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

• Confidential is a company that provides health insurance through subsidiaries Group Health Incorporated GHI and the Health Insurance Plan of Greater New York HIP . Considering HIP and GHI together, it is is the largest health insurer based in New York State serving nearly 3.4 million people with over 92,000 providers in 150,000 locations across the tri-state region. 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