Summary

• 8 years of IT industry experience with a proven skill in the field Software Testing and Business Analysis.
• Solid Experience in documentation of User Requirements, as well as organizing interviews, User meetings, workshops, JAD sessions and requirement elicitation sessions.
• 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 HIPAA 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)
• Performed data stage designing, extracting data packages, transforming and loading data packages, stored procedures, process design and implementation.
• Experienced working with x12 version 5010 transactions and ICD -10-CM and ICD-10-PCS Code set changes analysis, design and migration strategy.
• Have excellent knowledge of HIPPA 4010 /5010 versions.
• Experience working and testing mapping for X-12 transactions using Integration tools like SYBASE, TIBCO, EDIFECS and Sterling GIS suites.
• 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.
• In depth knowledge Rational Unified Process (RUP) methodology, Use Cases, Software Development Life Cycle (SDLC) processes, Object Oriented Analysis and Design (OOA/D).
• Experienced in conducting training sessions for users.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost benefit analysis and ROI analysis
• Expertise in writing SQL scripts used in manual testing both front-end and back-end
• Expertise in TOAD, SQL Server Management Studio.
• Experienced in testing applications developed using PL/SQL, Java, J2EE, 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

Technical Skills Inventory

Methodologies: Waterfall, RUP, Agile, UML

Modeling Tools: Rational Rose, MS Visio

Requirement Management Tool: Rational Requisite Pro

Testing and defect tracking Tools: Rational Robot, Rational Clear Quest, Rational Clear Case, Quality Center, Win Runner, Load Runner, and Quick Test Pro (QTP)

Project Management Tool: MS Project

Operating System: Windows Vista/XP/2000/98/95, Dos, Unix

Integration/ Middleware Tools: TIBCO, STERLING-GIS, PERVASSIVE

Languages: JAVA, JAVA Script, .Net, VB, COBOL, C, C++

DBMS: MS SQL Server 2005/2000/2008/2012 , Oracle, MS Access 7.x, PL/SQL

Web Technologies: ASP, .CSS, HTML, DHTML, XML

Professional Experience:

Confidential , Richmond, VA

Business/QA Analyst

Confidential , is one of the largest health benefits companies in the United States. Through its networks nationwide, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts.

Responsibilities:

• Conducted meetings with users, gathering and analyzing requirements using Requisite Pro.
• Extensively used Agile Methodology in the process of the project management based on SDLC.
• Designed and developed Process Flow Diagram, Use Cases, Activity Diagrams, Sequence Diagrams, and Object Oriented Design (OOD) using UML and extensively used MS Visio.
• Gathered and documented Business Requirements, created Functional specifications and translated them into Software Requirement Specifications.
• Used gap analysis framework to identify AS-IS processes of claims transactions of HIPAA X 12 4010/4010 A standard and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standard.
• Created monthly/weekly status reports to update the project schedules & deliverable plan.
• Performed impact analysis for deadliness of ICD-10 conversion.
• Created ICD-9-CM/ICD-10-PCS comparison document and dealt with Diagnosis Related Groups (DRGs).
• Assist coders to be competent in using ICD-10-CM/PCS.
• Exposed to using ICD-09/ICD-10 coding standards in Medicare and Medicaid domains of the healthcare systems.
• Worked on the 4010 to 5010 migration Project, conducted User interviews and work sessions with the Business to confirm the errata changes as per the 5010 changes.
• In depth knowledge of Medicare/Medicaid Claims processes.
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270/271 for Eligibility inquiry, and 276/277 for claims status.
• Worked Extensively with Inbound 837 I and 837 P, 835s (Out bounds) claims processing systems.
• Created mapping documents as per the requirement changes for HIPAA 5010.
• Involved in testing HIPAA EDI Transactions and mainly focused Eligibility Transactions.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Configured FACETS to adhere to customers work flow for claims processing, claims automation and group administration.
• Used FACETS to provide seamless transactions between the provider, members and the plan and used FACETS Workflow to route the claims according to the priority.
• Hands on experience in manual testing of the application on mainframes for claims processing.
• Worked closely with the Development teams to resolve major issues during testing and production phases of the project.
• Responsible for identifying and documenting business rules and creating detailed Use Cases.
• Experienced in creating Test Plans. Thorough hands on experience with designing test cases covering all test conditions and eliminating redundancy and duplications.
• Created Test Files and Test Cases for the 4010 to 5010 migration project.
• Performed and assisted various phases of testing which include: System Testing, Smoke Testing, UAT, Parallel Testing to ensure that both 4010 and 5010 EDI files are processing as per the Business requirements and no existing functionality has been disturbed.
• Extensively used the MVS utilities like File-Aid, QMF and DB2 Load for scheduling the jobs.
• Extensively tested Security on Web logic Servers and I-Frame portlets for Web Applications used Internal and External.
• Expertise in running Oracle Abstraction calls to load the data from the Web Services into the Data Mart/ Relational DB is accordance to the mapping requirements.
• Used IBM Mainframes- Incremental Scripts for adding, updating and modifying Datasets and fields in back-end to be populated in front-end.
• Tracked the Defects in Quality Center and Clear Quest.
• Involved in executing ETL Informatica scripts to load data into Oracle DB and HP9000 systems.
• 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
• Involved in executing Maestro Schedules in UNIX Environment.
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.

Environment: EDI X12N 4010, EDI X12N 5010, ICD 10, MS Outlook, UNIX, Windows95/98/NT/2000/XP, Sybase, Mainframe AS/400, TSO, SQL Server, Requisite Pro, Uses cases, Rational Rose, MS Outlook, FACETS 4.7, Quality Center 10.0, SQA Manager, Toad, SpecBuilder, TibcoBC & QC –Defect tracking.

Confidential , Philadelphia, PA

Business/ QA Analyst

Responsibilities:

• Conducted user interviews, gathered requirements to help create Business Requirement Documentation, using MS Word and MS Visio
• Analyzed the requirements using Rational Rose & Requisite Pro – RUP in Clinical Phases
• Performed Use-Case analysis using UML. Worked on the Flowchart and process diagram along with sequence diagram using Microsoft Visio.
• Researched and understood the claims adjudication and reimbursement systems based on HIPAA X12 4010 and 5010 standards
• Ensured that the application could be upgraded to X12 5010 Standard Code set Conversion from X12 4010 to 5010.
• In depth knowledge of Medicare/Medicaid Claims processes.
• Worked on 837, 835, 276 and 277 Institutional and Professional, EDI Gateway.
• Validated X-12 files sent by external vendors to ensure that they are passing EDI Gateway level using SpecBuilder.
• Prepared and Created Test Cases /Test Data according to 5010 Business requirements.
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating the database to file elements.
• Conducted Claims and HIPAA Compliance training to run the test case.
• Developed project plans and managed project scope.
• Involved in the Daily Standup Meetings.
• Analyzed business Requirements, performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams using Rational Rose.
• Identified and documented issues, risks, gaps and their impact to the project life cycle. Provided recommendations and alternatives.
• Maintained and submitted periodic/monthly status reports to the Program Manager to serve as the teams assessment of the project and its schedule
• Provided key input in working with users in defining project and system requirements.
• Used SharePoint to store document and version control.
• Worked to build extensions for FACETS Members, Claims, and Billing and enrollment applications.
• Worked with batch jobs, monitoring and scheduling jobs using JCL.
• Executed UNIX Shell scripts to enable and disable the environments.
• Hands on experience in manual testing of the application on mainframes for claims processing.
• Created Requirements v/s Test Case Matrix in Excel Spread Sheet template.
• Analyze and implement the type of testing to be performed (Manual / Automated) based on the re-usability of test scripts and ensured that test cases and automation scripts are traced to requirements.
• Used QUALITY CENTER 10.0 for preparing test plans and maul test scripts.
• 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.
• Involved in developing Test plan and Test cases based on Use cases and Functional Specifications Documented, reviewed, and verified testing procedures for compliance to Interface Quality Assurance and Development standards and policies.

Environment: EDI X12N 4010, EDI X12N 5010, ICD 10, Requisite Pro, Uses cases, Rational Rose, MS Outlook, UNIX, Windows95/98/NT/2000/XP, EDIFECS Suites: SpecBuilder 6.8.1, Xengine, FileZilla, Lotus Notes for Bug Tracking, FACETS 4.6, Quality Center 10.0, Oracle 10g, IBM Mainframe.

Confidential , Boston, MA

QA Analyst

Confidential is an Insurance provider for all the different kinds of memberships. It currently has a total membership of 735,000 members and is ranked as #3 in Commercial Policies and #4 in Medicare Preferred Policies.

Responsibilities:

• Created vision document to explain user demographics, profiles, environments and requirements for the project.
• Interacted with Project Manager to write Project Plan Document, Work Breakdown Document, and update project plan.
• Conducted JAD sessions to get an understanding of client business process with stakeholders as well as technical group.
• Worked on CMS (Centers for Medicare & Medicaid Services) requirements within the project.
• Analyzed existing system and develop requirements. Conducted Interviews with Management to get sign off Functional Requirements.
• Extensive experience to complete project live cycle including to doing cost-benefit analysis (CBA) and return on investment (ROI) analysis.
• Participated and lead development of overall strategies, budget and operational plans, responsible for issue pertaining to project cost, scheduling and staffing.
• Involved in Business Process Re-engineering to analyze gap between current process and suggesting business process.
• Involved in Change Management process and analyzed cost benefit analysis for new changes.
• Prioritized requirement and system capabilities to ease decision-making process.
• Created Use Cases to depict the interaction between the various actors and system using Rational Rose.
• Understood existing data model and documented suspected design affecting performance of the system.
• Worked with Data Analyst to design, reviewing and validation of final data model.
• Worked with the DBA to develop the best fit physical data model from the logical data model.
• Worked with Data Analyst in data transformation and data mapping from source to target database schemas, data cleansing procedures.
• Authored business analysis report for HIPAA compliance.
• Experience working with both versions of HIPAA i.e. 4010 vs. 5010
• Performed Gap Analysis for HIPAA transactions.
• Involved in creating flow charts and record layouts for 271 transaction sets.
• Designed and developed eligibility (270/271), claim status (276/277), service review and response (278), enrollment (834), and claim submission (837).
• Defined business requirements and X12 mapping requirements for several conventional and internet-based medical and claims products
• Involved in Unit Testing and System Testing.
• Involved in different level of testing, which is HIPAA compliance.
• Developed several Test Scripts for testing EDI transactions.
• Involved in documenting of Test Plan, Test Cases, and Defect Status Report.
• Interacted with QA team for Automation Testing using QTP.
• Worked closely with UAT team for User Acceptance Testing (UAT) and collaborated with the QA team to develop the Test Plans, Test Scenarios, Test Cases, Test Data to be used in testing based on business requirements, technical specifications and/or product knowledge
• Interacted with the Performance tester to assist in performance testing of end product.
• Responsible for processing change requests from the client by filling Change Request Forms (CRF).

Environment: EDI – Sun TIBCO, Requisite Pro, Uses cases, Rational Rose, Cognos, Crystal Reports, UML, Rational Rose, MS Office 2003, QTP, Interfaces, Erwin 7.0.1, IBM WebSphere, MS Project, Data warehouse,Mainframe,Director, COBOL/CICS, DB2, SQL, JAVA

Confidential , Dublin, OH

Senior Data Analyst

Responsibilities:

• Reviewed the entire application and develop requirements.
• Worked extensively with the users and with different levels of management to identify requirements, Use Cases and to Develop Functional Specifications.
• Managed all the requirements in Rational Req-Pro making requirements available to all team members.
• Participated in JAD sessions to allow different stakeholders to communicate their perspectives with each other, resolve any issues and come to an agreement quickly.
• Created data flow models, data quality analysis, and cost benefit analysis.
• Published all functional and specification documents in Share point.
• Involved in Business process reengineering to approach aiming at improvements by means of elevating efficiency and effectiveness of the processes that exist within and across organizations.
• Actively involved in development and maintenance of Share point team sites, Document libraries and custom list.
• Worked with senior level Share Point developer to help support the application using MS Share Point 2007.
• Created Use-Cases, Business Use-Case Model, data model, and ER Diagram after accessing the status and scope of the project and understanding the business processes.
• Created logical data model from the conceptual model and it’s conversion into the physical database design.
• Answered provider questions on the ANSI X12 format and looping structure of 837, 270/271/276/277 , and 835.
• Trained the team in HIPAA standards (4010).
• Interface was written to confirm the HIPAA Compliance.
• Involved in creating different EDI transaction set.
• Trained the team in HIPAA standards.
• Interface was written to confirm the HIPAA Compliance.
• Worked with ETL team to come up with Data mapping document.
• Interacted with various Cross-Functional Teams on building business use cases and understand expenses and revenue stream.
• Developed test plan, test script, test data for testing EDI transactions to run in different environments.
• Worked with the Automation Tester to assist in Automation Testing using QTP.
• Worked with performance tester in order to verify the performance of the system before hand off to users.
• Interacted with the developers to Report and Correct Bugs.
• Used the change management from rational to track changes to multiple artifacts by versioning artifacts, associating requirements specific change requests to streamline the defect/change tracking process.

Environment: RUP, Requisite Pro, Uses cases, Rational Rose, Content Management Systems, UML, Rational Rose, MS Office 2003, QTP, Interfaces, Erwin 7.0.1, IBM WebSphere, MS Project, Data warehouse, Mainframe, Test Director, COBOL/CICS, DB2, SQL, JAVA

Confidential , Covington, KY

Business/Test Analyst

As the nation's leading provider of long term care pharmacy, Confidential delivers comprehensive medication and related services that result in positive, cost-effective outcomes for patients in skilled nursing and assisted living facilities throughout North America.

Responsibilities:

• Responsible for developing Test Plans, Test Scripts and Test Cases using Test Director.
• Identified the Test Cases to be automated and lead the effort for automating the product using Quick Test Professional.
• Executed System, Integration, Functional, Data Validation and Regression testing of new and revised applications using Quick Test Professional.
• Responsible for creating and enhancing Test scripts by Creating Checkpoints, Synchronization points and Output values using WinRunner
• Responsible for carrying out Regression Testing to ensure that the new code has less or no adverse effect upon the current system, particularly in the area of corrupting data used by different applications or system performance.
• Responsible for developing SQL scripts and stored procedures using PL/SQL.
• Executed SQL queries as a part of Backend testing to verify the integrity of the database.
• Traced deadlock and expensive SQL queries and test procedures (MS SQL Profile, Oracle Performance Manager).
• Utilized Test Director for Defect Tracking and reporting.

Environment: WinRunner, Test Director, Windows NT/2000, Java 2, SQL, PL/SQL, Oracle, Sun Enterprise Servers and Sun Solaris.