Business Analyst Quality Assurance
CurrentQNXT Upgrade: The objective of the project was to upgrade Cognizant’s QNXT system, a claims and eligibility system with over 200K patient records that processes around 2M claims annually, to avoid significant upgrade costs and penalties, while ensuring the system processed claims without any downtime.EPIC implementation: The project entailed implementing Epic platforms, Tapestry and Healthy Planet, migrating Utilization Management (UM) and general care management from the legacy system to Epic, and transferring eligibility, benefits, and provider data from QNXT to the Tapestry platform.Other projects include NYS Medicaid – OSDS Implementation, ECHO Credentialing system (Provider credentialing) upgrade, Biztalk server upgrade, SQL Server upgrade, QNXT upgrade to version 5.7, and adding new line of businesses.• Elicited and documented requirements, and performed comprehensive data analysis, ensuring data consistency and integrity across multiple systems.• Managed configuration, loading and processing of claims and EDIs (837, 835, 278, 834, 999) ensuring 99% accuracy and alignment of the segments, elements, and values as specified in the companion guide and mapping documents.• Developed data mapping and transformation specifications and managed data migration from legacy to EPIC system, including authorizations and referrals, and provider, 278, enrollment and eligibility.• Developed comprehensive test plans, test cases and scripts for various applications adhering to best practices and rigorous testing methodologies.• Performed system and regression testing, and managed UAT for claims and interfaces, including EDI claims, NYS Medicaid, paper claims, encounters, claim repricing, claim letters, EOB, remits and enrollment/eligibility.• Developed reports based on data analysis and user input that facilitated data-driven decision-making and reduced reporting time by 25%.
