Sr. Business Analyst
Resume:
Coralie Povianou, ISS, MBA
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PROFESSIONAL SUMMARY:
● 8+ years of experience working as a Business Analyst/QA in the Health Care and IT domains specifically Medicaid, DSRIP, and Medicaid Managed Care.
● In-depth knowledge of Software Development Life Cycle (SDLC) utilizing Waterfall and Agile methodologies.
● Leadership experience and ability to work in a team environment.
● Experience with Business and Functional Requirement Specifications.
● Extensive knowledge of various project and performance management methodologies including LEAN, BABOK, and PMBOK.
● Knowledge of various HIPPA EDI transactions, which includes 270/271, 837I/P, 276/277 including mainframe and claim adjudication process.
● Experience in HIPPA 4010/5010 EDI transaction. Implementation and Knowledge of Facets, HIPAA code sets, 4010-5010 Migration, ICD-9, ICD-10 coding, HL7 and HEDIS rules and regulations.
● Knowledge of Health Insurance Plans (Medicare Part A, B, C and D),managed care concepts (Medicaid and Medicare), billing experience within life and disability in health plans with thorough understanding of CPT coding, CMS-1500 claim forms and reimbursement forms.
● Expertise in Defect Tracking tools like ALM Quality Center for logging defects, recognized defects priority and severity with in depth knowledge of the Defects life cycle.
● Excellent experience in creating System Test Plans. Thorough hands on experience with defining test cases covering all test conditions and eliminating redundancy and duplications.
● Thorough experience creating and maintaining Requirements Traceability Matrix and performing Gap Analysis.
● Expert in Requirement Analysis, Writing Test Plans and Test Cases, developing and maintaining Test Scripts, reporting and analyzing Bug Detection.
● Experienced with analysis tools such as SQL (queries and statements) and R Studio.
● Proficiency in Microsoft Office Suite.
EDUCATION:
● Master’s in Information Systems Security
● Master of Business Administration
● Bachelor of Science
TECHNICAL SKILLS:
Methodologies: SDLC, LEAN, Agile, and Waterfall
Tools: MS Visio, MS Access, MS Project, MS PowerPoint, MS Word, MS Excel, One Note, Outlook, Rational Clear Quest, Rational Clear Case, Remedy, Requisite Pro, Quality Centre 11.0 (HP ALM), SQL, and R Studio
Environment:SharePoint, Medicaid Analytics Performance Portal (MAPP), HP AML – Quality Center 11.52, Epic 2012 (ADT, ASAP, Cadence, Ambulatory, Mychart, OpTime/Anesthesia, HIM, Radiant Resolute Hospital Billing, Resolute Professional Billing, Stork, Willow, and 3M), HP Quality Center 10.00, Enterprise Architect, and QuickBooks Pro Operating System: Windows (95, 98, ME, XP)
Language:Fluent in English and French
PROFESSIONAL EXPERIENCE:
New York State Department of Health (DOH), Menands, NY (December 2017 – Present) Coralie Povianou, ISS, MBA
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Sr. Business Analyst
The purpose of this project was to develop and implement requirements for new or existing information technology (IT) systems and business processes for an Enterprise Portfolio Management Office (EPMO) supporting the centralized oversight of the NYS Department of Operations and Systems (DOS)’s IT portfolio including the Medicaid Data Warehouse (MDW). As a Senior Business Analyst consultant at the New York State Department of Health (DOH) Office of Health Insurance Programs (OHIP), my responsibilities were the following:
● Worked closely with program staff and other stakeholders to define and develop requirements for new or existing information technology (IT) systems and business processes for the Delivery System Reform Incentive Payment
(DSRIP) program.
● Supported the Project Management Office (PMO) in terms of developing standard operating procedures (SOP) for new and existing processes.
● Involved in a project where the risk level value table was published in the MDW for the Center of Medicare and Medicaid Services (CMS).
● Worked with Project Managers to help the project adhere to the Software Development Lifecycle.
● Coordinated and reviewed the change request form with the project team.
● Drove and gather the requirements for the Business Design Document (BDD) and the Requirement Traceability Matrix (RTM).
● Participated in the review of the Rough Order of Magnitude (ROM).
● Reviewed and participated in the development of the Functional Requirement Document (FRD).
● Supported Stakeholder Sign Off (SSO) process of the project artifacts and deliverables.
● Monitored the enterprise portfolio to ensure information is accurately and timely updated.
● Facilitated meetings with stakeholders, project team, and executives to communicate project information.
● Oversaw the MDW SharePoint site by managing access, calendar, and the artifacts in the PMO library.
● Monitored and coordinated risks and issues logged in the EPMO SharePoint for all the projects.
● Used Microsoft Access to run SQL queries in order to generate the MDW budget Report.
● Utilized Microsoft Suite of services to support project management practices including SharePoint, Excel, Access, and Visio.
Catholic Health Initiatives, Denver, CO (April 2014 – August 2017) QA Test Lead/Business Analyst
The testing initiative for government compliance for Federal mandate was the focus on this project, and the objective was to implement healthcare regulation in accordance with ICD using the Epic module. As the Application Lead, I was responsible for five health systems and drove the successful completion of the project for over 10 acute care hospitals using the Epic suite of applications with application inventory over 26 applications. I lead a team of testers serving as liaison between the Project Management Office and the Testing Center of Excellence:
● Responsible as a team leader for the ICD10 testing process for all phases within a specific market site that is comprised of multiple facilities.
● Coordinated and drove all meetings including kicks off, defects, Epic team collaboration, and validation of workflows with the Business Owners.
● Created vision, scope, and use case documents, use case diagrams.
● Responsible for generating innovative solutions to bridge the gap between business and IT
● Interfaced with business users to prepare and update Business Requirements Document (BRD), wireframes, and Detailed Requirements Document.
● Experienced in creating Business Requirement Documents, User Requirement Specification, and Functional Requirement Specifications.
● Developed use cases with UML using Microsoft Visio for new application functionality. Coralie Povianou, ISS, MBA
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● Conducted JAD Sessions with Management, SME (Subject Matter Expertise), users and other stakeholders for open and pending issues to develop specifications.
● Reviewed the Joint Requirement Documents (JRD) with the cross functional team to analyze the High-Level Requirements.
● Performed testing of HIPAA 5010 transactions 837P and 837I.
● Helped with the creation, development, and design of Test Cases for ICD 10 project by driving the test data creation for all test phases including naming convention, risk priority numbers, status.
● Oversaw the execution, validation, as well as the documentation of the Test Cases in HP ALM Quality Center by assigning risk priority numbers due to usage profiles or the technical risk of the problem.
● Involved in the creation and update of the Test Plan, Test Summary, and UAT Sign off forms.
● Responsible for reporting progress to the Test Center of Excellence Management Team as well as regression of the test cases in support of defect remediation.
● Worked on VBA Macros to generate the scorecard in Application Lifecycle Management. CIGNA, Philadelphia, PA (July 2012 – February 2014) Business Analyst/Quality Analyst
The project included the HIPAA Business Analysis and Quality Assurance testing activities, primarily for the addition of a new Medicare Advantage Health Plan (Medicare Part C) to the standard e-Portal usability platform for Eligibility and Benefits application for the Providers, Members, Customer Service and Provider web transactions and to choose the details about the medical service types, deductible and benefit limitations. This new Health Plan provides the benefits of Original Medicare
(Part A and Part B) and Prescription Drug Coverage (Part D). Additionally, involved in a parallel project team that implemented migration of HIPAA 4010 transactions to 5010 transactions as well as ICD-9 to ICD-10 code sets. My activities included the following:
● Gathered, understood the requirements, and was involved in writing a business requirement document and communicated Product road map to the end users.
● Defined detailed description of user needs (Use Cases), program functions (Business Rules and Supplementary Specifications).
● Created Application Test Strategy, Test Plan, Test Cases, and Test Scenarios according to the Business Requirements Documents.
● Participated in requirements design document reviews.
● Developed and executed test cases and followed-up defects using Quality Center.
● Generated X12 834 and X12 270 test data specific to the scope of test.
● Involved in 5010 837/835 EDI transactions following the HIPAA compliance EDI standard format of X12.
● Tested New Requirements for 5010 834 Transactions following the HIPPA compliance EDI Standard format of X12.
● Tested Regression EDI834 Transactions following the HIPPA compliance EDI Standard of X12.
● Identified the scope of the system that will be modified by the ICD-10 project to accommodate ICD-10 code and /or downstream impacts steaming from ICD-10 codes.
● Reported issues during testing by using Quality Center (QC) and entering defects with correct terminology and Standards and attended defect meetings.
● Ran new EDI file, extract results, compare to baseline validation files, identify discrepancies, and update quality Center.
● Involved in 5010 270/271 transactions testing thru HP Gateway.
● Analyzed the Facets Requirements and conducted gap analysis.
● Identified the processes and system to enable to trade files with non ICD-10 complaint trading partner. Coralie Povianou, ISS, MBA
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● Helped in preparing the ICD-10 context diagram.
● Conducted business validations, covered the deliverables like FACETS Providers, Facets Claims and Facets
● Documented and communicated test results and status in the Team Status meeting.
● Utilized project management methodologies to develop project deliverables.
● Conducted testing on the integrated application environment and process flows and covered both Assurant Healthcare, Miami, Fl (Jan 2011 – June 2012) Junior QA Analyst
The system provides a complete solution for electronic billing and interfaces to EMR software and lab systems. The system has different packages like electronic statement, electronic claims billing. The main focus of the project was to upgrade the existing system by enhancing the functionality of online bill pay and get more information for any transaction; the system performs all the functions of billing process such as billing customers, updating accounts receivable and getting transaction summary. My responsibilities were:
● Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
● Designed and developed all use cases and UML models using Microsoft Visio;
● Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artefacts and activities;
● Wrote Test Cases in Mercury Quality Center that would test various Test scenarios.
● Used UML notations for Object Oriented Design and Documentation.
● Wrote Test plan and Test cases for the Integration testing and system testing.
● Did Integration Testing, GUI testing, Smoke and Sanity Testing, and Acceptance testing in the new builds for Basic Functionality Checking.
● Provided implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.
● Analyzed and optimized the process, Prepared Business Requirement Document (BRD)and then converted the business requirements into Functional Requirements Specification and Technical Specification using Rational Requisite pro.
● HIPAA EDI transactions such as 835, 837 (P, D, I) 276, 277, 278.
● Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
● Verified Healthcare Eligibility, Claim, Benefit and Service using ANSI ASI X12 Standards.
● Effectively used Information Architecture to analyze and design of data stored by NASCO system for the benefit coding and their attributes.
● Established documentation for Agile methodology for implementation with a very water-fall-centric development team.
● Designed and implemented SQL queries for QA testing;
● Assisted the PM in setting realistic project expectations and in evaluating the impact of changes on the project, and conducted project related presentations;
● Prepared user manual and performed user acceptance testing;
● Played a key role in the planning and testing the system enhancements and conversions.
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