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Business Analyst/qa Lead Resume

Manhattan, NyC

PROFESSIONAL SUMMARY:

  • An astute, detail - oriented QA/Business Analyst with seven years of consulting experience Confidential
  • Experienced in testing implemented systems and system changes, including liaising with QA teams to develop test cases, test plans, test scenarios, generating test data, and conducting manual testing (regression, end-to-end, functional).
  • Proficient in creating User Acceptance Test (UAT) Plans and implementing and coordinating UAT.
  • Experienced running scripts to check web user interface and Portals for Broken Links, Frame Properties, Table Properties, URL links, Images, Text and has prepared Test Metrics to test execution status and results.
  • Demonstrated expertise with Medicare and Medicaid, including Claims, Adjudication and Billing.
  • Extensive experience with HIPAA regulations, I have got experience developing process maps, and AS-IS and TO-BE process conceptualization and improvements.

TECHNICAL SKILLS:

  • Expert at assessing business requirements and defining traceable, understandable application requirements.
  • Experience with Medicare and Medicaid: Confidential, Membership, and Eligibility Verification and care management.
  • Thorough knowledge of Eligibility and membership Affairs. Also knowledge of HIPAA, X12, and HL7 standards and Medicaid provider best practices.
  • Good Knowledge of ICD-9 codes and CPT codes for both Mental and Medical Health.
  • Worked extensively with 837i and 837p transaction sets.
  • Extensive experience in requirements gathering, feasibility analysis and successive documentation in project related artifacts like the User, Functional and System Requirements Specification documents
  • Extensive experience in Unified Modeling Language (UML) modeling, including Use Cases, Activity diagramming with swim lanes, and Context diagrams using tools such as MS Visio
  • Familiar with CMS1500 Medicare forms.
  • Experience capturing requirements for EOB’s
  • Experience testing implemented systems and system changes including liaising with QA teams to develop test cases, test plans, test scenarios, and generating test data; and conducting manual testing (regression, end-to-end, functional)
  • Creating artifacts such as URS, FRS, Traceability Matrix, project plan, BRD, test plans, and test cases
  • Experience running scripts to check web user interface and Portals for Broken Links, Frame Properties, Table Properties, URL links, Images, Text and prepared Test Metrics to test execution status and results
  • Developing AS-IS and TO-BE systems, and translating business needs into technical changes / developments

PROFESSIONAL EXPERIENCE:

Confidential, Manhattan, NYC

Business Analyst/QA Lead

Responsibilities:

  • Assisted Project Manager in drafting the Project plan; defining scope, and establishing work breakdown structure and project milestones using Microsoft Project.
  • Elicited Business Rules and other Non-functional specifications by interviewing the Subject Matter Experts (Doctors & Nurses) to further understand the business models
  • Documented and analyzed new requirements from the SME’s and end users.
  • Analyzed Data flow of the cases across all the systems and created the process flow diagrams.
  • Determined the key criteria’s for Medical Routing.
  • Conducted requirement feasibility analysis to determine the technology feasibility of each requirement with the help from System Architect/Developers.
  • Designed Functional Specification documents and Process Flow diagrams with Use Cases for different modules: Appeals, Disease Management, Adverse Determination, Complex Case Management and Surveys.
  • Designed Medical and Behavioral Health test scenarios for different phases of QA and UAT testing cycles using various parameters like; Member’s information - from different LOB’s (Line of Business) - Medicare, Medicaid, HMO, PPO, EPO, and POS; Different POS/TOS combination - with corresponding ICD and CPT codes; and Vendor / Provider Status - for both PAR and NON PAR.
  • Involved in testing different scenarios on Medical cases by creating Referral or Prior Approvals for: Inpatient services, outpatient services, office services, Home Care, DME and Transportation and the ER Notifications.
  • Extensively involved in testing the CERME (Care Enhance Review Manager Enterprise) assessments in maxMC.
  • Worked on testing and validations of the JCS and ECP rules.
  • Validated the Process flow and data mapping across all the systems: Web Portal (PEP / HD) to maxMC to QCARE and the back fills, during different phases of QA and UAT testing cycles.
  • Conducted detailed analysis on fixing the errored-out cases from QCARE.
  • Performed Eligibility checks for Members and Providers in QCARE.
  • Actively involved in system testing during all the phases of maxMC deployment for different departments of Confidential .
  • Maintained and Reviewed Change Requests and documented all analysis.

Environment: Medical Management System: maxMC & WinUCS, Web Portal: Heads Down & PEPs, Main Frame system: QCARE, MS Access, ORACLE, MS Word, Excel, and PowerPoint.

Confidential

QA Analyst

Responsibilities:

  • Evaluated business process requirements to ensure proper system configuration (i.e. identifying key decisions, process changes, pain points, interface issues, training considerations, etc.)
  • Understood EMEVS, the State’s Electronic Medicaid Eligibility Verification System; HIPAA compliant ePACES (Electronic Provider Assisted Claim Entry System) and Computer Sciences Corporation, State’s Medicaid and Medicare Intermediary, and their roles in Medicaid Confidential
  • Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team
  • Understood the healthcare plans offered, including Medicaid Managed Plans such as Children and Adolescent Care, Women’s Preventive Care, Maternal Care, Asthma Care, Diabetes Care, Cardiovascular Care, and Mental Health.
  • Gathered AS-IS and TO-BE information about Affinity Health Plan’s work processes and information flows (Claims process, Membership, Enrollment), and conceptualized using swim lane activity diagrams
  • Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
  • Performed gap analysis as pertains enrollment, membership management, Commissions, Finance and Confidential ; relating for instance to Provider IDs use on plan communications; remittance advice statements; explanation of payments (EOP); and Member ID cards; and healthcare providers use of the assigned Affinity Provider ID number(s) for use in claims submission and plan inquiries.
  • Used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
  • Made sure that the incoming 837I or 837P structure comply the validation process.
  • Tested HIPAA Gateway Application Interface for all inbound and outbound messages (Healthcare Eligibility 270 and 271, Healthcare Claim Status request 276 and 277, Healthcare Claim 837 and 835)
  • Expertise in development of High level design, Conceptual design, Logical and Physical design for Database, Data warehousing and many Distributed IT systems
  • Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team to understand repository objects that support the business requirement and process.
  • Various aspects of the project’s needs such as the logging, tracking, and resolution of issues, current state workflow assessments, facilitating/presenting DBV sessions, and assist with integration testing
  • Clarified to Claims personnel the new Affinity payments and EOPs for same claim processing cycle: Unlike currently where payments for all claims received within a given cycle are lumped into a single check, there would be two separate EOPs and checks in the same cycle since the new and old systems would be used to process different types of claims, based on dates of service and product
  • Conducted User Acceptance Testing and user training pertaining to old and new Affinity Provider ID appearing on documents providers receive from Affinity (mainly occur with EOPs, capitation rosters, PCP membership rosters, provider directory listings and some system generated letters)

Environment: Facets Extended Enterprise(TM), Oracle, MS Word, Windows XP, S SQL, VB.NET, HTML, Mercury Quality Center

Confidential, Washington DC

QA Analyst / Tester

Responsibilities:

  • Implementing an RUP methodology, assisted the Project manager with Project Initiation, business case development, phase planning, iteration planning, and risk analysis. Also implemented roadmap for Project implementation, conducted assessment, defined various stages, deliverables, templates and acceptance process
  • Managed the requirements gathering process including scheduling interview and brainstorming sessions with user groups to gather, prioritize, and to decompose business and technical requirements
  • Elicited, documented, and analyzed health and life insurance processes and procedures to conceptualize New Business Enrollment process, Commissions Process, and Claims process; and created a set of requirements to be used for workflow automation
  • Rational ClearCase was used to manage all the changes and change requests in the projects. Worked with QA team with the aid of ClearQuest for the bug tracking and Mercury Test Director for Test Case Management.
  • Designed and implemented SQL queries for QA testing;
  • Drafted many documents including Analysis Document, User Requirements Document, Functional Specifications Document, Design Specifications Document, Test Plan & Strategy, Traceability Matrix, and Training Manual
  • Captured data requirements for EOBs providing information about claim payment information and patient responsibility amounts
  • Performed extensive data modelling to differentiate between the OLTP and Data Warehouse data models
  • Designed and developed Project document templates based on SDLC methodology
  • Helped with data modeling and defining the conceptual and logical model of the data warehouse.
  • Drafted UML Diagrams such as Use Cases, and Swim Lane Activity Diagrams, and reviewed with SMEs
  • Drafted Request For Proposal (RFP) and sent out to 3rd Party Vendors (Varicet, SAP, Centive, Trilogy, Xactly, Synygy, Oracle, Intellinet, Varicent, Actek, Callidus) for a new Commission/Incentive Management solutions
  • Rated all the vendor responses on a scale of 1-5 (1-Strong Negative, 2-Caution,3-Promising, 4-Postive, 5-Strong Positive) based on Aflac’s needs and priorities; cost, vendor’s ability to deliver, and vendor support
  • Executed PL/SQL queries during manual testing to functional test, end-to-end test, and regression test TRAC (the commission processing mainframe system), SNG, AWES, and PBI systems; assisting the Software Testing System team
  • Prepared meeting materials including agenda; wrote down minutes of meetings during meetings; distributed and post them to the project repository; and did follow-ups monitoring work progress versus assigned tasks
  • Always maintained excellent problem-solving and communication skills; and effectively listened, negotiated, debated, discussed, brainstormed, communicated, and collaborated with a variety of individuals and groups

Environment: Life70, DB2, QSAM, VSAM, TeamWorks, EZTRIEVE, COBOL, Assembler, J2EE, MS SQL Server, Mercury Quality Center, MS Office, MS Visio, Certify, MQC, VB.Net, Java

Confidential, Chicago, IL

Business Analyst/QA Tester

Responsibilities:

  • Worked as an Interface between the Users and the different teams involved in the application development for better understanding of the business and IT processes.
  • Involved in analysis of the technical specifications of the current system and the infrastructure needs performed Gap analysis.
  • Created Need Analysis Documents of the requirements gathered through JAD and JRP individual elicitation sessions using MS Word
  • Created Data structure and Data model diagrams associating myself with Data modeler.
  • Created User Requirement Specifications (URS) and Functional Requirement Specifications (FRS) documents.
  • Assisted in preparation of Request for Proposal (RFP).
  • Provided management with metrics, reports and schedules as necessary and participated in the design walkthroughs meeting using MS Project
  • Participated in entering, tracking system defects in Rational Clear Quest
  • Authored progress and completion reports, which were then submitted to project management on a weekly basis.
  • Created customized report using OLAP Tools such as Crystal Report for business use
  • Wrote Test Cases in Mercury Quality center that would test various Test scenarios.
  • Used UML notations for Object Oriented Design and Documentation.
  • Interfaced with the development team utilizing ASP, JavaScript and Visual Basic and produced detailed user-interface prototypes and performed usability testing.
  • Manually tested and GTS modules using Quality Center.
  • Collaborated with Quality Assurance Analyst in Rational Clear Quest to track defects and used Rational Clear Case to maintain consistency in the builds.
  • Reviewed and incorporated enhancement to current functional testing scripts. Extensively used the Quick Test Pro Check Points (Object Property, text, table, and database)
  • Parameterized test scripts using Regular Expressions to handle dynamic data names.
  • Attended meetings with management to discuss the status of project and draft strategies for the near future.
  • Followed RUP quality Assurance and Testing Process. Interfacing with program management and executive teams regarding quality assurance goals
  • Set up definitions and process for test phases including Product test, integration test, system test and User Acceptance Test (UAT).
  • Prepared automated generic Test Scripts and Functions using Rational Robot for functional/GUI and regression testing
  • Executed test cases manually and reported bugs using Quality Center
  • Interacted with Business teams and Developers to understand business requirements and bug fixes

Environment: QTP, Load Runner, Test Director, Mercury Quality Center, VB.Net, ASP.Net, MS Office Suite, Windows XP / NT, Oracle.

Confidential, Washington DC

QA Analyst

Responsibilities:

  • Gathered Business Requirements by working extensively and interacting with the Client Service Managers, Designers, Developers, Project Manager and SMEs to get a better understanding of the Business Processes
  • Assisted the project manager in preparing project schedules, resource allocation using MS Project and delivered timelines for project delivery and managed projects, resources and change requests to successful completion.
  • Used Test Director and Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
  • Performed Load and Stress Testing using Load Runner.
  • Automated confidence tests that run on new builds on regular basis.
  • Created “AS-IS” and “TO- BE” documentation for the allocation processes.
  • Conducted Gap Analysis to optimize the productivity.
  • Developed Business Requirement Document (BRD), Functional Requirement Document (FRD), ETL Specifications and Report Specification Document (RSD).
  • Developed UML diagrams like Activity/State Chart Diagrams, Sequence Diagrams, and Collaboration Diagrams using MS Visio thus defining the Business Process Model.
  • Involved in all phases of Software Development Life Cycle (SDLC)
  • Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
  • Establish "Hot" and "Cold" store lists for allocators to address Establish turn goals and inventory caps for "Space-Challenged Stores"
  • Analyzed and ranked all the stores by the sales and evaluated inventory levels.
  • Facilitated Buyer/Merchandise Manager to develop, implement and manage initial purchase plans.
  • Met with clients & Stake Holders groups to determine User Requirements and goals.
  • Utilized Rational Unified Process (RUP) to configure and develop process, standards procedures.

Environment: MS Project, MS Office Suite, MS Visio, TFS (Team Foundation Service), Microsoft Share Point, Cognos, SSRS and SSIS.

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