SUMMARY:

• I have worked in Agile test team environments and autonomously remote setting. Supported test lead, Developers, Configuration and Business Unit to identify risks. I have maintained scope of testing time frame and compliancy.
• Created requirements, reports, and test cases for Confidential, Eldorado and Nasco.
• QXNT 5.0: QA created and executed test scripts and Test cases. UAT tested on Fee schedules, Pharmacy claim processing, Capitated Terms, pharmacy codes, Benefit terms, Rule IDs, Medical Benefit Terms, Provider Agreement Terms, pricing terms, eligibility Extracts, provider agreements for test execution. Authorization service codes, Authorizations per provider agreement, pharmacy authorizations, Benefit service code authorizations.
• Tested Authorization Term data. Created mocked authorization/Utilization management data for testing purposes.
• FACETS Testing and Validation over 5yrs on various application groups: Customer service, Medical Plan, pharmacy/Drugs, Authorization tables, Authorization Terms for Inpatient/Outpatient Claims, Provider service Authorizations per Agreement, Eligibility, Subscriber/Member, Accumulator, Benefit Summary, Product, Networx Pricer.
• Testing on X12, 837,831,834. Data warehouse applications. Created Business requirements for Test from dashboards into Test Cases.
• Facets QA testing: UAT, Validation, functional, EDI, Integration tested on Fee schedules, Dental, Pharmacy, Service Authorizations, Medical claims. pharmacy testing benefit terms, pharmacy coding, pricing terms, benefit terms, eligibility, provider pricing terms. of business Medicare/Medigap/Medicaid IPA/ACA/ASO/HMO/PPO/EPOs & Neighborhood Health Plans.
• Facets 4.71 - 4. created and executed test scripts and Test cases. Functional, Negative and regression testing based on developer updated configuration, BRDs, benefit grids, Edi formats, CSRs, provider data, authorizations, referrals, HTML extracts and Test requirements.

TECHNICAL SKILLS:

• Facets
• Facets NetworkX Pricer
• Claims Test Pro
• Open Source Test Tools
• Diamond
• CMS pricer Tools
• CICS
• Sql Server Studio
• SoapUI
• QNXT 4.2-5.0
• HP ALM
• Mainframe
• AS400
• SVN
• Pricer Analysis Tools
• Data Warehouse
• OnBase
• Jira
• Amisys 4.5-6.0
• HP QC
• Javelina
• Xcelys
• Postgres Sql
• McKesson claim Tool
• Linux
• API Testing Frameworks
• Portals

PROFESSIONAL EXPERIENCE:

Confidential, Richardson, TX

Provider Configuration Analyst

Responsibilities:

• Provider agreement and fee schedule Tier configuration on test conversion Xcelys /Diamond 3.0.
• Autoloaded Tier Fee Schedules into Facets.
• Professional pricing fee schedule updates on an autoloader into Xcelys via Open Sourced config Tools.
• Configuration on pricing tiers in configuration test environments. Validation Tested on Facets production server.
• Pricing tier update and configuration in BPS for conversion to Facets production server.
• Configuration design on build macro templates. Xcelys, client- Confidential Florida. Sybase validation and Testing.

Confidential

Integration QA Analyst

Responsibilities:

• Created Test Cases and Test scripts: Various types of Benefit Products, Medical & Pharmacy benefit terms, coding, NDCs. claim pricing, custom fees, Fee schedule CMS. Medical & Pharmacy member cost share testing. Built Test Cases with Test Requirement. Created auto and manual script. Extraction of test claims and test data by CTP & SQL.
• Created Test Suites, Test Plans via Product/Benefit ID in CTP & Sql server. Built and cloned test claims (837/834). Built mock test data, validation testing on Live production data.
• Tested 271 in claim formats.
• Extracted authorization test data from existing database using back end queries from QNXT.I have Created mocked authorization data for testing purposes.
• System integration testing for new and existing code updates. Applied payment methodologies including RUGs and NDCs.
• Tested Authorization terms, Benefit Term and all service categories. Created mocked auth data for testing purposes. Test Pharmacy Benefit Terms, Claim Edits, Claim Lines, and Claim Headers.
• Created automated and manual test scripts for benefit Term, ICD 10, Product, and Provider/Institutional, contract Terms. Resolved CCRs in ticketing system OnBase for request to test on various types of configuration updates (Regression) and newly created contracts (Integration). Rule ID and Capitation validation testing. Creating Test Cases for CCRs. Executing test claim scripts. Validation of test results using SQL queries. Recording Defects into Jira application. UAT/Regression/Functional testing for configuration activities. Created Batches for test claims in CTP. Used Claims Test pro for creating and batching out Batched claim reports. In CTP, created 1500 & UB04 claims for testing various benefits Terms and contract terms from configuration. Integration testing payment funds by Payment group. Reporting defects, Reporting analysis. Batch Extracts on most tables.
• Member x12 extract testing and creation. Macros created executed in CTP.
• Benefit Testing for Accumulators, visits, limits, Max OOP, deductibles and all other member cost shares. Used complex queries for all types of benefit, authorizations, provider term testing.
• Utilized Benefit Plan Module, Agreement, Contract service categories, Encoder Pro, CMS fee schedule, Authorization service testing, Claims module, Provider Module, Contract Module, Claims Finance module, Member Module, Case management, Fee Table module and Rules, Rule ID and Rule descriptions. Soft administrative troubleshooting in OnBase
• Service groups, Authorization Term data, Contract Terms and Benefit terms are tested. Medicaid and Self-Funded (IPA) plans benefit terms and provider term testing. Utilized Expanded steps as validation of results during testing. Used fee sched code query to validate Medicaid FFS rates. Tested on RBRVs and custom fee Service groups and Contract Terms. Test request are delivered by tickets from configuration and business analysis.
• Claims Test Pro, Qnxt 5.0 ITE & Prod, Encoder PRO, OnBase reporting and ticket closure, MySQL Server Studio for validation Testing and Extracting, macros, Excel spreadsheets, ETL, and Batch reporting.

Confidential, Phoenix, AZ

QA Test Analyst

Responsibilities:

• QA testing Benefit terms and provider pricing terms for Dual Benefit Plans. Test script creation. Test Case Creation. Supported integration testing on Conversion data.
• Authorization testing per LOB on Dual benefit service plans.
• Benefit term validation, QA testing on pricing terms and Authorization Terms, benefit terms. Testing on X12, 837,831,834. Created Test Cases on manual Test scripts. Error reporting in Jira. Batch creation, claims processing, Regression and Integration testing on configuration updates and test. Benefit Grid builds and Benefit Test Execution. Dual plans/Medicare Part D. Client Confidential of Maryland
• Built Test claims for test activities. Cloned and Batched out claim reports. Jira Reporting Claims XTEN 4.8, dashboards, EDI Warehouse document viewer, HP ALM, Jira

Confidential

QA Test Analyst

Responsibilities:

• Created/executed UAT, Functional, Regression, Integral scripts and test cases in HP ALM for testing all Fee schedules, pricing configurations, i.e. benefit Terms and Testing on X12, 837,831,834.
• End to End Testing on tables and subsystem tables. Build test claim data. Tested providers allow, benefit allow keywords and all types of terms. CARCs, Cost-Shares, Pends, ACA & other Neighborhood plans of RI. Reported errors into HP ALM /Jira. Enrollment testing. Benefit/Provider Term testing and Rule Ids. Tested Pricing provider Tiers and claims testing. Tested reference controls regarding Optum Pricing and Pricing Analysis Tools. Claim data creation, Member X12 data extraction for creation of test script. Pharmacy authorization Terms, Service Authorizations terms, Benefit service code authorization testing. Claim adjudication of Authorization record and field Testing.
• Built Authorization records for provider agreement testing. Tested Authorization data in the claim record and the benefit plan record. Created mocked authorization data for testing purposes.
• Created automated and manual test scripts for upload into HP QC repository. Execution and Results reported within Test Case. Validation in sql. Status reporting. Created Test Suites. Data Extraction for test purposes. API Testing frameworks.
• Copied provider pricing agreement into new agreements and updated existing fee schedules. Autoloads for Fee schedules, fee loader, code set loads, Claims Loading copying data sets in DEV and TEST. Manual/Auto testing performed. UAT/Regression/Functional Test execution. Executed test scripts for fee schedules, benefit terms: benefit keywords, benefits, updates and new records. Manual & Automated. Error reporting in HP ALM.
• Enrollment configuration. Group loads and Provider loads in Amisys. Worked in Amisys 6.2-6.4 core, OPTUM Pricer, McKesson, PowerMHS (AS400). production and HP QC ALM 11.0. SoapUI.

Confidential, Baltimore, MA

Benefit Term Testing and Configuration

Responsibilities:

• Created test cases based on SRs in ticketed system. QA test on X12s, test scripting, Test validation. Test scripts were manually created to be executed automatically after uploading into test software.
• QA on the BSBS table. Updated the HTML mapped table to create test scrips.
• Created Benefit term scripts and Benefit test cases. Provided manual updates in benefit BRD & Data Dictionary updates.
• Authorization terms, Authorization service categories and service codes were tested in cohort with pharmacy benefit, benefit plan, provider service contractual agreement.
• Built and Audit benefit product and benefit plans i.e. Created new Benefit Summary Components from New EOCs and Existing products.
• Assisting with building and creating Product Benefit component updates.

Environment: Facets v4.71 and SharePoint.