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 InformationTechnology 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 Experiencedtesting 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, Jira

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 Center, SoapuiBusiness Applications

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

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

PROFESSIONAL EXPERIENCE

Confidential, Plano, Texas

Senior Quality Analyst

Responsibilities:

• Extensively worked on creating different scenario xml file.
• Extensively working on web services testing using SoapUI.
• Executed different Transaction (Add, Change, Term, Delinquent, Payment and Reinstatement) and perform end to end Testing.
• Validated, Verified and resolved the issues that were coming from Developers, UAT and Production.
• Used Clear Quest and Team Foundation server for defect tracking Tools
• Responsible in writing Test cases, Test Plan and actively resolving the issues that was coming from Developers and Team.
• Participation of XSD schema validation for BenefitEnrollmentSchemaV27
• Mostly Worked on 834 Xml and Edi File, validated based on the Business Rules, Mapping Document, and Companion Guide.
• Responsible in sending Edi File daily and Monthly to the client including complete Reports.
• Extensively Worked on Xcelys migration from version 2.0 to version 3.0 different application CSR Light, FMS Admin, Premium Billing, Small Group, Non- Group Broker Commissions and Lockbox, and Boomi
• Responsible in reviewing, analysis functional Requirement Document and giving feed back to the business analyst and Developers if any changes needed.
• Wrote complex SQL queries to perform the backend testing of the Oracle database using Oracle SQL Developer and Toad
• Updated Daily and Weekly Status reports to the Team Lead, Test Groups and Test Managers to co-ordinate test cycles
• 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.
• Analyzed Test Plans, Assist the Test-Team in writing Test-Scripts, Upload Test Scripts to Team Foundation Server (TFS), and Recommend Change Controls.
• Used Claredi to EDI File for HIPAA Validation
• Extensively worked on Subsidized and NON- Subsidized Member 834 and 820 transaction
• Extensive worked on XCELYS modules like Claim processing, Claim pricing and claim adjudication, Member Eligibility, Groups, Providers & Vendors, Health Plans, Benefits, Third party Functionality, Remittance Advice, Customer Management, Correspondence, CMS, Premium Billing, HIPAA transactions and proficient in testing applications on different browses and platforms.

Environment: Agile, SOAP UI, DB2, Clear Quest, JavaScript, HTML, XML, UML, MS Office, Windows XP/2000, Java/J2EE, MYSQL, Oracle SQL Developer, TFS, FileZilla, Notepad ++, Ultra Edit, Altova

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, 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.
• 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.