Project Test Cases

RAMYA C

Employer Details: Ram, ****@***********.***, 610-***-****

Over 8 years of progressive experience as a Business Analyst in the Healthcare Domain, in Business Analysis, System Analysis, Design, Development, Business Re-engineering, Requirement Gathering/Analysis, using extensive knowledge of SDLC methodologies principally AGILE-SCRUM, RUP, Waterfall, and proficient in conducting interviews, workshops, Joint Application Development (JAD) sessions, and requirement gathering sessions with stakeholders, business users, and development team.

PROFESSIONAL SUMMARY:

Excellent communication skills, writing skills as well as presentation skills; experience working with business users as well as senior management.

Extensive knowledge of SDLC methodologies and exposure to Agile, RUP, and Waterfall.

Strong knowledge using UML diagrams (Use Case, Activity, Sequence) using MS Visio and Rational Rose

Excellent knowledge in Health Insurance Portability & Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI), HL7 and ICD-9 to ICD-10 coding.

Extensive knowledge on the various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), PPO, HMO, and POS.

Proficient in conducting GAP analysis, SWOT analysis, Cost Benefit analysis and ROI Analysis.

Extensive experience with claim transactions such as 834 (Benefits & Enrollment), 835 (Billing/ pay/ Remittance), 837 (Submit medical claims)

Proficient in ICD 9 to ICD 10 transition process and developing one to one and one to many mapping based on GEMS files from CMS.

Strong knowledge in understanding and enhancing EPIC EHR system’s Enterprise Data Warehouse (EDW).

Highly experienced in conducting JAD sessions for project definition involving analyzing requirements, creating prototypes, user interface, database schema, system design and product design workflows.

Extensive experience in gathering Business/Functional user requirements, creating Use Cases as per user requirements, developing/designing diagrams such as Activity, Class, and or Sequence diagrams, and in addition to creating Business Requirements Document (BRD).

Broad knowledge in writing SQL queries/scripts for data analysis and QA report testing.

Conducted successful projects with the help of teams to achieve deadlines timely and proficiently.

Well versed in creation of Test Plan and Test Cases from the Requirements document.

Documentation of Test Plans, Test Cases, Test Scripts, Test Procedures based on the Design Document and User Requirement Document for the Black Box, Functional, Usability and User Acceptance Testing (UAT).

Proficient in the use of Requirements Traceability Matrix, writing Use cases and Functional Requirement Document.

Strong knowledge in identifying the Data Sources, ETL methods, Data Conversion process, OLAP designing, MDM and Reports generation required for reporting purpose.

Organized, goal-oriented, self-starter, and able to master new technologies, manage multiple tasks while following through from start to completion.

EDUCATION:

Master’s in Information Systems, Health Care Informatics Concentration

TECHNICAL SKILLS:

Business Modeling Tools: Rational Rose, MS Visio, Erwin, Rally

Testing Tools: HP ALM, HP Quality Center

Methodologies: SDLC, Agile Scrum, Waterfall, RUP, UML

Languages: SQL, C, C++.

Databases: MS Access, SQL Server, Oracle PL/SQL, Informatica

Operating Systems: Windows 95/98/2000/XP/Vista/NT

Project Management: MS Office Suite (Microsoft Word, Microsoft PowerPoint, Microsoft Excel), MS Project, Rational RequisitePro, and COGNOS.

Tools: QlikView, SPSS

Change Management: Rational ClearQuest

HER Software: EPIC.

PROFESSIONAL EXPERIENCE:

Client: Anthem, Norfolk, VA

Role: Sr. Business Systems Analyst/ Scrum Master

Duration: July 2014-Present

Project 1:

The goal of the project was to develop an automated process to send service verification letters through their Claims operations department to the members to be complaint with the state mandate. These letters would include information regarding a service or supply for which the insurance company received a claim on member’s behalf. Anthem wants to make sure that member received this service.

Project 2:

The goal of the project was to extract Claim transactions like EDI 276-277 for Claims Status Check, EDI 837 for Claims Submissions from Facets database to keep a track of the claims. Agile methodology was used for both projects.

Responsibilities:

Gathered requirements through JAD sessions, interviews (group and one-on-one) with users and stakeholders for the service verification and claims transaction extraction projects.

Involved in all four phases of the requirements development including Elicitation, Analysis, Specification and Quality Validation.

Established and performed detail project plan using project management tools like MS Project.

As a Scrum Master, conducted Scrum meetings and ensured that project deliverables and milestones were met.

Understood the requirements and prepared technical requirement document (TRD) for the Service Verification letter project.

Conducted the TRD walk through for stakeholders sign off.

Created the Use Cases Diagrams, Activity Diagrams, Class Diagrams, and Sequence Diagrams using MS Visio.

Facilitated Electronic Data Interchange and worked on developing the business requirements and use cases for Facets batch processes; automating the claim status entity, and claim status response processes.

Developed Screen Mock-ups/Prototypes to provide demonstration to the Business teams.

Developed BRD for Functional and Non-Functional Specifications.

Developed New Used Cases and updated existing ones.

Reviewed and analyzed the file specifications document from the clearing house.

Conducted data mining on Facets tables for the required data elements in accordance with the file specifications document given by the clearing house using SQL queries.

Worked on the extraction of HIPAA EDI Transactions (276,277,837) using the SQL scripts.

Designed dashboards of the extracted claims, billing, and payments data using QlikView and presented it to the clients.

Prepared test plans with detailed test steps, involved in testing and defect tracking.

Prepared UAT document and assisted in UAT and regression testing.

Tools & Technologies:

Agile Scrum, Rally, SQL, MS Office, MS Visio, MS Project, HP ALM, UML, FACETS 5.01, QlikView

Client: UPenn Medical Center, Philadelphia, PA

Role: Sr. Business Systems Analyst

Duration: March 2013- July 2014

The scope of the project was involved in enhancing the EPIC EHR system’s Enterprise Data Warehouse (EDW) by capturing Best Practice Advisory (BPA) alerts. The purpose of these BPA alerts is to improve the patient care and patient outcomes processes and to prevent errors. The project also included meaningful use compliance reporting for CMS incentives. Agile methodology was used for this project.

Responsibilities:

Collaborated with the hospital staff to understand the existing EPIC system and analyzed the requirements for the BPA alerts.

Analyzed and validated requirements for BPA alert triggers and users.

Worked with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.

Created logical statements of business requirements researched and assessed alternative solutions and recommended the most efficient solution for system design.

Participated in preparing flow diagrams for various scenarios of triggering BPA alerts and the necessary actions to be taken for the alerts.

Consolidated Data sets using Prototyping and conducted data testing using the PL/SQL scripts.

Created the Use Cases Diagrams, Activity Diagrams, Class Diagrams, and Sequence Diagrams using MS Visio.

Created Mapping Documents, Report Mockups and modified existing report mockups and finalized for development.

Analyzed requirements comprehend technical recommendations and constraints; develop comprehensive and accurate functional specifications; Data Mapping, and process flows.

Participated in Testing by using SQL and collaborate with QA team to develop test Scenarios and test cases.

Performed defect tracking and maintained Requirement Traceability Matrix

Assisted in UAT and documented User manuals for the user community

Facilitated training sessions to ensure user acceptance.

Tools & Technologies:

Agile Scrum, Rally, MS Project, MS Office, MS Visio, MS Excel, SQL, UML, Quality Center.

Client: Emblemhealth, New York, NY

Role: Sr. Business Analyst

Duration: March 2012 – May 2013

The project goal was involved in enhancing the existing Web-services for Claim Transaction like EDI 270-271 for Claims Eligibility Inquiry, EDI 276-277 for Claims Status Check, EDI 837 for Claim Submission to comply with the HIPAA 5010 standards, Wherein integrated all HIPAA 5010 rules with ICD10. The project followed RUP methodology.

Responsibilities:

Conducted JAD sessions, meetings, teleconferences to gather business requirements from various stakeholders and SMEs.

Developed understanding of various transactions involved in transition from HIPAA 4010 to HIPAA 5010 like Eligibility, Benefit, and Claim submission transactions.

Analyzed and validated requirements for HIPAA 5010 and gathered requirements for ICD10.

Worked on EDI 270/271 (Claim Eligibility Inquiry) /276/277 (Claim Status Check) /837 Claim Submission /835 (Claim Remittance).

Worked on different EDI (270/271/ 835/837/834) and ICD 10 Procedural and Diagnosis codes.

Developed mapping documents for ICD 9 to ICD 10 application.

Analyzed all ICD10 codes and validated the outcomes.

Analyzed Business requirement document, developed functional requirement document (FRD) and got it approved by the client.

Created help documentation in accordance with the client's documentation guidelines.

Facilitated sessions on Group Insurance, Eligibility, Benefit and Claims transactions in HIPAA.

Supported User Acceptance testing (UAT) and collaborated with the QA team to develop test plans, test scenarios, test cases and test data to be used in testing, based on business requirements and application knowledge.

Reviewed Integration Test Plan for integration between modules.

Efficiently interacted with designers and software developers to understand application functionality and navigational flow and keep them updated about business user’s specifications.

Preparing document for customer service training on changes to the members and providers portals.

Tools & Technologies:

Windows XP, Rational Unified Process (RUP), MS Excel, Word, UML, power point, SQL, Oracle, Rational Rose, Business Objects, Erwin, ClearCase, ClearQuest.

Client: McKesson, PA

Role: Business Analyst

Duration: July 2011- July 2012

The goal of the project was to establish five epic centers across the country that dealt with medical supplies to the distribution centers in order to avoid medicines expiry. This distribution process was automated to keep track of the medicines usage in various distribution centers. Some of the key products in this line are the Robot, Acudose, Anesthesia, Med Carousal, MedComm etc. Agile Methodology was used for this project.

Responsibilities

Assisted the Program Manager on tasks related to the planning, scheduling and coordination of project activities.

Developed Use Cases for unit testing, prepared spreadsheet for testing criteria, including regression, positive and negative testing, process flow testing and screenshot for test results to complete expected and actual results.

Prepared various diagrams and Swim Lane diagrams using MS Visio and IBM Rational Rose tools.

Prepared documents for the wireframe and prepared a data dictionary for the same.

Documented environment setup for system.

Involved in the planning, development, coordination and presentation of specific testing needs, appropriate for the quality assurance needs of the end user.

Established and maintained test cases and test data in Quality Center while assisting business users in defining UAT test cases and plans.

Worked with the QA Team for testing activities across multiple systems and managed Conversion test execution.

Creating required test cases for the developers in order to fix the defects.

Involved in QA team meeting and bug tracking meetings.

Managed testing for various functionalities using JIRA and Quality Center tools.

Tools & Technologies:

Agile Scrum, MS Office, MS Visio, IBM Rational Rose, JIRA, MS Project, Rally, QTP, HP Quality Center

Client: Compass Insurance Agency

Role: Business Analyst

Duration: October 2009- June 2011

The project was involved in implementing credentialing system for the organization that included various functionalities like medical staff management, streamlined primary source verification, and online applications.

Responsibilities:

Organized meetings with various stakeholders to gather business requirements for the credentialing workflow

Produced initial project scope, schedule, and budget document along with the Project Manager

Efficiently transferred high level analysis, product use cases, and process diagram to development team

Managed the credentials of medical staff members to ensure both new and currently employed Doctors were in network compliance with the group’s 33 accepted insurance plans.

Researched rules and mandates, imputing and editing database information, and working closely with license boards and care providers.

Evaluated candidates’ suitability based on this research, and communicated this analysis to others on the hiring committee. Medicaid billing.

Ensured adherence to both state and regional regulations governing education and professional preparation

Maintained records and proof of the paperwork associated with compliance.

Successfully implemented departmental goals, objectives, performance standard measurements, policies, and procedures, improving departmental efficiency.

Client: Johnson & Johnson

Role: Jr. Business Analyst

Duration: March 2008 – October 2009

The project involved in automating the HRIT operation of Johnson & Johnson as there was an initiative to integrate 250+ opCos to exchange HR Related data.

Responsibilities:

Organization of meetings with stakeholders to gather business requirements

Analyzing the requirements from a business value perspective to determine the feasibility of constructing an application.

Production of initial project scope, schedules, and budget.

Responsible for managing office operations on a day-to-day basis.

Acted as a scribe in JAD sessions to capture the requirements.

Strategically planned methods to achieve operational goals and targets.

Maintained issue log to track issues based on priority (critical, high, medium, low) and impact.

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