SUMMARY

• I have worked in Agile test team environments and autonomously remote setting. Supported test lead, Developers, Configuration and Business Unit to identify risks. I have maintained scope of testing time frame and compliancy.
• Created requirements, reports, and test cases for Confidential, Eldorado and Nasco.
• QXNT 5.0: QA created and executed test scripts and Test cases.
• UAT tested on Fee schedules, Pharmacy claim processing, Capitated Terms, pharmacy codes, Benefit terms, Rule IDs, Medical Benefit Terms, Provider Agreement Terms, pricing terms, eligibility Extracts, provider agreements for test execution.
• Testing on X12, 837,831,834. Data warehouse applications.
• Created Business requirements for Test from dashboards into Test Cases.
• MACESS
• Facets QA testing: UAT, Validation, functional, EDI, Integration tested on Fee schedules, Dental, Pharmacy, Medical claims. pharmacy testing benefit terms, pharmacy coding, pricing terms, benefit terms, eligibility, provider pricing terms. Manual/Auto
• Testing using lines of business Medicare Part A,B,C,D/MediGap/Medicaid IPA/ACA/ASO/HMO/PPO/EPOs & Neighborhood Health Plans.
• Facets 4.71 - 4. created and executed test scripts and Test cases. Functional, Negative and regression testing based on developer configuration, BRDs, benefit grids, Edi formats, CSRs, provider data, HTML extracts and Test requirements.
• NASCO NPSA - EXTRA Claims Testing. NCSW, Efde, HIQK, HURK, HEHK (EEC)
• Portal Testing. All have similar architecture and payment structure to HealthRules/HealthEdge.
• Fee for service UAT testing based on agreement. All payment methodologies used for UAT and unit testing. End to End testing in an Agile environment.
• Tested from claim X12s. Fee schedules updates, benefit terms, contract terms, HTML/XML docs, member cost share testing and validation.
• Automated test scripts; Conducted File validation checks for programming & auditing purposes using K shells commands (AS400) Unix.
• Data Analysis. Database creation.
• Supported testing of incidents and reporting into ticketed based application, system upgrade testing, patches on Regression testing, and task fulfillment.
• Reporting Analysis from SQL for validation test and data quality. Auto loading data into repositories via SVN. Data field updates in PostgreSQL.
• Built claims in SQL Server Studio and claims test pro for Automated Testing.
• UAT test execution, Regression, Functional and Validation testing using XML files, HTML, MySQL querying and updating DCLs and records in MS Access.
• Configured Test claims records. Created Test Case via X12s for EDI 837 I & P, 834, 270/271.
• Executed Error correction programs to ensure Data quality. Error reporting via Jira/ Confidential QC/ALM.
• Reported daily on Test metrics and Data Analysis. Worked autonomously and remotely.
• Created Reports in SQL and Claims Test Pro
• Mainframe and PowerMHS testing in SoapUI
• Creating SQL queries in Claims Test Pro. Used Data analysis tools. Utilized Business Objects. Followed Agile workflow processes.
• Executed macros for benefits and claims testing. Submitted daily Test cases and weekly Status Metric Reporting
• QA, Integrity tested, UAT, Unit, Integration, Validation, Regression testing and Functional Testing.
• Data extraction, Compression, Validation in MS Access and SQL of errors and mapping positioning data.
• Benefit Tested on Facets, QXNT 5.0, UNIX, AS400, GBAS, Mainframe, CICs, Qmacs.
• Automated tested and User Acceptance Test and daily application support remotely.

TECHNICAL SKILLS

• Facets
• Facets NetworkX Pricer
• Claims Test Pro
• Open Source Test Tools
• Diamond
• CMS pricer Tools
• CICS
• Sql Server Studio
• SoapUI
• QNXT 4.2-5.0
• Confidential ALM
• Mainframe
• AS400
• SVN
• Pricer Analysis Tools
• Data Warehouse
• OnBase
• Jira
• Macess
• Amisys 6.0
• Confidential QC
• Javelina
• Xcelys
• Postgres Sql
• McKesson claim Tool
• Linux
• API Testing Frameworks
• Portals

PROFESSIONAL EXPERIENCE

Confidential, Richardson, TX

Data Configuration Analyst

Responsibilities:

• Provider agreement and fee schedule Tier configuration.
• Professional pricing fee schedule updates on an autoloader into Excelys via Open Sourced config Tools
• Configuration on pricing tiers in configuration test environment Provider
• Pricing tier update and configuration in BPS for conversion to facets. V
• Configuration design on build templates. Xcelys, client- Confidential FL, PCA and Sybase validation and Testing.

Confidential, Nashville, TN

Integration QA Analyst

Responsibilities:

• Provider contract Term and AEP Benefit Term Functional/ Regression (configuration) Testing.
• Created Test Cases and Test scripts: Various types of Benefit Products, Medical & Pharmacy benefit terms, coding, NDCs. claim pricing, custom fees, Fee schedule CMS. Medical & Pharmacy member cost share testing. Built Test Cases with Test Requirement.
• Created auto and manual script. Extraction of test claims and test data by CTP & SQL.
• Created Test Suites via Product/Benefit ID in CTP & Sql server. Built and cloned test claims (Institutional/Professional).
• Created automated and manual test scripts for benefit Term, ICD 10, Product, and Provider/Institutional, contract Terms.
• Resolved CCRs in ticketing system OnBase for request to test on various types of configuration updates (Regression) and newly created contracts (Integration).
• Rule ID and Capitation validation testing.
• Creating TestCases for CCRs. Executing test claim scripts.
• Validation of test results using SQL queries.
• Recording Defects into Jira application.
• UAT/Regression/Functional testing for configuration activities.
• Created Batches for test claims in CTP.
• Used Claims Test pro for creating and batching out Batched claim reports.
• In CTP, created 1500 & UB04 claims for testing various benefits Terms and contract terms from configuration.
• Integration testing payment funds by Payment group. Reporting defects, Reporting analysis. Batch Extracts on most tables.
• Member x12 extract testing and creation. Macros created executed in CTP.
• Benefit Testing for Accumulators, visits, limits, Max OOP, deductibles and all other member cost shares.
• Utilized Benefit Plan Module, Agreement, Contract service categories, Encoder Pro, CMS fee schedule, Claims Module, Provider Module, Contract Module, Claims Finance module, Member Module, Case management, Fee Table module and Rules, Rule ID and Rule descriptions. Soft administrative troubleshooting in OnBase
• Service groups, Contracts and contract terms are tested.
• Medicaid and Self-Funded (IPA) plans benefit terms and provider term testing. Utilized Expanded steps as validation of results during testing. Used fee sched code query to validate Medicaid FFS rates. Tested on RBRVs and custom fee Service groups and Contract Terms. Test request are delivered by tickets from configuration and business analysis.
• Claims Test Pro, Qnxt 5.0 ITE, Encoder PRO, OnBase reporting and ticket closure, MySQL for validation Testing and Extracting, macros, Excel spreadsheets, ETL, Batch reporting.

Confidential, Phoenix, AZ

QA Test Analyst

Responsibilities:

• QA testing Benefit terms and provider pricing terms for Dual Benefit Plans. Test script creation. Test Case Creation. Supported integration testing on Conversion data.
• Benefit term validation, QA testing on pricing terms and benefit terms. Testing on X12, 837,831,834. Created Test Cases on manual Test scripts. Error reporting in Jira. Batch creation, claims processing, Regression and Integration testing on configuration updates and test. Benefit Grid builds and Benefit Test Execution. Dual plans/Medicare Part D. Client BCBS of Maryland
• Built Test claims for test activities. Cloned and Batched out claim reports. Jira Reporting Claims XTEN 4.8, dashboards, EDI Warehouse document viewer, Confidential ALM, Jira, Macess.

Confidential, Harrisburg, PA

QA Test Analyst

Responsibilities:

• Created/executed UAT, Functional, Regression, Integral scripts and test cases in Confidential ALM for testing all Fee schedules, pricing configurations, i.e. benefit Terms and Testing on X12, 837,831,834.
• End to End Testing on tables and subsystem tables. Build test claim data. Tested provider allow, benefit allow keywords, CARCs, Cost-Shares, Pends, ACA other Neighborhood plans of RI. Reported errors into Confidential ALM /Jira. Enrollment testing. Benefit Term testing and Rule Ids. Tested Pricing provider Tiers and claims testing. Tested controls in regards to Optum Pricing and Pricing Analysis Tools. Claim data creation, Member X12 data extraction for creation of test script.
• Created automated and manual test scripts for upload into Confidential QC repository. Execution and Results reported within Test Case, Jira and Confidential ALM. Validation in sql. Status reporting. Created Test Suites. Data Extraction for test purposes. API Testing frameworks.
• Copied provider pricing agreement into new agreements and updated existing fee schedules. Autoloads for Fee schedules, fee loader, code set loads, Claims Loading copying data sets in DEV and TEST. Manual/Auto testing performed. UAT/Regression/Functional Test execution. Executed test scripts for fee schedules, benefit terms: benefit keywords, benefits, updates and new records. Manual & Automated. Error reporting in Confidential ALM.
• Enrollment configuration. Group loads and Provider loads in Amisys. Worked in Amisys 6.2-6.4 core, OPTUM Pricer, McKesson, PowerMHS (AS400). production and Confidential QC ALM 11.0. SoapUI.

Confidential, Baltimore, MD

Responsibilities:

• Created test cases based on SRs in ticketed system. QA test on X12s, test scripting, Test validation. Test scripts were manually created to be executed automatically after uploading into test software.
• QA on the BSBS table. Updated the HTML mapped table to create test scrips
• Created Benefit term scripts and Benefit test cases. Provided assistance in benefit BRD & Data Dictionary updates.
• Built and Audit benefit product and benefit plans i.e. Created new Benefit Summary Components from New EOCs and Existing products.
• Assisting with building and creating Product Benefit component updates.

Environment: Facets v4.71 and SharePoint.

Confidential, Plymouth, MN

Configuration Build Analyst

Responsibilities:

• QA testing on Provider Agreements, Capitation, Pricing Terms and Fee Schedules. Created Test scripts, Test Case and Data analysis on batched reports. Tested on provider fee schedules and payment Terms. Building medical plans from EOCs from beginning to end.
• Benefit term testing. Test script and Test cases created and executed. Manual testing. Regression Functional testing. API testing frameworks
• Data Extraction. Built Benefit BRDs. Provider contract data installation for Medicaid and Behavioral Health providers. Built from provider design documents into Facets beginning to end. Tested on Provider Terms and Pricing, Member cost share. QA validation. Building from requirement documents inserted Serena mashups/Sharepoint. Submitted daily test cases and weekly status reports for metrics. Manual Testing Project.
• Utilized Facets 4.71, Mysql and Facets data model, Serena Mashups and SharePoint.

Confidential, Houston, TX

QA Test Analyst

Responsibilities:

• In Facets 4.71, built Provider Agreements from existing Agreements (during migration projects). Configured Fee Schedule Profiles for Facilities including Mental health from actual Provider Agreement. Preformed validation testing on these fee schedule profiles.
• Created and executed UAT test cases and scripts. UAT testing based from benefit term, Fee schedules other payment methodologies.
• Submitted daily test cases and weekly metric test reports
• Configured benefit plans, provider and institutional contracts Facets 4.5-4.81 for Medicare Advantage plans.
• Mapped and procedure codes, ICD 9 code sets from Data Flat files to support my configured benefit plan and provider contracting agreements
• Built on 4.7-4.8 Facets Build test server.
• Utilized MS Access, Contract Agreement Summaries, s of coverage\benefit plan summaries while configuring benefit plans for groups.
• Modules: Medical Plan: Product, Service Definition, Service-related parameter, ben summary, service rules, etc.
• After I configured benefit plan, Provider/Institutional contracts, I created test claims for Testing Pricing, ICD9, Procedure Codes, Network Pricing for provider and facility claims based on my provider/institutional or benefit configuration. Testing ICD-9 and procedure codes new created provider contracts configuration.
• Created Test Bed/Test Cases on my provider contracts and benefit plans. ICD9, procedure code, Pricing test.
• Claim Processing experience with Testing.
• Configured Medicaid, HMO, Medicare Advantage health plans. Created test plans, Test Bed Builds, Executing test in Facets Software and Test plan configuration. Documentation of test results in SharePoint.

Environment: Facets: 4.5-4.6, 4.7, 4.81 Network Pricer X 2011.2

Confidential, Chattanooga, TN

Responsibilities:

• Installed Institutional, Provider contracts and benefit (products) plans, rules, exclusions, UM, eligibility, Medical procedures, Mental Health, Cob Rules, thresholds, and network pricing rules etc.
• Built Institutional Provider Contracts in managed care networks, HMO, PPO and ASO networks.
• UAT/UNIT and regression testing on configuration
• Mapped ICD-9 codes from flat file into the resource document for building.
• Benefit plan/product configuration.
• Executing test claims to ensure provider contracts are attaching to affiliate benefit products. Claim process and Global Testing.
• Executed macros during installation of medical and mental health provider contracts that are in the same networks

Environment: Power MHS, proclaim, AS400, CICs

Confidential, Atlanta, GA

Benefit Analyst

Responsibilities:

• Tested PPO and major medical plans.
• Tested aggregate claim fields to meet all test scenarios. Built benefit plan summaries. Validated benefit code mnemonics in hrbk screen then tested in EEC, HEHK, eFDE. Unit, Regression, UAT, and Manual testing. Developed manual test scripts and Test Plans.
• Reported to development and client. Test Requirement and Test Case Creation. Execution of test cases into NPS and ITS.
• Benefit Plan Design and Benefit File support. After Benefit plan designed ran claims against newly installed Ran automated utilities for error correction.
• Created CSRs as applicable and updated CSRs for business. Ran claim test for all benefit scenarios, Confidential -insurance, Confidential pays and maximums, Exclusions, benefit rules, EDI, allowable, provider NPI, Networks, Medicare compliance, hcpc code, rev, and diagnosis codes and all other claim functions and demographics.
• Created Testcases, requirement, error and default reporting. Benefit Coding on NPS mainframe. Software-NPS and Blue Exchange. Bug tracking and documentation 100 percent.

Environment: NASCO Processing System, Blue Exchange, Blue Card, ITS, PDM, Unix Editor, UNIX, AS400, Confidential Mainframe, CICS, NASCO, EEC, Excel.

Confidential, Phoenix, AZ

Data Analyst I/ Configuration Analyst

Responsibilities:

• Authored and documented requirements for new and previous accounts.
• Created source documents into reports to be implemented by technical, development and conversion.
• Supported client through web and secured email. Reported results to project manager.
• Configured provider and institutional contracts into Javelina. Javelina has the same payment structures as HealthRules/HealthEdge.
• Mapped and procedure codes, ICD 9 code sets from Data Flat files to support my configured benefit plan and provider contracting agreements
• Utilitzed s of coverage\ benefit plan summaries while configuring benefit plans for groups.
• Mapped and procedure codes, icd 9 code sets from Data Flat files to support configured benefit plan building and provider contracting agreements
• Manual testing production/mock data uploaded in conversion server to ASP client server.
• UAT Testing production data on mainframe and .ASP client server.
• Acted as a liason between client and IS dept. Functionality requirements and User analysis gathered from client and translated to IS Dept.
• Regression/Functional Testing-Tested data to uncover errors on modified or new software on client server or mainframe application.
• Configuration of Benefit plan, eligibility, claims, Group (new and existing), Accumulators and provider/institutional configuration on Web based relational based software and on Unix OS.
• UAT claims testing: benefit terms, fee schedules and other payment methodologies.
• Documentation and Reporting results in Jira. Developed manual test scripts and test plans against my built provider contracts and benefits plans.
• Utilized basic pl/pg SQL statements for resolving test results.
• Utilized the 837 claim format for claim configuration. Followed CMS guidelines.
• Ensured that errors revealed in previous tests are fixed properly and no new occurrences appearing during bug fixing.
• Mapping of data in access database then used ETL to repository.
• Ran automated utilities for error discovery and correction.
• Mapped data and configured for federal GEHA (government employee health plan).
• Built Group, Provide/Institutional contracts, and Benefit Plan Master files on conversion server then conducted functionality testing on that data.
• Tested and mapped ICD-10 format for GEHA.
• UAT and Integrity testing on mainframe and relational based applications. Application support on client server on site and remote.
• Extraction of converted data for compression into different applications.
• Validation Process and Data Modeling, plan building, and group master building on UNIX and web applications. Assisted client and developers on application support.
• Built test master EDI, 835s, Provider 837x demographic files. Validation on of hierarchy and networks.
• Gathered client specific requirements and documentation of the conversion plan needed to implement through various depts. (i.e. eligibility, benefit plans, claims, provider demographics)
• Automated testing with script and text files that encountered errors to report to project managers.
• Wrote, maintained, and executed automated test scripts for software product upgrades.
• Responsibilities include the maintenance of baseline databases which require importing and exporting database tables for the purposes of automated test execution.
• Assisted team members and
• Utilized DBC, Confidential MAINFRAME, AS400, UNIX, mySQL, Health Pac (Unix), K-edit, and Javelina.

Environment: SmartDraw, DBC, UNIX, GBAS, SQL, Health Pac, Web Based Applications (Relational), K-edit, Squirrel, Jira, PgAdminIII, Javelina.

Confidential, Phoenix, AZ

Test Analyst II QNXT/Qmacs

Responsibilities:

• Master file configuration for Benefit plan from Resource Doc Summaries and Benefit plan documents, group configuration, provider contracts.
• UAT testing on claims, eligibility data, benefit configurations.
• Executed and created manual test scripts
• Created Providers agreement and added the network row.
• Created the Room type profiles and Fee Schedules.
• Built provider/institutional agreements and benefit plans on to Qxnt front end.
• UAT regression testing eligibility, claims, provider contracts-data on client server.
• Provided application support for Medicaid clients and some commercial to developers/business.
• Manual UAT/UNIT testing after configuration. claim data from older client server to newer modified data using eligibility, claim data on test conversion servers.
• Uploaded corrected data into repository for programming. Documentation of results in excel report.
• Functionality requirements and User analysis gathered from client and translated to IS dept.
• Ran data in test to identify errors after configuring provider/institutional and benefit contracts. Used SQL select statements to query.
• Reported errors on issue logs and communicated with vendor and Project Test Lead.
• Ran automated test scripts for error reporting.
• Data tested and converted from workbooks, departmental request and issue logs.

Environment: QXNT Essentials, Mercury Quicktest, web-portal Rational Test Manager (function test) issue logs database. SQL. Bug tracking software. SoapUI.

Confidential, Libby, MT

Support Analyst

Responsibilities:

• Configured Confidential master file record used Magic.
• Application support for employees/depts.
• Abstracted data from client server to build records
• Ran utilities for compression and abstraction.
• Functional test. Validation of data on client server
• Mapped data. Built master Confidential files. Reporting to information systems dept.

Environment: Meditech, Magic, Confidential demographics

Confidential, Columbia. MD

Test Specialist I and Support

Responsibilities:

• ICN Claims data, Test Script Design and Manual Test Case creation in AGILE end to end test environment.
• Used HRBK assistance with Built benefit coding grids for benefit plans for BCBS of New Jersey.
• NCSW, EfdE, HIQK, HURK, HEHK (EEC), OLRX to resolve ODL,
• Access ODL via EEC, INUM.
• Testing performed by NASCO CSR process
• Created Benefit Grids for testing and config updates. Extracted and created test data to meet NASCO claims workflow conditions, testing methodology.
• Defined Test data requirement for Test efforts.
• UAT, Regression, Functional, Unit, BlackBox and Integration testing on claims for benefit terms, Cost share, Provider pricing and fee schedules.
• Testing at different levels (unit, functional, integration, end to end, regression, system, load and performance testing)
• Created Test Scripts for test claims from subscriber information on NPS.
• Defect management tools. Unix and GUI environments.
• Worked problem logs using PID values 491 Confidential NJ prod X to 515 New York PPO/EPO reimbursement codes.
• Compiled, tested, and tracked derived benefits codes from summaries and workbooks.

Environment: NASCO Processing System, PDM, Unix Editor, CICS, UNIX, AS400 Test Plans, NASCO (NPS), EEC.

Confidential, Oxnard, CA

Build and Test analyst I

Responsibilities:

• Mapped and procedure codes, icd 9 code sets from Data Flat files to support configured benefit plan building and provider contracting.
• Built Provider and Institutional contracts on the front end of Facets.
• Built benefit plans from benefit summaries
• Tested claims on AS400 mainframe system, WGS 2.0, Diamond and Star.
• Attached and built provider/institutional agreements to matching benefit plans then executed claim test on them.
• Tested benefit plans by creating test claims using company matrix and pricing tables.
• Handled commercial accounts, ASO accounts, EPO, federal employees, and HMOs, TPA, PPO, and POS accounts. Adjusted HCFA and UB-92 claim forms.

Environment: Facets, WGS 2.0, NPS and Diamond

Test Analyst

Phoenix, AZ

Responsibilities:

• Used QMACS and QNXT software and, UNIX, AS400
• Claim processing and UAT Testing on QNXT 2.6, 3.2, and 3.4.
• Utilized web based portals in testing. Automated script execution. Reported errors in issue logs.
• UAT testing on benefit codes, benefit and contract terms and provider fee schedules and other pricing methods.
• Adjudicated out of network provider and facility claims in both Test and Live environments.
• Developed manual test cases, organized test design and test scripts.
• Testing performed by CSR process
• Tested Mercy Care Plans.
• Processed and tested regular COB claims with secondary and tertiary carriers, including Medicare.
• Tested claims under 3 different self-funded accounts.

Environment: QXNT test, web based portal Rational Test Manager and Function, executed automated scripts for testing, error reporting, error correction.

Confidential, Taft, OH

Benefit Analyst I

Responsibilities:

• Developed test plans and Dept scripts for export to Mercury.
• UAT, Regression, Functional, Unit, Black Box and Integration testing on claims for benefit terms, Cost share, Provider pricing and fee schedules.
• Tested ICNs (Claims) and updated P A 123 - Updated allowed amt for Testing purposes.
• Developed manual test cases, organizing, test design and test scripts.
• Provider pricing analysis. Data analysis and Test Data Validation on Test Case Results.
• Product Benefit component, plan, eligibility, claim pricing and provider agreement testing
• UAT testing on benefit codes, benefit and contract terms and provider fee schedules and other pricing methods
• Created manual test cases from Use Cases, Functional Specs and other requirement documents.
• Built subscriber benefit master files from benefit summaries then tested eligibility and subscriber modules.
• Defect management tools and processes. Data extraction. Designed automated test scripting.
• Tested and processed claims in NPS environment, NCSW, Efde, HIQK, HURK, HEHK (eec), OLRX to resolve ODL,
• Used ODL via EEC, INUM.
• Utilized provider master file for entering contracts, fee schedules, contract codes, and service codes.

Environment: Facets 4.1, NPS, AS400, Confidential Mainframe, NASCO (NPS), NPSA- EXTRA, Sql test validation