SUMMARY:

• 10 + years of experience in Application Analysis and 6 + years Quality Assurance Testing of application systems coupled with Strong Database Knowledge in Client/Server and Web and database environment.
• Managed QA activities of Software Development Life Cycle for insurance and healthcare clients.
• Strong leadership ability, can work and manage multiple projects, give direction to others, and take a lead role in improving organizational processes.
• Proven track record of getting Deliverables delivered in highly chaotic and fast - pace environments.
• Detail-oriented and outstanding communication, organizational and leadership skills.
• Experience with HL7, HIPPA 4010, 5010 EDI transaction codes 270/271, 276/277, 834, 835 and 837.
• Experience in EDI Testing, Mainframe Testing, with great noledge of QA methodologies
• Involved in testing Batch and Real Time updates of HIPAA-4010-mandated ANSI 270 (Eligibility and Benefit Request) and teh ANSI 271(Eligibility and Benefit Response)
• Working noledge in ICD 9 Health codes in teh claims environment.
• Extensive experience in Rational tools (Rational Requisite Pro, Rational Clear Quest and Rational Rose), and skilled in using MS office applications for day to day activities, and MS Project for prioritizing and managing individual tasks.
• Hands-on experience working on Trizetto Facets.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in Facets.
• Expertise in preparing and executing Batch Tests to improve testing efficiency.
• Expertise in manual /automated testing using Rational tools.
• Extensive experience working with Agile and RUP.
• Experience in using Test Director for requirements management, Planning, Scheduling, running tests, defect tracking and defect management.
• Integrated QTP with Quality Center to store and execute automation scripts and log execution reports.
• Expertise in Analyzing Business Specifications and writing Test Cases, develop Test Scripts and execute them.
• Experience of teh full Software Development Life Cycle (SDLC) Methodologies and Validations to ensure teh Quality Assurance Control.
• Extensive experience in Functional, Integration, Regression, User Acceptance (UAT), System, Load and Stress testing, Black Box Testing and white box testing.
• Maintaining teh Requirements Traceability Matrix (RTM) across deliverables of a project.
• Experienced in planning, delegating and tracking teh test activities to meet teh project schedule.
• Experience working with SQL scripting, managed version control software and defect tracking systems.
• Executed and Tested Batch files.
• Strong Analytical skills, excellent communication and interpersonal skills, team player and self-Starter.
• Liaison between teh Project Manager, QA Manager and Testing Team. Created Data Mapping document to migrate teh Data from existing system to teh New System.

PROFESSIONAL EXPERIENCE:

Automated Test Tools: Quick Test Pro, Winrunner

Defect Tracking Tools: Quality Center 9.0/10.0, Track Record, Rational Clear Quest, Rational Requisite Pro, and Rational Rose and Rational test manager.

Documentation Tools: MS Word 2000, MS Excel 2000, Microsoft Project, Visio.

Programming Languages: Java, VB. Net, ASP. Net, C++.

Databases: Oracle9i/10G, MS-Access & SQL Server . Sybase

Web Technologies: HTML, XML, VB-Script, Java-Script, JSP.

Application Server: Web logic Server, IIS.

Operating System: Windows 9x/Xp/2000/NT, UNIX.

Reporting Tools: Micro Strategy, Crystal Reports10.

PROFESSIONAL EXPERIENCE:

Confidential, NC

Sr. QA/EDI Analyst

Responsibilities:

• Analyzed teh FIDA guidelines provided by teh state and conducted gap analysis between teh current state and future state requirements; and identified potential pitfalls, risks, and issues that would impact teh successful implementation of teh project.
• Tested all Types of WEDI/SNIP Testing for HIPAA including Integrity Testing, Requirement Testing, Balancing, Situational Testing, Specialty or Line of Business Testing and Trading Partner Testing.
• Identified New (EHTR) Confidential Transaction Repository futures and understood teh effects on existing surrounding application.
• Performed regression testing after replacing teh (Microsoft) BizTalk (converting X12 file to flat file).
• Validated ICD9 and ICD10 files for HIPAA compliance.
• Worked on Transaction Management in validating claims.
• Used ALM to store all testing results, metrics, implemented Test plan, created Test Cases, Defect Tracking & Reporting.
• Collaborated with teh project team, business owners, end users, and subject matter experts to understand business requirements and needs for teh SAA Base Model
• Identify, analyze, document and implement all changes necessary to ensure that teh vendor transactions and teh related business processes are successfully accepted, processed, loaded, generated, transmitted and converted to handle ICD-10 compliance readiness as outlined in teh capable strategy adopted by CHI.
• Mitigated any relevant risks such as teh liability of claim payments, by working with different business areas to develop contingency plans for risk management.
• Reviewed that testing is in compliance with teh QA master plan, and project deadlines are met.
• Facilitated project status meetings; solved bottleneck issues that effected teh timely completion of teh project.
• Maintained a requirements traceability matrix (RTM) to ensure that all teh requirements are covered in teh test cases, and high priority defects impacting teh progress of teh project are prioritized over minor cosmetic defects.
• Performed data analytics on operational healthcare processes at CHI to verify compliance to HIPAA.
• Mentored and coached Jr. Quality Analysts, and assisted them in resolving conflicts between IT and business.

Environment: Oracle, Toad, PL SQL, SQL server, Share Point, ALM, MS Office, MS Visio, Business Objects.

Confidential, NYC

Sr. QA Analyst

Responsibilities:

• Involved in creation of Test Plan, Test Strategy and estimation of test duration.
• Manual Test case preparation for ICD10 837 me, P in ALM.
• Experience in mainframe testing using AS400 for claims adjudication.
• Experience in IBM mainframe system using File Aid.
• Experience in Database testing using Oracle, MS SQL Server, SQL and PL/SQL queries
• Internal creation of test data for converting ICD9 to ICD10 in TDM.
• Modified teh files using Ramp Manager and Spec Builder.
• Tested all Types of WEDI/SNIP Testing for HIPAA including Integrity Testing, Requirement Testing, Balancing, Situational Testing, Specialty or Line of Business Testing and Trading Partner Testing.
• Identified New (EHTR) Confidential Transaction Repository futures and understood teh effects on existing surrounding application.
• Performed regression testing after replacing teh (Microsoft) BizTalk (converting X12 file to flat file).
• Validated ICD9 and ICD10 files for HIPAA compliance.
• Wrote SQL queries to verify teh data in database (ODS, EHTR, HLLAPI and SEAGULL).
• Worked on Transaction Management in validating claims.
• Worked on Edifecs Specbuilder to modify teh X12 files.
• Used EDIFECS XEngine to validate teh X12 files.
• Used ALM to store all testing results, metrics, implemented Test plan, created Test Cases, Defect Tracking & Reporting.
• Assigned bugs to Programmer by using "ALM" bug (Defect) tracking tool (Verifying that all teh reported bugs fix thru software developers)
• Performed Test Data set up a pre-requisite to executing use cases during system testing.
• Followed teh testing progress during status meetings and prepared contingency plans when required.
• Acted as a point of contact regarding defect status / resolution for teh Development team, QA team.
• Conducted weekly status meetings to discuss teh testing progress and weekly activities.
• Interacted with teh developers in fixing all teh problems.

Confidential, Buffalo, NY

QA Analyst

Responsibilities:

• Analyzed BRDs, SRSs & PRDs to ensure 100% Requirements coverage in execution of Test cases
• Developed various test cases and test scripts for testing FACETS Functionality
• Tested FACETS 4.71: Claims, Subscriber/Member, Application Support, UM, Provider.
• Constantly involved in review meetings and made sure testing is done based on teh QA master plan and deadlines are met.
• Used FACETS to provide seamless transactions between teh provider, members and teh plan.
• Used FACETS Workflow to route teh claims according to teh priority.
• Involved in processing TIGER claims and Claim Retriever (In house Applications of Confidential )
• Assisted with testing EDI 837(me, D, P), 835, 834 transactions processing flow from teh Trading Partners to teh translator to teh Mainframe and back to teh Trading Partner.
• Created Test Data for 837I, 837D, 837P to have teh Segments/Loops information with different combinations of Submitter, Receiver, Billing Provider, Pay-To Provider, Subscriber, Payer, Patient, Claim Information, Physician, Referring Provider, Service Line info, Adjudication Info, COB Information.
• Created Test cases involving PEGA( Routing, Adjustments and Rules) and Validated teh same Claims in FACETS
• Used SQL Queries to verify teh data from teh Sybase database
• Creating and consolidating SIT Test Cases and UAT test Cases using MS Excel or Quality Center.
• Preparing sample Test Data and executing Test cases using Quality center.
• Provide support to end users while execution of UAT with proper test scenarios & test data.
• Monitored RTM to close teh defects/cases as and when developers resolved teh defects
• Communicated with developers and Business Analysts through all phases of testing to prioritize defect resolution.
• Reporting teh Test Execution status to teh project manager on daily basis.
• Logging & re-testing defects and assigning them to teh developers/responsible persons
• Actively involved in weekly walkthrough meetings and Daily Defect calls to verify teh status of teh testing efforts meeting teh deadlines & mid-term targets.

Environment: Spec builder, Quality Center 10.0, DB2, Sybase, Trizetto Facets 4.41/4.71, PEGA, SQL, MS Word and MS Excel

Confidential, MI

QA Analyst

Responsibilities:

• Developing test cases based on requirement specification documents, use case docs, and user interface specifications.
• Attending onsite call with teh client on weekly basis regarding status of work done and regular interaction with onsite company employees for requirement issues.
• Participating in black box testing, regression testing, and integration testing.
• Reporting and tracking teh defects with HP Quality Center
• Giving KT to team members or new comers in to teh module about all teh Screens present in teh module.
• Wrote SQL queries to verify teh data in database.
• Working on status report to teh client regularly.
• Giving presentations to teh managers on reports and status of teh work done.
• Experience in mainframe testing using IBM Mainframe DB2 for claims adjudication.
• Experience in IBM mainframe system using File Aid.

Confidential, New York, NY

QA Analyst

Responsibilities:

• Analyzed Business requirements, Functional Specification Documents.
• Wrote teh test cases for different EDI transactions 834, 835, 837, 276, 277.
• Prepared and analyzed use case diagrams and created test cases that provide a detailed list of conditions under which teh system will be tested using Quality Center
• Developed Test Cases, Test Scenarios and Test Conditions based on Business Requirements and design documents for teh Faciledi application
• Involve in Verifying HIPAA complaint EDI (Electronic Data Exchange) and ANSI X12 files.
• Validated files that are processed through eligibility enrollment system to CMS
• Created and Generated profile reports to teh Trading Partners using Champs Subsystem
• Developed and executed SQL queries on database to perform Back-End Testing
• Conducted and attended teh meetings with teh users and team members to discuss and resolve various issues during teh testing process
• Participated in weekly status meetings, and conducted walkthroughs for team members, and documented teh proceedings.

Confidential, PA

Supervisor Clinical Call Center

Responsibilities:

• HIPAA compliant cell center dealing exclusively in healthcare
• Worked with Large, Medium, and Small Pharmaceutical, Biotech and medical device companies
• Worked with MD’s, RN’s, Pharmacists, Social Workers, Med Techs, Pharmacy Techs, drug counselors
• Medical Affairs, Patient Compliance, Centralized Clinical Trial Recruiting, Adverse Event Reporting, Reimbursement programs
• Maintained event logs, generated reports
• Participated daily and weekly meeting discussions with Director and conducted walkthroughs for team members, and documented teh proceedings.
• Maintained Integrity of Patient information
• Created and Generated profile reports to teh Trading Partners using Subsystems

Confidential USA, PA

Medical/Clinical Consultant

Responsibilities:

• Drug Information systems, Practice Management Services, Medical Publishing, Consumer Healthcare, Continuing Medical Education
• Discussion of Disease Management and drug utilization
• Worked within a strict FDA approved guidelines
• Conducted peer to peer consultations, teaching current medical treatment protocols via video detailing, compliance regulations, dosage, adverse events, pharmacokinetics, pharmacodynamics, safety, efficacy, contraindications and usage.
• Conducted healthcare interviews at all levels of initial follow-up information regarding adverse events, compliance issues, filling out adverse event reports which were specifically designed.
• Extensive training with major pharmaceutical companies for products along with extensive Compliance training for each company