SUMMARY:

• More than 6 years of extensive experience working as Quality Analyst Tester and Business Analyst increasing responsibilities in the healthcare industry.
• Experience and understanding of software development process including Software development life cycle (SDLC), RUP's Iterative System Development Life Cycle process, Rational Unified Process (RUP) in all four phases.
• Experience in creating and maintaining Requirements definition documents that included Business requirements, Functional requirements, and Technical Requirements Documents.
• Strong experience with developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams.
• Expertise in Membership Enrollment, Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions.
• Medical and Hospital Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 processes of the Healthcare Industry from the Provider/Payer side.
• Knowledge of health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDI and XML.
• Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and transaction sets mapping documents to validate the projects implementations according to HIPAA regulations.
• Thorough hand on experience with all levels of testing techniques such as; Integration, Performance, Regression, Sanity, Functional and System testing.
• Experience in enhancing, modifying and executing both manual Test Scripts and other Test Scripts created by Test Automation tools as Win Runner, Quick Test Pro.
• Experience in capturing data requirements, data analysis & data mapping for Vendor feeds and Databases.
• Bug reporting using Test Director, Quality Center and Bugzilla
• Used MS Excel spread sheet, PowerPoint, MS Visio, and MS Projects.
• Experience to Management, Execution and Documentation skills

Operating systems: Windows 2003 Server, Windows XP/2000, UNIX
Testing tools: Win Runner, Load Runner, Quick Test Professional
Bug tracking tools: Quality Center, Rational Clear Quest, Test Director
Front-end tools: MS Office, MS Visio, MS Project
Languages: C, SQL, TSL, PL/SQL
Web technologies: HTML, XML, .NET
Databases: Oracle, MS SQL Server

PROFESSIONAL EXPERIENCE:

07/2012 - Present Confidential, New York, NY
Sr. QA Tester
Project Scope: The project is to implement the conversion of 837 P/835 EDI transactions from 4010 to 5010. I am also responsible for preparing requirements documents and testing for conversion of 837, 834/835 4010 to HIPAA compliant 5010.
Environment: Windows XP/7, Quality Center, HIPAA Standards, MS Visio, MS Project, IBM Mainframe 3270/3290

Responsibilities:

• Responsible for leading, assigning work and giving directions to the team of 2 QA testers.
• Reviewed the Use Case Requirement, Functional Design Documents and Technical Specification documents.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 837/835.
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
• Analyzed HIPAA 4010 and 5010 standards for 837i EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets, value fields and definitions.
• Enhanced Test Scripts for Data Driven testing using QTP.
• Performed black box testing including smoke, regression, integration and functional testing.
• Performed GUI testing manually.
• During the Progress of the Project Participated in walkthroughs and reviews.
• Used teleconferencing to have a clear understanding of the business change request.
• Used the Quality Center to create and maintain Test Requirements and to communicate the bugs with the Developers.
• Participated in the meetings to follow up on Defects/Issues
• Performed Functional and Regression testing using automation tool QTP and validating, documenting the actual results.
• Participated in UAT along with the business users after the application was deployed.

06/2011 - 06/2012 Confidential, New York, NY
Business Technical Services Department
System Analyst / UAT QA Analyst
Project Scope: Hospital Claim Processing System, HIPAA regulations, ICD-10 implementation
Environment: IBM Mainframe 3270/3290, Windows XP 5.1 - Windows 7, IE 6 - IE9

Responsibilities:

• Being involved into all stages of the Project development life cycle.
• Worked very closely with the Business Users to achieve the Business Requirements in a timely manner.
• Created TRD's once receiving the BRD's from Business Analysts to have a clear understanding of the project outcome and communicated to Technical team, Business team, and Testing team to ensure they understand the project scope, and translated business documents and BA's input into Test Cases, Test Scenarios, and Test Plans.
• Participated in transition from ICD-9 and implementation of ICD-10 in Emblem Health Claim Processing system based on Windows, Web and Mainframe platforms.
• Took part and lead numerous meetings, walk-troughs and inspections.
• Conducted Integration, Regression, System testing and UAT of Claim Processing Application functionality on various platforms, as Network Access, Winstrat application and validated and reported the expected results.
• Analyzed and tested APC pricing in Winstrat a number for each service covered under Outpatient Prospective Payment System (OPPS), and return information to be used as input to a PRICER program.
• Processed and priced APR DRGs were linked to Mainframe Platform Systems through Winstrat and Production.
• In-depth knowledge of Hospital Claims processing, Health Insurance Industry standards and GHI-specific standards processes and practices.
• Extensively worked with ICD-9 & ICD-10 standards, codes and structure, their relationship and cross-mapping, also knowledge of CPT & HCPCS codes, Modifiers.
• Extensive use of SQL for DB2 back-end testing result verification
• Experience with HP QC as Functional Documents Repository and defect tracking tool
• Assign an ASC payment group for services on claims from certain Non-OPPS hospitals.
• Tested rates for out-of-network providers, also providers that use grouper, POA exempt facilities, and POA exempt target services.
• Processed Claims and validated a variety of Emblem Subscriber categories rates and Benefits such as; Co-payments, Deductibles, Co-insurance, and COB whether the system performs in accordance of the expected results.
• Involved into creating use cases, test plans and test cases for the EOB redesign screen to GHI, HIP & Emblem Health and validating, reviewing and reporting the testing output.
• Obtained the Mainframe platform training.

07/2010 - 05/2011 Confidential, Dublin, OH QA Analyst
Project Scope: Cardinal Health is a leading provider of products, services, and technologies supporting the healthcare industry. The Medi-Pharma online service was designed to deliver refill medication to follow-up, disabled and elderly patients at their homes without the necessity to visit the physician. I was involved in implementing HIPAA EDI transactions in the application; also involved in modules: Pre-pricing claims, Claims Adjudication, Claims Payment, Coordination of Benefits (COB) and Adjustments
Environment: Quality Center, QTP, MS-Windows, MS Project 2003, XML, SQL, Mainframe

Responsibilities:

• As a QA Analyst worked with other QA in Unit Testing tasks, Trading Partners for connectivity issues; liaison between customers and corporate staff or between IT and Business Units as well as performing system matrix testing.
• Worked with trading partners, clients, management, technical and non-technical personnel to create use cases and system validation artifacts and testing documentation.
• Corresponds with members/groups regarding more complex membership enrollment changes and provides accurate and timely responses to all inquiries.
• Gathered and maintained requirements from the Business users and analyzed the requirements.
• Followed Unified Modeling Language (UML) methodology using Requisite Pro and Rational Rose to create/maintain: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams
• Involved in performing functional, application, integration, system, and regression Testing.
• Developed the Test Data for different Groups
• Responsible for performance testing and functional decomposition of web-based (SOA).
• Managing the Test Process, Web Testing, Test Process Improvement, Test Automation Architecture, Automation Planning, Intelligence Testing, Web Security Testing, Unit Testing and SOA Testing
• Created test plans and test procedure templates and guidelines to be used by the QA team
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Performed Load, stress and Performance Testing, Backend testing.
• Involved in writing test cases based on the requirements.
• Performed UAT testing for HIPAA 4010 and 5010 projects including legacy testing and HIPAA requirements and compliance mandates
• Performed Functional and Regression testing using Quick Test Pro.
• Interfaced with marketing for product demonstrations and documented incidents and enhancement requests in Rational Clear Quest.
• Used Quality Center for defect tracking and reporting
• Communicated with development team to ensure testing issues are resolved

11/2009 - 06/2010 Confidential, Buffalo, NY
QA Analyst
Project Scope: The assignment was all about installing new version of Facets 4.71(Had version 4.41 before), integrating with company's landscape and making sure that claims get processed as per the business needs.
Environment: Configuration and Testing Management (In house Tool), Tiger, Facets 4.71, Sybase, Interactive SQL, MS Word, MS Project, MS Excel

Responsibilities:

• Reviewing the Use Case Requirement, Functional Design Documents and Technical Specification documents.
• Creating Test Cases after analyzing the BRD's.
• Performing Functional and GUI testing on Facets.
• Logging of defects in CTM to maintain Test Requirements and to communicate the bugs with the Developers.
• Involve in testing of FACETS Implementation, involve an end to end testing of FACETS Claims Processing module, Membership and benefits.
• Creating claims in Tiger for validating members benefits against different Medicare and non-Medicare products.
• Performing Backend Testing extensively by writing validation queries on DB database.
• Validating member's benefits against the benefits matrix.
• Analyzed and tested data on claims manually and writing queries on DB database for validating data.
• Validating member's accumulator track right member's benefits and making sure that Claims gets paid according to the SEPY's rule.

09/2008 - 10/2009 Confidential, New York, NY
QA Tester
Project Scope: I was associated with Multiple Work stream Assignments including Web- based Marketing Information Management Portal (RUP-Requisite Pro), Web based Meta Data Management Portal for Marketing Agencies, Embrace- Clinical Trial Management System (Siebel CRM) Program, Electronic Global Document Management Systems (GDMS), Siebel Sales Force Automation etc
Environment: Quality Center, Siebel CRM, Microsoft Office tools, Oracle 9i, SQL server, UNIX

Responsibilities:

• Used Agile Methodology to minimize risk by implementing software development in short time boxes or iterations
• Worked with the validation team in determining the testable requirements.
• Developed Test Plans, Test Cases for the test
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Tested the interface between database and the application
• Involved in writing extensive SQL Queries for back end testing oracle database.
• Retrieved files using SQL statements and UNIX commands.
• Maintained Traceability matrix and Test Matrix
• Created and maintained SQL Queries for back-end testing
• Performed manual back-end testing using PL/SQL to connect to an Oracle 9i database on a UNIX server
• Maintained various versions of Test Scripts
• Performed Sanity Testing and Smoke Testing
• Investigating software bugs and reporting to the developers using Quality Center Defect Module
• Generated defect reports using Quality Center for the developers.
• Performed Usability Testing

07/2005 - 06/2008 Confidential, Albania
Business Analyst Implementation Analyst for POS system
Project Scope: Upgrading the application system according to the Trinissoft's software/hardware products retail stores in order of local vendors to access the new features and functionalities of the future standard.
Environment: Win Runner, Load Runner. Test Director, Windows 2000, MS IIS, MS SQL Server, Websphere Application Server

Responsibilities:

• Participated in process of evaluation & selections of the most suitable POS (Retail Management System) for a national retail chain
• Based on interviews with Trinissoft management and key employees created Functional specifications and Risk management documents determining POS system selection criteria.
• Evaluated various POS systems, in-house, on vendor's site and on implementation sites.
• Participated as Subject Matter expert in transfer of business knowledge to the vendor
• Participated in adaptation of Vendor's software to Trinissoft requirements.
• Tested various features of vendor\'s POS - Retail Management System Application
• Developed Test plan, Test Procedures and Manual Test cases for the application
• Involved in regular walkthroughs with vendor's Business Analysts to understand the functional requirements and in turn identifying the test conditions.
• Created test conditions/scenarios from the requirements and detailed test scripts/cases that would completely test the quality and reliability of the application.
• Tested final version of POS - Retail Management System Application system created by the local software vendor
• Configured available functions and implemented them in various Trinissoft's retail chain locations what resulted in highly operational processing environment with no supply shortages or overhead or any downtime because of the logistic glitches.
• Tested, selected and pitched new register/printer hardware in the stores.
• Trained End-Users to operate installed POS software and hardware.
• Participated in presentations of POS - Retail Management System Application to suppliers and prospective customers

02/2005 - 07/2005 Confidential, Albania (subsidiary of Meggle EE GmbH)
Quality Assurance Food Technologist
Projects Scope: Meggle's Same Product project - EU/Meggle EE GmbH/national dairy processing standards and regulation, localization, implementation of Meggle Quality production procedures and company's proprietary software monitoring production process
Environment: Windows 2000/XP, MS Visio, PLCM system

Responsibilities:

• Developed monitor document of HACCP plan, manuals, working instructions.
• Directed, planned, and implemented quality assurance function, food safety, and sanitation programs for the facility.
• Setting QA compliance objectives and ensuring that targets are achieved
• Conducting-process and finished product quality inspections as well as evaluation of all raw materials and packaging materials.
• Ensures the facility meets all required quality & food safety national laws, regulations, and corporate policies.
• Develop specifications for raw materials and finished goods. Monitor incoming shipments of dairy products and product processing to ensure compliance to Ferlat's and government regulations.
• Provide technical support to Operations to continually improve product quality and line efficiencies.
• Realization of Quality audits including planning, execution and reporting and also audit follow up.
• Participated in local implementation of Meggle EE/Ferlat's Product Lifecycle Monitoring system

EDUCATION: (BS) Management Information System