Skills Summary

• 7 years of IT industry experience with a proven skill in the field Software Testing.
• Possess strong knowledge of healthcare terminology and extensive experience working on healthcare projects. Specialized experience in healthcare insurance domain. Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice),837(Health care claim)
• Good knowledge of EDI/HIPAA and Facets.
• Experienced working with x12 version 5010 transactions and ICD -10-CM and ICD-10-PCS Code set changes analysis, design and migration strategy.
• Have good knowledge of HIPPA 4010 /5010 versions.
• Expertise in COBOL, CICS, DB2, VSAM, JCL, File Manager, QMF, SPUFI and File-Aid.
• Strong experience in Mainframe Batch Cycles & Online Real-time Processing.
• Expertise technically with database development and data warehousing concept/tools.
• Worked in the performance tuning of the programs, ETL Procedures and processes.
• Experienced in testing applications developed using PL/SQL, Java, J2EE,.Net, HTML, XML, ASP, Visual basic and C/C++.
• Experienced in writing test queries/scripts for data analysis and QA report testing
• Extensive experience in writing and executing complex SQL queries using TOAD 9.0.1 to validate data within SQL Server 2007 database.
• Experienced in Object Oriented Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case development using UML methodology
• Expertise in developing QA Test Plan, Test Conditions, and Test Cases; ensuring adequate testing of software both before and after completion; conducting and documenting UAT.
• Expertise in the management of User Request Change, and handle User Conflicts
• Ability to organize, document and track changes and defects by Traceability Matrix, using Rational Requisite Pro, Clear Quest, Clear Case

Software Skill Sets

• Database : Oracle 9i, MS SQL Server
• Operating Systems : Windows 95/98/00/XP and NT
• Languages : SQL, Informatica
• Change Management Tools : Rational Clear Quest, Test Director, PVCS,FileNet
• Methodologies : RUP, CMM, UML
• Testing Tools : Mercury Test Director
• Version Control Tools : PVCS, Rational Clear Case
• Project Management Tools : Microsoft Office (Microsoft Word, Microsoft PowerPoint,

Professional Experience

Confidential

Pittsburgh, PA

Sr QA Analyst

Responsibilities:

• Developed Test Cases bases on Functional Specifications and Design Documents for the 5010 changes for 837 I,837 P & Non X-12 837
• Prepared and Created Test Cases /Test Data according to 5010 Business requirements.
• Reviewed test cases based on Functional Specifications and Design Documents which are prepared by QA team.
• Responsible in processing claims and validating full payment cycle process until it generates 835 files.
• Used EDIFECS SpecBuilder version 7.0 for creating and validating Baseline 5010 files as per the CMS guidelines.
• Edited files within Specbuilder to ensure that all files were complaint with Level 1 and Level 2 errors.
• Used EDIFECS TM – Transaction Management for transactions supervision and determining the transactions at various levels of their processing.
• Imported Trading Partners contracts into EDIFECS TPM – Trading Partner Manager.
• Responsible for preparing test data for 835 (Remittance), 837 (Claims), 270 (Eligibility Request) and 276 (Claim Status Request) transactions as per the Implementation Guide.
• Responsible for processing all 835, 837 (X12-Institutional, X12-Professional and Non X12 files), 270, 276 transaction files.
• Worked with 4010, 5010, 5010A1 versions of all transactions i.e., 835, 837, 270 and 276.
• Responsible for preparing specific test files to convert 4010 to 5010 versions for all transactions as per Implementation Guides.
• Responsible for preparing 4010, 5010 and 5010A1 test files before production deployment and validating the same after production.
• Verified the remittance files once the payment cycles are generated by comparing both payment and remittance files
• Involved in comparing 5010 Companion guide with 4010 Companion guide and make sure all segments or codes are tested
• Involved in testing EDI transactions 270 & 271 for benefit eligibility enquiry and response
• Involved in preparing the response files like 271/277 and dropping them in MB, as right now Test data for 5010 is not set for Networks.
• Responsible for processing 837, 835, Non X12 files, 270, 276 transaction files.
• Responsible for database testing for Data Mapping and Validation as a part of the 5010 process.
• Executed complex SQL queries for test data selection and exported data onto Microsoft Excel for usage of data by the Business teams.
• As part of negative testing prepared X12 837 835,270,276 files and make sure the removed codes from 5010 IG(by comparing from 4010IG) are rejected at the EDIFECS Level

Environment: Java, J2EE, .Net, Message Broker, SpecBuilder 7.0, Edifices, Microsoft Excel, Lotus notes, Oracle 11i, Quality Center 9.0.

Confidential
Watertown, MA

EDI Analyst

Responsibilities:

• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Transactions focused on were 270,271, 834, 835, and 837.
• Worked collaboratively with BI and ETL resources to design and develop effective solution.
• Experienced with high-volume load processing into Data warehouse database.
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating the database to file elements.
• Closely worked with development team to enhance and standardize the ETL Process to load underlying system that supports UI.
• Created Requirements v/s Test Case Matrix in Excel Spread Sheet template.
• Developed the Reports for Manager Using Crystal Reports.
• Participated in user acceptance testing for the UDD application.
• Worked on 837, 835, 276 and 277 Institutional and Professional, EDI Gateway.
• Validated mappings from X-12 to XML and Flat file via TIBCO services.
• Performed HIPAA/ SNIP Level edits within TIBCO BC – Business Connect 5.6 for EDI transactions
• Validated Business transformations using TIBCO BW – Business Works 5.4 for Claims processing.
• Analyzed existing processes, Extracted XML/COBOL files, for successful FACETS implementation and integration with other proprietary tools/application.
• Researched the existing client processes and guided the Vendors in aligning the HIPAA compliance output with the client systems.
• Worked with different functional groups to arrive at the common business and technical specifications.
• Designed and delivered HIPAA training material regarding information security and best practices
• Used Share Point to store document and version control.
• Lead as well participated in JAD sessions and interacted with various functional leads and analysts.
• Well versed with Claim processing from point
• Used SQL statements for Back-end testing
• Performed User Acceptance Testing, developed Test logs and opened/closed as and when the issue is fixed and Quality checked with the assumed company data with all the possible Test Scenarios.
• Worked Extensively with Inbound 837 I and 837 P, 835s(Out bounds) claims processing systems

Environment: TIBCO 5.4/5.6, Quality Center, z/OS, IBM Mainframe, TSO/ISPF, JCL, XML, File Manager, UNIX, JAVA, J2EE, AJAX, JavaScript, DB2,Oracle 10g, HTML, COBOL, Putty, Ultra Edit, MS Office, shell scripts, Microsoft Excel, MS Word, Internet Explorer, Microsoft outlook, Office communicator.

Confidential

EDI QA Specialist

Responsibilities:

• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Experience working with FDA regulatory process and standards.
• Transactions focused on were 270,271, 834, 835, and 837.
• Worked Extensively with Inbound 837 I and 837 P, 835s(Out bounds) claims processing systems
• Experience in documenting Electronic Medical records submitted for audits to the Department of Federal Drug and ensuring that the Part 11 is met with all the necessary rules as established by the FDA.
• Extensively used the MVS utilities like File-Aid, QMF and DB2 Load for scheduling the jobs.
• Used Claridy tool to verify mapping to X12 format.
• Modifying JCL's accordingly to run the required tests submitting the batch jobs
• Base-line and Regression tests were scheduled and performed on every Release and build.
• Use of QMF and SPUFI in extracting the queries and File Aid to edit Data sets
• Extensively involved in real time testing.
• Review FTP processing jobs using with Core FTP Lite tool.
• Extensively involved entire Reference subsystem with COBOL and JCL jobs.
• Extensively involved in Reference Interface (In bound and out bound) testing.
• Used IBM Mainframes- CICS, ISPF, File Aid, IMS, and TSO for mapping Datasets and fields.
• Worked on JCL to run the batch during the end of the business day
• Used Quality Center for preparing the test plans and manual test scripts.
• Worked extensively with Quality Center for requirements, Preparing Test cases, Executing, Defect openings and closings.
• Involved In loading the flat files into Oracle Database and involved in writing Complex SQL Queries.
• Involved in generating Reports using Oracle Report Builder and testing the reports using Oracle Run Time.
• Involved in writing Complex SQL Queries using TOAD to validate the loads for Caremark and DEA.\
• Involved in writing UNIX shell scripts.
• Executed a whole bunch of PL/SQL code including stored procedures, functions and triggers using TOAD.

Environment: Cobol, CICS, EDI X12N 4010, Sybase Paper Free HIPAA Toolkit, DB2, TSO/ISPF, JCL, Visual Basic, ASP, Java Script, VB Script, XML, SQL, MS Access, UNIX, Oracle Run Time, IAS Web server, Web logic, BEA Tuxedo, Windows95/98/NT/2000/XP and Internet Explorer.

Testing Tools: SQA Manager, Win runner, Test Director, Quick Test, Toad and PVCS Tracker.

Confidential

Providence NJ

Quality Analyst-I

Responsibilities:

• Worked with Fixed Income, Bonds and Bond Trading Cycle, Bond Pricing, Equities, Trade Cycle, Derivatives (Options and Futures), Portfolio Management, Sales and Marketing.
• Implemented the entire Rational Unified Process (RUP) methodology of application development with its various workflows, artifacts and activities.
• Involved in preparing Test Plans, test cases and test conditions.
• SQL queries were used to retrieve data from tables and to perform back end testing.
• Executed test cases manually to verify actual results against expected results.
• Performed GUI, Functional and regression testing using Win Runner.
• Conducted stress and Performance testing using Load Runner.
• Involved in creation and preprocessing of the Usage as per the requirements.
• Involved in issuing of service orders as per the requirements for new connections and changing class of services and Adding Users.
• Communicated with project manager and application team to know if there are any changes in requirements with in the release.
• Coordinating with the PM and with developers in validation process to get the expected results accurately.
• Coordinated with planning team to complete all the projects with in the release time.
• Analyzed error messages and investigated the defects.
• Created the Test Scripts for performance testing using Load runner.
• Maintained requirements, Test plans, Test cases and defects in Test Director.
• Participated in the team meeting to discuss issues arising out of testing.
• Participated in status meetings to provide status updates on the tests
• Performed Data Analysis of existing data through SQL.
• Analyze business requirements and segregated them into Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and OOD using Borland Together according to UML methodology thus defining the Data Process Models.
• Responsible for preparing Business Requirement Document (BRD) and then translating into functional specifications and test plans. Closely coordinated with both business users and developers for arriving at a mutually acceptable solution.
• Documented and delivered Functional Specification Document to the project team.
• Used MS Project to manage schedules, deadlines and resources and collaborate on the project.
• Interacting with the developers on resolving the reported bugs and various technical issues.
• Assisted the QA team in designing the Test Plan and Test Cases for User Acceptance testing.

Environment: Borland Caliber, Borland Together, MS Office Suite, Web Logic6.1/8.1, J2EE, Windows NT, Win-SQL.