Quality Assurance Customer Service

Beth L. Bodenheimer Resume December **** www.Linkedin.com/in/BethBMechPa

Professional Summary:

Extensive experience in all aspects of Blue Cross/Blue Shield and Government Healthcare Business Analysis, Quality Assurance & Testing, Technical Documentation (Policies & Procedures/Playbook), Training, Customer Service, Payer, Business Transformation & Management. Expertise in understanding and managing business, technical and customer requirements, translating all into a workable project plan, testing and implementing the appropriate solution. Adept in end-to-end traceability, management, testing and installation of requirements and customer guidelines. Highly skilled in User Acceptance Testing (UAT), Positive, Negative, Quality Assurance/Audit, Regression, Functional and Nonfunctional. Facilitation of recommendations and best practices into successful implementations.

Technical Skills:

Proven track record of mastering technical systems/flows/requirements tracking and testing tools: Microsoft Office Suite, including IBM Rational Tools; Test Manager, ReqPro, RQM, ClearQuest, SharePoint Admnistration, Clarity, Atlassian’s JIRA/Confluence, HP’s ALM and Accompa. Expertise with Agile and Waterfall development methodologies for Enterprise Resource Planning (ERP/SAP) & System Development Life Cycle (SDLC). Experience with stored procedures using SQL. Experience with NASCO/BlueCard and ITS processes. Familiarity with HTML & COBOL/IMS/DB2, User Experience/User Interface (UI/UX), DevOps/TFS, Pivot Tables, Tableau, OnBase. ECM, Extensive knowledge of HIPAA EDI transactions: 834, 835, 837 for different lines of business. SQL Server & SSRS, Power BI, Workday. Knowledge of CICS, IMS, DB2 and various ASPs.

Employment History:

4 Consulting for Deloitte; Mechanicsburg, PA Jan 2025 - present

Consultant/Functional Tester

PA DHS eCIS Transformation Project from Legacy to ERP platform in the Caseworker/DHS Portal. Included are creating test cases and scripts for previously manual/now automated processes, new and updated Case Management GUI screens.

Performing manual system testing and tracking of defects in TFS and guidelines in a Waterfall environment.

Working directly with developers to collaborate on ideas, workarounds and fixes for retesting of bugs and keeping leadership aware of test case status and issues.

DHS Programs include: Child Support, Cash Assistance, LIHEAP, SNAP. TANF, etc.

Ernst & Young LLP (EY); Philadelphia, PA Aug 2022 - Jan 2024

Business Analyst/Quality Analyst/Transformation Manager II

Health & Human Services Transformation Project (HHSTP) – Performed UAT/E2E testing for MDOM/MDHS programs in systems: Client Web Portal (CWP/SSP). This included creating process flows and step-by-step procedures for client approval and checkout.

Logged and tracked in ServiceNow: tickets, processes & procedures, service requests and change management in Agile.

Using best practices, wrote test case scripts and internal training material

Performed RTM comparisons between client’s test cases/requirements in Confluence and SharePoint and what EY

had in Accompa for State of Mississippi

Utilized newly-implemented PingID Single Sign-on (SSO) app to access EY’s internal proprietary websites. Wrote guidelines for team (train-the-trainer how-to) and trained staff on this.

Spearheaded invoicing for deliverables and financial budget tracking for the Alabama Medicaid project, Documented process & procedures and trained the team.

Held virtual team building sessions with direct reports and team.

Completed states research and prepared slides for EY’s Childcare Connected initiative.

Completed research for Government-wide Acquisition Contract (GWAC) Commercial initiatives

Defense Logistics Agency (DLA) Strategic Transformation & Enterprise Project Support (STEPS) Indefinite Delivery Indefinite Quantity (IDIQ) via Past Performance Qualifications (PPQs) Federal RFP - performed research for the RFP, coordinated meetings with GCSPs, updated documents to reflect statuses and contributed to the RFP response

Arizona RFP - contributed answers to RFP questions added into Confluence.

Member of the CoPA Account Team to make inroads into PA programs; PennDOT, PA Turnpike, PA DHS.

Oklahoma Project BA/Lead for various DHS program initiatives worked directly with DHS clients. Data Modernization for all departments - ZoS Connect transition to OnBase Lead; drafted requirements document (BRD) for all internal Medicaid-related departments. Mentored. managed and coached junior peers while participating with interviewing. Air Force Strategic Transformation Support II Defense Logistics Agency (DLA) Strategic Transformation via Past Performance Qualifications (PPQs) Federal RFP - performed research for the RFP, coordinated and documented data of team.

Cambria Solutions, Inc.; Sacramento, CA & Jackson, MS (acquired by EY Aug 2022) July 2022 - Aug 2022

Business Analyst/Quality Analyst

Health & Human Services Transformation Project (HHSTP) - Used GSDs, training materials and documentation to develop test cases and perform testing in Accompa software for MDOM/MDHS programs in systems:

Client Web Portal (CWP/SSP), MAVERICS, New MEDS, CARS. Documented issues for Change management.

Apex Systems; Indianapolis, IN Feb 2022 - June 2022

Senior Business Systems Analyst

Developed documentation and training materials in Confluence for Pension Systems for all parts of the BeneSys

pension system: eligibility, health & welfare, reports, disability, check generation, claims, healthcare, Workday (HR).

Performed mapping of legacy data to new system/format for installation of new software.

Info-Matrix; Camp Hill, PA Aug 2021 - Dec 2021

DHS Medicaid EDI Business Analysis Lead

Developed requirements in Waterfall method for EDI transactions.

MMIS Modifications from CMS government to PA State DHS systems; UI/UX.

Scheduled, scribed and distributed meetings minutes for EDI-related portions of projects.

Performed internal Project Management for team projects.

Documentation, publication and training of functionality within MS Teams.

Implemented process improvements; created a template for reporting/tracking defects and how to record calls in Teams.

Completed documentation for Prior Authorization transactions.

Piloted ServiceNow as a tracking mechanism for tickets and incidents.

WPS; Madison, WI Dec 2020 - August 2021

Tricare DOD Contract Modifications Consultant

Work within an Agile framework.

Traceability of Contract Modifications from CMS government through vendors to end client.

Translate and refine requirements to user stories.

Provided input for issues which were discovered for presentation to Change Management oversight.

Drafted process mapping for user stories/flows stored in SharePoint.

Participated in pilot program for OnBase as a system user in relation to testing the routing of imaged/stored documents.

Reviewed files transmitted from and to NASCO via FlexLink

Created a data dictionary for BAs.

Work within an Agile team of Developers & Quality Assurance Analysts to implement and provide

post implementation support.

Participated in pilot for ServiceNow software platform for use in triage of internal tickets, prioritizing work and guidelines.

TEKsystems; Mechanicsburg, PA Nov 2017 - Nov 2019

e-Business Systems Consultant 5/Channel Secure Security Engagement Manager

Provided project management (PM) for global banking client, Wells Fargo. This included security of 100s of their intranet websites.

Facilitated SSO/ Lightweight Directory Access Protocol (LDAP)/Active Directory (AD)/Enterprise Asset Management (EAM), Identity Access management (IAM) remediations; using app web cloud-based solutions OKTA, CA SiteMinder and AZURE Cloud Foundry. Wrote PM guidelines and trained newer PMs on entire process from gathering requirements to post-implementation.

Served as the main point of contact for integration of Vanity/Cloud user URL authentications and authorization governance.

Served as primary liaison between LDAP/AD engineering groups, business partners, QA teams and management teams.

Responsible for requirements gathering (BRD), test plans, scenarios and cases, timelines, project/test plans, technical troubleshooting, CR requests, training/mentoring of junior team members, design documentation, task tracking/reporting.

Performed and oversaw QA processes as well as triaging and assigning defects in ServiceNow.

Leveraged SharePoint and other Microsoft tools: Excel, Outlook, OneNote, also JIRA/Confluence, +Pac2000/APPONE with Remedy/ServiceNow, UI/UX and Tech Tools.

PA Department of Human Services / Ohm Systems; Camp Hill, PA Jan 2017 - Jul 2017

Senior Business Analyst, Quality Assurance

Supported the rework effort of the claims/reporting systems and the web portal in response to new Federal mandates for Medicaid Management reporting (MMIS/TMSIS) for DHS (Commonwealth). Performed manual and automated UAT testing for Medicaid, SNAP & TANF programs.

Leveraged CMS; ACA, FFM, payments and reconciliations for Government programs.

Responsible for requirements gathering, documentation, report creation, all aspects and types of testing in an Agile environment.

Performed validations against Oracle relational DBs / modules via BI tool SQL Developer, PuTTY, and spreadsheets.

Responsible for data modeling, ER diagramming and User Stories from a technical BA perspective for internal DOCO Tool development, data clean up and conversion from an Access DB to GUI.

Relatedly, determined Data User Security levels/roles for mapping; AD/LDAP for updates to internal IAM user tables. Also, collaborated with developers to create new screen prototypes/mock-ups.

Worked on Enterprise Data Warehouse (EDW), data mapping testing and documentation in XML format.

Provided installations and support within the PROMISe System.

Leveraged Agile testing tool, Application Lifecycle Management (ALM) for UAT and automated testing, documentation within Excel add-on.

Created a claims system data dictionary with elements, values and definitions working with a DBA.

Generated Pivot Tables by using SharePoint as back end and using Power BI Pivot Tables.

Designed and generated numerous reports from Excel and Access Macros for internal client requests.

Provided reports for support, guidance for Security staff and Claims Managers.

Developed and generated reports using custom built queries from SQL Server using SQL Management Studio.

Wrote test cases and performed testing of Web Portal and manual claim entry with updated Provider NPIs and ICD10s.

Blue Cross Blue Shield/ika Systems; Mechanicsburg, PA Aug 2015 - Dec 2016

Senior Business Analyst, Quality Assurance

Served as Remote Claims Development / Sustaining Primary Level One customer interface for various Claims/Medicare/Medicaid/OPTUM/Gateway Payer systems, including UI/Portals, for small-to-mid-size clients.

Applied functional and nonfunctional knowledge of all automated in/out processing and flows, files, Oracle and hierarchical file layouts, triage, analysis, extensive EDI analysis with claim and encounter data; 837I, PD/835/276/277/834, XML and Enterprise Data Warehouse (EDW) mapping, EHR, EMR, ETL exploration and testing front and back-end processes.

Leveraged BizTalk, Online/Real-Time/Batch processing, SQL and SFTP - included conversion from HIPAA 4010 to 5010 for ICD10.

Triage and some resolution of claims issues from Providers, Clients and Account Managers - this was done via the physical claims system, incoming EDI 274 Provider files and on the Provider Web Portal. Led efforts to resolve Provider submission issues over the Holiday season.

Utilized NASCO BlueCard/BlueSquared for various ITS file transmissions and testing.

On-boarded new externa client staff: obtained accesses, system training.

Recent release changes caused incoming Provider Files to abend - tracing from CRM to Claims System and comparing to file raw data indicated that code/mapping was incorrect in Production. Partial back-out of release had to be completed; initiated this effort with IT management and oversaw retesting and reprocessing of files/claims and adjustments.

Frontline for client issues, as well as, Provider EDI or claims processing issues - triage, analysis, and manual system updates were done to correct submission errors, network setup, incorrect tiering or coding and mapping errors.

Was responsible for enterprise-level Customer Service Call Center support, vendor/offshore relations, KPIs for dashboard support, including trending, reports, documentation, tracking, testing and installation of CRs/defects.

Was responsible for solicitation, definition and development of user and high-level client requirements solicitation, including initiation, assumptions, objective and ROI.

Worked within JIRA/Confluence in a fully Agile environment, utilizing Scrum/Kanban Boards, User Stories, wrote and stored client documentation and training materials.

Leveraged Microsoft’s TFS for Agile project tracking, development and reporting.

Leveraged TFS to view / create GIT file records, change reports, and make client dashboard updates.

Contributed process improvement recommendations.

Participated in pilot testing and installations.

Leveraged JIRA to record, track, trace, test and implement system changes.

Created and managed tickets within JIRA to handle workflow.

Participated in sprint planning, daily stand-up and weekly Scrum meetings and served as backup Scrum Master as needed.

Momentum, Inc.; Camp Hill, PA May 2015 - Jul 2015

Senior Business Technical Quality Assurance Analyst

Completed QA analysis and auditing/IV&V.

Led JAD sessions and documented customer requirements gathering for Oracle PeopleSoft 9.2 implementation of Core Human Capital Management (HCM); Human Resources (HR), Payroll, Financial data conversion.

Reviewed and documented as-is processes with clients and mapping of client requirements/translation to PS 9.2 functionality.

Worked with developers on DB2 data modeling from a BA perspective for a large, nationally-known, private school client.

Highmark, Inc.; Camp Hill, PA 2012 - 2014

Technical Business Analyst, Provider DB Capitation System Rewrite

Analyzed enterprise-level company initiatives and large sized projects for internal/external customers for system releases - this included determining business needs, JAD sessions, all requirements gathering/documentation/tracking, non/functional/UAT testing, defect resolution, partner tester and end-user training and obtaining systems accesses for peers/customers - primary customer was Independence Blue Cross (IBC).

Leveraged IBM Rational Tools to record, track, trace, test and implement issues/changes for SDLC, which included the Excel add-in for test cases, expected results, outcomes, documentation and tracking.

Coordinated testing/defect resolution, testing with TCOE, implemented changes for new Reports, AR, GL, Financial, billing, EDW, Group, Enrollment, Provider and Health Care Procedure Code areas - projects included a new DB2 capitation system and updating an existing system to differentiate between Blue Plans, both included Graphical User Interface (GUI) and Mainframe development.

Determined business and user requirements; functional (technical), non-functional (usability, load and security), regression testing, defect resolution, documentation, training and obtaining systems accesses for peers/customers, primary customer; Independence Blue Cross (IBC).

Used IBM Rational Tools and traceability matrices to record, track, trace, test and implement requirements/issues/changes for SDLC from both Agile and Waterfall perspectives.

Leverage TFS for system changes which required project management, requirements and reports development.

Leveraged IBM’s ClearQuest, Test Manager, RQM, ReqPro to record, track, trace, test and implement issues/changes.

Trained team on SharePoint and served as admin.

Created Use Cases and User Stories, test case scenarios, cases and expected results, performed manual and automated testing/defect resolution, testing with TCOE, created and implemented changes for new Reports, AR, GL, Financial, Enterprise Data Warehouse (EDW), Group, Enrollment, Provider and Health Care Procedure Code areas. Projects included a new DB2 capitation system and updating an existing system to differentiate between Blue Plans - both included Graphical User Interface (GUI) and Mainframe application development, testing software used to house all test data, dataset and results: IBM’s Rational Test Manager (RTM) and Rational Quality Manager (RQM). Conversion of data from TM to RQM. These, integrated with other IBM Rational tools, were used to take projects from inception to implementation.

Leveraged BI tools: Teradata SQL to write statements, queries/table joins. Crystal Reports and SAS to extract, analyze, compare, map and convert claims data, OLAP. This included feeder and downstream systems data, such as; eligibility, group, provider, rates, billing, capitation, diagnoses, etc. against Oracle and hierarchical DBs, familiarity with ETL tools/ methodologies; SAP, SAS.

Conducted data mapping, translations, cleanup, interpolation, creation of new data and partner testing of new and existing elements/values for Capitation included up and downstream processes and applications.

Worked with internal Enterprise Data Warehouse (EDW), Capitation, Finance, IMAGE (similar to OnBase & FileNet) and external client Enterprise Data Warehouse (EDW) areas.

Served as SME for system accesses, security and navigation; management security access proxy/role-based access, customer service, claims applications, testing procedures and related tools; IBM Rational Tools.

Provided mentoring to Business Analysts.

Documented processes and procedures.

Conducted remote training for customers/peers/vendors and created how-to and processes and procedural documentation.

Highmark, Inc.; Camp Hill, PA 2009 - 2012

Technical Business Analyst, Optimum System Claims Adjudication and Reconciliation (OSCAR) Back-end Solutions

Worked on Optimum System Claims Adjudication and Reconciliation (OSCAR) Back-end Solutions.

Implemented medium system changes in a lead/support role.

Analyzed business needs, documenting requirements to provide proposals for releases.

Liaison between all customers/developers to identify business processes and systems requirements.

Obtained all security accesses and fielded questions for claims, customer service and testing.

Leveraged SQL Writer for research, testing and validation purposes, including HIPAA 4010 to 5010 issues.

Supported production by reorganizing weekly processes; history claim errors/balancing and MEDCO Web Errors.

Implemented changes for error resolution saving .25 of an FTE over a calendar year.

Trained new Business Analysts.

Completed analysis, defined requirements, wrote test plans/scripts for CRs initiated by BCBSA/other Blue Plans.

Tested Prof, Inst, ADJ, FEP claims; and BlueCard claims via the OSCAR (Highmark) and ITS (Inter-Plan Teleprocessing Services) & NASCO systems.

Partnered with tech staff to test, identify business needs and solutions. Familiarity with ITS from green screen, to GUI to Blue Squared. Partner tested large OSCAR claims projects interfacing with ITS staff and software. Worked with both HOME and HOST; understanding of SF, RF, DF NF, SIRF.

Highmark, Inc.; Camp Hill, PA 2006 - 2009

Business Analyst II, Health Plan Operations (HPO) (ePlatform)

Served as Lead BA for Web Unit. Coordinated initiatives for Web Portals: Consumer, Employer, Producer.

Reviewed and tested requirements, led workgroups, documented and conducted training for CSRs. This included Internet and Intranet applications.

Team rep for conversion to PeopleSoft HCM for Payroll, Benefits, HR and Financial - submitted requirements for all web-related changes.

Managed BA Production: CSR 3rd Party Search - alerted management about weak security surrounding process demonstrated internal Personal Health Information was accessible from outside systems.

Initiated a project tightening Web Security, saving company from breaches and legal issues.

Implemented Web Password Resets – drafted, directed training and implemented ahead of schedule; for inexperienced, hourly staff to file telephonic technical inquiries.

Coordinated/supported large initiatives: Web Registration Verification, Personal Health Registry (PHR), Plan Cost Advisor (PCA), Blue Account - HSA/FSA/HRA, Sales2Enroll, Role-Based Security, Portal email inquiries.

Highmark, Inc.; Camp Hill, PA 2003 - 2006

Technical Business Analyst II, Dental (Concordia-UCCI) & Vision (Davis) Systems

Led Commercial/DOD Claims/Web projects. DOD; TDP (TRICARE) - DITSCAP/DoD Certified.

Leveraged FrontPage / HTML.

Implemented Web Portal migrations; Web Xpress Web Claims, My Dental Benefits, My Patients’ Benefits, IVR, Faxback. Dental Claims: batch reporting, history/pending, quality assurance control, Reporting.

Tested and prepared documentation for national clients, ex: Wal-Mart, Verizon presented in WORD/Visio.

Tested EDI files: for 837/835/834 X12 Transactions; HIPAA/ANSI standards.

Lead on Image Integration project/eliminated manual toggling between UCCI/IWPM (IBM) claim images.

Provided extensive testing/training of UCCI staff, coordinating with various areas.

Presented to management.

Created BA Training Manual and trained new staff, Claims end-to-end overview, and drafted RFP responses to national clients, worked CR backlog.

Coordinated claims data/dataset analysis, mapping and conversions, including Orthodontic Accum Loads for additional Blue Plans.

Estimated history loads and conversions for new business and stayed within budget for all projects.

Solicited and wrote requirements from Claims client, designed new reports, wrote SQL queries to validate data for testing and change management - Implemented and provided ongoing post-implementation support.

Led migration/conversion projects to move all History claims data: group, enrollment, provider, etc. from legacy platform to new.

Highmark, Inc.; Camp Hill, PA 2000 - 2003

Supervisor, KHPC, Integrated Point of Service Claims & Enrollment

Supervised nine hourly Claims Reviewers/Review Nurses.

Directed projects to ensure optimal operating efficiencies & cost effectiveness. Research/resolution of claims issues. Analyzed workflow/data to request operational changes. Oversaw Complaint Coordinator/Act 68 Appeals for Hershey HealthStyle/HealthOne; Capital Blue Cross (FACETS) & Highmark (OSCAR).

Implemented numerous procedural guidelines and training for staff: adjustments, referral development to eliminate lag, Enrollment, Point of Service, group conversions and Act 68.

Coordinated employee training and on-boarding, oversaw Claims’ Enrollment assistance between Highmark, CBC and unit.

Implemented cross-training for high-priority groups; ITS, PEBTF, Hershey, between Claims and Customer Service.

Changed feedback for staff, allowing input for non-production time to better account for monthly reporting.

Oversaw system changes: Automate Manual Inventory Repts-.30 FTE savings, Intranet search functionality.

Revised payment/adjudication process, per Act 68. Updated manuals/flows required by BCBSA, which resulted in the development of a new Access (Oracle) DB.

Business Analyst II, BluePRINT Claims 1998 - 2000

Completed Legacy claims conversion projects after merger of PA Blue Shield and BCBS of Western PA which formed Highmark. Lead BA for Internal/External History conversions, new data element mapping, benefits coding, imaging, data dictionary updates. IMAGE, OnDemand, fische and OCR, Mainframe JCL. MS Access DB and MS WORD used for requirements traceability and implementations. Utilized Reciprocity/OOA/Bluecard/ITS/NASCO software for testing OOA claims. Trained new staff on all parts of History processes and end-to-end testing.

Staff Support BA II (1995 – 1998)

Sr. CSR (1990 – 1995)

Education: Millersville University, Millersville, PA B.A. Art/Liberal Arts

Certifications and Certificates:

DITSCAP/DOD Certified

HIAA Accredited

SAFe Product Owner/Product Manager 5.0

Leading SAFe 6.0

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