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Snehjot
sney.sandhu@gmail.com
904-624-5467
10135 gate pkwy n
Jacksonville, FL 32246
Business Systems Analyst and Testing Analyst
12 years experience W2
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Summary

Seven years of experience as a Business Systems Analyst and Testing Analyst in the IT industry. Expertise in Rational Unified Process (RUP) methodology, AGILE methodology, Use Cases, Software Development Life Cycle (SDLC) processes, Unified Modeling Language (UML) using modeling tools such as Rational Rose and MS Visio. Experience of Client-Server and Web based applications using methodologies and practices in Healthcare Industry. Experience in gathering business requirements, analyzing, and converting user requirements into business requirements and have ability to work effectively both as a team leader and a team member. Efficient in creating Test Plans, Test Strategy, Test Cases for end-to-end functionality testing and configuring Defect Management Process. Possess extensive knowledge of Problem Solving Techniques and excellent Analytical skills coupled with Good Communication and Interpersonal skills describing a committed Team Player.

SPECIFIC EXPERTISE:

  • Experienced in Working on HIPAA – EDI 5010 series for EDI Transaction code sets:
  • 837 – Claim and encounters.
  • 834 – Benefit enrollment and maintenance.
  • 270/271 – Eligibility benefit inquiry and response.
  • 277 / 276 – Claim request for additional information and response.
  • 835 –Claim payment/Advice.
  • Excellent knowledge of all phases of Software Development Life Cycle methodologies; with thorough knowledge of various phases including Requirements, analysis, design, development, testing (STLC) and implementation of software applications.
  • Adequate knowledge in Health Administration – Claims processing (auto adjudication), Claims pricing and testing, enrollment, membership, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
  • Developed business required documents (BRD) on the basis of JAD sessions for project.
  • Worked in GAP analysis to understand the difference between two systems and documented the GAPs in GAP analysis spreadsheet.
  • Documented the meeting minutes from the JAD’s and stored the artifacts in an appropriate place holders and SharePoint for both the teams to review.
  • Experienced in ETL CA workload runner (Autosys) to run specific jobs for different modules.
  • Experienced in creating/maintaining Test Plans, Test Strategy, Test Cases, Traceability Metrics, Test Summary Reports and Test Scripts for end to end functionality testing and configuring Defect Management Process.
  • Proficient in Change management.
  • Immense experience in various testing types like Functional, System, Regression, Performance, and UAT testing.
  • Experienced in performing manual testing and defect tracking using HP Quality Center and Rational Clear Quest.
  • Reviewed and analyzed Business Requirements, Functional Specifications, and Detail Design of the Application to develop the test plan.
  • Expertise in creating complex SQL Queries using Joins and sub-queries and providing it to developers to build up the logic for the UI screens or Report using IBM Data Studio.
  • Excellent Analytical, Decision-Making coupled with good co-ordination, communication, problem solving and interpersonal skills describing a committed Team Player with an ability to handle multiple projects.
  • Extensively used tools like Quality Center for defect tracking and change management and Microsoft SQL server R2 (SSIS) for validating cubes.
  • Excellent judgment and management skills acquired through experience in identifying areas of high risk early in development life cycle and prioritizing my tasks to focus my testing effort when time is limited.

TECHNICAL SKILLS:

Tools/Applications:

Rally, Service Manager, Microsoft SQL server R2 (SSIS), Ab Initio (EME)portal, Quality and Revenue Management Program (QRPM), Quality Center, Quest, Availity, Siebel, Diamond, EAS, GAP, PL/SQL, CA Workload control Centre (Autosys)

Rational Tools:

Rational Requisite Pro, Rational Clear Quest, Rational Rose

Project Management:

MS SQL Server, MS Visio, MS Office (Word, PowerPoint, Excel, Access), MS Project

Modeling and Analysis Environment:

UML, RUP, Agile, Waterfall Methodology

Operating systems:

Windows 9x/2000/XP/Vista/7

Experience
Business Systems Analyst - consultant
Healthcare
Feb 2015 - present

Project: Quality Risk and Revenue Program

I have worked on QR2 platform project that provides an optimized model that further helps in Ability to integrate with tenants due to flexible design approach needed for serving multiple clients with different levels of services and price point metrics. It also supported accurate risk score data, and exceeds regulatory thresholds for data submission and exception resolution. Also worked for Revenue Program Management (Prospective) project which involved in getting Members outreached by third party vendor at the time of care or prior to providing care, the provider has knowledge of care and coding gaps.

Responsibilities:

  • Facilitated requirement gathering sessions with the Business users, Stakeholders and third party Vendors to evaluate member populations and identify members using predictive modeling for Care management, MCM and other business activities.
  • Conducted workshops with the key end client users to document functional design documents for QR2 being single source for three capabilities (Member, Provider, Employer)
  • Created Process flow diagrams and Data flow diagrams for all new requirements/data and analyzed Business process to support accurate risk score data and exceed regulatory thresholds for data submission and exception resolution.
  • Responsible for creating Production ticket every week for all the database changes that needed in Production in Service Manager for all the cross-functional teams
  • Built mock up screens for the reports with suggestions to the necessary software components required for the system setup in order to give shape to Business’s requirement and get sign off from the Business
  • Worked with Cross functional teams to set up access of the accounts for smooth flow of information (example:- SFT account set up) while sending Outbound files to Vendors and receiving Inbound files from the Vendors
  • Provided direction and supported Tableau application by validating User screens and aligning them with the requirements in order to achieve accuracy of the reports
  • Responsible for writing User stories in Rally tool with all the tasks, points, hours allocation and dependencies for all the team members before every sprint and meet with the Product owner to set up priorities of the features
  • Conducted Sprint planning sessions and defect log sessions with the team on weekly basis and raising the impediments to higher management in case of any blocker
  • Supported the technical team such as providing business logics, Change log for Target tables and Attributes to be created for ADM schema in DB2, providing full validation support after data load by ETL and also supported Business users throughout by conducting UAT sessions with them
  • Determined and planned new table structures to analyze naming conventions of the attributes and data types as per BCM standards with DBA’s and Data architects
  • Conducted Brainstorming sessions and JAD sessions with technical team in case of ambiguous requirements and unexpected work effort to make quick decisions and remove dependencies
  • Created ETL mapping document and change log with full Source and Target information of all the new and alter tables in order to hand it over to developers for execution
  • Responsible for providing Logical names and Business definitions of all the new fields from Ab Initio EME portal
  • Facilitated sessions with third party Vendor for the Member chase list for all the Inbound and Outbound files
Data Architecture Ab Initio EDI Tableau ETL UAT Agile Methodology Business Analysis Scrum DB2 JAD HIPAA Requirements Gathering System Analysis BSA Program Management Project Management
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Business Systems Analyst
Healthcare
Oct 2014 - Feb 2015

Project: NY Encounters

Well Care provides managed care services, focusing on Medicaid and Medicare. Well care is an MCO which provides health insurance for customers in several states like Kentucky, North Carolina, Florida, New York and etc. The project was to send HIX Institutional, Professional and Dental claims in outbound for different states. I was also responsible for preparing requirements documents for HIX data which was orange stack and 837 P/835 EDI transactions.

Responsibilities:

  • Performed Requirements Gathering and Analysis, and ensured that contributors and all key stakeholders were satisfied.
  • Coordinated with developer and testers for HIX related requirement documentation.
  • Performed GAP analysis of PRS and HIX using implementation guide to identify the changes in the segments and data elements.
  • Gap Analysis of client requirements, generated workflow process, and relevant artifacts.
  • Responsible for Daily Status reports to the Business owner, Project executives & Team.
  • Documented business needs for HIX orange stack.
  • Developed Incident documents and portrayed the as-Is reporting structures versus To-be Reporting needs for data integrity and accuracy.
  • Identified the scope, business objective and documented the functional requirements for each release.
  • Helped testing team by working on CA workload control Centre (Autosys) to run specific jobs based on the requirements and tested the functionalities based on the module status in case of aggressive timelines.
  • Conducted and attended walkthrough meetings and test case review
  • Directly involved in process improvement Plans and implementing business change.
  • Produced clear user manuals & training guides for User Acceptance Testing (UAT) and deployment for end-clients with step-by-step instructions.
  • Created use cases specifications, use case diagrams to define the workflow and segregate high-level and low-level requirements using MS Visio.
  • Conducted JAD sessions to gain consensus on various issues related to the project.
  • Facilitated the resolution of project-related issues, identified risks and mitigation steps to manage risk using PL/SQL.
  • Created requests for codes or data to be deployed into certain environments
Analysis System Analysis Requirements Gathering Data Integrity Test Case Preparation UAT Training SQL EDI Documentation Gap Analysis MS Visio Process Improvement AutoSys JAD HIPAA BSA 837
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Business Solution Quality Analyst
Healthcare
Feb 2013 - Sep 2014

Project: ICD10, FEP

I have worked on ICD10 project which involves large amount of system integration testing as part of ICD10 implementation, worked on various tools and applications during the project.

Federal Employee Program (FEP) to the common platform initiative migrate the Existing Federal Employee Program claims processing business to the Common Administrative Platform (CAP)

Responsibilities:

  • Reviewed functional/design specifications and other relevant documents to extract test requirements.
  • Coordinated and lead project updated meetings, documented project status and issues related to project.
  • Developed Change Request Form to satisfy client requirement changes and created.
  • Responsible for validating the claims are accurately adjudicated on the Diamond claims processing platform according to defined FEP requirements and benefits.
  • Responsible for validating Claims Processing systems suspense processing and claim rejection logic.
  • Participated in meetings with stakeholders, development team and business users to discuss UAT plan. Reviewed functional/design specifications and other relevant documents to extract test requirements.
  • Worked on claim processing on the basis of Medicare and MITA compliances.
  • Experienced working on member provider management along with Fiscal, waiver program, and federal reporting.
  • Involved in Training of various modules (Releases, Requirements, Business components, Test plan, Test lab, Defects) in Mercury Quality Centre for FEP testing team and FEP business team.
  • Used Availity Provider Web Portal for submission of 835P/I electronically using FTP gateway to validate HIPAA 5010 edits for ICD10 Codes.
  • Involved in Smoke Testing, System End to End testing and Regression Testing on Florida Blue's system used for Claim processing.
  • Validated Claim Pricing (Member Contracts, Provider contracts, Procedure pricing, DRG grouping, Benefits Accumulators).
  • Experience with HIPAA 4010 and 5010 versions of EDI transactions like 837I/P, 835, 270/271, 276/277, 278 etc.
  • Worked on Analyzing the HIPAA 5010 EDI File format created for 837I/P transactions and also created new X12 files, Worked on various adjudication systems like FEP, ITS etc. Working in a waterfall environment, Involving weekly Touch base meeting updates/ status. Performed backend testing using SQL queries to check backend data and data integrity.
  • Established new requirements for administrative transactions with implementation in compliance with Patient protection and affordable care act (ACA).
Integration Testing Waterfall UAT Test Planning Systems Integration SQL Smoke Testing Training Regression Testing HIPAA FTP EDI Data Integrity Compliance Backend Testing Diamond HP QC Quality Assurance
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Business Analyst / Test Analyst
Healthcare
Feb 2011 - Dec 2012

Project: Claim Processing module

At BSC the application being developed consisted of a claims processing module to make claims processing more efficient in submitting claims to various insurance and Health Services such as Medicare and Medicaid. The fully integrated solution offered support for the financial, administrative and clinical management needs, and also features functionality such as medical records, managing care and electronic connectivity.

Responsibilities:

  • Analyzed and evaluated technical information on business regulations and policies based on business analytical documents.
  • Worked in GAP analysis to understand the difference between both the billing systems and documented the GAPs in GAP analysis spreadsheet.
  • Created the strategy document that defines the test environment, phases of testing, entrance and exit criteria into different phases of testing and resources required conducting the effort.
  • Validated the requirements with end clients and preparing the functional specs with to proceed further and implement the same
  • Participated in review and walkthrough meeting with 5010 testing team and development team.
  • Active participation in developing BRD for the transactions 835, 837, 270/271, and 276/277.
  • Responsible for Smoke testing, Unit test scripts reviews and validating using smoke and unit test scripts with Development and Testing team
  • Prepared test data for positive and negative test scenarios for Functional Testing as documented in the Test Plan.
  • Executed test cases manually to check GUI and Functional features of the AUT, compared and analyzed actual with expected results and reported all deviations to the appropriate individual(s) for resolution using Test Director.
  • Performed browser compatibility testing on different platforms.
  • Performed the Back-End testing to ensure data consistency on front-end by writing and executing SQL queries on the database.
  • Coordinated with users for User Acceptance Testing in a production environment.
  • Prioritized and reported defects using Test Director and generated documents and reports for further analysis.
  • Analyzed Defect Reports using Test Director and worked closely with Application to fix defects.
Test Planning Test Case Preparation SQL Smoke Testing UAT Gap Analysis Functional Testing Compatability Testing Business Analysis Backend Testing Analysis Business Requirements HIPAA EDI BRD 837
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QA Test Analyst
Healthcare
Sep 2009 - Sep 2011

Project: Claims and Membership modules

Work on project focusing on the Care Engine, an interactive care management solution which administers more than 12,000,000 members nationwide. It provides members with online access to personal information, including individual personalized messages and alerts, detailed health history, and integrated information and resources to help members make informed decisions about their health care. The application implemented followed ASC X12 Standards. The reporting tool was used to query, print and display tracking reports in compliance to HIPAA Act. As per ICD 10 mandatory conversion, the application was undergoing the change of codes from ICD 9 to ICD 10

Responsibilities:

  • Developed Test Plans, Test Scenarios and Test Cases for ICD10 Implementation.
  • Analyzed the membership data to create test scenarios and test cases for the online web application.
  • Prepared Test Cases for 837 claims to Test and implement the ICD10.
  • Executed all the 837 test cases with test team from Quality Center.
  • Coordinated with performance team using load runner to make sure the performance of the claims for ICD10
  • Responsible for running different batch processes such as adjudication batch, payment batch, and EDI claim load batch for testing purposes.
  • Actively responsible in providing Test Data for User Acceptance Testing (UAT).
  • ICD10 defects have been identified by executing latest test cases and identified the defects and loaded the defects in the Quality Center
  • Conducted Bug review meeting to discuss resolution of issues.
  • Re tested all the defects using Quality Center based on the request from business and test leads
  • Performed Database testing using SQL queries
  • Conducted GUI and Data Driven Testing.
  • Tracked defects using Quality Center.
UAT Test Planning Test Case Preparation SQL Quality Assurance HP QC HP Loadrunner HIPAA EDI Database Testing Compliance Load Testing 837
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Edit Skills
Non-cloudteam Skill
Education
Bachelor's in Business Administration
BS
Certifications
User Story writing certification
Florida Blue, 2015
Skills
EDI
2021
6
HIPAA
2021
6
UAT
2021
6
BSA
2021
5
SQL
2015
5
837
2015
4
MS Visio
2015
4
Program Management
2021
4
Project Management
2021
4
Test Case Preparation
2015
4
Test Planning
2014
4
Compliance
2014
3
HP QC
2014
3
Quality Assurance
2014
3
Agile Methodology
2021
2
Analysis
2015
2
Backend Testing
2014
2
Business Analysis
2021
2
Data Architecture
2021
2
Data Integrity
2015
2
Database Testing
2011
2
DB2
2021
2
Gap Analysis
2015
2
HP Loadrunner
2011
2
JAD
2021
2
Load Testing
2011
2
Requirements Gathering
2021
2
Scrum
2021
2
Smoke Testing
2014
2
System Analysis
2021
2
Training
2015
2
Ab Initio
2021
1
AutoSys
2015
1
BRD
2012
1
Business Requirements
2012
1
Compatability Testing
2012
1
Diamond
2014
1
Documentation
2015
1
ETL
2021
1
FTP
2014
1
Functional Testing
2012
1
Integration Testing
2014
1
Process Improvement
2015
1
Regression Testing
2014
1
Systems Integration
2014
1
Tableau
2021
1
Waterfall
2014
1
834
0
1
Manual Testing
0
1
Microsoft Excel
0
1
MS Project
0
1
SQL Server
0
1
UML
0
1
Windows
0
1