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Qa Analyst Resume Profile

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

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