SUMMARY

• Over 7 years of professional experience as QA Analyst with expertise in Software Development Life Cycle (SDLC) and Business Process Reengineering specially working with Health care insurance clients.
• Primary focus has been on FACETS analysis and up - gradation, ICD 9- ICD-10 enhancements, member eligibility and enrollment, Claims and reporting.
• Recent project include working with Insurance Companies on up-gradation projects legacy systems to FACETS, ICD-9 to ICD-10; EDI ASC X12 by creating functional requirements solutions, analyzing existing system, preparing test plan and test cases, performing gap analysis, and impact analysis.
• Experience in analyzing system and functional specifications used cases, Business Requirements and business rules to prepare Test Plans and design Test Cases
• Expertise in documenting the Business Requirements Document (BRD), Technical Requirement Document (TRD), generating the UAT Plan, maintaining the Traceability Matrix and assisting in Post Implementation activities.
• Experience with Individual business Off-Exchange and On-Exchange (Healthcare.gov) and group enrollment process.
• Performed the groups and Individual enrollment in Connecture
• Familiar with the Salesforce and Connecture data integrations system
• Experience in Medicare and Medicaid enrollment process.
• Experience with Facets backend data model tables and frontend application module like Subscriber/Member, Claims processing and providers.
• Experience in Data Quality and Data integrity
• Experienced with HP QC and now the HP ALM to track the defects.
• Performed the system integration testing while keeping track and logging defects of the testing effort in HP Quality Center (QC) and now using the HP ALM.
• Excellent understanding of Software Development Life Cycle (SDLC) models.
• Good understanding on EDI transactions, HIPAA gateway, ICD9 and ICD10, HIPAA 4010 and 5010
• Adept at using both Manual and Automated Testing tools to troubleshoot systems, Integration, User Acceptance, Positive and Negative, GUI and Functionality, Regression Testing and End to End Testing
• Understanding and hands-on working experience with EDI transactions like 834 Enrollment, 835 Health Care Claim Payment/Advice, 837 Claims, 270 Eligibility inquiries, 271 Eligibility responses, 276 Claim status inquiry and 277 Claim status response277.
• Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor Management Business Areas.
• Change Control Process - Led the Change Control Process for changes submitted for the BRD once the document was submitted to IT department.
• Experience in conducting User Acceptance Testing (UAT) and documentation of Test Cases
• Hands on experience in testing the claims Adjudication Process using Facets

TECHNICAL SKILLS

SDLC Methodologies: Agile, Waterfall

UML Modeling Tools: MS Visio

Databases: MS SQL Server 2008, Oracle, Sybase

Software Testing: ART, Integration, Regression, User Acceptance, System Integration and Functional

Data Modeling: E-R Diagrams, Data Flow Diagrams, Data Dictionary, Data mapping

Testing Tools: Quality Centre, HP ALM and Clear Quest

Operating Systems: Linux, Windows

Applications: TriZetto Facets 4.71, 5.01, 5.10

Tools: Ultra Edit, Claredi, Edifecs, Note Pad++, Snagit, Snipping tools, XML Spy etc.

PROFESSIONAL EXPERIENCE

Confidential, Durham, NC

Sr.QA

Responsibilities:

• Outlining the roles and responsibilities needed to support each of the large group and individual group bundle project test scope.
• Participating in the review of the business and functional requirements from the business for testability.
• Participating in the designing phase of the functional design documents
• Identify a list of stakeholders that will participate in the signoff to production.
• Participating in the review of the SIT regression test case execution results and defects from delivery Partners for the current Small Group.
• Planning for the execution and defect resolution using current Quality Center reporting.
• Planning and initiate creating the test cases for Delivery Partner SIT, Acceptance Testing and BAT for any potential gaps in test coverage.
• Creating Project Test Strategy/Approach to be reviewed by Business Owners and Software Developers.
• Planning the functional, regression and end to end testing scope for the each sprint release by Connecture team
• Documenting all information regarding the testing and defects and uploaded in the SharePoint so anyone can use it in the future necessity
• Working together with Facets team to validate the product grid configuration in Facets for the NCTIO Large group
• Creating the test scenarios for the various applications like Connecture, Edifecs and Facets data integration for the End to End testing.
• Creating the functional and system integration test scenarios for the each individual application for e.g. Connecture and Facets to enroll the group/members through the Connecture to load the data into Facets
• Creating the Test scenarios condition for the online enrollment of group/member by uploading EDI X12 834 file to Edifecs for the HIPAA Validation and integrate the data in Facets.

Confidential, Southfield, MI

QA Analyst

Responsibilities:

• Involved with business and development team teams to understand business flows and requirements.
• Reviewed functional requirements documents, high level design documents and finalize the testing in scope and scenarios for integration testing each for each project.
• Supported within production testing for each sprint release.
• Created test plan and test cases documents for system integration testing.
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating the database to file elements.
• Mocked-up the X12 834 file according to test conditions scenarios
• Validated and mocked up the XML file for the EFT payment transaction
• Performed the billing entity module testing in Facets
• Performed back-end testing in Sybase mainframe environment to execute the data table by writing the SQL queries.
• Performed the application readiness testing, functional and end to end testing for individual business off-exchange and On-exchange(CMS FFM)
• Performed the system integration testing while keeping track and logging defects of the testing effort in clear quest.
• Performed Application Readiness/Business and User Acceptance testing in Facets into Subscriber/Member and Billing module for the rate plan testing in the front-end facets and data model back-end table.
• Documented the test results and reported the status of assigned test tasks and issues to project QA Lead.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Worked with migrated group scenarios for integrated application.
• Involved working together with Product Configuration team to understand the product and plan crosswalk value and documents
• Configuration of online custom configuration and Product configuration.
• Worked on various testing requests from Business team.
• Change request analysis and testing.

Confidential, Southfield, MI

QA Analyst

Responsibilities:

• As part of QA analyst team I am responsible for understand the state specific Medicaid and Medicare requirements.
• I was responsible for understanding CMS requirements.
• I was involved in migrating NJ, NY, AZ and WI State. And Facets implementation for the KS, NE & MD States
• I was responsible for CMS Medicare mapping between TRR file and Facets tables.
• Responsible for creating test plan and test scenarios for different module of Facets application like Claims, Members/Subscribers, Providers and portals.
• Skilled knowledge of understanding and validating the X12 EDI format files 834 benefits and enrollment.
• Responsible for creating the test plan and designing test cases for the EDI 834 members’ enrollment file loading process into Facets through HIPAA Gateway.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Load testing, User Acceptance testing on multiple projects
• Wrote Test Scenarios, Test cases in excel sheet.
• Participated in Leadership Meeting, Defect Call Meeting to discuss about the issues.
• Good Understanding of necessary configuration changes from State to State as per business requirements.
• Knowledge of gap analysis between Legacy System (Diamond) and Facets in terms of Group Structure.
• Responsible for unit testing and working with System/Integration testing team in debugging/resolving any issues raised during testing.
• Responsible for Data Quality and Data integrity.
• Reviewed functional requirements documents, high level design documents and finalize the testing in scope and scenarios for integration testing each for each project.
• Performed back-end testing in Sybase mainframe environment to execute the data table by writing the SQL queries.
• Performed the gap-analysis of ICD-9 to ICD -10 changes
• Validated the code changes for the ICD-10 with in the Facets system
• Performed the system integration testing while keeping track and logging defects of the testing effort in HP Quality Center (QC) and now using the HP ALM.
• Very well known to the Subscriber/Member, Claim processing and Provider module in the front-end facets and data model back-end table.
• Involved in member, provider and claims service Portal web service testing as well.
• Performed the Front-end billing testing by validating the paper claims and electronic claims file which load in to the Facets database and Macess as well for the tracking
• Tested all the HIPAA regulation in Facets HIPAA privacy module transactions for multi version support ( ) and validating the database to element file.
• Mocked-up EDI 837 I & P Claims file according to the test scenarios
• Very well known to the EDI transaction according to the HIPAA Compliance rules
• Mocked - up the EDI 834 states file for the system testing purpose and very well known to the loading process of the MMS file into Facets database.
• Actively participated in all the walkthrough and enhancement meetings

Confidential, Louisville, KY

QA Analyst

Responsibilities:

• Worked with Business Analyst and QA Lead in reviewing and analyzing the business requirements Documents and functional requirements.
• Worked on AGILE methodology /Agile-Waterfall Hybrid environment for software development and testing.
• Developed and created master test plans and related documents, test cases, and test schedules
• Executed test cases and test scenarios across development projects
• Wrote and executed SQL queries to interpret test results and create test data
• Created, enhanced and maintained high-end object repository for various functional and regression test using Quick Test Professional (QTP)
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 276/277, 270/271, 837/835.
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating the database to file elements.
• Performed Gap analysis.
• Performed Smoke Testing, Sanity Testing, Positive, Negative and functional testing while keeping track of the testing effort in QC.
• Hands on testing experience in Facets pricing module. end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module Performed Security Testing on the application
• Involved in FACETS Implementation, involved.
• Set claim processing data for different Facets Module.
• Identify processes and systems to enable to trade files with non ICD-10 complaint trading partner. Monitor and resolve testing issues.
• Tested HIPAA regulations in Facets HIPAA privacy module.
• Documented the test results and reported the status of assigned test tasks and issues to project QA Lead.
• Conducted Back-End Testing Using SQL Commands.
• Responsible for Performing Integration Testing, UAT testing.
• Actively participated in walkthroughs and enhancement meetings
• Maintained Test Matrix and Requirement Traceability Matrix.

Confidential, Miami, FL

QA Analyst

Responsibilities:

• Responsible for decomposition of the requirements based on the functional specifications, design, development, coding, testing, debugging and documentation of applications to satisfy requirements.
• Involved in Development Test cases and Test plan.
• Wrote detailed test plans based on Business Requirement Document (BRD); System Requirement Specification (SRS)
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
• Entering Claims and Customer Service Tasks into the FACETS.
• ValidateEDI Claim Process according to HIPAA compliance.
• Tested HIPAA regulations in Facets HIPAA privacy module.
• Involved in testing HIPAA Transactions & Code Sets Standards like (834- Enrollment /enrollment cancelation to a health plan, 835, 837 ...etc.)
• Select, design, and prioritize test scenarios and test cases that will provide efficient coverage of requirements consistent with acceptable level of risk.
• Followed Agile methodology.
• Wrote Test Plans and Test Cases for UAT testing.
• Wrote test cases for Endorsements, Cancellations and Reinstatements.
• Prepared test summary and defect reports from MQC
• Performed Manual Testing to check the usability of the application.
• Executed Configuration Testing to check if the application was compatible in different environment for each module of the application.
• Conducted Back-End testing of the application by writing routine SQL queries.
• Used Quality Center for Bug Tracking and Reporting, generating customized graphs and reports.
• Found errors reported defects, determined repair priorities, did regression testing and close by using Quality Center
• Involved in creation and maintenance of test matrix and tractability matrix and also involved working thought the SDLC.
• Conducted result analysis and interacted with developers to resolve bugs.
• Interacted with developers, business analysts and discussed technical problems and reported bugs.
• Met with the developers and technical content writers on a daily basis to update the test documents.

Confidential, Hartford, CT

QA Analyst

Responsibilities:

• Formulated detailed Test Plan and Testing Procedures, which included Test Cases/Scripts, capturing Test Results and capturing and resolving Test Anomalies.
• Followed RUP methodology
• Performed configuration/ compatibility and user interface testing manually.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 837, 835.
• Created Test Cases for Claims Adjudication Process for 837P.
• Tested all edits for Facets Claims module.
• Performed Positive and Negative Testing Manually
• Performed Security testing on the application.
• Experiences working in ANSI X 12 270/271 EDI Transaction.
• Documented the test results and reported the status of assigned test tasks and issues to project QA Lead.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Made sure that the systems complied with the rules of HIPAA.
• Helped in project testing efforts for doing integration tests, regression tests and user acceptance tests.
• Worked on Data mapping, logical data modeling and used SQL queries to filter data within the Oracle database tables
• Actively participated in walkthroughs and enhancement meetings
• Maintained Test Matrix and Requirement Traceability Matrix.
• Created Status and Test Summary Reports on Weekly basis.
• Extensive UAT Testing Manually.
• Used MQC for bug tracking and reporting, also followed up with development team to verify bug fixes, and update bug status.
• Documented bugs found out during the process of testing.