Jenny Borsis

314-***-**** **** *th Street North Beach, MD 20714

abhs4j@r.postjobfree.com

BUSINESS ANALYST / Quality Assurance Specialist

Software Testing Electronic Data Interchange (EDI) Systems Analysis

Top-Performing Quality Assurance Specialist with

solid work ethic and 7+ years' experience in ( Unit Testing

functional, load, regression, unit, system testing ( Business Analysis

and Web applications testing. Extensive background ( Regression Analysis

utilizing CAPS, AniTa, Phoenix, and MHC claims ( Quality Assurance

systems. Proficient in troubleshooting of information ( Process Improvement

systems and software. Proven abilities in ( Document Gathering

streamlining processes and improving overall ( Regulatory Compliance

workflow. Valued consultant and contributor to

management teams with outstanding analytical

abilities. Experience gathering and documenting

requirements from users.

TECHNICAL PROFILE

Sybase EDI Products ? EDI X12 Maps ? SQL ? SDLC ? VB.net ? Visio ? AS400 ?

UltraEdit

UltraCompare ? Unix ? Mercury Test Director ? Edifecs Specbuilder ? Snagit

8

CAREER HIGHLIGHTS

. Worked as a BA on special projects. Recovered $710K for Blue Cross

Blue Shield by recognizing system processing error and manually

calculating amount of money owed by providers.

. Served as project leader for Blue Cross Blue Shield and directed

design of new customer service system.

. As Supervisor of Claims for Legion Insurance, designed and implemented

access queries to reconcile electronic and hard copies of information

submitted from third party administrators.

. As Systems Analyst for Magellan Health Services, collaborated with

users to determine their needs and created Business Requirement

Document to improve project procedures.

PROFESSIONAL EXPERIENCE

Chartered Health Plan Washington, DC 2009-Present

EDI / EDP Supervisor

Hired to serve as second in command to EDI Manager for largest managed care

organization serving DC Medicaid population. Supervise EDI Analyst and

direct testing of program bugs and fixes. Monitor daily production files

provided by EDI Coordinator and submit DC Medicaid encounter data to

Affiliated Computer Services (ACS) on weekly basis. Document workflow

procedures, analyze process issues, and attend quarterly meetings with

Encounter team to review issues.

. Discover and fix errors in claim files submitted through HIPAA

compliance and translator maps.

. Research encounter denials from ACS and submitted discrepancies to

Department of Health Care Finance (DHCF).

. Effectively train vendors on submission process for 837 X12

transactions.

I. Levy & Associates St. Louis, MO 2007-2008

Consultant - QA Tester

Recruited to consult on software enhancement and new releases for #1

provider of case management software for state SSA disability programs.

Monitored queue log for open items that required QA expertise. Utilized

tracking system to record QA test results. Performed Structured Query

Language (SQL) searches to track the status of individual case records.

. Collaborated with Programming team regarding test results and possible

improvements for Case Management System software.

Jenny Borsis Page 2 abhs4j@r.postjobfree.com

Texas Medicaid & Healthcare Partnership Austin, TX 2007

EDI / BA Consultant - NPI Project

Employed as analyst and consultant for public company with more than 78K

employees carrying out Medicaid claims payment and primary care case

management administrator duties for entire state of Texas. Created test

cases for cash financial reports, provider portal, 835, and 277 EDI X12

transactions and documented results and defects in Mercury Test Director.

Performed system, functional, load, and regression testing on Phoenix

claims system (GUI application). Completed QA review of books for User

Acceptance Testing (UAT) and state audit.

. Downloaded 837's, 835, and 277 EDI X12 files into Edifecs Specbuilder

and ensured loops and segments were populated with correct data.

. Successfully executed SQL searches to obtain provider's missing

information and cash financial transactions.

Wellpoint St. Louis, MO 2006-2007

EDI / BA Consultant - NPI Project

Provided integration, functional, load, and regression testing and analysis

for largest health plan company in Blue Cross Blue Shield Association with

annual revenue of $60B+. Documented test results, defects in test plan, and

functional workflow processes. Completed regression testing for provider

portal.

. Worked with Claims Unit for requirements gathering.

. Performed QA testing for new claim print program related to new UB04

and CMS 1500 Medicare and Medicaid forms, ensuring NPI and Taxpayer

Identification Number (TIN) was populated correctly.

. Tested old and new mapping of 837 X12 file, analyzed 837 X12 files

sent by vendors for accuracy, and mocked-up NPI data.

. Confirmed new data field was populated with NPI by testing

270,271,276, and 277 EDI transactions on provider portal.

Magellan Health Services Maryland Heights, MO 2005-2006

Business Analyst

Reviewed production files and performed testing analysis for leading

specialty health care management organization with 5K+ employees and annual

revenue of more than $1.5B. Analyzed test and production files sent by

clearinghouses to ensure accuracy of data. Collaborated with vendors to

develop specification reports to meet business needs. Worked with claims

unit regarding unit testing.

. Developed test files using UltraEdit for 837P and 8371 X12 mapping.

. Successfully performed 837P and 8371 X12 on AS400 platform and

communicated with AS400 programmers regarding test results and areas

of improvement.

. Efficiently resolved all EDI production issues.

Tenet Healthcare Bridgeton, MO 2001-2005

Insurance Reimbursement Specialist

Old Republic Risk Management Milwaukee, WI 1999-2001

Financial Data Analyst

Legion Insurance Corporation Milwaukee, WI 1998-1999

Supervisor of Claims

Blue Cross Blue Shield of Florida Jacksonville, FL 1987-1998

Supervisor of Claims and Customer Service / BA

Education

M.S. in E-Commerce Candidate University of Maryland University College -

Adelphi, MD

B.S. in Accounting Jones College - Jacksonville, FL

Contact this candidate