our test region same as production so that the testing process smoothly.
• Responsible in going through the detail call list from our new vendor twice in a week to make sure the detail call list is correct and non of the calls are duplicate calls before we bill to our clients for the service.
• Responsible in formatting the day-to-day reports and sending it to the team for our day-to-day operations.
• Involved in reviewing the invoices for our new vendor on daily basis to ensure all the information like Patient Name, Adjuster Name, Product ID, Patient ID, Claim # is correct before we receive purchase order for billing purpose.
• Involved in looking orders more then 10K dollar amount.
• Involved in ensuring the price we have in our system is correct based on ‘Fee Viewer’ as price varies from state to state and HCPCs codes.
• Involved in creating the process document and providing training to offshore team on WebEx to ensure they understand invoice import processing steps correctly.
• Involved in verifying the doctor, whose record is in our patient claim for billing purpose, I was responsible to verify doctor’s license for TX & FL to make sure that doctor is clear/active.
• Involved in adding new doctors in our system for our patients for billing purpose.
• Involved in ICD9-ICD10 crosswalk mapping manually for operations department.

Environment: Window 2010, Jira, Jama, Consumer Portal, Worker Portal, SharePoint, MS Office, MS-Project 2000/2007, CMS, PMP, 1095A, CRM.

Confidential, New York, NY

Business Analyst/QA Analyst

Responsibilities:

• Validated Global, Professional & Technical Rates for RBRVS File for Radiology & Surgical Lab
• Develops complete business specifications and screen designs for MCS and HCS system enhancements/modifications, recognizing any gaps and deficiencies and making recommendations to enhance current processes.
• Oversees all system modifications that impact Rates and Benefits tables related to provider, facility, and member reimbursement.
• Identify systemic issues based on daily reviews in both the HCS and MCS systems and develop process improvement plans.
• Validate system modifications and perform UAT for ICD10 related changes, such as field expansion, code conversion, business rule configuration, and other related updates.
• Perform postproduction validation to ensure accuracy of file releases.
• Compiles, completes, and/or coordinates all documentation required by BTS, such as: special reports, Business Objects (BO) reports, spreadsheets, and other required forms.
• Involved in loading of rates packages in Prototype for MCS.
• Created test plan for MAPD Table & WPS table by taking screen shots from production region and test region of Medical & Hospital systems to ensure its copied correctly in test region for conversation of ICD9 to ICD10 conversation
• Created MAPD ICD10 Diagnosis table for testing
• Verified all the screens are accurately maintained its functionality and commands
• Ensured all ICD fields continue to display from 5 bytes to 7 bytes and 125 fields from ICD9 to ICD10 conversion
• Verified all ICD fields are left justified in MCS & HCS systems
• Validated the data/codes to ensure accuracy of ICD9 to ICD10 codes, effective/termination dates and the new codes with the associated proprietary codes
• Validated the ICD9 codes mapping to the ICD10 by taking screen prints of the mapping spread sheet according to the CPT codes
• Revalidated open defects by updating in the Testing Verification Log
• Reviewed Child rates are loaded correctly in systems by doing QA
• Compared test plan screen shots with the respective extract grid to ensure all the new ICD10 codes are copied correctly in medical & hospital system
• Terminated the list of HCPCS codes in MCS system which are not in used in ICD10
• Responsible in creating Mass Adjustment Test Plan & Overpayment Test Plan from settled report to verify that claims paid correctly for various departmental audits.
• Involved in doing Post Validation for test plans created by other team mates to ensure that its calculated & paid correctly
• Loaded rates in MCS systems based on CPT codes & GHI codes for particular Svc codes
• Involved in adding Benefit contract for Benefit Configuration department
• Responsible in loading new Contract for Benefit Team in contract file of Mainframe system
• Involved in updating Benefit change on existing account for Benefit Team as per the requirement from Membership/Sales Team
• Responsible for Post Implementation with Corrections/Update on existing accounts for Benefit Team
• Verified new and Existing accounts loaded by teammates & ensuring that its loaded correctly in system
• Involved in Terminating accounts which are no longer an EH member as per the instruction sheet provided by Membership/Sales Team
• Maintaining Diagnosis & Procedure files in MCS & HCS system for Benefit Team
• Involved in updating Emblem Health CR/ER Benefit Grids for Benefit Team
• Developed & Maintained departmental PPM/Project Request for the team
• Responsible for all Email Inquiries for the team
• Involved in scanning instruction sheet provided by Membership/Sales department for our record and was also responsible in doing Post Implementation for contracts
• Responsible in working on Departmental Projects related to ICD9-ICD10 codes & CPT/Diagnosis Code Validation

Environment: Window2003/2010, Mainframe, SharePoint, QCare, MS Office Suite, Mercury Quality Center 10.0, SQL Server 2000, MS-Project 2000/2007.

Confidential, Manhattan, NY

UAT Tester

Responsibilities:

• Involved in EDI UAT Testing by creating test cases in Quality Center and executing for 270/271, 276/277, 837I, P and D, 835 transactions.
• Reviewed GAP Analysis to enumerate major differences between 4010 and 5010 transactions format.
• Interacted with BA’s, PM & Lead to discuss functional and Non-functional testing in regards to system
• Worked towards resolving various defects and updating status reports for weekly business and technical meetings.
• Leveraged Quality Center to log and co-ordinate defects.
• Involved in creating test cases with positive & negative scenarios for all EDI transactions.
• Created dummy claims by using Ultra Edit to check the response of the system.
• Used BizTalk In & BizTalk Out for dropping all edited claims to check claim process & procedure to get desired output

Environment: Window2003, Mainframe, BAM, BizTalk In & BizTalk Out, Ultra Edit, SharePoint, MS Office Suite, Mercury Quality Center 10.0, MS-Project 2000/2003.