Business Analyst Senior
Resume:
Consuela Ingram
Phoenix Area
********@*****.***
Consuela is a highly trained and experienced Senior Business Analyst with experience as a QA Engineer, Test and Project Manager. Working with CMS (Centers for Medicare & Medicaid) DHHS (Department of Health/Human Service) Child Support and Provider Eligibility and Enrollment.
Technical Proficiencies
Microsoft Office, MMT, HBOC, HP Quality Center, Rally, TFS, ALM, Jira, MITS, MMIS, SETS,FACETS, SharePoint, Quick Test Pro, EDI transaction sets, Agile and Oracle SQL, Automation experience using MS Visual Studio Coded UI, Team Foundation Server and Microsoft Test Manager
BA in Information Systems Project Management pursuing
IT Certification
Associates Healthcare Management at Technology Education College
07/16-Current Senior Business Analyst
Contractor
HP/DXC State of Ohio/Colorado/Mississippi Medicaid
Testing the eligibility system for Medicaid programs for ABD (Aged, Blind, and Disabled) Children and Adults who meet the poverty guidelines.
Testing encounter claims data systems for CMS agencies for system fixes an updates.
Writing test cases and requirements for Medicaid and Medicare encounter claims systems for release updates for MMIS software.
Writing requirements for software updates for MMIS eligibility system for Mississippi Medicaid and BCBS
Writing test cases in ALM to test the eligibility and guidelines for recipients in the Medicaid programs.
Gathering along with analyzing requirements, create test case scenarios and scripts, and execute scripts in different testing software including MMT/Rally/JIRA/TFS in an Agile/Waterfall environment.
Core Business Support for system maintenance and break/fix testing.
Implement different ways to improve quality claims submission for accurate and timely payment to providers and beneficiaries in the facets claims system.
Running cycles, reports and system testing on Claims System for the state of Colorado and facets software.
Uploaded parent and child requirements on Excel Spread Sheet
Responsible for planning and conducting a wide range of quality control tests.
Verified software requirements and modifications are complete and accurate for regression validation/smoke and UAT/User Acceptance testing.
Logging bugs and tasks in MS Visual Studio, Coded UI Team Foundation, Microsoft Test Manager
Using IBM Rational Team Concert/Quality Manager for script and defect management
Building and designing a web application for case management.
Working closely with the business and development to ensure a quality defect free release.
Using HEDIS to gather data and information for performance and service for healthcare providers and insurance payers.
Manual and automated black, white and grey testing on web applications to ensure security and no breach of HIPPA or PHI.
Assisting and preparing necessary documentation for MMIS development and certification.
Create documents through EPO and EPMO to implement, maintain and organize projects.
EDI transactions Healthcare 837 835 838
EVV Electronic Verification testing and software updates
Prior Authorization for Case Management
Designing and preparing training documentation for providers through PowerPoint. Also, providing training to providers to ensure they are fully knowledgeable on any current software updates.
RFP, RFI, Technical writing and, detailed documentation
Working close with DHHS to ensure software updates were tested in all phases of SDLC
Ensuring a 98% successful release with minimum defects
1/14 to 07/16 Senior Business Analyst
Right Source Staffing
Plan/Facility Source
Performed system, unit, performance, load, regression, stress and data interface testing.
Gathering requirements for test planning and test case execution in Agile environment.
Writing user stories and test cases for test execution.
Provided developers team with detailed reports on quality metrics, identified bugs and recommended fixes enhancements to product team
Participated in implementation process on POS application design / software methodologies and user interface.
Conducted formal and informal product design reviews throughout the software development lifecycle.
Provided input on functional requirements, product estimation design, schedules and goal potential.
Communicated effectively with software developers and product teams on the new and existing projects. (Compete / HP QC)
Developed Quality Assurance Test Plans for 3 major releases (JIRA/Quality Center/ ALM / SharePoint, POS, Reporting).
Testing claims processing and billing on MMIS system for Medicaid/Medicare CMS
Writing test cases and requirements for Medicaid and Medicare encounter claims systems for release updates for MMIS software and Medicare software.
Analyzed business requirements, conducted gap analysis and estimated project scope to deliver high-quality product
RFP, RFI, Technical writing and, detailed documentation
Verified software requirements and modifications are complete and accurate. Performed Regression Validation / Smoke and UAT / User Acceptance Testing. (GL Reporting / Billing / EFT / POS)
Immediately alert Supervisor of challenges/barriers in the practice environment impeding successful attainment of program goals
Completed and submit reports per guidelines
Actively participated in program improvement for Centers for Medicare and Medicaid
Submitted daily visit documentation within expected time frame
QA on test cases that were executed to ensure accuracy
Analyzed requirements, create test case scenarios and scripts, and execute scripts
Core Business Support for system maintenance and break/fix testing
Implemented different ways to improve quality claims submission for accurate and timely payment to providers and beneficiaries.
Ran cycles, reports and system testing on Claims System.
Uploaded parent and child requirements on Excel Spread Sheet
Responsible for planning and conducting a wide range of quality control tests
Point of sale and retail testing
Prepare/conduct JARs with stakeholder groups to elaborate/gather business requirements
Prepare/conduct JADs with stakeholder groups to define functional designs
Conducted all tests through healthcare system facets for updates and release management Software D Development Lifecycle
Met with stakeholders and CTO to develop implementation of web based projects and system enhancements
12/10 to 07/13 Sr. Business Analyst
QSSI/Palmetto GBA
Executed tests for MCS system for CMS/ Centers for Medicare and Medicaid to ensure correct electronic claim payments and denials.
Wrote test cases as assigned by CMS for System Changes.
Performed test planning, test design and test execution
Tested case mapping with Quality Center
QA on test cases that were executed to ensure accuracy.
Performed requirement gathering from the stakeholder’s/end client systems
Analyzed requirements, create test scenarios and scripts, and execute scripts.
Core Business Support for system maintenance and break/fix testing
Responsible for planning and conducting a wide range of quality control tests
Processed and tested EDI transactions
Updated system codes for ICD-10 and HCPT codes per request from CMS.
Ensured all system testing was completed by required deadline by CMS.
Implemented different ways to improve quality claims submission for accurate and timely payment to providers and beneficiaries
RFP, RFI, Technical writing and, detailed documentation
04/09 to 05/10 Healthcare Analyst
Molina Managed Care Medicaid
Processed incoming calls from Providers to help them administer correct claims submission for payment
Troubleshot and responded to customer concerns or questions regarding their specific policy or coverage file
Monitored claims in system for payments and processing
Worked different projects regarding correspondence and customer satisfaction
Assisted the member with coverage, authorizations and grievance policies
Performed system updates for codes using claims system
Created spreadsheets with Microsoft Excel
Check claim status and accuracy of electronic claims submission (to include EDI transactions)
10/05 to 04/06 Quality Assurance Analyst
06/08 to 11/08
Palmetto GBA
Processed incoming calls from beneficiaries to help explain their Medicare coverage
Assisted beneficiaries with navigating thru Medicare website to find Doctors or understand their policy and coverage
Checked claims in system for payments and processing
Worked different projects regarding correspondence and correct claims processing
Updated the system with current ICD-9 CPT codes for electronic claims submission
Ran test on system software for correct electronic processing and payments
Corrected and updating audits per CMS requirements
Tested case mapping and writing business requirements
Executed tests for MCS system for CMS/ Centers for Medicare and Medicaid to ensure correct electronic claim payments and denials
Wrote test cases as assigned by CMS for System Changes
Updated System codes for ICD-9 and HCPT codes per request from CMS
Ensured all system testing was completed by required deadline by CMS
Updated provider and pricing files to ensure correct claim processing
Implemented different ways to improve quality claims submission for accurate and timely payment to providers and beneficiaries
Tested case mapping with Quality Center
QA on test cases that were executed to ensure accuracy
Processed/tested EDI transactions
01/08 to 06/08 Medicare Biller
Medassist Inc./Express Personnel
Processed claims electronically in Medipac and Cubs for payment from Medicare
Checked claims for error and status on FSS system for Medicare Part A and B thru UGS
Corrected any errors in FSS system and refilling claim with Medicare
Entered claims in FSS system to be processed for processing
Sent claims to Secondary payers to process claims for payments
Processed incoming calls from beneficiaries regarding their accounts and resolutions
07/04 to 10/05 Account Resolutions Specialists
04/06 to 11/07
OSI Collections
Processed outgoing calls to resolve patient balances, setting up the best possible arrangement for the patient and the client
Called insurance companies for follow-up on receipt of claim and payment
Assisted patients understand their insurance policies regarding deductible co-pays and coinsurance
Sent UB92 or HICFA forms for prompt payment of insurance claims
Sent claims to Secondary payers to process claims for payments
07/00 to 08/04 Patient Analyst
Mt. Carmel Health Systems
Processed 150-180 calls a day to assist patients with their billing statements and resolving patient accounts
Managed reports using Microsoft office to reduce A/R, and collect on patient accounts
Called insurance companies for follow-up on receipt of claim and payment
Assisted patients understand their insurance policies regarding deductible co-pays and coinsurance
Sent UB92 or HICFA forms for prompt payment of insurance claims
Sent claims to Secondary payers to process claims for payments
Qualifications Summary
Education and Certifications
Professional Experience
Contact this candidate