SUMMARY

• Healthcare/IT professional with over 15 years claims, configuration and testing in payer systems.
• Awarded for Outstanding Quality and Efficiency in teamwork from Confidential Facets UC in 2013.
• Performed system enhancements in Facets applications during multiple Facets 5.1 ACA conversions from
• Managed ACA baseline requirements and client’s system assessment results in Facets 5.1.
• Able to implement the best configuration approach in Facets front - end and back-end for updates to Profile type, Payment Drag, Outlier, Min/Max Discount in Facets 4.81-5.1 Networx Pricer.
• Configured pricing details for calculating multi-level case rates based on number of days in hospital with additional days to be priced separately.
• Managed 20+ team members from requirements-gathering to implementation and support.
• Proactive in defining direct project objectives, critical success factors, milestones, and risks.
• Tracked and controlled precedence relationships activities along with time and resources.
• Managed and controlled data warehouse projects using data, technical and application tracks.
• Created documentation/stories in agile environments using backlog and scorecard for scrum.
• Lead functional unit work-sessions as a solid communicator with exceptional team-building skills.
• Created Gantt, Pert, and CPM charts for monitoring predecessors, dependencies, and CA’s
• Executed Project Evaluations to validate Inputs match outputs using multiple feasibility analysis.
• Managed and controlled sequences of tasks using multiple dimensional views in Gantt charts.
• Adept knowledge of providing detailed analysis of all interfaces and data feeds for the project.
• Project Methodologies include: Initiation, Planning, and Execution; controlling, and closing.
• Rendered UML diagrams and charts for stakeholder’s demonstrations and user’s work-sessions
• Updated and added Networks, Medical groups, Capitation rules, and Provider Agreements for multiple Facets provider build.

TECHNICAL SKILLS

Software Testing: Test Planning and Design, Unit Testing, SIT, Functional testing. UAT

Business Requirements: HP ALM, QC, Test Manager, Clarity, Sharepoint, Jira,Clearquest, Requirements Development and Management, GAP Analysis,, Forward/Backward TracingAutomation Tools: QTP, Silktest,Test Monkey, RIA Test,Junit Selenium, TFS,Netbeans,Eclipse

Test Management: Burndown reports, Defect Mgmt, Test Execution Report,, Baseline Testing

Scripting and Messaging: JavaScript, JSON, VBScripts,Biztalk,,PHP,korn, VI editor, bash

Databases: Microsoft SQL Server, Access, Teradata, T-SQL,PL/SQL,Oracle 9i-11g,MySQL, Sybase,Netezza

Project Management: CPM,Pert/Ganitt,Outsource Model, CMMI-ACQ,Core Strategy

Strategic Alignment and BPM: Baseline, Core Strategy,SLA,Dashboards, Balanced Scorecards

Networking: OSI and TCP Model, Network Architecture and Topology, Hardware and Software.

Security: CISP,BCP and DR, Risk Management with Risk Assessment, Security Posture.

Payer Systems: Facets 4.2-5.1, QNXT 3.2-4.8,IDX,EZCAP,RIMS,GEMS,UHC,AS400,Claimfact.

PROFESSIONAL EXPERIENCE

Database Developer

Confidential, Irvine, CA

Responsibilities:

• Project manager for design, automation, and solution development of various applications, including integrating existing user-developed Access databases into SQL server back-end and modifying front-end screens.
• Analyze business models, logical specifications, and user requirements to design and test solutions for application environment.
• Employ activity and data modeling, transaction/workflow analysis, internal control and risk analysis, and performance-measurement techniques.
• Defined disaster recovery plan, recommended options, and created user manual. Led tool evaluation.
• Prepare reports, studies, and documentation. Deliver presentations and lead meetings.
• Designed a MS SharePoint portal for migrating data mapped from MS Access 2014.

Database Developer

Confidential, Irving, TX

Responsibilities:

• Extracted and transformed source data using CDC techniques in the ETL process for a small client.
• Able to mine historical data in OTLP for the creation decision support for OLAP systems during Data Warehousing process.
• Leveraged data warehouse requirements to identify business entities for creation of business keys in dimension tables and look up surrogate keys in Fact tables.
• Loaded fact tables using file-based bulk loader tools for million rows or DML for smaller loads.
• Validated data changes during load from source system using queries for updates/inserts in dimension rows.

Lead Configuration Analyst

Confidential, Denver, CO

Responsibilities:

• EPIC Certified in TAP110/112(Dec 2014) for configuring Carriers, Benefit Groups, Employer Groups, Networks, and Providers using EPIC Tapestry Core.
• Created and configured provider contracts and pricing mechanisms in EPIC to match service related or claim level events.
• Set up Access Control and permissions for application and component levels for EPIC. Users.
• Gathered high-level requirements for configuring provider’s information in EPIC Tap110 and Tap112.

Meditech Test Lead

Confidential, Denver, CO

Responsibilities:

• Validated HL7 ADT Workflow along with Meditech applications, interfaces, and Reporting.
• Validated (Scheduling, Admit/Discharge, Orders, PHA, and LAB) messages during ICD10 testing of Meditech 5.66 and 6.0.
• Facilitated BPR at CHI ICD10 initiatives for upgrading to Facet 5.0 - 5.1 as a downstream application for Benefits, Pricing, and claims modules.
• Validated Facets manual and automated conversion activities for Facets applications with new fields for 5.1 conversions
• Analyzed design and build of products to configure Facets tables affecting Medical/Medicare, self-funded, and Blue products along with SEPY, SESE, DEDE, and LTLT tables.
• Ran unmatched queries and Inner, Outer Joins in Access during validation of product and groups.
• Unit testing of product updates affecting service ids/rules for code migration to production.
• Performed root cause analysis with SWOT for meeting project/product scope using Six Sigma.

QNXT Senior Developer

Confidential, Ventura, CA

Responsibilities:

• Used agile methodology to elicit and transformed user requirements into a standard reporting solution and worked closely with clients to ensure change requests were met.
• Generated multi parameterized reports in MS SSRS 2008 to allow end users to generate dynamic QNXT 4.81 claims aging reports.
• Rendered dynamic Reports in SSRS 2008 using raw SQL, BIDS, Report Builder, and Report Manager to create final .RDL file and C#
• Manipulated data/fields/columns in QNXT tables using indexes, triggers and stored procedures to create customized reports in SSRS 2008.

Facets Benefits Configuration Analyst

Confidential, Buffalo, NY

Responsibilities:

• Performed system enhancements in Facets applications during multiple Facets 5.1 conversions from baseline requirements and client’s system assessment results.
• Used Facets Data Models to and conversion activities specifications with expected results.
• Member of the TZG QA team for testing efforts for manual and automated conversions in Facets.
• Validated Facets manual and automated conversion activities for Facets applications with new fields for 5.1 conversions.

Test Lead/Facets/QNXT Configuration Analyst

Confidential, Denver, CO

Responsibilities:

• Facilitated the creation QNXT Gold Test Cases for Confidential Upgrade Center at Confidential in 2013
• Performed product build and functional testing of Carrier/Providers, Benefit Plans, Providers/Claims modules in QNXT 4.8.1 - 5.01.
• Elicited requirements with stakeholders for implementation of ICD10 and EMR initiatives in CareAdvance 5.0.
• Trained QNXT functional testers on importing and executing test cases using HP ALM/Sprinter.
• Tracked defects and created queries to extract daily test case execution results in HP QC ALM.

Facets Business Analyst Manager/Configuration Analyst

Confidential, Kansas City, MO

Responsibilities:

• Tracked defects and created queries to extract daily test case execution results in Quality Center.
• Facilitated Test planning phase with the creation of the System Test Plan and 400 test scripts.
• Conducted multiple work-sessions to elicited requirements from over 25 business units.

Project Test Lead

Confidential, Hartford, CT

Responsibilities:

• Tracked defects and created queries to extract daily test case execution results in Quality Center.
• Validated Baseline Test Strategy for testing inbound/outbound messages to Facets 4.7, Macess, and ClaimCheck.
• Organized and conducted data summits and Business requirements for validating 25 applications for ICD10 and 5010 conversion
• Facilitated Test planning phase with the creation of the System Test Plan and 400 test scripts.

Test Lead/Biztalk Support

Confidential, Fort Worth, TX

Responsibilities:

• Validated scorecard from decision engine along with transported messages for business rules, mapping and formatting in Biztalk Server 2008.
• Manually calculated NOAA and Lease approvals scores from downstream applications using BizTalk Server 2008,C#, and Presta Billing module.
• Coordinated with offshore teams for defect tracking and time estimation for completion tasks.
• Created C# interfaces along with Maintenance on minor .NET bug fixes for Presta BTS support.

Project Lead

Confidential, Detroit, MI

Responsibilities:

• Interviewed and trained resources for test planning during Pre-live ICD10 Remediation SIT testing.
• Augmented testing approach along with managing Test schedule and executing test cases for Facets 4.7 ClaimChek.
• Managed CSR’s and test efforts for over 550 test cases in interfacing with Facets 4.5 for testing

EDI Analyst

Confidential, Dallas, TX

Responsibilities:

• Identified each failed Segment Id/elements against HIPAA rules using text editors and HIPAA Compliance tools
• Created Test plans to capture Open Enrollment and Ongoing Scenarios for 834 and non 834 ansi file
• Created SQL statements to extract data for end-to-end test scenarios in the QA and Prod DBMS environments.

Automation Test Lead

Confidential, Irving, TX

Responsibilities:

• Verified broken builds and merged builds to main trunk in object tree for development and testing environments using VBScript, Apache ANT Server and Hudson CI.
• Automated Web-based, Mainframe, and Window application using Keyword, Object Spy, Data table parameters, Expert View,
• Splitting Actions in test scripts while running single test scripts or those belonging to a suite in QTP 10.
• Created VBscript functions in QTP 10 to capture Flex 3 objects in QTP 10 during regression testing for a Tmobile portal.
• Used descriptive programming to mirror objects in web-based applications using QTP/VB Scripts.

Senior QA Analyst

Confidential, Mason, OH

Responsibilities:

• Created Test plans Test cases for testing transporting of inbound and outbound HL7 messaging to Care360.
• Performed Test Case Review and performed demonstrations to stakeholders before build releases.
• Created SQL statements to extract data for end-to-end test scenarios in the QA and Prod DBMS environments.

QA Analyst/Automation Developer

Confidential, Coppell, TX

Responsibilities:

• Performed product testing (EDI Submission) and Client reporting on findings and resolving any discrepancies.
• Validated data sources data migrated format and mapping to staging during ETL process.
• Performed data analysis, transformation, merging of Java code, and source data to staging during a Pharmacy BI project in 2008.
• Used T-SQL for creating indexes and views, renormalization and aggregation, and backing up and archiving data during ETL processes
• Created test scripts in QTP 8.5 for the Automating web-based and command driven applications.

Project Lead

Confidential, Dallas, TX

Responsibilities:

• Created ad hoc queries using DDL in RAPID SQL pointed to data source to validate updated items for Prelive Facets 4.3 Benefits clean-up.
• Validated Claims edits and warning messages mapped from QNXT to other downstream interfaces during SIT testing. of QNXT 3.2 during a software conversion at WEA trust in 2007.
• Linked SEPY and SESE along with validating LTLT, DEDE, BSDL, SEPY tables in Facets 5.1.
• Member of the Go-live Facets Provider and Networx Pricer configuration team at Amerigroup.
• Created. Configuration and Testing in Diamond 750/950, Ezcap, Facets, QNXT, IDX, and MC400 payer systems for multiple clients throughout the US