SUMMARY

• Experienced Senior Business Analyst with over 7 years of proven skills in requirement gathering, interacting with developers, documenting various business processes, executing test plans, coordinating various projects contributing 3 - Years of experience in Medicare D in region of Healthcare IT Industries.
• Have excellent knowledge and experience in working of QNXT methodologies.
• Comprehensive working knowledge of Macross/ Vlookup modules.
• Proficient with EDI translators, EDI and FTP standards, ANSI X12/EFIDACT and XML
• Comprehensive and proficient knowledge of EDI X12 Standards in Healthcare
• Concrete understanding of Business Requirement gathering, Business Process flow, Business Process Modelling and Analysis, design documentation.
• Excellent knowledge of ICD9/ICD10,Epic Build, Epic Clinical Workflows, Epic Implementation, Revenue Cycle, Provider, Professional, Facility, COB, Medicare/Medicaid Claims, HL7 Interface Messages, Split Claims, Medical Necessity, Dual Coding, 834,270/271,276/277, TA1 /835, 820 EDI Transactions, EOB, EOP, Claim Adjudication, FACETS & NASCO User Interface.
• Completed Training in Epic Bridges Interface module in Madison, WI.
• Very good working experience on Nasco and Facets Claims Processing system
• Functional knowledge in Creation of Professional and Institutional Claims by generating Flat files using NDM input/output folders.
• Extensively involved with the NASCO - HIQK, HEHK, and EFDE applications
• Operational experience in HealthCare Provider & Payer Industry - EPIC Implementation, Membership, Eligibility, Claims, Billing and Reimbursement.
• Extensive experience working in all stages of System Development Life Cycle (SDLC). Extensive experience leading, facilitating conducting Joint Application Development (JAD) sessions among user community, stake holders and technical management, creating project plans and schedules and managing changes.
• Analyzed and synthesized results from Joint Application Development (JAD), proposed alternative tasks and transformed those into Business Requirement Document (BRD).
• Solid working experience in Backend Testing using SQL Queries on various databases such as Oracle, MS SQL Server
• Around 2 years of experience in Test Automation using QTP (9.2 to 10.0 versions)
• Good exposure in using of QTP Integrated Environment (Step Generator, Synchronization, Actions, Recovery Scenarios and Methods etc )
• Proficient working on Various EPIC Modules used in Hospital Organizations and Providers.
• Expertise in building ICD10 Test Scenarios and Test Scripts from Epic Workflows in all Epic
• Applications like ADT Prelude, Op Time, ASAP, Cadence, Epic Care Inpatient, Ambulatory, Beacon, Resolute Hospital (HB) & Professional Billing (PB), Anesthesia, Radiant, Patient’s My Chart Activation, Beaker, Stork, Willow, HIM Coding, Tapestry & Cupid
• Involved actively and had experience with one complete Implementation Cycle of Epic EMR
• In Depth Knowledge on Working of Cerner-McKesson Application which includes Surg Net (Surgery), Path Net (Lab/Pathology) & Rad Net (Imaging) Modules and Processing of Physician Orders in Cerner and Patient Creation, Discharge, 3MCoding & Billing in McKesson.
• Excellent knowledge in Software Development Life Cycle (SDLC) / Rational Unified Process (RUP) methodologies, Agile Methodology.
• Preparing graphical depictions of use cases including State Diagrams, Activity Diagrams, Sequence Diagrams, Use Case Diagrams, Component-Based Diagrams, Collateral Diagrams, including the Business Workflow Chart.
• Experience using Rational Rose and MS Visio for business process modelling and designing data flow diagrams (DFD).
• Very sound knowledge in HP-ALM QC for Test Planning and Test Asset Management throughout the Software Development Life Cycle.
• Excellent knowledge working on Team Foundation Server (TFS) for creating Sprint User Stories, Queries, Bugs and maintaining overall project status
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction and code set rules such as EDI 835/837,270/271,276/277,834 &820.
• Sound Knowledge in Processing of 834 EDI Transactions.
• Proficient inICD-9-CM and ICD -10-CM coding and Claims processing
• Expertise in Agile/Scrum methodology in Testing, including Sprints, Stand-ups, Story board, User Stories, Defect Tracking
• Proficient in working with testing tools like Rational Quality Manager, Clear Quest, HP-ALM/QC
• Involved in preparation of Defect Report and Weekly Status Reports
• Excellent Analytical, Organizational, Interpersonal, Communications, teamwork and leadership skills with proven skill to interact across multiple levels of organization.
• Good Team Player and a Self-starter with excellent verbal & written, analytical & documentation skills and Ability to quickly master new concepts and applications
• Thorough knowledge in Requirement analysis, Planning, Scheduling & Tracking projects.
• Hands on experience of using MS Office Suite, MS Project, MS Visio, Rational Tools.
• Enjoy working in a Collaborative, Fast Paced Environment

TECHNICAL SKILLS

Testing Tools: Rational Quality Manager, Rational Clear Quest, HP-ALM (All Project Life Cycle management)/ Quality Center (QC), Team Foundation Server (TFS), Microsoft Test Manager (MTM)

Methodologies: Rational Unified Process (RUP), SDLC, Agile/Scrum, EMR/EHR

Operating System: MS Windows

Database: Oracle, MS SQL Server, TOAD, SQL. Dotnet

Languages: JAVA, .Net, Mainframe, NASCO, EPIC, HL7 Interface, Cerner-McKesson, SQL, FACETS

Other Tools: Mainframe, MS Word, MS Excel, MS PowerPoint, MS Project, MS Outlook, MS Visio, MS Access

PROFESSIONAL EXPERIENCE

Confidential - Beaverton, OR

Sr. EDI Analyst

Responsibilities:

• Responsible for business process analysis that includes requirements facilitation, definition & analysis, Business process design and data mapping.
• Involved extensively in writing Agile User Stories in Team Foundation Server (TFS) and reviewed with Business lead and project manager for Sign Off
• Extensively worked on creating Business Requirements Documents (BRD’s) and Technical Specification Documents.
• Participated in daily Scrum Meetings to review the Business, functional and Non-Functional Requirements and to discuss the status of Product/Sprint Backlogs.
• Participated Actively in Sprint Planning Meetings to discuss about the User Stories, Story Points and Product/Sprint Backlog created and had Brain Storming sessions with Product Owner, PMO’s, Developers and Business Users
• Extensive knowledge of Patient Protection and Affordable Care Act (PPACA)
• Trace and inform business requirement changes through the lifecycle of the project using Rational Requisite Pro while maintaining customer needs and maintain a Requirements Traceability Matrix (RTM) to keep the stakeholders informed of the progress of the project.
• Understand and have the ability to configure, test, and resolve transmission set up for standard files (SFTP, FTP)
• Hands on experience with the 834 ANSI X12 transaction understanding loops, segments, elements and structure
• Extensively participated in verification of EDI file formats against HIPAA ANSI X12 Standards
• Maintained Excellent team collaboration with Developers, QA Team and tracking from time to time regarding the status of the bugs detected and updating them in TFS.
• Gathered detailed business and technical requirements and participated in the defining the business rules and data standards.
• Transform business requirements or policy documentation into Features, test plan, test cases and scenarios.
• Extensively worked on Data mapping of EDI Segments from 834 FFM (Federally Facilitated Marketplace) to Facets database and vice-versa.
• Copied 834 files received from FFM (Federally facilitated Marketplace) to a specific folder for further processing and finally installing enrollment data to Facets.
• Extensively involved in gathering Reconciliation files and sending them to FFM for further analysis for unpaid members.
• Analyzed and compared data present in HIX Middleware Canonical (BizTalk/Windows Service Bus) to Facets by writing SQL Queries.
• Excellent knowledge creating and working on Change in Circumstances (Cic834) and Reconciliation Scenarios and User Stories in TFS.
• Sound knowledge working on Facets UI in processing and validating Enrollment, Subscriber Eligibility, Claims and Membership Data.
• Profound Knowledge working on Inbound (I834) and Outbound (IC 834) 834’s according to FFM (Federally Facilitated Marketplace) and Issuer perspective.
• Hands On experience working on 820 Payment order Remittance Files in order to validate the 834 Enrollment payment data to and from CMS.
• Excellent knowledge working on 834 Re-enrollments/Renewals and Reconciliation member data

Environment: FFM, HIX Middleware, TFS, Facets, Biz Talk, Dot Net, EDI, Microsoft Excel, Visio, One note, SQL, Windows Service Bus, Microsoft Test Manager (MTM).

Confidential - Englewood, CO

Sr. Business Analyst

Responsibilities:

• As a Lead Analyst III, I am responsible for analyzing the functional Requirements, Epic End to End Clinical Workflows and business requirement documents in order to Build Test Scripts for various Epic modules and for upgrading EPIC Software and Validating Scripts using HP-All Project Lifecycle Management (ALM/QC) software in ICD 10 Perspective.
• Involved extensively and hands on experience in building ICD10 epic Test Scripts in both Inpatient and Ambulatory Settings and for Revenue Cycle Applications like 3M Coding, Professional, Hospital Billing and Claims portion by reviewing Epic clinical Workflows, Visios and Epic User Web documents.
• Co-ordinated and assisted the Project team in executing the Test Scripts in EPIC Software.
• Had daily team meetings with Project Manager and updated the daily team status
• Created Test Plan, Test Scripts in Excel spreadsheet and uploaded them to HP-ALM/Quality Center Test Plan module using ALM Export Wizard.
• Built and Performed Scripts for Outpatient Registries, Scheduling Appointments, Check-In, Nurse Rooming, Ambulatory physician Orders, Check-out in Epic Care Ambulatory module.
• Moved Test Scripts from Test Plan to Test Lab module and performed them in EPIC System and updated the Test results in ALM Test Lab Module.
• Logged various Defects and conducted Defect Review meetings with SME’s and updated the Status of the defect from time to time in Defects Module in ALM
• Involved in automation infrastructure development in Quick Test Pro
• Extensively involved in Regression testing using QTP 11.0 Version.
• Generated Score Card Reports in ALM stating daily work progress and sent to Project Team
• Hands on Experience working in performing the scripts related to Patient Admit, Transport to a hospital, Discharge of a patient (ADT), Coding of a Patient Account, Billing of an account and finally generating and sending Claims to the Payer.
• Built Test Scripts for Patient Transport using AD/ Prelude, Oncology Department using Epic Beacon, Emergency Department using ASAP, Outpatient using Cadence and Epic Care Ambulatory, Surgery Scripts using Op Time, Patient Admission and Stay in hospital using Epic Care Inpatient and Bed time, Managing, Verifying & Dispensing Orders as a Pharmacist using Epic Care Willow, Verifying Patient’s Lab/Pathological Results using Beaker and Billing & Claims using Resolute/ Revenue Cycle Applications.
• Performed Test Scripts in Epic Test Environment for various Epic Applications to evaluate routine tasks of Charge Nurse (RN), Front Desk, Physician/Surgeon (MD), Central Scheduler, Unit Clerk, Registrar, Supervisor, Lab Technician, HIM Coder, OR Biller & Pharmacist using appropriate Log in Credentials
• Conducted Script Reviews with SME’s for various ICD 10 Impacted Scenarios for Epic ADT, Bridges, Ambulatory, Inpatient, Op time, Beacon, ASAP, Cadence, Stork, Anesthesia, Resolute PB&HB modules
• Validated DRG’s, Diagnoses and Procedure/CPT Codes to be compliant with ICD-10 version in Epic Test Environment in order to ensure proper Billing and Reimbursement from the Payer.
• Conducted Test Scripts Sign off Meetings with SME’s to ensure all affected Epic areas related to ICD10 are included in the script for System, Interface and End to End Phases of Testing.
• Arranged meetings with Subject matter Experts (SME’s) and the development team regarding the defects found and their resolution in ALM QC Defect Module.
• Involved extensively in building epic ICD 10 test scripts and performing for System, Interface, User Acceptance (End to End) & Payer Testing.
• Extensively Validated various ICD 10 impacted HL7 Interface messages generated between 3rd party applications( Ensemble) and Epic Applications (ADT, ASAP, Outpatient, Inpatient, Pharmacy) and communicated effectively to ensure No loss of Data Integrity using Epic Bridges.
• Validated the Reports of the Patient’s Imaging Orders (Ultrasound, CT/MRI Scanning, EKG/PACS) placed by a Physician under Radiology Department using Epic Radiant Application
• Written and Executed Test Scripts in Epic Implementation Application for Diagnosis Calculator which is a newly implemented system in EPIC ICD 10 Application Software in order to validate the Specificity of ICD 10 Diagnosis (Dx) and CPT/Procedure (Px) Codes.
• Performed Admitting Labor & Delivery Patients logging as OB Nurse and documented C-Section Procedure Results logging as an Obstetrician in Epic Stork Test Application Environment.
• Functional knowledge in Signing up Patient’s My Chart Activation to access their Medical Records. Expertise in Coding a Discharged Patient Account using 3M Software and coded appropriate Diagnosis, Procedure and DRG associated with patient’s problem and verified charges posted using HIM (Health Information Management) Module.
• Efficient in creating Test Summary Reports at the end of each Testing phase of Validation.
• In Depth Work Knowledge in Revenue Cycle Billing Workflow to view required Charges posted to the patient’s Guarantor account and then to Payer (Insurance) on Charge Review Work queue.
• Very sound knowledge working on creating Professional & Hospital Electronic Claims and to verify accurate ICD 10 Diagnosis and Procedure Codes are filed in order to ensure proper Billing and Reimbursement from the payer perspective in Epic Tapestry module.
• Verified Diagnosis Calculator- a new ICD10 epic tool which is required to choose appropriate administrative details when a generic or Non-Billable diagnosis code is used for Billing.
• Excellent functional work knowledge on evaluating Medical Necessity for Medicare accounts and profound work experience on Split Claims for Inpatients, Outpatients, Observation and Emergency encounters i.e; Dual coding and Validating two separate claims generated for the encounter who admitted prior to oct, 1 2015 billed with ICD9 Codes and who discharged after oct, 1 2015 billed with ICD10 Codes for the accurate Billing & Reimbursement from the payer.
• Involved extensively in directing and escalating the issues/defects found during testing with Subject Matter Experts from Epic headquarters located in Madison and resolved them.
• Sound knowledge working on dual coding the accounts in ICD-9/10 to validate the specificity and accuracy of the system and its impacts from the Billing and Claims perspective.

Environment: EPIC, HP-ALM, HL7, Sql, .Java, Oracle 11g,, Use Case, Toad, SQL, MS Office Suite(Word, Excel, Power point)

Confidential, Indianapolis, IN

Business Analyst

Responsibilities:

• Gathered requirements through interviews, meetings and existing documentation.
• Participated in JAD sessions (Joint Application Development).
• Involved in Risk Analysis.
• Communicating and conferencing with Leads and programmers for client requirements analysis and for accurate translations.
• Identified the deliverables at the end of the inception and elaboration phase of the Rational Unified Process (RUP) life cycle in terms of business modeling and requirements analysis.
• Developed Analysis Model that includes use case diagram that provide the development team a view of the requirements for construction phase activity.
• Reviewed the business Requirements with Business Lead.
• Define functional specifications from existing business requirements.
• Created use cases for business specifications.
• Develop elaborate test plan as per business specifications.
• Create and maintain test cases based on functionality and use cases.
• Created SQL queries for backend database validation.
• Scheduling and coordinating for meetings, seminars and conferences.
• Involved in preparing test plans for functionality tests by QA team.
• Defect reporting and tracking through IBM ClearQuest.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT).
• Attended QR (Quality Review) Process Meeting.
• Involved in conducting User Trainings.

Environment: Windows NT, Java, Oracle, Toad, ClearQuest, MS Office Suite (Word, Excel, PowerPoint), MS Project.

Confidential, Troy, MI

Sr. Test Specialist

Responsibilities:

• Involved in analyzing and gathering requirements and created the Product Backlog.
• Requirements were thoroughly analyzed for developing the Test Scenarios
• Involved in writing Test Approach and assisted in the development of Test Plan
• Designed the Test Cases and responsible for executing them.
• Developing and execution of Regression, Integration Test cases.
• Participated in Test Plan and Test Case Walk through
• SQL Queries were written to query the database for the status of the records
• Performed smoke test to ensure that the right code is delivered
• Integration testing between the different applications is tested for their stability
• Attended daily stand-up meetings and provided status by the end of the day to the manager
• Logged various defects and are followed up until their closure
• Defects reporting and tracking through Clear Quest
• Verify status of submitted defects, and participate in defects review/prioritization activities
• Provided detailed problem description for the issues to the development team to enable and facilitate them in proper analysis for the defects resolution
• Participated in various sprint review and design meetings.
• Recorded and documented Test Results for test cases and suites executed
• Created deliverables like support documents and evaluation summary reports.

Environment: .Net, Oracle 11g, ClearQuest, Toad, SQL, MS Office Suite (Word, Excel, PowerPoint)