Heera Shelly Email & Phone Number

Raleigh-Durham, North Carolina Area

Sr.Business Analyst serving the Digital Operations Department.

Cary

Collaborate with diverse teams across the organization and responsible for developing business requirements, SLA needs, user remediation plans, expected outcomes, performances needs, implementation/test plans and for working closely with the Solution Designers to review technical requirements to ensure the overall functionality can be delivered. Work as part of a multi-disciplinary project team on customer implementation projects, taking the leading role in requirements gathering, analysis… Show more Collaborate with diverse teams across the organization and responsible for developing business requirements, SLA needs, user remediation plans, expected outcomes, performances needs, implementation/test plans and for working closely with the Solution Designers to review technical requirements to ensure the overall functionality can be delivered. Work as part of a multi-disciplinary project team on customer implementation projects, taking the leading role in requirements gathering, analysis, design and customer documentation. Lead customer workshops, prepare requirements and user documentation for project delivery. Runs projects that include many phases and multiple project teams. Develops detailed work plans, schedules, project estimates, resource plans, and status reports. Leads project meetings and provides updates to senior and executive leadership regarding project status and designs, implements, and monitors the progress of initiatives, milestones, and budgets to ensure timeliness and deliverables are met.Validate requirements specifications and solution design with stakeholders, project team members, and senior management sponsors via an iterative and collaborative review and verification process to obtain consensus and approval. Develop and maintain project plan, issues log, action item log, meeting agendas, meeting minutes and other artifacts as required.Identify and manage scope concerns, risks and issues and escalate to appropriate team members and management as needed. Act as Project Lead for multiple small projects following the IT System Development Lifecycle (SDLC) methodology and project management best practices. Create and maintain project schedules by developing project plans, estimating time requirements, establishing deadlines, monitoring milestone completion, tracking all phases of the project/product lifecycle on small projects. Show less

• Tested the positive and negative scenarios for all the claim edits related to recipient, provider, diagnosis codes and other third party insurances.• Validity testing of the NCtracks provider and Operations portal for the online submission and inquiry of claims.• Tested the pricing of claims as per pricing manual and applied rules and also tested the co pay, patient monthly liability and deductible balance if applicable.• Created, submitted and tested the 4010 transactions via x12… Show more • Tested the positive and negative scenarios for all the claim edits related to recipient, provider, diagnosis codes and other third party insurances.• Validity testing of the NCtracks provider and Operations portal for the online submission and inquiry of claims.• Tested the pricing of claims as per pricing manual and applied rules and also tested the co pay, patient monthly liability and deductible balance if applicable.• Created, submitted and tested the 4010 transactions via x12 tool and also obtained the 276/277 and 997 responses as per test criteria.• Responsible for retrieving all claims and claim details from the database thru SQL queries and proving the status of claims for claim type or claim status.• Responsible for reviewing and responding to state comments related to the test case reviews.• Logging defects in silk and following up of the defect for its whole life cycle as well as rerun of the related test cases.• Processing of all kinds of claims: Medical, dental and institutional.• Designed tests using keyword driven methodology for selected areas.• Created recovery scenarios for error handling• Involved in all phases from test case writing to string testing to final system integration testing.• Creating claim reports based on the report templates available.• UI validation testing as per the technical design document and DOC builder screens.• Handling audits and prior approval requests.• Creation, handling and submission of paper claims and adjudication thru batch process.• Claims adjustments and voiding and testing the audit trails.• Checking for duplicate claims and posting dupe check edits.• Claims pricing and benefit plan determination according to payer and health plan associated with the claim. Show less

Raleigh-Durham, North Carolina Area

• Participated in requirements analysis and reviews and given feed backs.• Prepared the alpha test plan with the corresponding testing strategy, test specifications and schedule estimates.• Write positive, negative and regression test cases for the tools and the video portal involved in the project.• Provide BAT’s for the tool as well as the video portal and checking the basis tests whenever new builds are ready.