PROFFESIONAL SUMMARY:

• Over 7 years of experience as a QA analyst in managing software testing efforts for Healthcare Industry.
• Experience in FACETS Implementation and hands on end - to-end testing of FACETS Billing, Enrollment, Claim Processing and Subscriber/Member module.
• Experience in manual testing and automated testing of client/server and web applications by using different methods of testing.
• Skilled knowledge on different modules within healthcare such as membership, billing, enrollment, claims, capitation, and providers.
• Experience working on 4010 and 5010 HIPAA implementation guides relate to Claim Testing and Medical Billing.
• Experience providing primary analysis for business processes running on the EDI (Electronic Data Interchange) standard.
• Experience working on batch testing/ online testing and manual testing on Facets application
• Experience on Facets Version upgrade (Facets 4.81 to 5.1).
• Experience working on duplicate claim for Facets testing.
• Experience providing end-to-end analysis and support for claims processing systems 
• ­Experience handling HIPAA ANSI X12 (270/271, 834, 835, 837, 276/277), ICD 9, ICD 10, NDC, DRG codes.
• Expertise in writing   SQL Queries   using   Oracle ,   SQL Server   and   Teradata   in validating data into Data Warehouse/ETL applications.
• Extensive experience in Integration testing, User Acceptance Testing (UAT), System testing, Performance, User Interface testing, Back end Testing, Black Box testing, Functional testing and Regression testing.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277 (X 12 Standards) process of Medical claims industry from the provider and payer side.
• Efficient in analyzing data samples and identifying factors that affect development costs.
• Proficient in System Analysis, ER/Dimensional Data Modeling, Database design and implementing RDBMS specific features.
• Well in testing of the web services using the SOAPUI  and PARASOFT  SOA testing tool.
• Strong working experience in the   Data Analysis ,   Data Verification and Validation   of an ETL Applications   using Backend/Database Testing.
• Efficient in data mart design and creation of cubes using dimensional data modeling.
• Well versed in Normalization/Demoralization techniques for optimum performance in relational and dimensional database environments.
• Experience in development of PL/SQL, Functions, Stored Procedures, Triggers and ActiveX Scripts.
• Experience in data mapping from source to target database schemas.
• Used expert knowledge of HIPAA, X12, EDI, and CLAREDI on a See Beyond team to test for HIPAA complianceExperience in Backend testing using SQL Queries on Oracle and MS SQL Server databases.
• Knowledge of Test matrix, Traceability matrix and Gap analysis.
• Coordinate with business analysts, developers and technical support to resolve technical issues with problem solving and planning skills.
• Experience in Writing Scenarios and Cases during UAT sessions.
• Participated in design Walkthroughs and Inspections.
• Involved in preparation of   Test Data   to test the functionality of ETLSources Mappings and Targets.
• Made extensive use of MS WORD and MS EXCEL to prepare documents, generate reports and also document test procedures used in executing the test cases.
• Gather and review business and functional requirement documents.
• Possess excellent communication, coordination, interpersonal skills, and Team working Skills.

TECHNICAL SKILLS:

Testing Tools: QTP (Quick Test Pro), Load Runner, Quality Center

Bug Reporting Tools:  Quality Center.

Operating Systems: Windows 00/03/07/XP/VISTA, UNIX.

Programming Language: PL/SQL, VB Script, MATLAB

Database: MS SQL Server, Oracle, MS Access.

Other Tools: MS Project, MS Visio, MS Office, MS Access,

PROFESSIONAL EXPERIENCE:

Confidential, Raleigh, NC

QA Tester

Responsibilities:

• Worked with Business Analyst and QA Lead in reviewing and analyzing the business requirements Documents and functional requirements.
• Prepared Test Cases based on business requirements and business rules for HIPAA EDI 5010 Transaction 834, 276/277, 270/271, 837/835.
• Maintaining knowledge of Medicare and South Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
• Performed Integration Testing, System Testing, Regression Testing, User Acceptance Testing (UAT), Performance and Back End testing of an application.
• Used SOAP UI, WebLogic ANT task to test Web Services running on WebLogic Server.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Enrollment Claim Processing and Subscriber/Member module.
• Set claim processing data for different Facets Module.
• Involved with business user and stake holders and performed UAT.
• Worked with Business /Technical Analyst in analysis of functional design specifications of ETL/Data warehouse applications of Global Direct, Sales Order Processing and Blue Hornet Email for Microsoft & Adobe clients
• Created claim test data and test claim to validate the facet application.
• Create duplicate claim to edit the information as per business requirement.
• Performed Positive and Negative Testing Manually for security testing.
• Maintained Test Matrix and Requirement Traceability Matrix and Performed Gap Analysis
• Tested user interface and navigation controls of the application using QTP.
• Experiences working in ANSI x12 837-835 EDI Transaction.
• Validate the date from ED5010 I transaction related to batch files.
• Tested the HIPPA EDI 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data on different modules.
• Used   TOAD for Oracle   in creating & executing   SQL queries   for testing ETL process.
• Conducted Back-End Testing Using SQL Commands to extract information from Oracle database.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Executed test cases found errors reported defects, determined repair priorities, did regression testing and closed by using Mercury Quality Center.
• Involved in preparing Test cases and Test plan for the execution of UAT scenarios.
• Responsible for Performing Integration Testing, UAT testing.
• Responsible for Setting up Web Services project using WSDL in SOAPUI and provided setup help to other team members.
• Analysis of   ETL Mappings   based on Facts & Dimensions from Source to target tables for directs moves and indirect moves based on transformation rules & lookup tables.
• Customized Quality Center to suit the requirements of testing effort and integrate QC with Excel in order to extract all the test cases from Excel file.
• Monitored the Defect Tracking Process and generated customized graphs and reports for the client using QC.

Environment: SQL, FACETS, Agile, DB2, MS Office Tools, MS Visio, DB2, IBM Process Modeler, Windows XP, UML, Mercury Quality Center

Confidential, Vienna, VA

QA Analyst

Responsibilities:

• Worked on requirements of the 837 HIPPA projects and HIPAA EDI Transactions across enterprise.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Enrollment Claim Processing and Subscriber/Member module.
• Initiated with a comparison report of migration of 4010 to 5010, 270 Eligibility, Coverage or Benefit Inquiry vs. 270 Eligibility.
• Testing of Web Services using web services client generated using Apache Axis, SOAP UI, TCP Monitor to track request and response SOAP Messages
• Tested the ANSI X12 Version 5010 / EDI transactions (HIPAA) like 837P, 837I, and 837D.
• Used General equivalence Mappings (GEM) to convert ICD 9 to ICD 10.
• Involved with business to conduct UAT among different users.
• Used MS Sql server Management studio for Creating & executing SQL queries for testing the conversion & ETL process .
• Used Apache Axis utility to generate client for Web Services, executed Web Services using Eclipse Java IDE and SOAP UI.
• Wrote Test scenarios and test cases for testing the migration of EDI 4010 to 5010 and the processing of member enrollment and benefits, batch jobs corresponding to the claims (837).
• Performed the Gap Analysis to find the existing gap between the HIPAA 4010 and HIPAA 5010 EDI transactions.
• Developed Data Mapping and Crosswalk documents.
• Involved in preparing several Use Cases, Business Process Flows, and Activity Diagrams using Microsoft Visio.
• Worked with multiple teams and coordinated with them to do various releases.
• Did gap analysis for HIPAA 5010 837P and 835 transactions.
• Transactions focused on were 270,271,276,278,834, 835, and 837.  
• Analyzed and documented ICD 10 requirements related to data elements, data exchange and data transmission.
• Documented business needs for ICD 10 resulting from the HIPAA 5010 gap analysis.
• Processing (ITS) Performed Functional, User Interface, End-to-End, Cross Browser, Application, System, Integration, Regression, UAT and Back End Testing.
• Analyzing Data Processing implementing Data Mart applications mainly transformation processes using ETL tool and understanding of   ETL workflows   and   ETL mappings   and also monitoring the Production Environment.
• Involved in SOAP and Restful web services using SOAP UI, axis client.
• Worked on the ICD 9 to ICD 10 crosswalks and coordinated the development of the crosswalk solution.
• Determined the requisite ICD 10 training for both internal staff and Medicaid provider groups and assisted in the development of training materials.
• Re-engineering and capturing of EDI transactions with legacy systems.
• Interacted with the Test Team and reviewed Test Plans and Cases.
• Analyzed data and created reports using SQL queries for all issued Action Items.
• Assisted in Regression Test, System Test, and UAT.

Environment: SQL, FACETS, Agile, DB2, MS Office Tools, MS Visio, IBM Process Modeler, Windows XP, UML, Mercury Quality Center

Confidential, Brooklyn, New York

QA Analyst

Responsibilities:

• Involved in writing Test Plan for the testing effort of the module.
• Performed Manual and Automated testing of various modules of the system.
• Performed EDI Validation, personally responsible for attaining HIPAA EDI validation from Medicare, Medicaid, and other payers.
• Developed HIPAA EDI Transmissions.
• Developed data importing processes for EDI files.
• Developing test plans and test cases from functional requirements for System and UAT testing.
• Produced EDI Testing environments for HIPAA EDI transactions.
• Involved in testing various Outpatient Interfaces in End-to-End Scenarios using Applications.
• Tested various Clinical Interfaces like LS (Lab Orders), IGS (Imaging Orders), LURS (X- Ray Orders), etc
• Involved in testing various workflow that involved Resolute Professional/Hospital Billing Modules.
• Performed Technical Specification Creation for EDI.
• Implemented test plans to validate converted Members data in facets.
• Designed provider mapping document between legacy system and facets.
• Customized Facets Reports to meet the business needs of the company.
• Involved in Web Services Testing using SOAP UI.
• Involved in designing and developing Extensions for FACETS and generated customized reports and tools for claims processing to cater to the needs of HealthNet.
• Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy.
• Used EDI to improve care delivery, optimizes workflow, reduce ambiguity and enhance knowledge transfer.
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets.
• Performed work included complete business cycle management and hands-on production as well.
• Involved in testing HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 834- Enrollment /Dis-enrollment to a health plan, 835, 837 ...etc.)
• Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 835, 837-(I, P, &D), 276, 275, 835 Remittances and others.
• Involved in writing Use cases, test plan creation and Companion Guide development, Development or oversee others in developing EDI Specifications, Test plans and/or companion guides for the 837 Institutional, 837 Professional, 837 Dental, 835, others.
• Installed, configured SOAP UI to test web services using WSDL file given by Development team.
• Test plan design, from stage to production, including both internal and external requirements.
• Defined and suggested needed improvements to management and perform a key role in execution of those roles, including reporting and custom applications for analyzing flat files as well as HIPAA EDI files.
• Worked as an EDI Coordinator, working with Trading Partners / Providers.
• Worked on the information system, doing EDI claim testing and EDI processing functions.
• Performed Negative and Positive testing manually.
• Performed Data-Driven Testing using parameterization in QTP using advanced Data Tables.
• Interacted with developers to report and track bugs using Quality center.
• Quality Center was used to create the test plan, store test cases and run the test sets.
• Provides feedback concerning completeness and accuracy of AUT.
• Regularly met with team leads, other team members and developers to evaluate the project progress.

Environment: HIPPA EDI, Quick Test Pro, Ms SQL Server.

Confidential, Reston, VA

QA Tester

Responsibilities:

• Analyzed, designed, and implemented web applications for Risk Managers to assess insurance applications.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 276/277,270.
• Experiences working in ANSI x12 2700 -271 EDI Transaction.
• Validate the date from EDI transaction.
• Conducted Back-End Testing Using SQL Commands.
• Used Facet for claim validation and claim processing
• Analyze errors in Facets and pull the reason code from the database (Sybase).
• Created Graphs and Reports in Quality Center to keep track of Daily Testing Efforts.
• Planned and reviewed the Test Cases and Test Scripts for Unit, Integration, Functionality, System, Regression, Database and User Acceptance Testing.
• Extensively worked on all kind of joins and operators to fetch data from multiple tables.
• Conducted Data integrity and Data validation test manually.
• Developing Test cases for System testing, UAT and documentation.
• Performed back-end testing by extensively using SQL commands to verify the database integrity.
• Created and maintained SQL Scripts and UNIX to perform back-end testing on the oracle database.
• Performed manual testing in the UNIX environment.
• Performed Smoke testing, Sanity testing, Positive testing, and Negative testing
• Performed Security testing and Backend testing manually.
• Responsible for inserting Check points to verify Functionality of the application using QTP.
• Maintain a log of all defects found during testing and send updates using Quality Center.

Environment: Quick Test Professional, Quality Center, MS-SQL Server