Summary

• 8 years of experience in Healthcare Clinical EHR implementation, and financial- Billing
• Working knowledge in Hospital and Clinical settings on various systems, and applications
• Industrial experience includes Healthcare HIPAA and EDI , EHR clinical Systems
• Detailed knowledge of various phases of Software Development Life Cycle SDLC with emphasis on Requirements gathering Test phases in RUP, SCRUM and Waterfall methods
• Know-how of other Epic applications/Foundations and how they integrate with Billing - Epic Care Ambulatory, HIPAA, Health Care industry overview
• Integrated knowledge of ADT, Orders, and Clinical Documentation for CPOE phases in end-to-end realistic Outpatient and Inpatient workflows
• ICD 9-ICD 10 Conversion knowledge -Worked in the analysis of the ICD 9 - 10 codes
• HIPAA 4010 - 5010 Conversion Analysis -Involved in documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 Transactions
• Experience working in different Business Areas - Finance, Billing, Claims, Benefits Administration, Group and Provider Administration
• Knowledge of Hospital Billing, Charge and Revenue Codes CPT , HCPCS, ICD-9-CM code books, CMS 1500 professional claim forms and UB-92 hospital claim forms
• Support and implement non-production and HIPAA compliant Test Data Strategy.
• Expertise in analysing Business Specifications, Use Cases, Workflows and develop Test Cases.
• Extensive experience in Functional, Integration, End to End, User Acceptance UAT testing.
• Hands on experience with industry's leading QA tools - HP Quality Center, and Clear Quest.
• Ability to multi-task and work under extreme pressure in a deadline driven environment.
• Creative self-starter capable of establishing positive and productive working relationships

TECHNICAL SKILLS:

QA Testing Tools Quality Centre, SOAPUI, Edifecs, Claredi Methodologies Rational Unified Process, SCRUM, Waterfall Web Technologies HTML, XML, Apache Web Server. Operating Systems UNIX, Mainframes, Windows Server 2003, MS-DOS Reporting Tools Business Objects XI R2/6.5 Languages DBMS Oracle, MS Access, SQL Server, DB2 Documentation Tools Microsoft Project, Excel, Word, Access, PowerPoint, Visio

Healthcare/Clinical Information Systems

• Epic Inpatient ADT, ClinDoc, Willow
• Epic Outpatient Cadence, Ambulatory
• MDLand
• EZ Claims
• HIPAA ANSI X12 4010/501
• ICD 9/10, HL-7.

Work Experience:

Confidential

QA Analyst

Responsibilities:

• Portal testing, for Emblem Health emblemhealth.com GHI ghi.com that covered testing of Search functionality for users for searching participating doctor, claim status, status of pre authorization also, direction/location of provider office, SMS and email alert functions. etc.
• Testing of IVR
• Testing of provider functionality towards searching of claim status, status of pre authorization, and searching for eligibility status of subscriber.
• Preparation of detailed Test Scenarios and Test Cases in HP Quality Center
• Used MAXMC and PEP for testing Database functionality from subscribers and provider perspective.

Confidential

QA Analyst

Responsibilities:

• Migration of HIPAA 4010 to 5010 conversion analysis .
• Preparation of detailed Test Scenarios and Test Cases in HP Quality Center
• Validation of various transactions and documents base on EDI files 837 I, 837 P, 835,834,820/270,271, 276 277 and 278.
• Access information from patient provider database, subscriber database and code set database DB2 databases and use the same to generate messages using EDIFACT tool.

Confidential

EDI Test Analyst

Responsibilities:

• Responsible for testing entire claims processing workflows as per business requirements.
• Gathered requirements and reviewed Use Cases for the applications that used SSN and DOB as unique identifiers.
• Created a comprehensive QA framework, which would test the implementation of the new claims rule engine for any specific Carrier from all possible angles.
• Validated displays of Patient Screen to include masked SSN DOB Information.
• Claims Process validation - Identified Claims Matching Scenarios upon which millions of Claim records were matched daily based on Patient's Information.
• Involved in writing Test plans, creating Test scripts, and Team Co-ordination.
• Performed Analysis of ICD 9 Procedure and Diagnosis Codes in accordance with ICD 10 CM and ICD 10 PCS Conversion Compliances.
• Organized meetings and led JAD sessions to ensure legal and compliance deadlines of CMS Centres for Medicare and Medicaid Services are met.
• HIPAA 4010 - 5010 Conversion Analysis - Involved in the documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 Transactions.
• Defined the approach for automating significant parts of the QA framework.
• Responsible for carrying out manual testing like Integration, Regression testing during various phases of test cycles.
• Interacted with dev. various members to discuss and resolve defects based on priorities.
• Developed and Maintained Test Schedule for Quality assurance deliverables.
• Responsible for working with application team in UAT and Production Release.
• Tracked defects in Quality Centre and provided test execution progress updates

Confidential

EPIC/EDI Analyst

Responsibilities:

• Responsible for coordinating, Go Live support call center for Inpatient Department application involving ADT, ClinDoc and Orders.
• Coordinated with test execution manager and project manager in prioritizing and tracking test case scenario execution for ADT workflows.
• Assisted with validation of various transactions and documents mandated for various Plans including ANSI 270/271, 835 and 837 transactions.
• Gathered data requirements from business team, and downstream ancillaries for Daily Reporting, and validation.
• Performed extensive EDI testing on X12/5010 837,835, 270 etc, and validate inbound /outbound EDI transactions to Facets.
• Thoroughly reviewed and tested each new release/enhancement and analyzing data conversion needs.
• Daily communication - Clinical Support System Managers for charge entry on test patients.
• Verified that correct Charge Codes were matched to corresponding DEPs Login Departments , with revenue and charge codes.
• Assuring that all test scenario pre-requisites for Patient Class, Epic Login Departments, Unit/Room/Bed, Providers, Coverage, and Guarantor information by working with ADT and Hospital Billing team.
• Assisted Testing Coordinator with coordinating logistics with project team members to ensure testing activities are carried out as planned

Confidential

QA Analyst

Responsibilities:

• Analyse, support, test, document and problem solved issues within the Electronic Health Record to maintain quality clinical data, accurate test data.
• Responsible for supporting design, validation and build sessions and perform work generated from those sessions.
• Program system to support and facilitate the ADT Admission/Discharge/Transfer process scheduling process, clinical workflow, and integration between systems.
• Coordinated the analysis, implementation, and testing of new Epic functionality during special updates, interim updates, or upgrades.
• Participated in 24/7 on-call rotation supporting end users of EPIC.
• Onsite EPIC go live support April/May 2008.
• Validated preference lists, reports and print groups, BCA reports, best practice alerts, inbasket messages, care plans and flow sheets

Confidential

Epic Analyst

Responsibilities:

• Involved with Physician Implementation team who supports EPIC during Go-live throughout all 7 Sentara Hospitals and two stand-alone Emergency Departments.
• Responsible for reviewing specialty specific workflows, a demo of EPIC Inpatient functionality, develop support plan and post go-live support plan.
• Co-management readiness for next rollout including two stand-alone Emergency departments which includes, Physician training, computer accessibility, and workflows.
• Successfully implemented eCare EPIC at Sentara Leigh Hospital 250 beds with Clinical Documentation and CPOE.
• Ensuring that data interfacing into Cadence meet business needs - both for ongoing interfaces and one-time data conversions.
• Trained front desk clerk on EPIC Care scheduling patient appointment.
• Successfully recruited and hired implementation team and leads discussions during go-live at daily debriefings with Hospital Execs and PMO.
• Works directly with the design, and build, teams to review training plans and actively participates in on the fly build during go-live