Management Quality Assurance

Deepthi Vangala

*****************@*****.*** 312-***-****

Professional Experience:

●4+ years of experience as a Business Analyst with solid understanding of Business Requirements Gathering, Translating Requirements into Specifications, Application Design.

●Professional experience in Business Analysis, Software Development Life Cycle, ITSM, System Analysis, Design, Development, Testing, and Implementation on Business Systems.

●Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.

●Extremely proficient in using Agile and XP methodologies performed roles of Scrum Master following sprint sessions and used Rally software extensively to write User Stories, assign tasks to individual team members.

●Good Working Knowledge of HIPAA Regulations. Medicaid, Healthcare delivery systems and Claims Processing.

●Strong experience in Requirements elicitation techniques - conducting user interviews, document analysis, JAD sessions and managing the requirements.

●Expertise in UML (class diagrams, object diagrams, GAP Analysis, use case diagrams, state diagrams, sequence diagrams, activity diagrams, and collaboration diagrams) as a business analysis methodology for application functionality designs using IBM’s Rational Rose.

●Possess strong knowledge of healthcare terminology and extensive experience working on healthcare projects. Specialized experience in healthcare insurance domain. Good understanding of insurance policies like HMO and PPO and proven experience with HIPAA 4010 EDI transaction codes such as 837(Health care claim), 270/271(inquire/response health care benefits), 276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice).

●Expertise in project documentation, Release level documentation and reference guide on SME level.

●Experience working on 4010 to 5010 and ICD 9 to ICD 10 projects.

●Extensive knowledge of various EDI standards including American National Standard Institutes (ANSI), Accredited Standard Committee (ASC) X12 structures and formats.

●Comprehensive experience in writing Test Plans, Test Cases and Test Scripts using manual and automated testing tools from Rational and Mercury Interactive such as TEST DIRECTOR and WINRUNNER.

●Actively involved in developing, executing and managing User Acceptance Testing (UAT).

●Good leadership knowledge on when working with sales team and claims systems

●Assisted Quality Assurance (QA) team in writing test plans, defining test cases, test scenario and data sets.

●Built strong relationships with clients and demonstrated commitment to delivery.

●Highly motivated, organized and target oriented team player who enjoys working with multi-functional team towards a common goal.

●Excelled in guiding the work of technical teams. Articulated project goals and scope, translated business needs into technical terms, prepared detailed work breakdown structures (WBS) and instilled shared accountability for achieving project milestones.

Technical skills:

Databases: MS ACCESS, MS SQL SERVER

Methodologies: RATIONAL UNIFIED PROCESS, OOAD, AGILE, WATERFALL.

Modeling Tools: RATIONAL ROSE, ERWIN 4.0, CRYSTAL REPORTS, MS VISIO

Testing Tools: HP Quality Center, HP ALM, HP QTP/UFT.

Operating Systems: WINDOWS 98/2000/ME/XP, WINDOWS NT, UNIX

Office Tools: MS WORD, MS EXCEL, MS POWERPOINT, MS PROJECT 2002/2003

Quality Management: HIPAA

Educational qualifications:

Masters in Healthcare Administration. University of New Haven, CT.

Masters in Information Systems and Management. Harrisburg University, PA.

United Health Group, Eden Prairie, MN. Feb 16-Nov16

Role: Business Analyst

Project Description:

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance for provider data application measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).

HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. Although not originally intended for trending, HEDIS results are increasingly used to track year-to-year performance. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs).,

Activities and Responsibilities:

I facilitated & did weekly/bi-weekly & monthly reporting for multiple projects as PIMS.

Created Process Work flows, Functional Specifications documents and documented system requirements.

Highly process oriented with excellent listening skills and follow direction across multiple work streams.

Interacted with various cross-functional teams on building business use cases, and understanding expenses and revenue stream.

Working with clients to better understand their needs and present solutions using structured SDLC approach.

I did Incident Management, Problem Management, Change Management, Release Management etc. for WebEx

Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.

Peer reviewed business requirements, test plans, test cases & conducted Quality check on multiple artifacts to improve existing processes as well as devise new processes for business process improvements.

Created detailed test plans, test cases, test strategy documents.

I worked in AGILE methodology & did 3-week sprint sessions & worked closely with Scrum-master and Product owner.

Prepared release level documentation and Reference level documentation without repetitive writing.

I maintained log repository and reduced issue-resolution time using Remedy & also tracked production problems

I did peer review log to improve efficiency in base-lining Functional Specs & used Team tracks to log issues & obtain resolutions

Conducted meetings to coordinate implementation including requirements, design, and testing & implementation documentation/management.

Involved with sales team and claims teams for stages of clarifications and concerns.

I built Test Plan, test cases and did Regression Testing, SIT & UAT & provided daily quality status reports using QC.

Worked on HP ALM Synchronizer to establish connectivity b/w QC & Rational Requisite Pro tools.

Conducted daily test status calls to ensure testing is on track along with defect escalation, defect tracking & management.

I created, updated test plans and executed Test Scripts using Quality Center & lead large tester teams to meet deadlines.

Environment: XML, Clear Case MS Office, MS-Visio, TOAD, Agile, Quality Center, MS Project, SOA, SQL server, Ultra Edit EDI, Ultra Comparator, MS Outlook, XSLT, HP ALM, Rallydev, Remedy. SAAS, Adobe Suite, service now, HTML, CSS, JIRA.

United Health Group, MN. June 2012-June13

Role: Business Analyst/Scrum Master

Project Description:

The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance for Provider data application measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).

HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks. Although not originally intended for trending, HEDIS results are increasingly used to track year-to-year performance. HEDIS is one component of NCQA's accreditation process, although some plans submit HEDIS data without seeking accreditation. An incentive for many health plans to collect HEDIS data is a Centers for Medicare and Medicaid Services (CMS) requirement that health maintenance organizations (HMOs).,

Activities and Responsibilities:

●Created User stories, prototypes and epics for multiple teams.

●Being a scrum master facilitate scrum ceremonies (grooming, sprint planning, retrospectives, daily stand-ups, etc.)

●Enact change and continuous improvement increasing the productivity of Scrum teams by 16% and the quality of deliverables by 22%.

●Met with client groups to determine requirements and goals. Utilized Rational Unified Process (RUP) to configure and develop process, standards, and procedures and create a Business Requirement Document.

●Responsible for preparing Software Requirement Specification (SRS) and documenting them.

●Established questionnaires and resource leveling required for implementing HIPAA 5010.

●Involved in the full HIPAA compliance lifecycle from gap analysis, mapping, and implementation and testing for processing of Medicaid Claims.

●Provide implementation assessment, strategy, and mentoring services for Rational Rose, UML and RUP.

●Working with clients to better understand their needs and present solutions using structured SDLC approach.

●Interaction with the developers to report and correct bugs.

●Developed the systems implementation project management plan with milestones and steps from procurement of vendors to project implementation and maintenance.

●Followed a structured approach to organize requirements into logical groupings of essential business processes, business rules, and information needs. Ensured that critical requirements are not missed.

●Aided management in standardizing web applications by preparing GUI standards and recommending alternatives for incorporation in a phased, iterative manner.

●Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.

●Analysis of new Business Requirements and preparation of the Functional Design Specifications

●Interacted with clients like SPF Securities to finalize their website look and contents.

●Analysis of the new requests specified by the end users for the future releases and discussion with the functional and technical teams.

●Communicated changes to requirements promptly and precisely to all personnel involved

●Identified and clearly defined functional issues and support IT development staff throughout the design, development, unit testing, and implementation phases of the software development life cycle.

●Analyzed and translated business requirements into system specifications.

●Participated in Code Reviews, System Testing and UAT followed by production verification, post production testing and support

Environment: Microsoft Visio, RUP, Rational Tools, OOAD, Mercury Test Director, Rapid SQL, SAAS,UNIX, Microsoft Excel, Microsoft Word, Microsoft Access, Windows 2000 Professional, Agile, Rally, Water fall, UML.

Cigna Corp. Chicago, IL Jan 2011 – June 2012

Role: Business Analyst

Cigna major service lines include worker’s compensation claims administration and healthcare management services, property and casualty claims management, class action services and risk management information services.

As a Business Analyst in Cigna I performed pivotal role in multiple projects & handling three releases at the same time. Release 1 & 2 was web-based service application developed for streamlining office workflow processes involved in Electronic Data Interchange (EDI) transactions and benefits in claims management cycle based on HIPAA Guidelines. Release three was based on reporting the policy premium. There were seven reports, which were generated in Brio portal.

Activities and Responsibilities:

●Worked closely with IT personnel and business partners to identify and maximize opportunities to improve products services and program business processes.

●Reviewed, analyzed and created detailed documentation of business systems and user needs, including workflow, program functions and steps required to develop or modify application programs.

●Assisted in developing and maintaining business & financial reports and IT work/databases which was required to support the various lines of business and specific projects.

●Consulted with IT Personnel to determine business, functional and technical requirements for specified applications.

●Developed effective reporting tools for the business unit and completed existing projects from original concept through final implementation

●Organized chart-holding facilities and assisted in training staff. Assisted various projects from start to finish through the SDLC process.

●Participated in Code Reviews, System Testing and UAT followed by production verification, post production testing and support

●Performed internal & external reporting, cash management, cost reduction & efficiency.

●Owned the entire reporting process. Interacted with the ETL team, developer(s), management, and account holders to get the requirements, document them, design templates, and write specifications.

●Identify Member, Provider, Coverage, Medicare, and Medicaid.

●Designed report templates based on the requests by account managers.

●Designed Functional Specification Documents for the reports.

●Analyzed trading partner specifications and created EDI mapping guidelines.

●Extensive use of Excel to create Functional Specification Documents & Templates.

●Designed the process flow diagrams for flow of information and report creation process.

●Conducted JAD sessions for the report users, requestors, and the developers.

●Prepared Need Analysis Documents of the requirements gathered through JAD sessions.

●Facilitated strategic meetings between Perot technical team and hospital administrators resulting in identifying key differences in clinical systems.

●Defined, designed and created initial specifications for SharePoint website to be used as project data repository for project.

●Created and designed custom webpages on SharePoint to maximize storage on SharePoint website.

●Created new processes/procedures/guidelines to leverage data.

Environment:

SQL Server 2000, Windows, Crystal Reports, Oracle, Mantis Defect Tracking, UML, MS Office, MS Visio, Microsoft Visio, RUP, Rational Tools, OOAD, Mercury Test Director, Rapid SQL, UNIX, Microsoft Excel, Microsoft Word, Microsoft Access, Windows 2000 Professional.

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