SUMMARY:

• 11+ years of experience in analysis, design, development, testing and implementation of software applications.
• Work with team members to identify project goals research methods, variables, and other test parameters
• Develops negotiating strategies and positions by studying integration of new venture with company strategies and operations; examining risks and potentials; estimating partners' needs and goals.
• Ability to collect data and offer recommendations on evaluating the projects.
• As a technical writer I have prepared instructional manuals and other important supporting documents that are technically complicated for most readers and then communicates them into a much easier to understand language
• Business consulting and solution recommendation experience
• Benefit and enrollment specialist (834 FILE PROCESSING)
• Understands the end users need of technical documentation and then organizes and translates the needed information into an easy to understand manual
• Perfect experience with HIPAA 837 (Claims) 835, 845, 277,997 etc.
• Wide knowledge of CPT and ICD 9 CM coding, governmental and HIPAA mandated patient confidentiality regulations
• Collects technical data and information from customers and disseminates that information for the companies use
• Good knowledge of EDI 844,845,849,810
• Very good understanding of procedure codes
• Excellent knowledge in developing and maintaining test methodology
• Ability to define test strategies for projects.
• Used SAP claim module to create EDI X12
• Production Planning (SAP PP), Material Management (SAP MM)
• Knowledge of SAP module Sales and Distribution (SAP SD)
• Coordinated the work of test teams and monitoring their performance.
• Following up any outstanding open test risks / issues.
• Managing the gathering of results and compiling test metrics for management.
• Reported to senior managers on progress and issues
• Great skills in Business Acceptance Testing & e2e Program Testing
• Ability to Identify test approaches that optimize the delivery schedule
• Able to plan, estimate, and arrange team meetings and workshops.
• Experience across multiple types of testing i.e. user acceptance, system integration and scenario testing
• Experience of working on Business, Technical and Functional Requirements
• Knowledge of MS Office tools including MS project, PowerPoint and Visio
• Able to take preventative action when any risks become unacceptable
• Understanding of different test approaches and techniques
• Excellent knowledge of Enrollment Resolution and Reconciliation process for health insurance exchanges
• Perfect skills in troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges
• Basic Knowledge of cloud - based EDI / Supply Chain Integration capabilities (Boomi)
• Ability to provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
• Worked on FACETS Data tables and created audit reports using queries. Manually
• Modified the 834 file and then checked if the eligibility enrollment is properly loaded onto Facets
• Translated technical data into simple, user-friendly language
• Proofread and edited other forms of written documentation
• Ensure document content and style adheres to appropriate regulatory guidelines
• Analyze and identify trends and provide reports as necessary
• Excellent knowledge in backend testing, end to end testing.
• Extensive knowledge in gathering and understanding BRDs (Business Requirements Document), FRDs (Functional Requirements Document), SRS (Software Requirement Specifications) and Use Cases.
• Use existing report template, modify existing template, monitor the consistency of format and create new template accordingly
• Expertise on identifying the Test Requirements based on User Requirements and Design Specifications.
• Perform quality checks to ensure accuracy of near-final documentation and confirm functionality of final output
• Basic knowledge of UNET claim processing software
• Ability to manage large sets of unstructured data and make sense out of it
• Excellent skill working remotely
• Worked as a senior technical writer for Law firms.
• Created lots of product review templates and wrote audit process metrics
• Developed customer service internet website e-commerce materials and templates.
• Validated claim work flows in facets, member enrollment, eligibility, benefits etc.
• Excellent knowledge of designing Data analysis plan and able to manipulate data using SQL
• Ensuring payments are in line with the customers' expectations
• Strong knowledge of EDI Claims, member enrollment, and billing transactions
• Understanding of HIPAA Standards and Compliance issues, HIPAA Privacy policy.
• Strong Knowledge of EDI Mapping
• Strong knowledge of ICD 9 and ICD 10 coding and mapping
• Able to identify business performance problems and tentative solution strategy
• Knowledge of project Management
• Good understanding of third party and government payer regulations
• Excellent knowledge of work break down structure (WBS) and Gantt Chart
• Good understanding of product review and process Audits
• Experience using QTP, Bugzilla and selenium
• Hands on experience in testing of all EDI X12 HIPAA 4010 and 5010 standards.
• SQL to perform backend testing, Data integrity and Data mapping.
• Performed Usability Testing and User Acceptance Testing.
• Participated in team meeting giving the status reports for the team on test execution and results.
• Perfect knowledge of Agile Methodology
• Excellent understanding of MS Visio using UML diagrams
• Perfect knowledge of file convention and review
• Performing claim validation testing for new business and health plan changes

TECHNICAL SKILLS:

XML, Quality Center, Bugzilla, SAP PO, SAP PI, Dev Track, SQL, MS - Visio, MS - Project, MS - PowerPoint, MS - Word, MS - Excel, notpad ++ PMP trained, Windows XP, NT 2000, EDI, ICD mappingSharePoint, EHR, centerprize, EDI manager etc…

EXPERIENCE:

Confidential

EDI Functional/Technical Analyst

Responsibilities:

• Strong knowledge of Health Care Insurance, EDI HIPAA transactions. Currently working on EDI Transaction sets including 837, 270, 271, 834, 835, 276, and 277..
• Good understanding of ICD-9 and impacts related to ICD-10.
• Perfect experience with HIPAA 837 (Claims) 835, 845, 277,997 etc.
• Wide knowledge of CPT and ICD 9 CM coding, governmental and HIPAA mandated patient confidentiality regulations
• Good knowledge of EDI 844,845,849,810
• Automating manual scripts by using Quick Test Pro (QTP) 9.5, 10. Use Mercury Quality Center for Defect tracking and reporting. Extensive Experience in Black Box Testing. Reviewing of Business Requirement Analysis, and System Specifications Analysis.
• Writing positive and negative Scenarios and Test Cases for System & Web testing using QC. Hands on experience testing Commercial Websites and business applications. Database querying and data manipulation using SQL and PL/SQL and involved in back-end testing as well as front-end testing.
• Proficient in back-end database testing on different database systems including Oracle, SQL Server, MS-Access.
• Strong analytical and problem solving, interpersonal and communication skills, self-starter, quick learner and able to adopt new technologies as needed in rapidly changing IT environment

Confidential

EDI/Test Manager

Responsibilities:

• Worked as an EDI Analyst for a federal project
• Excellent knowledge in developing and maintaining test methodology
• Ability to define test strategies for projects.
• Coordinated the work of test teams and monitoring their performance.
• Following up any outstanding open test risks / issues.
• Managing the gathering of results and compiling test metrics for management.
• Reported to senior managers on progress and issues
• Great skills in Business Acceptance Testing & e2e Program Testing
• Ability to Identify test approaches that optimize the delivery schedule
• Able to plan, estimate, and arrange team meetings and workshops.
• Experience across multiple types of testing i.e. user acceptance, system integration and scenario testing
• Experience of working on Business, Technical and Functional Requirements
• Knowledge of MS Office tools including MS project, PowerPoint and Visio
• Able to take preventative action when any risks become unacceptable
• Understanding of different test approaches and techniques.
• Worked on 1095 A project
• Performed cases analysis and made decisions based on the findings
• Review all transactions for compliance, timeliness and accuracy prior
• Performed HICS updates
• Worked on assigned projects by team leads and follow through to ensure work is completed
• Designed traceability and assessment metrics
• Managing test teams and strong influencing and Communication skills
• Having a flexible attitude and positive approach and the ability to lead offshore testing teams
• Experience of client facing roles and constantly maintaining high levels of accuracy
• Ability to quickly learn applications with minimal documentation Actively participated in project enhancement meetings
• Worked on an Agile Environment.
• Participated in defects review and Test Readiness meetings on weekly basis.
• Interacted with business user for any updates on Requirements of these projects

Confidential, Towson, MD

Sr. Business Analyst

Responsibilities:

• Worked heavily on SQL statements (designed hundreds of SQL statements to assist the team to retrieve data easily)
• Worked on 837, 834, 4010 and 5010 HIPAA files
• Great knowledge of revenue services, 835/837 claims processing and X12 version of HIPAA
• Performed HIPAA compliance check against any 837 files before submitting to the client
• Receive and distribute enrollments transactions to the appropriate party for processing
• . Review all transactions for compliance, timeliness and accuracy prior to creating the 834 file
• . Ensure accuracy and return errors to be corrected
• Process online enrollments for other carriers
• Perform EDI mapping and set up file transfer for carrier transactions
• Run Daily crosswalk report to populate membership # for each active employee enrolled in benefits
• Create, review and edit daily 834 files and ensure that coverage level and plan
• Ensure compliance issues are checked using E-file manager and SEF Application
• Performed Level 2 testing, regression test and any other test necessary
• Perfect understanding of rendering provider loop and 837 data element errors
• Perfect knowledge of insurance file segments
• Designed the team’s 837 tracking metrics, SQL templates and data analysis plan template
• Extensive knowledge of HCFA 1500, UB 92, ICD9 and CPT coding
• Designed lots of functional Spec and updated functional Spec documents to meet business requirements.
• Worked with DB Visualizer, my SQL, Oracle, Data Modeler, MS Visio, PM tools etc.
• Designed and updated most of the client’s 837 functional Spec
• Worked with over 100 different clients and understands their business protocols
• Currently working in an excellent Agile environment
• Made sure that what is on the business document correlates with the actual work performed
• Wrote EDI documents that tracks the progress of the 837 inbound and outbound files
• Runs 837 import and export jobs and makes sure any errors are fixed within the SLA
• Resolved hundreds of 837 tickets based on work experience and business requirement.
• Assigned projects to team members and follow through to ensure work is completed
• Designed employee’s traceability and assessment metrics
• Worked directly with clients, vendors and acts as a subject matter expect between the business owner and the team.
• Reviewed the Business Requirement documents and the Technical Specification documents
• Developed Test Plans, Test Cases and Test Scripts to define scope of overall quality assurance testing
• Performed the Back-End testing to ensure data consistency on front-end by writing and executing SQL statements on Oracle Database.
• Involved in coordinating with developers, systems engineers and subject matter experts
• Conducted Bug Review meetings with developers and subject matter expects
• Analyzed and tested HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Tested the HIPPA EDI 837/835 transactions according to test scenarios and verify the data on different modules.
• Tested XML generated data.
• Managed both institutional and professional HIPAA files
• Currently writing from scratch functional specification document for some of our new clients

Confidential, Reston Virginia

Sr. Business System Analyst

Responsibilities:

• Conducted Functionality testing and Regression Testing using Lancelot Application
• Verified HIPAA rules
• Worked on HL7
• Converted RX guardian Report to XML format
• Used Xifin tool to generate HL7 file
• Worked on EDI 837, 834, and 850
• Worked on EDI data mapping and data integrity also designed data analysis plan for the project
• Translated EDI file into a more readable format
• Tested EDI segments and wrote test cases based on BAs documents
• Understand EDI matching logic
• Understand data security and privacy
• Verified that HL7 file is received by FTP server
• Tracked and verified Bugs in both Bugzilla and FTP
• Processed urine samples in both Aurora and Lancelot
• Tracked Bugs in Aurora Application
• Worked heavily on Lancelot staging environment
• Bug re-verification towards any roll out and release into production
• Tested data to check HIPPA- eligible & participation check for individual coverage
• Performed web application security vulnerability testing.
• Used parameterization to test the application for different kinds of data.
• Uncovered multiple issues related to the data population in the backend database manually.
• Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have knowledge on FACETS business rules.
• Tested the changes for the front end screens in FACETS
• Modified the 834 file and then checked if the eligibility enrollment is properly loaded onto Facets
• Prepared test scripts and test scenarios
• Performed point of care testing (POCT) using Lancelot project test
• Conducted GUI Testing manually.
• Performed Security Testing manually using Positive and Negative Testing to ensure appropriate user authentication
• Tested and detected bugs in the front end of the application
• Performed UAT, Usability, Cross-Platform and Regression Testing during different stages of the application development.
• Used Quality Center to communicate bugs with other members in the project.
• Developed thousands of Test Cases and scheduled in Quality Center and MS Excel
• Created regression script scenarios in MS Excel and Quality Center
• Performed Specific Validity testing at the back end
• Participated in various meetings and discussed Enhancement and Project Change Requests
• Actively participated in project enhancement meetings
• Worked on an Agile Environment.
• Participated in defects review and Test Readiness meetings on weekly basis.
• Interacted with business user for any updates on Requirements of these projects.
• Worked on EDI 837, 834, and 850
• Tested database of Legacy System using Microsoft SQL Server for checking integrity of database
• Identified the test scenarios followed by the Use Case documents.
• Participated in the peer reviews to validate the test cases written by different teams.

Confidential

BA/QA Analyst, Columbia MD

Responsibilities:

• Reviewed the Business Requirement documents and the Technical Specification documents
• Developed Test Plans, Test Cases and Test Scripts to define scope of overall quality assurance t
• Conducted Functionality testing and Regression Testing using QTP
• Performed Back-End testing to ensure data consistency on front-end by writing and executing SQL statements on Oracle Database.
• Able to run multiple test Partner projects at once in command prompt
• Used parameterization to test the application for different kinds of data.
• Prepared test scripts for automated testing using QTP
• Conducted GUI Testing manually.
• Performed Security Testing manually using Positive and Negative Testing to ensure appropriate user authentication
• Used Recovery Scenario Manager in QTP to handle exceptions
• Inserted variety of check points (Object Check point, table check point, test check point, etc) to match the object properties captured during the recording session with the objects properties captured during the run session using QTP.
• Tested and detected bugs in the front end of the application
• Performed UAT, Usability, Cross-Platform and Regression Testing during different stages of the application development.
• Used Quality Center to communicate bugs with other members in the project.
• Developed Test Cases and scheduled Test Runs in Quality Center.
• Participated in various meetings and discussed Enhancement and Project Change Requests
• Tested the upgraded SAP Finance and SD Module, which consists of Accounts Payable, Accounts Receivable and General Ledger.
• Coordinated with offshore teams on a daily basis to get the status updates.
• Performed negative testing heavily to encounter invalid unexpected values

Confidential

BA/QA Analyst

Responsibilities:

• Adapted UML standards to define modularized Data Process Models.
• Conducted JAD / JAR and Elicitation sessions for user interviews to gather requirements
• Performed GAP Analysis for new functionality requirements and prioritized them based on the business needs.
• Developed and enhanced the Test Scripts in QTP for automated testing.
• Performed web application security vulnerability testing.
• Performed point of care testing (POCT) using Lancelot project test
• Conducted GUI Testing manually.
• Performed Security Testing manually using Positive and Negative Testing to ensure appropriate user authentication
• Tested and detected bugs in the front end of the application
• Performed UAT, Usability, Cross-Platform and Regression Testing during different stages of the application development.
• Performed the Back-End testing to ensure data consistency on front-end by writing and executing SQL statements on Oracle Database.
• Involved in coordinating with developers, systems engineers and subject matter