OBJECTIVE

• To obtain a challenging position as a Sr. Quality Analyst and add value to a fast - paced dynamic environment to apply my professional skills in the field of Information Technology Company, by utilizing my proven Technical, Interpersonal skills and Analytical Skills, abilities and my diversified experience in business system analyst, to ensure the company’s sustained growth and continued success.

SUMMARY

• Over 7 years of experience in creating innovative and cost effective Quality Assurance solutions with expertise in Insurance, Healthcare processes, applications using manual testing procedures & test automated tools
• Extensive experience in all phases of SDLC processes
• Hands on experience working with HIPAA transactions such as 837, 835, 834, 278, 270 and 271
• Well versed in Health Care with HIPPA, HL7, EDI and x12 data formats
• Worked in ICD 9 and ICD 10 codes and involved in migration from ICD 9 to ICD10
• Worked with adhering HIPAA compliance and ICD 9 and ICD 10
• Strong understanding of ICD 9 and ICD-10 structures and format
• Did a comparison of all the EDI Transaction (837,834,835,820) between 4010 and 5010 HIPAA Version.
• Good understanding in 4010 and impact study of 5010 Transactions, 837 Claims (Institutional, professional and dental), (inbound and out bound), 834 Enrollment, 270/271 Eligibility inquiry and Response, 835 Remittances, 276/277 Claims Status Inquiry, 278 Referrals Pre-Cart, 820 Premium Payments and 999 or 997acknowledgements
• Experienced in testing Facets different modules Member Enrollment and Eligibility, Billing, claim Processing.
• Expertise in testing Client-Server and Web Applications using Mercury and Rational Tools.
• Experienced in different types of testing like Black box testing, white box testing, functional, GUI testing, Systems testing, regression, integration, Negative Testing, UAT and performance testing
• Expertise in reviewing requirements, Business requirements gathering, Data warehousing, evaluating data sources, translating requirements into specifications and application design.
• Experienced in documenting Test Plan, Test Objectives, Test Strategies, Test Scripts, Test Scenarios and Test Cases.
• Experienced in backend testing of ETL mappings developed using data warehouse tools like Informatics.
• Performed User Acceptance and Usability testing.
• Hands on Experienced testing Different EPIC Application Modules PRELUDE, ADT, AMBULATORY, CANDENCE, BEACON, BEAKER, and HIM CODER, HAR
• Profound working knowledge in defect management and tracking tools like Quality Center, ALM, TFS & JIRA.
• Good experience in performing backend testing on Oracle, SQL Server, DB2, Sybase and MS Access databases
• Experience with structured QA Methodology and QA Process to ensure the Quality Assurance Control.
• Used Quality Center/ALM to prepare Test cases, Requirements Traceability Matrix and managing the Defects as per the Business requirements.
• Experience working on SQL database, querying the database for claim entries into gateway and different fallout scenarios.
• Strong experience in capacity planning, load test configuration. Versatile team player with strong written, communication, interpersonal and analytical skills. Experience leading team to meet deadlines and goals set by clients.

TECHNICAL SKILLS

Project Methodologies: Rational Unified Process (RUP), Agile, Waterfall

Business Modeling Tools: Rational Rose, MS Visio

Requirement Management Tools: Rational Requisite Pro, Clear Case

Prototyping tools: Axure pro version 6.5

Defect Tracking Tools: Rational Clear Quest, Test Director

Operating Systems: Windows XP/2000/NT, UNIX, DOS

Databases: SQL Server, MS Access, Oracle

Languages: Toad, SQL, HTML,XML

Testing Tools: Quick Test Pro (Selinium), WinRunner, LoadRunner and Rational Team Test, Application Life Cycle Management (ALM), Quality CenterBusiness Applications:

MS Project, Microsoft Office Suite- MS: Word, Outlook, Power Point

Design Tools & Languages: Microsoft Visio, C++, HTML, VBA

PROFESSIONAL EXPERIENCE

Confidential, Denver, Colorado

Senior Quality Analyst

Responsibilities:

• Tested PID values, reimbursement codes, HCPC, CPT, DX codes for claim test. Coded from benefit grids and benefit booklets. Received workbooks and summaries.
• Worked closely in All the Epic application modules PRELUDE, ADT, HIM, HAR etc.
• Work with Developers to review Unit Test plans and review results
• Responsible for writing test plans, test cases and developing test scripts
• Provided status reports and created deliverables.
• Tracked and developed metrics for testing
• Work with BA, Developer and Rule Lead to add and test new functionality
• Update Functionality Spreadsheet to identify configuration example
• Document and analyze test results for all types of testing
• Write clear and precise JIRA reports to communicate defects found in SIT, QA Functional, and QA Regression Testing. Work closely with developer as needed to resolve issues
• Assist in documentation and training of new system enhancements
• Arranged weekly team meeting to assign testing tasks and acquisition of status reports from individual team members.
• Successfully mapped the ICD 9 code to ICD 10
• Validating the ICD 10 code
• Verify and validate all the charges, and run the claim successfully.
• Participated in various phase of the project Life cycle (PLC) to ensure customer business and technical requirements tested and validated
• Accountable for development of Master Test Strategy and Test Cases across participating teams
• Accountable for the definition and execution of Performance Testing and any technical testing
• Works with the Technical Lead/Build Manager to plan build schedules
• Reviews requirements and functional specification to ensure completeness in test cases
• Responsible for obtaining sign-off of successful testing completion from all involved areas
• Conducted Bug review meeting to discuss resolution of issues

Environment: Agile, SOAP UI, DB2, Clear Case, JavaScript, HTML, XML, SOA, UML, MS Office, Windows XP/2000, Java/J2EE, MYSQL, SQL Server

Confidential, Dayton, OH

Sr. Quality Analyst

Responsibilities:

• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Developed various test cases for testing HIPAA 837I/P/D and 277(5010).
• Validated the reports and files according to HIPAA X12 enforced standards.
• Created Test Plan that defines the test environment, phases of testing, entrance and exit criteria into different phases of testing.
• Identified, built and executed Test Cases and Test Sets for Functional, Error Handling, Navigation and Regression in Test Director.
• Worked closely with the other members of the Development Team and review the designs of systems, implement test plans, and test the quality of software products.
• Executed the 5010 system test scenarios for 5010 HIPAA transactions 837I/837P/837D, 277 and 835 after loading and adjudication.
• Worked on ICD-9 validation for EDI records.
• Thorough experience of HIPAA compliance like 837 and extensive knowledge of ICD 9, ICD 10 as well as conversion of .
• Test HIPAA regulations in FACETS HIPAA privacy module.
• Design, analyze and performed Integration and wrote System requirements on different leading health care software’s such as FACETS.
• Entering Claims and Customer Service Tasks into the FACETS.
• Participated in testing various interfaces (Inbound and Out bound)for FACETS
• Responsible for integrating with FACETS. Designing test scripts for testing of Claims in Development, Integration and production environment.
• Involved in Data mapping to/from legacy to FACETS that will be used to populate the oracle database.
• Involved in processing claims in FACETS and validating the full cycle process to make sure the checks are generated and 835’s are generated.
• Involved in claim adjudication process of FACETS application.
• Tested the data conversion from Legacy systems to FACETS.
• Experience with ICD 9 and ICD 10 in Health Care.
• Understood the business process that included Sales processes, Rating methodology, different Products, Group Renewals and Enrollment process in Facets.
• Involved in testing Facets for Group Information, Enrolling Subscribers, adding members, Related Entities, Class/Plan definition, Premium Rate Tables and all.
• Completed several HIPAA 4010 and 5010 Projects, included Medicaid and Commercial entities. Projects include claims and enrollment testing as well as NPI and medical coding and ICD-9 EDI testing
• Used Team Foundation Server (TFS) and SharePoint for reporting purposes, to track the progress and to enter tasks. Also created test cases from the user stories stored in it.
• Worked on the Trading Partner migration to production by submitting different claims with specific levels of errors.
• Load and execute Test Scripts via HP ALM (Application Lifecycle Management) system
• Use Smart Bear ALM Complete to manage bugs.
• Performed Backend Testing by writing SQL statements to review the returned data to ensure that the correct data was retrieved.
• Developed and executed several SQL queries in DB2 as part of backend testing.
• Conducted database integrity testing by executing SQL statements
• Performed complex data validation using SQL queries.
• Written several complex SQL queries for data verification and data quality checks.
• Performed Regression testing and Smoke testing for the above.
• Involved in the user acceptance testing (UAT).

Environment: Windows Server, ALM, Oracle, Microsoft .NET, TFS, ASP.NET, Power shell, Crystal Reports Server, IBM Websphere MQ.

Confidential, Tampa, Fl

Quality Analyst

Responsibilities:

• Extensive Knowledge of benefit grids, summaries, group booklets, contracts and benefit group coding.
• Uploaded benefit codes to repository.
• Tested benefit codes in queries. Converted to benefit Mnemonics. Reported information to project managers and software configuration department.
• Unit Tested 837 (Institutional, Dental, and Professional), 835, 270/271, 276/277, 820, and 277U transactions with TSO, ISPF, and File Aid.
• Tested PID values, reimbursement codes, HCPC, CPT, DX codes for claim test. Coded from benefit grids and benefit booklets. Received workbooks and summaries.
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Test Manager
• Responsible for creating UNIX shell scripts for retrieving information from the X12 files.
• Tested the 837 Institutional and Professional Claims and 835 payments for HIPAA Compliance
• Unit Tested 837 (Institutional, Dental, and Professional), 835, 270/271, 276/277, 820, and 277U transactions with TSO, ISPF, and File Aid.
• Done End to End testing on entire claims life cycle with testing the EDI transactions like 837,276,277,835,270,271, 278.
• Also done end to end testing on entire claims with EDI Functional Acknowledgement Transaction Set (997).
• Good knowledge and experience on various X12 transactions
• Worked extensively on various EDI’s like 270/271, 276/277, 835/837, 277U
• Worked on HIPAA X12 claims 837 (Institutional, Professional and dental claims) and also on HIPAA X12N 835 version 4010 A1 electronic remittance advice.
• Analyzed Test Plans, Legal Documents, Assist the Test-Team in writing Test-Scripts, Upload Test Scripts to QC (ALM), and Recommend Change Controls.
• Supported the Manual Testing Team for execution of test cases in HP (ALM).
• Responsible for creating UNIX shell scripts for retrieving information from the X12 files.
• Tested the 837 Institutional and Professional Claims and 835 payments for HIPAA Compliance
• Involved in project planning, coordination and implemented QA methodology.
• Track system bugs using TFS (Team Foundation Server) application
• Excellent knowledge of Configuration Management and Version Control (PVCS, MS Visual Source Safe, TFS, Rational Clear Case)
• Tracked defects, recorded, reviewed, analyzed using TRAX and Team Foundation Server (TFS) and Microsoft Test Manager (MTM) and assisted
• Developed, executed and documented highly complex test plans and test cases for business-related application running on multi-tiered platforms.
• Planned, coordinated, and monitored project levels of performance and activities to ensure project completion before or On-Schedule.
• Participated in writing data mapping documents and performing gap analysis on the systems.
• Developed and performed business data validation and integrity of generated database during various stages of SDLC.
• Used Object Repository and Object Repository Manager to handle the known VB exceptions in the application.
• Created Rendezvous Points to simulate heavy load for particular transaction points.
• Monitored online transaction response times, Hits per Second, Throughput, CPU, and Memory.
• Involved in claims submission and payment (remittance) retrievals by using ASCX12N 820 for the In- bound premium payments; ASC x12N 834 for the Inbound Enrollment and Maintenance; ASCX12 276/277 for the claims status enquiry and response; and ASC X12 835 for the Health care Claim Payments
• Involved in UAT for Provider Enrollment, Prior Authorization, Benefits Administration, Encounter, Claims and Encounters, Eligibility Subsystem.
• Verified the changes and updates that occur for the Data Validation on MS SQL Server while listing or creating the users that occurred on the Business Units Web sites.
• Conducted Back-end testing using Oracle and prepared reports by developing and executing SQL queries.
• Worked on backend testing on Oracle and written SQL, SQL/PL queries.
• Performed Back-End testing by creating SQL queries on Oracle and Netezza database
• Performed Backend Testing by writing SQL statements
• Developed test cases and scripts for Functionality, Security and GUI Testing.
• Conducted Load testing to generate the load on the server by creating Database User scripts
• Database integrity testing by executing SQL statements.
• Executed test cases manually to verify the expected results.
• Involved in Configuration testing.
• Conducted database verification testing by using different SQL queries.
• Used HP Quality center to track, analyze and document the Test Plan.
• Participated in various meetings and discussed Enhancement and Modification Request issues.

Environment: Windows, Oracle, Sybase, TFS, ALM, Onyx, HP quality center, DOORS, JAVA script, Perl scripting, UNIX scripting, object oriented programming (OOP), Web logic, and Crystal reports

Confidential, Durham, NC

Quality Analyst

Responsibilities:

• Hands-on QA Analyst responsible for coordinating and performing System Integration, functional and data-related testing.
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Mercury Quality center
• Extensively used TOAD to test various ETL process flow through to meet the Business rules and Technical Requirements
• Map inbound date to internal LPF structure claim routing (Legacy, State, FEP, ITS) to payment system based on Eligibility.
• Tested the EDI interfaces and X12/EDI transactions (270, 271, 835,837 and 997).
• EDI Claims Processing - documented enhancements to the EDI Claims Processes to ensure accurate processing of claims of various member/provider scenarios
• HIPAA Conversion Analysis - Involved in the documentation of HIPAA 5010 changes to EDI 837, 834, 835, 276, 277 Transactions.
• E2E testing of Line of Business Legacy, ITS(Inter Tele Processing), FEP
• Worked on HIPAA Transactions and Code Sets Standards such as 837, 835, 270/271, 276/277 transactions.
• Identified the test scenarios and performed Web Services functional testing using SoapUI
• Tested Data extraction, Data Migration and Data conversion using ETL tools from application front-end with Oracle databases and data warehouse.
• Involved in project planning, coordination and implemented QA methodology.
• Developed test cases and scripts for Functionality, Security and GUI Testing.
• Conducted Load testing to generate the load on the server by creating Database User scripts
• Working experience in creating SQL queries that involved complex operations joins and sub queries.
• Manually performed Back-End testing by creating SQL queries on Oracle and MS SQL database
• Database integrity testing by executing SQL statements.
• Performed User Acceptance Testing (UAT).
• Performed Backend Testing by writing SQL statements to review the returned data to ensure that the correct data was retrieved
• Created and maintained SQL Scripts to perform back-end testing on the oracle database
• Participated in various meetings and discussed Enhancement and Modification Request issues.

Environment: PL/SQL, Rational Tools Suite (Rose, RequisitePro, Clear Quest and Clear Case), Agile, UML, JAVA SQL, MS Project, MS Office, PowerMHS, Blueplan ITS

Confidential, Houston, TX

Quality Analyst

Responsibilities:

• Design and document the test data requirements, validate the test data received from Business team
• Created Test Plan, Test Matrix and Test Cases.
• Used Quality Center for documenting and executing Test Cases.
• Developed Test Cases for testing EDI transaction.
• Tested the EDI interfaces and X12/EDI transactions (270, 271, 835, and 837).
• Involved in end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module
• Performed Integration testing and coordinated User Acceptance Testing (UAT).
• Used Quality Center for defect management.
• Preparing Test Reports and keep track of defects using the bug tracking system (Mercury Quality Center).
• Worked extensively on various EDI’s like 270/271, 276/277, 835/837
• Maintained Test Metrics for management reporting.
• Provide daily and weekly status reports to the QA Lead
• Involved in validating XML Files
• Coordinated, planned, & performed UAT with business teams
• Wrote complex SQL queries to perform the backend testing of the Oracle database using PL/SQL
• Wrote SQL queries to verify the database tables for the data inserted from the GUI
• Conducted database verification testing by using different SQL queries.
• Database integrity testing by executing SQL statements.
• Used Mercury Quality Center for updating the status of all the Test Cases & Test Scripts that are executed during testing process.
• Involved in check the EDI set up process.
• Validate data records using SQL queries.

Environment: Windows NT, MS-Visio, Oracle, SQL, MS Access, Test Manager, Office, MS Project, Requisite Pro.

Confidential, Detroit, MI

Quality Analyst

Responsibilities:

• Developed Test Plans/Cases for Testing at various stages of the development cycle, resource/time estimates.
• Created Requirement Traceability Matrix (RTM) for reviewing and tracking requirements and Test cases.
• Involved in writing the Test plan and Test Cases based on the business requirements in Mercury Quality Center.
• Followed SDLC methodology and STLC for testing.
• Referred Companion Guide, Implementation guides to validate the data element and Loop for Testing the EDI’s 835, 837, 270s
• Created transaction sets and mappings in various ANSI X12 EDI formats like X12 837, X12 835, X12 270/271, X12 276, X12 277.
• Did a comparison of all the EDI Transaction (837,834,835,820) between 4010 and 5010 HIPAA Version.
• Involved in preparation of Test strategy document that defines the Test environment, phases of Testing, entrance and exit criteria into different phases of Testing and resources required conducting the effort
• Prepared detailed Test execution schedule, including data setup and batch execution dependencies.
• Involved in the Review of Requirements Specification with functional manager and technical specialists of the application
• Performed Backend and Database validation using complex SQL queries including but not limited to Joins, Sub queries, Nested queries and aggregate functions
• Created and maintained SQL Scripts to perform back-end Testing on the oracle database.
• Worked on various BizTalk errors on the outbound 837 transactions.
• Retrieved records from multiple tables from Oracle Database by using SQL QUERIES.
• Experienced in Testing XML web services using Soap protocol.
• Extensively wrote SQL queries to do the data integrity Testing.
• Worked along with business analyst to meet clients during initial phases of the project.
• Used Quality Center as a Test management for tracking and managing the defects.

Environment: Agile, UML, PL/SQL, SQL plus, Rational, HTML, MS Visio, MS OFFICE (Word, Excel, MS Access, PowerPoint)

Confidential, Irvine, California

Quality Analyst

Responsibilities:

• Authored Test Cases to include prerequisites, detailed directions and descriptions of the anticipated outcome.
• Performing sanity testing, functional testing, user interface testing, system testing regression testing and smoke testing.
• Tested deployment of applications in Enterprise environments during all phases of the product cycle.
• Worked with Developers, as necessary, to isolate and repair bugs. Tracked software problem reports
• Verified resolutions.
• Prepared and developed test cases, test scripts, and test approach documents.
• Involved in writing comprehensive test plans based on business requirements.
• Performed manual testing testing.
• Developed test scripts for functionality and data driven tests.
• Coordinating with team, and resolving the critical issues with development team.
• Involved in test case reviews.
• Defects were tracked, reviewed, analyzed and compared using Test Director.
• Responsible for writing SQL queries for accessing data from the Oracle database.
• Conducted functionality and regression testing of bugs, fixed and closed or re-opened the defects as accordingly.
• Developed test cases manually for functional and regression testing by analyzing the specifications of business document.
• Status Reports: Daily and Weekly Status reports updates to the Team Lead, Test Groups and Test Managers to co-ordinate test cycles.
• Possess excellent Interpersonal and communication skills.
• Highly motivated and flair to adapt to challenging environment.
• Functional Testing on Java based front end of the application.

Environment: Windows2000, MS-Visio, Microsoft Project 2000, Java Script, VB Script, XML, Axure, Oracle.

Confidential, Norcross, Georgia

Quality Analyst

Responsibilities:

• Analyze business and system requirements, mange development of specifications to create and execute detailed test plans, and verify bug fixes.
• Configure test environment and create strategy for product development and certification. Assure test data, schedule manual tests.
• Approve results documentation and tracking systems updates.
• Use Clear Quest for repository, reporting and tracking bugs, and providing updates on resolved bugs.
• Determined testing requirements developed and reviewed scripts for positive and negative test scenarios, conducted baseline testing, and generated reports.
• Tested server and Web Portal.
• Attended weekly defect report meetings and presented progress updates.

Environment: MS Office, MS Visio, Project, Rational Tools, SQL Plus, Agile, UML, Rational Request Pro, Clear Case.