PROFESSIONAL EXPERIENCE Healthcare, Location Sr.

Quality Analyst Date I worked in the Enrollment department coordinating with business and other Insurance companies IT team to implement file intake processes for incoming groups. Generated reports and audits for business and management to make sure that implementation has been a success or not. I also worked in Claims area as Business/ Quality Analyst to develop applications which accept different claims like Medical claims, Dental claims, and vision claims from different vendors and route the claims into Batch Adjudication System and Online Adjudication.. Responsibilities: y As the Sr. QA Analyst my responsibilities included developing and documenting Product Test Plans, using several SDLC methodologies; Assisted in writing efficient and effective Master Test Plan, Test Strategy, System Testing, End-to-End Test and User Acceptance Test Plan y Performed end-to-end "System Integration" testing which covered the entire business process flow from the initial point of sales through to all the (10) downstream systems and XML output files, including apps/interfaces. y Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user y Developed and executed SQL queries to verify the proper insertion, deletion and updates into the data Warehouse supporting tables and cubes. y Assisted business users in defining UAT test cases and plans; Established and maintained test cases and test data in Quality Center. y Coordinated with the QA Team for testing activities across multiple systems and managed Conversion test execution. y Used MS Visio for flow-charting, process model and architectural design of the application. y Strong experience in conducting Gap Analysis (GAP), Functional testing, User Acceptance Testing (UAT), and System Integration testing (SIT), SWOT analysis, Cost benefit analysis and ROI analysis. y Involved in implementation of HIPAA EDI Transactions ( 835,837,820,276) y Facilitated Electronic Data Interchange. y Performed GAP Analysis for HIPAA 4010 and 5010 transactions. y Used EDI tools to verify mapping to X12 format y Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI. y Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and 276 and looked for defects for amendment. y Did data analysis for various version changes of EDI messages on different sub-systems. y Providing the required test data for the developers in order to fix the defects y Participating in QA team meeting and bug tracking meetings. y Produced management reports using Informatica relative to inventory, productivity, accuracy and cycle time and maintained team leave documents and artifacts in web based MS Share point

Tested the enhanced FACETS/AMISYS system, evaluating claims adjudication needs and creating HIPAA-compliant business rules configuration. y Involved in assessment of tools for use in future HIPAA 4010/5010 migration and compliance by performing GAP Analysis. Provided business and technical process flow recommendations. y Performed comparative analysis and gap analysis to identify variation in the process as per HIPAA X12 4010 and 5010 guidelines to incorporate updates as per 5010 guidelines y Mapped EDI 4010 provider claim payment/advice/status (835/837/276) from clearinghouse sources to ASC X12 formats. y Extensive testing of EDI Eligibility/Inquiry/Response (270/271) transactions via reports generated by developers. y Mapped claims, payments, and status to back-office database. y Logged the defects in Quality Center and maintained track of the defects throughout the life cycle. y Participated in QA Team meetings and bug tracking meetings. Environment: MS-Visio, MS Office, MS Project, TOAD, SQL, Quality Center, HIPAA/ EDI X12, FACETS, Oracle, SharePoint, Informatica, FTP. y