PROFESSIONAL SUMMARY:

• 6 years of professional experience in Information Technology with emphasis on Quality Assurance/Software Testing with exposure of both Manual and Automated testing of Web based and Client/Server applications in healthcare domain.

• Knowledge of web services testing using Service Oriented Architecture tool, SOAP UI.
• Experience developing and testing Business Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrollment and Maintenance), 835 (ERN - Electronic Remittance Notification), 837 (Claims Submission) transactions and their acknowledgements.
• Extensive experience in Manual Testing and Automated Testing.
• Managed and tracked the requirements through Requirements Traceability Matrix.
• Experience in preparing and maintaining Requirement Traceability Matrix document.
• In depth knowledge of Software Development Life Cycle process (SDLC) and Software Testing Life
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
• Knowledge of Confidential information and Confidential care services regulatory environment including HIPAA, Medicaid/Medicare, EDI and XML
• Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefit
• Experienced in developing Test Plans, Test Cases and Test Reports based upon the business requirements.
• Experience in Black Box, Positive, Negative, Integration, System, Front-End and Back-End Testing
• Worked with MMIS (Medicaid Management Information system) to analyze the subscriber eligibility.
• Experience in loading from various data sources like database, fixed length and Delimited Flat Files.
• Experience in GUI Testing, System Integration Testing, Regression Testing and User Acceptance Testing using Rational Robot (GUI Scripts)
• Experience in Regression and Functional Testing
• Experience in reporting bugs using Bug tracking tools such as Quality center
• Performed Sanity testing, Smoke testing, Usability testing and Security testing of various applications
• Maintained Test Matrix, Requirement Traceability Matrix (RTM) to make sure that test plans were written for all the requirements and performed Gap Analysis
• Participated in Walkthroughs and Inspection meetings to review Test scripts and results
• Wrote complex SQL queries to perform the back end testing and Data Validation
• Involved in creating and working with stored procedures.
• Expertise in using Test Management tools: Quality Center, Rational Suite (Requisite Pro, Rose, Robot, Test Manager, Clear Quest, Clear Case)

TECHNICAL SKILLS

Testing Tools: Quality Center (QC), Quick Test Professional (QTP), Facets, SOAPUI.Bug Tracking Tools: Jira, Quality Center, Bugzilla

Databases: MS SQL Server 2008, ORACLE, MS Access

Languages: SQL, PL/SQL, Java, C, Visual Basic

Web Technologies: VB Script, HTML, XML

Operating Systems: UNIX, Linux, MS DOS, Windows 2000/XP/7/8

SDLC Methodologies: Agile, Waterfall, RUP

EXPERIENCE

Confidential, Charlotte, NC

QA Tester

Confidential is a leading provider of products, services, and technologies supporting the healthcare industry. The Medi Pharma online service was designed to deliver refill medication to follow-up, disabled and elderly patients at their homes without the necessity to visit the physician. I was involved in implementing HIPAA EDI transactions in the application; also involved in modules: Pre-pricing claims, Claims Adjudication, Claims Payment, Coordination of Benefits (COB) and Adjustments

Responsibilities:

• Handle multiple Quality Assurance projects simultaneously with a team of 4 and 3 Testers.

• Responsible for my Team’s Status and Progress report to the Test Manager.
• Lead the UAT effort and arrange/facilitate UAT testing sessions
• Coordinate feedback from testability reviews to PM from the QA team
• Set up Provider's Access to the System. (Security Setup).
• Act as UAT Lead in planning and executing UAT testing sessions with the business team
• Assist UAT Business Leads with set up in tools and tool training as needed.
• Coordinate UAT testing preparation, execution and reporting activities
• Prepared and executed different SQL Queries against the Oracle and Sybase Database.
• Verified and Validated the Rates Calculations and Rate Renewal Calculations for different Products and benefits by Preparing and executing different SQL Scripts.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Performed Functional, Regression and Usability Testing using QTP.
• Performed Compatibility Testing against different browsers and versions.
• Used Quality Center for reporting defects.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Working with management to establish, document and maintain EDI procedures by identifying errors and taking corrective action, reconciling EDI transactions through coordination of information with internal and external customers, Accounting Department, IT Department and external vendors to maintain EDI integrity.
• Overseeing and maintaining the EDI Inquiry Problem database including the evaluation of problems or issues through to resolution.
• Did data analysis, created data mapping and data interface documents and kept the documents updated with changes in requirements and functional specifications.
• Developed Reports and Graphs to present the Stress Test results to the management
• Wrote VB script for automated testing in QTP
• Created BPR charts for AS IS and TO BE processes of different business functionalities

Environment: Quality Center, Quick Test Professional, UAT, MMIS, MS SQL Server 2008, MS Office, Quality Center, Oracle.

Confidential, Albany NY

QA Analyst

Responsibilities:

• Involved in requirements gathering sessions with Business Analysts and Architects to understand requirements in terms of business change.

• Actively worked on Business requirement analysis and Data analysis.
• Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
• Created Business Rule Comparison (BRC) documents and Side-By-Side (SBS) comparison documents using 4010 / 5010 implementation guides for X12 transactions in Excel spreadsheet.
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Worked on IBM mainframe environment for Medicaid Management Information System impact assessment. Dealt with the EDI transaction-835 claims payments and remittance advice, which deals the payment from payer to provider.
• Involved in GAP Analysis for HIPAA transactions and implementation of HIPAA EDI Transactions (835,837,820,276)
• Wrote SQL queries to check for data validation
• Created and executed SQL statements manually to perform Backend Testing that ensured data consistency on the Front-end
• Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.
• Analyzed MMIS system impact for Windows and Interfaces.
• Gathered all the needed data (table names, column names, field names, notes) from the Windows and Interfaces documents
• Analyzed RRI/Viking Subsystem (an external system off the state, dealing with conversion of paper claims to electronic claims) and recommended changes for HIPAA 5010.
• Experience in Forward Mapping and Backward mapping analysis of ICD 9 - ICD 10 Conversion for CM (Diagnosis Codes) and PCS (Procedure Codes).
• Facilitated requirements gathering sessions with the business unit managers and subject matter experts to document requirements.
• Documented the user Stories, Functional Specifications Documents and also Designed Data Flow Diagrams using MS-Visio.
• Implemented Agile Framework throughout the software Development Life Cycle (SDLC).
• Created the documentation for the data elements that need to visible for Adhoc and Aggregate Reports
• Derived the work flows for various users based on role provisioning, self-service and access management.
• Responsible for design work flows for various users based on security and access management.
• Documented the Technical Specifications for the system and designed a Software Architecture Document.
• Documented the triggers for RUGs, Scales and CAPs Reports using the existing code in SAS and SPSS.
• Participated in development of automated keyword driven framework for functional and regression testing
• Documented the changes to be made in the Ice Faces controls existing in the system based on the requirements of the business users.
• Developed the work flow charts and use cases for development of Report of Medications and Allergies.
• Co-ordinated with the Development Team and Testing team to track the Defects and Resolution.
• Designed the Test Metrics Documents for tracking the Status and Compliance of the Application.
• Performed Gap Analysis of client requirements, generated workflow process, flow charts and relevant artifacts.
• Participated in the walkthroughs and meetings specifically for Assessments and The report Generation. Participated in design of the Master Test Plan Documents, Test Cases, Test Plan and UAT

Environment: Java Server Faces, Ice Faces, Seam, UML, MS-Project, MS-SharePoint, Windows XP, Microsoft Visio, XML, SAS, SPSS, Rational Requisite Pro, SQL, Oracle, Agile.

Confidential - Oakland, CA

QA

Confidential is one of the nation’s largest Confidential Insurance providers. This application allows Kaiser Employees to pull up customer information, customer claims, claim status, their monthly payments and their plan types.

Responsibilities:

• Analyzed, designed, and implemented web applications for Risk Managers to assess insurance applications.

• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 837, 835, 834, 277, 276, 271 and 270.
• Experienced on working in ANSI x12 270-271, EDI Transaction.
• Validated the date from EDI transaction.
• Conducted Back-End Testing Using SQL Commands.
• Planned and reviewed the Test Cases and Test Scripts for Unit, Integration, Functionality, System, Regression, Database and User Acceptance Testing.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Performed UAT testing along with call center managers to make sure that application meets their requirements.
• Developed plan for data feeds and data mappings for integration between various systems, to follow ICD 10 Code set and ANSI X12 5010 formats.
• Involved in gap analysis and implementation of HIPAA 5010, ICD 10 and Claim Validations
• Utilized corporation developed Agile SDLC methodology. Used Scrum Work Pro and Microsoft Office software to perform required job functions.
• Wrote SQL queries to check for data validation
• Created and executed SQL statements manually to perform Backend Testing that ensured data consistency on the Front-end
• Developed and conducted statewide HIPAA 5010 and ICD-10 awareness program for all IDS staff in Tenet.
• Tested Backend testing of the DB by writing PL/SQL queries to test the integrity of the application and Oracle databases using TOAD.

Environment: QTP, SQL, UNIX, Quality Center, Windows XP, IIS, EDI, MS Office.

Confidential - Miami, FL

Quality Analyst

Confidential is a healthcare services company whose subsidies and affiliates own and operate acute care hospitals and related ancillary healthcare businesses. Tenet’s hospitals aim at providing the best possible care to every patient who comes through their doors with a clear focus on quality and service.

I was involved in verification and validation of data which entered through Tenet’s prescription cards and checked each object of the application to ensure that it met the functional requirements. This was basically focused in the back end testing.

Responsibilities:

• Was responsible for analyzing the business requirements interacting with business analyst and developers

• Created Test Plan and developed Test Cases according to requirements
• Attended Scrum meetings to discuss the progress of the project
• Imported Test Cases from external files to HP Quality Center and mapped them with requirements creating Requirement Traceability Matrix
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 276/277, 270/271, 837/835.
• Validated the claims of the member via EDI with the database and then the processing is done afterwards.
• Automated the tests by writing the scripts for functional, data driven testing of web based application using QTP
• Performed various types of testing including functional, integration, smoke, and cross browser testing
• Tested application compatibility in different browsers like Firefox, Internet Explorer, Safari using Quick Test Professional
• Performed back-end testing by writing SQL queries using SQL Server 2008
• Prepared progress reports, defect reports and test execution reports.
• Filed and linked defects to the requirements and sent email notifications to the developers using HP Quality Center
• Performed regression testing after the defects were fixed by developers

Environment: Quality Center 9.0, Quick Test Pro 9.5, Windows 2008 Server, SQL SERVER.

Confidential - Salisbury, MD

QA Tester

Confidential is one of the leading Confidential insurance providers in Chicago. The company currently runs its business on Facets and provides medical plans. I worked as a QA Analyst and worked closely with project team to interpret complex business needs and translate them into system requirements. I mainly worked on Claim, Subscriber and Provider modules.

Responsibilities:

• Participated in preparing Test Plan, Created Test Cases, Test procedures, Test Matrix and Defect Strategy detailing scope, resource assignments, schedules etc. for the Functional Testing.

• Analyzed the requirements to design and determine the various scenarios and Test cases.
• Organized meetings with the developers to communicate the defects and other issues.
• Developed detailed Manual Test cases and Scenarios. Studied Requirements and designed manual test cases accordingly.
• Used Object Repository in QTP, in order to understand the Objects properties of application.
• Wrote VB script in QTP as Descriptive programming for handling different dynamic scenarios.
• Reviewed and Analyzed Test results using the result log in QTP.
• Manual and Automated Testing is done both front end and back end for modules.
• Analyzed test specifications and performed manual testing.
• Involved in writing Test Cases, Review, Execution, Defect Tracking and Reporting.
• Executed Test cases using QC in the Test lab.
• Interacted with the developers on application bugs.
• Developed various test cases for testing HIPAA 837I/P (4010, 5010).
• Assign the Benefits in the Benefit Configurator.
• Extensively used SOAP UI tool to test the eligibility inquiry and response and claim status inquiry and response Web services
• Performed regression tests to check for unintended errors after the enhancement.
• Participated in weekly meetings with the management team and walkthroughs.
• Provided status reports on a regular basis to the QA Lead.
• Bugs were reported to developers and after rectification of the bugs, regression testing was performed.

Environment: Quality center, QTP, My SQL, Passenger Server, Excel