SUMMARY:

• Over 7 years of experience as a Quality Assurance Tester with Healthcare Domain.
• Focus on designing, developing and implementing business processes and system solutions.
• Highly experienced in manual and automation testing of Web - based, client-server and E-Commerce applications with cross browser testing.
• A result oriented professional with highly developed planning, managerial, analytical, technical communication, and decision-making abilities.
• Responsible for testing software packages thoroughly and integrated systems to ensure proper operation and absence of defects. Has strong business knowledge and contributor in planning, analysis, design and execution of software applications.
• Hands on experience with all phases of Software Development Life Cycle (SDLC) and Software Test Life Cycle (STLC) and also have Exposure to Agile process and methodologies.
• Working knowledge of testing client-server, web based and Stand-alone applications.
• Effectively involved in the Analysis of Bug Severity, Bug Tracking system and Bug Reporting using HP Mercury Quality Centre, JIRA etc.
• Expertise in writing SQL Queries using Oracle, SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
• Strong knowledge of Software Development Life Cycle (SDLC) as well as Testing Methodologies and the Role of QA/ EDI Specialist
• Involved in Facets Output generation, Interface development and Facets Migration Projects.
• Experience in testing with multiple application in Java, .Net, C#, Facets etc
• Good experience in Functional testing, Integration testing, Regression testing, GUI testing, Back-end, Cross browser testing, Ad-hoc Testing, Black/White Box Testing, System Testing.
• Excellent analytical skills with strong programming and database experience in working with State, Federal Health Insurance exchanges, Medicare, Medicaid, Medicaid Expansion, Duals, Marketplace, Healthcare Benefits Administration, Affordable Care Act/Health Care Reforms (ObamaCare).
• Knowledge of MMIS (Medicaid Management Information System), HIX (Health Insurance Exchange), EMR (Electronic Medical Record), EHR (Electronic Health Record) and healthcare reforms like the Patient Protection and Affordable Care Act (PPACA), Emergency Medical Treatment and Active Labor Act (EMTALA).
• Experience in developing business rules for Claims, Claims Settlements, Claims Adjudication, MMIS, Benefit Plan Administration, Claims Payment Cycle, Revenue Cycle, Reference and Waiver Programs for Managed Care, MarketPlace, SHOP, Duals, LTSS, Hospice, CHIP, Administrative Service Only (ASO) and Commercial Line of Business.
• Analyzed defects status using Quality Center interacted with developers to fix defects/bugs of the application.
• Extensive experience in developing Use Cases, creating Screen Mockups, conducting Gap Analysis and Impact Analysis, SWOT analysis, Cost Benefit Analysis, Risk Analysis.
• Facilitated Change Management across entire process from Project conceptualization to Testing through Project Delivery, Software Development and Implementation Management in diverse Business and Technical Environments.
• Involved in Facets Output generation, Interface development and Facets Migration Projects.
• Involved in preparation of Test Data to test the functionality of ETLSources Mappings and Targets.
• Extensive knowledge of HMO Medical Management Information Systems (MMIS), Health Insurance Portability and Accountability Act (HIPAA) standards, Electronic Data Interchange (EDI) and implementation of HIPAA code sets, ICD-9, ICD-10.
• Well versed in Health Care with HIPPA, HL7, EDI and x12 data formats
• Proficient in using Microsoft Office tools and Knowledge of creating procedures, triggers, functions etc in PL/SQL.
• Experience in ICD-9 to ICD-10 Conversion.
• Experience in Developing, maintaining and Analyzing Requirements, Test Plans, Technical Specifications, Test Strategy, Test Scenarios, Test Cases, System Specifications, Use Cases, Test Summary Reports, Bug Reports, Track Report and Traceability Matrix based on business requirements.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Well versed with all documentation process for testing related activity.
• Worked closely with developers and other stake-holders of the team.
• Experience of testing in Windows/UNIX environment.
• Good knowledge of Shell commands and Shell Scripts.
• Good knowledge of Web services with SOAP-UI, XML.
• Excellent communication and interpersonal skills with problem solving abilities, effective in working independently and an exceptional team player.

TECHNICAL SKILLS:

Methodology: SDLC, STLC, Agile, Scrum, RUP

Testing Tools: QTP, RFT, SOAPUI, Microsoft Test Manager

Defect Tracking Tools: HP Quality Centre, JIRA

Operating Systems: DOS, Windows, UNIX, Red Hat Linux

Programming Languages: C, C++, C#, Java, Visual Basic, ASP, .NET, PL/SQL

Databases: ORACLE, TOAD, SQL, SQL Server, Access

Scripting Languages: HTML, XML, VBScript, Java Script

Business Modeling Tools: MS Visio, MS Project, MS Office

Revision Control Syste: Clear Quest, Concurrent Versions System (CVS)

WORK EXPERIENCE:

Confidential, Chicago, IL

Sr. QA Tester

Responsibilities:

• Performed testing in agile scrum methodology and involved in daily scrum meetings.
• Participated in the technical reviews and walkthroughs starting from the initial phases of the Software Development Life Cycle.
• Validated claims using HIQK, Benefit file using HRBK with help of HURK documentation.
• Analyzed Clinical Quality Measures under the Meaningful Use EHR Incentive Program of the Centers for Medicare and Medicaid Services (CMS).
• Analyzed Clinical Data and from CMS and based on EMeasures Guide created test strategies and test plan.
• Expertise in EDI transactions used in healthcare industry and good knowledge of HIPAA X12 .
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims. Worked on EDI transactions: 834, 835 and 837 (P/I) to identify key data set elements for designated record set. Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes.
• 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 benefits
• Analysis and manipulation of EDI data to conform to ANSI Standards (Examples: construct rules in Paperfree to calculate HCPCS and splitting diagnosis codes to the correct qualifiers)
• Worked with ETL group for understanding Ab Initio graphs for dimensions and facts.
• Works to assess and respond with corrective actions for control gaps found in the UAT for the HIX
• Created requirement documents for the development of the new HIX connector product that would integrate the exchange enrollment data with the existing core applications.
• Works to assess and respond with corrective actions for control gaps found in the UAT for the HIX daily/monthly 834/999 enrollment transactional process as noted by self-assessments, and audit findings.
• Experience with SOAP UI to test web service interfaces
• Used SOAP UI, WebLogic ANT task to test Web Services running on WebLogic Server.
• Established questionnaires and resource leveling required for implementing HIPAA 5010 and upgrading ICD-9 diagnosis codes to ICD-10 codes.
• Worked with BA’s, Developers and End Users to create test data according to Clinical Quality EMeasures Logic and Implementation Guidance.
• Knowledge in the ETL (Extract, Transform and Load) of data into a data ware house/date mart and Business Intelligence (BI) tools like Business Objects Modules (Reporter, Supervisor, Designer, and Web Intelligence).
• Experience as an EDI analyst performing verification and validation of the EDI transactions.
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/Drafts, Claims pricing and testing, HIPAA, enrollment, EDI, Medicare, Medicaid, CDHP (consumer driven health plans)
• Created ETL execution scripts for automating jobs.
• Experience in ETL Data Warehousing, database testing using Ab Initio for ETL process.
• Leaders, for defining broader scope which will offer a mechanism by which patients, physicians, public health officials and researchers will be able to access data and actionable information, to allow them to demonstrate measurable improvements in health care quality, safety, efficiency and population health.
• Claims testing with various integration modes such as Web Services, MQ, MSMQ, Batch and Report Testing
• EDI X12 transactions 835/837 testing/validation.
• Extensively worked with Edifecs Specbuilder to create test files, analyzed all EDI test files with 5010 implementation guides and gap analysis of EDI transactions.
• Go od knowledge on HIPAA and different modules within healthcare systems. (Membership, billing, enrollment, claims, COB, providers).
• Worked with Business Analysts understanding and analysis of design specifications for conversion and ETL of Coverage Administration Module for CNO & SHIP carriers.
• Experience with HIPAA 4010 EDI gateway healthcare transactions like 270, 271, 276, 277, 837, 835, 834, 820, and 278.Knowledge of HIX (Health Insurance Exchange), HIPAA 5010 transaction set.
• Did the 4010/5010 gap analysis for all EDI transactions such as 837, 835, and 999
• We used Medical claims are sent by doctor’s offices with these ICD 9 codes, along with procedure codes known as CPT codes, and the amount billed for the services rendered.
• Conducted GUI testing, Functionality testing, Interface testing and Regression testing, Database testing using QuickTest Pro.
• Worked on NetworX Pricer which routes the Claims based on Configuration made on FACETS and configured with Benefits and member enrollment
• System Integration testing for Facets core modules with external systems.
• Tested the claims processing with EDI transactions (270, 271, 835, and 837) in HIPPA and HL7 Environment.
• Responsible for Setting up Web Services project using WSDL in SOAPUI and provided setup help to other team members.
• Managed multiple priorities, project plans, time frames and trade-offs while ensuring the clinical and administrative staff understood the final results of the projects, sharing detailed vision of cost-benefit analysis
• Tested the Membership and claims files (XML) in Facets.
• Data mapping and Data migration testing from ICD9 to ICD10
• Was Responsible in finding the eligibility of the members and filing claims for the States Disability Insurance benefits for both short term disability who are not eligible for the Social security benefits and for the Long term disability customers who are qualified under Social security plan for the payment of benefits as a result or injury
• Tested the Members, Claims, Providers and Services in Facets.
• Assist team in performing EDI transactions(835/837)

Environment: Windows Server 2008 R2, NHibernate, Crystal Reports Server 2011, HRA, FACETS, ETL, HL7, SOAP UI, MSMQ, Microsoft .NET 4.0, ASP.NET, XML, Fitness

Confidential, NY

Sr. QA Tester (Medicaid)

Responsibilities:

• Analyzed the business and functional requirements and developed Test Plans, high level Test scenarios, Test Scripts, Estimates to facilitate the process of testing.
• Worked on 837, 835, 276 and 277 Institutional and Professional, EDI Gateway
• Involved in weekly meetings with developers and business analysts to understand the Application logic and business process. Analyzing Data Processing implementing Data Mart applications mainly transformation processes using ETL tool and understanding of ETL workflows and ETL mappings and also monitoring the Production Environment.
• Understood the business process that included Sales processes, Rating methodology, different Products, Group Renewals and Enrollment process in Facets.
• Written Test Cases for ETL to compare Source and Target database systems.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, 270/271, and others. Provided healthcare provider problem resolution. Work as a medical coding SME, including ICD-9, HCPCS; Procedures and diagnosis testing
• End to End working experience of Medicare, Medicaid, Duals, Hospice, LTSS, Vision, Dental, Pharmacy and behavioral health benefits projects from Patient/Member Eligibility, Patient/Member Registration to Patient/Member departure.
• Prepared Clinical Data to test Clinical Quality Measures in Molina Analytical tool Collabra.
• Provided support to CMS/ Federal and State stakeholders on objectives relative to PPACA -HIX by performing the following duties in an agile (scrum) SDLC environment.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Expertise in working with direct submitters, clearing houses and providers in regards to all the issues with EDI setup, claim submissions, eligibility transactions and ERA’s.
• Tested the Registration process of common practitioner in Facets and validated
• Conducted and participated in internal QA meetings, Status Calls, Release meetings with onsite and offshore teams regularly and interacted effectively with cross blocks.
• Designed and developed UNIX shell scripts as part of the ETL process to automate the process of loading, pulling the data for testing ETL loads
• Worked on Member Coordination of Benefits (COB) Accumulator configuration related to Benefits tables in Members.
• Provided Clinical Data to different cross functional teams for testing EMeasures.
• Effectively managed and coordinated with the offshore teams throughout various phases of a Release.
• Involved in designing and review of Test Scripts in build phase of a release.
• Extensively used Companion guides and Implementation guides to write the test case and to test the EDI transactions.
• Worked on FACETS Benefits Configuration to simplified benefit plan maintenance and renewal processes based on CSD provided by Benefits Analyst.
• Identified and documented data model processes and system deficiencies for the HIX eligibility & enrollment.
• Involved in testing Facets for Group Information, Enrolling Subscribers, adding members, Related Entities, Class/Plan definition, Premium Rate Tables and all.
• Extensively used SQL queries to verify the back end process and prepared test data.
• Involved in Manual Testing of the various reports developed.
• Assisted EDI team with the testing of maps for HIPAA transactions 835 and 837 .
• Executed SQL Queries to check the data table updates after test execution using TOAD.
• Manage Coordinate and Responsible for overall system test effort, including the development of a comprehensive system test plan, management and coordination of test efforts for Molina.
• Managing a team of internal & external quality assurance consultants to develop test cases, test scripts.
• Partnering with Business Users in a collaborative effort to design the test strategy and execution.
• Developed Master Test Plan, Test Strategy report, Bug Summary report.
• Preparing Functional Test Plan, Performance Test Plan & Performance Test Strategy approach document.
• Preparing Test Strategy ensuring it is updated and baseline to reflect changes to the project risk profile, schedule, testing processes
• Prepared Traceability Matrix to review the requirements and Test Case coverage.
• Performed the Peer Reviews for the Test Designs and suggested required modifications.
• Performed impact analysis whenever a new Change Request is released.
• Wrote Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Mercury Quality center
• Validate EDI Claim Process according to HIPPA compliance.
• Designed, Communicated, and enhanced QA testing plan for the application.
• Performed back-end testing by extensively using SQL commands to verify the database integrity.
• Created and maintained SQL Scripts to perform back-end testing on the oracle database.

Environment: Rational Unified Process (RUP), Mercury Quality Centre, Facets, Oracle 10g, VB script, HL7, Crystal reports, ANSI X12, JavaScript, HTML, XML, Lotus Notes, SQL, PLSQL, HIPAA, EDI, UML, MS Office, Windows XP/2000

Confidential, PA

QA Analyst

Responsibilities:

• Reviewed Business Requirements with Business Analyst, Project Manager and Lead Developer to learn the functionality of the application.
• Used EDIFECS spec builder to manage claim transaction and billing application requirements.
• Performed regular verification sessions and walk-through sessions to check the proper functioning of the application
• Performed Online Security testing of different profiles in Facets.
• Involved in preparing Test Plan and Test Cases based on business requirements.
• Created and generated test scripts for different test scenarios covering all aspects of project functionality.
• Mapped enrollments, payments, and status to back-office database.
• Tested several ETL routines and procedures.
• Interacted with business users in understanding business requirements for developing new ETL solutions.
• Validate different EDI formats and transactions under HIPAA compliance.
• Involved in re- engineering of the EDI Gateway to assist in the development of HIPAA repository to process 5010 claims.
• Used EDIFECS spec builder to manage claim transaction and billing application requirements.
• Tested and Validated Request and Response of XML using SOAP UI.
• Performed testing and implementation of X12 HIPAA standards.
• Using EDIFEC SpecBuilder to develop Companion Guides for providers, third party billers/trading partners.
• Responsible for the complete design, development and implementation of 834, 835,837,270,271 using Gentran ODBC functionality.
• Analyzed the responses of the web service using SOAP UI and validating the data in backend.
• Developed and executed Data Driven tests using Quick Test Pro.
• Developed automated test scripts using QTP and performed functional and regression testing.
• Run test scripts according to test specifications/requirement using Load Runner.
• Parameterized data table for Data-driven testing.
• Vast knowledge and experience in Health Care industry, experienced in testing different healthcare ERP solutions such as FACETS, MedPlus, EPIC and other claim processing solutions.
• Guidelines and Maps development using Edifecs Suite
• Used HP-QC for Test Planning, Test Designing, Test Analysis, Test Execution, Defect Tracking and Reporting.
• Developed and maintained the Traceability matrix between requirements and test cases.
• Used SOAP UI for web service testing like validating the response of claim processing.
• Wrote extensive SQL queries for Back End testing also verified the data from the Oracle database.
• Tested the application for cross browser compatibility.
• EDI / EDIFECS Production Issue Analysis and Resolution

Environment: SQL, Quality Center, SOAP UI, XML, HTML, UNIX, Windows 7/XP, facets 5.01, MS Office Tools, , Edifecs Spec Builder 7.0.5

Confidential, Tampa FL

Manual Tester / Functional Tester

Responsibilities:

• Worked as a Member of the QA team, responsible for the testing and certifying the software applications as safe for deployment
• Daily Update Meetings with QA Manager to discuss the status of Projects.
• Interacted with QA and Development engineers to learn about work flow, analyzed the test process, helped develop strategies for testing products and services in an Agile environment
• Writing complex SQL queries for data validation for verifying the ETL Mapping Rules.
• Prepared test data for positive and negative test scenarios for Functional Testing as documented in the test plan
• Responsible for Black Box testing, Regression testing and Browser Compatibility testing
• Created and implemented test cases for EDI files generated for various transactions as 837/835/276/278 using ICD9 codes
• Validated the reports and files according to HIPPA and HL7 enforced standards
• Designed report layouts with Crystal Reports and generated different reports through coding.
• Reported bugs in HP Quality Centre and Issue resolution.
• Tested the data load process using the Ab Initio ETL tool.
• Tested graphs for extracting, cleansing, transforming, integrating, and loading data using Ab Initio ETL Tool.
• Prepared all documentation such as user manual and other reports for future reference.
• Understanding the requirements and Preparation of Understanding document and Clarification log.
• Review, Repair and ready status.
• Reported the daily status reports and weekly status reports on time.
• Testing based on different user roles.
• Worked on pre authorization of Claims in FACETS and Knowledge of ICD-9, CPT, REV codes.
• Maintaining the repository of the project artifacts in the Test Director.
• Provided training and support to end-users.
• Tested for mappings in EDI files through Transaction Mapping Documents.
• Checked the AUT for cross browser compatibility
• Trained the junior testers on Quality Center
• Worked extensively on Quality Center for logging & tracking the defects
• Analyzed Defect Reports using Quality Center and worked closely with Application Developers to fix defects

Environment: Quality Center, Edifecs Specbuilder, QuickTest Pro, Windows XP, MS Visio, Oracle, Java, SQL, HTML, XML, SQL server 2005