SUMMARY

• Over 14 years of experience in IT field covering Business Analysis, Quality Assurance/Testing in various Client/Server environments, B2B applications, IBM Mainframe and Web based products. Strong software testing background includes reviewing system Requirements, writing and executing test cases and business requirements.
• Expert in business process engineering and software development life cycle, including analysis, design, development, testing and implementation of software applications.
• Has experience in doing excellent documentation on business requirements and configuration specification.
• Has wide noledge in Reengineering concept.
• Strong noledge & experience in HIPAA (EDI), ICD, OIR, CMS, Claims, Under Writing, Membership, Pre - authorization, Pre-certification, Billing, Medicare, Medicaid, Claims and Medical management systems
• Expert in HIPAA Transactions testing and in-depth noledge of HIPAA framework (Health Insurance Portability Accountability Act) rules for ANSI X12 messages 837P/I, 835, 276/277, 270/271, 278, TA1 and 997 in 4010A1 Standards
• Extensive work experience in testing teh medical management tools like maxMC (Landacorp’s product), HIP’s Web portals like HeadsDown and PEP (Provider Portal), Network Access (Web Portal, Winstrat/Webstrat (Web Portal), QCare (Claims Processing System) system and HCS (GHI MaineFrame Hospital System).
• Extensively involved in performing UAT Testing
• In-depth noledge of Rational Unified Process (RUP); risk engineering; data modeling and mapping; and design using UML, Rational Rose, and Visio.
• Has vast experience in Project Management, Business Analysis, Business Modeling, and Data Modeling.
• Familiar with current industry standards, such as HIPAA, 21 CFR Part 11, ISO, Six Sigma, and Capability Maturity Model (CMM).
• Interacting with teh developers on resolving teh reported bugs and various technical issues.
• Excellent communication, analytical, interpersonal, and presentation skills; expert at managing multiple projects simultaneously.
• 2 years of experience in automation testing using QTP and WINRUNNER.
• Wrote complex business requirements for E.H.R system including SRS (System Requirement Specification) & FRD (Functional Requirement Documentation)
• Experience on translating business requirements and TRD (Technical Requirement Documentation) to UAT test plan to do a detail regression UAT testing
• Experience in analyzing & deciding test approach i.e. Automation testing v/s Manual tests.
• Experience in both Black Box & White Box testing.
• Experience in Backend testing (SQL, Oracle), GUI testing, Functionality testing, System testing including Integration and Regression Testing.
• Experience in writing UAT scripts for Web & Client/Server based application.
• Defined and developed quality assurance process & methodology for ISO 9001 certification.

TECHNICAL SKILLS

Testing Tools: Winrunner, Test Director and QTP, Quality Center (QC) 9.2 & 10 version.

Bug Tracking/Reporting Tools: Rational Clear Quest, Visual source safe. Crystal Reports 8.5, 9

Industry Standard: HIPAA, 21 CFR Part 11, ISO, Six SigmaLanguages: PL/SQL & TSL

Databases: SQL Server2000, Oracle 8/9i.

Design tools: Rational Rose and MS Project

Web Technologies: HTML/DHTML, XML, Java Script.

Operating Systems: Windows 95/98/2000/Me/XP/NT/7, MS Server 2000 &2003Hardware: IBM/HP/DELL PC, Sun & EMC RAID, LAN, WAN & Legacy Interface

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst/UAT

Responsibilities:

• Validated Hospital claims in HCS system
• Validated Hospital claims & Treatment plans in HCS system
• Validated Pre-Auths in QCARE for CCI projects
• Validated RAW Data files for MREC project for Third Party Information
• Validated RAW Data files for subscriber, provider & payment information for Extended 837 project
• Validated detail of teh PPO claims
• Created & executed test cases for HMO claims
• Validated detail of teh PPO claims
• Created & executed test cases for PPO claims
• Validated claims for Target service Group generation for ICD-10 project
• Documented defects in word document & stored in teh ALM
• Designed test plans for system modifications and additions for teh HCS system
• Documented traceability of test cases to business requirements via ALM system (Application Lifecycle Management)
• Analyzed and tested APC pricing in WEB Strat a number for each service covered under Hospital Claim System (HCS) and return information to be used as input to a Mainframe program
• Processed and priced APR DRGs were linked to Mainframe Platform Systems through Web Strat and Production
• In-depth noledge of Hospital Claims processing, Health Insurance Industry standards and GHI-specific standards processes and practices
• Assign an ASC payment group for services on claims from certain Non-OPPS hospitals
• Tested rates for out-of network providers, also providers dat use grouper, POA exempt facilities, and POA exempt target services
• Processed claim and validated a variety of Emblem Subscriber categories rates and Benefits such as: Co-payments, Deductibles, Co-Insurance & COB whether teh system performs in accordance of teh expected results
• Validated tons of claims for CBP, RBRVS, ASC, AWP & ASP fee scheduling
• Involved into creating use cases test plans for teh EOB redesign screen to GHI, HIP & Confidential and validating, reviewing and reporting teh testing output
• Used Pivot Tables to create weekly, monthly & yearly roll-up sheet
• Designed test plans for systems modifications and additions for teh HCS system
• Evaluated and recommended changes in modification/addition as well as methods and procedures for systems testing.
• Documented all defects in Application Lifecycle Management, coordinate with IT staff members and vendor personnel as required within teh document Test Plan.
• Identified, track, research and resolve system problems.
• Interfaced with IT Department and User Community to resolve systems issues
• Reviewed test plans written by senior BA's to ensure all requirements has been met and test cases are accurate.
• Executed all testing, record and report test results, communicated issues via teh issues log and conducted post implementation monitoring.
• Wrote several SQL queries for backend testing to validate teh search result
• Created 2700 Test Cases for teh Financial and Clinical ICD-10 applications
• Tagged Business requirements for all teh Financial and Clinical Applications
• Prepared UAT test plan (UATP) & RTM for HIX project
• Validated members in teh maxMC system for HIX project
• Validated Plan ID for HIX members in teh maxMC system for HIX project
• Mock up tons of EDI files for HMO claims
• Created test cases for EDI PCR-162 project in QC-ALM
• Created test scripts for EDI PCR-162 project in QC-ALM
• Executed test scripts for EDI PCR-162 project in QC-ALM
• Validated Client code for Montefiore members in teh PEP Heads Down and maxMC system for HIX project
• Created & validated more than 800 test cases (combination of prior approval & referral) in teh PEP Heads Down application
• Created & validated more than 800 test cases (combination of Inpatient & Outpatient) in teh maxMC application
• Created & validated more than 800 test cases (combination of Facility & Professional) in teh QCare application
• Documented more than 30 defect reports during teh time of validation
• Updated existing Test plan for ICD-10 project,
• Wrote RTM, Test scripts & test cases for ICD-10 project
• Wrote Test plan, RTM, Test scripts & Test cases for Treatment plan project
• Test Cases entry and validation for HIP and GHI
• Edited User Manual Guide for teh CMDS Department
• Detected highest number of defects during teh project session
• Developed Use Cases for each of teh Service Types - Inpatient, Outpatient, DME, Transportation, Home Care, Referrals, ER Notifications, and Office Services
• Responsible for teh UAT testing of teh ICD 9 to ICD 10 Diagnostic and Procedure codes while reviewing teh information to ensure accuracy
• Developed Functional Testing Approach for ICD-10 Remediation and included in UATP Plan
• Conducted Smoke Testing of teh new ICD-10 UAT region and recorded all teh testing results in RTM
• Performed teh data validations for MLTC Members and Providers in maxMC and QCARE systems.
• Prepared separate Test Scenarios for MLTC Members based on teh business requirements
• Pre-Authorizations entry in maxMC system and Validations in QCARE system
• Generated Client letters in teh maxMC application
• Responsible for team coordination and daily task prioritizations and assignments. Daily test status updates to teh CMDS Director
• Prepared positive and negative test scenarios and test cases using different LOB’s for Medicare and Non-Medicare members
• Tested different scenarios for different types of project using multiple applications like maxMC (Medical Management Tool), PEP Heads Down and QCare (Claims Processing System)
• Extensively used member populations from different LOB’s (Line of Business) - Medicare, Medicaid, HMO, PPO, EPO, and POS for testing and validation process
• Designed Medical and Behavioral Health (Psychiatric, Alcoholism, Drug Addiction and Substance Abuse) test scenarios for UAT Testing cycles
• Designed Test Cases for Medical and Behavioral Health with different combinations of Place of Service and Type of Service with corresponding ICD and CPT codes for different phases of UAT testing cycles
• Extensively involved in testing different scenarios on Medical cases by creating Referral or Prior Approvals for: Inpatient services, outpatient services, office services, Home Care, DME and Transportation and teh ER Notifications using teh HIP Legacy system: PEPs and Heads down
• Extensively involved in testing different test scenarios on Behavioral Health cases by creating Referral or Prior Approvals for: Inpatient services, outpatient services, office services and teh ER Notifications using teh HIP Legacy system: PEPs and Heads down
• Extensively involved in testing different test scenarios on Medical and Behavioral Health cases by creating Pre-Authorizations for: Inpatient services, outpatient services, office services, Home Care, DME and Transportation using medical management system: maxMC and teh mainframe system: QCARE
• Extensively involved in creating test scenarios, testing and validations of teh JCS, ECP and tasking rules in maxMC system
• Extensively involved in testing teh Pre-Authorizations in teh Claims Processing System: QCARE (Mainframe system).
• Extensively involved in testing teh entire data flow or mapping validations across teh systems: Web Portal (PEP / Heads Down) to maxMC and maxMC to QCARE and back fills during different phases of UAT testing cycles
• Extensively involved in testing Pre-certifications in teh GHI PPO Web for teh GHI PPO members
• Extensively involved in validating Referral test cases in teh VYTRA-Portal
• Extensively involved in validating and fixing teh error out cases from QCARE system
• Extensively involved in validating teh Eligibility checks for Members and Providers in QCARE system
• Designed and created a database for teh Care Management Department using MS Access DB in order to maintain teh data tested and validated scenarios
• Created several test scenarios and Validated several test cases for teh EnTops Project, ICD-9 & ICD-10 claims remediation project, Treatment Plan testing, Gender & Age Edit Projects & ICD-10 Compliance project
• Collected member & provider data for teh 5010 project
• Created several test scenarios and Validated several test cases for teh EDI 278 testing
• Validated backfill testing after teh cert-extract done for teh ICD-10 project
• Reviewed test cases for teh other team members
• Mentored newly hired team members on how to use systems (PEP Heads Down, maxMC & QCARE) and also how to execute test cases
• Extensively involved validating pre-authorization, prior-approval and referral test cases in teh WIN-7 virtual machine
• Identify/Document all Test Issues during Testing
• Perform Additional Tasks as assigned by ICD-10 Project Manager
• Validated & edited more than 3000 pre-authorizations for teh maxMC Error Edits project in teh production region of maxMC
• Trained 7 team mates on teh validation rules for teh maxMC Error Edit project
• Extensively worked on CCI project to validate pre-authorization in teh QCARE system
• Attended daily and weekly meeting for teh CCI project
• Generated minutes of meeting notes on a regular basis for teh CCI project
• Generated daily auth count report for teh CCI project
• Validated pre-authorizations for teh defect error report in teh CCI Project
• Communicate and interact with CCI team to correct teh pre-authorizations for
• Validated more than 400 pre-authorizations for teh CCI project in teh QCARE system
• Got a professional training on eSAWS system for teh CCI Project
• Validated Outcome reasons for teh Medical Director Denial Workflow process

Confidential

System Analyst/UAT Analyst

Responsibilities:

• Wrote & executed tons of UAT scripts for POMS, JDE & CSOPS system;
• Wrote several queries to do detailed of backend testing
• Generated several queries to validate data with teh front-end application
• Responsible for developing, executing and coordinating teh end-to-end Interactive Voice/Web Response System User Acceptance Testing.
• Responsible for teh quality review of teh URS and UAT deliverables;
• Wrote & executed UAT script for performance project for Assembly and packaging module in order to track container ID, Carton ID and Pallet ID in POMS system;
• Wrote & executed UAT scripts for updating CSOPS system for WAG project for several business process;
• Developed UAT documentation consisting of: test plans and scripts, pre, post, specification reviewer and binder UAT checklists, and all other required documents
• Maintained contact for UAT execution and UAT error resolution
• Collaborated with both external vendors and internal functions to develop scenarios for testing purposes;
• Wrote several SQL queries for backend testing to validate teh search result
• Wrote and Executed several UAT scripts for teh upgraded of JDE system;
• Wrote & executed several UAT scripts for Address Book module, Item master module, Bill of Materials module, Shop floor management module, Sales Order Management module, Procurement module, Purchase Requisition screen, Purchase Order screen, Work Order screen and many more JDE system.
• Wrote & executed several UAT scripts for Recipe creation module, Production Planning module, Material management module, Bill of Material module, Assembly and Packing module, Ship order management module, Execute Recipe module, Inter-site transfer module, Clinical-site Transfer module, Unship module, Assign Recipe module, Record Carton Data module, Batch Order processing module, Stage Shipment screen, QC Release screen, Material Move screen, Order Receipt screen, Manage Order Screen, Misc Receipt screen, and many more screen in POMS screen.
• Addressed and resolved UAT findings with vendor and core teams;
• Wrote & executed several UAT scripts to test more than 150 Business Requirements for updating CSOPS System 4.3 to 4.4 version and migrated to JBOSS server;
• Executed 8 ERP-IVRS regression testings with several vendors for several IVRS in-house & out source studies;
• Prepared a project charter for ERP-IVRS Vendor Guidance project;
• Prepared a prep-meeting guide for ERP-IVRS meetings for several IVRS studies;
• Documented all teh event reports in a spread sheet for several ERP-IVRS testing for several IVRS studies;
• Attended several ERP-IVRS prep-meeting for several IVRS studies;
• Worked with developer and business users for teh Win 7 and Office 2010 migration;
• Worked closely with teh Business Lead and users to execute teh UAT test scripts for Win 7 & office 2012 migration;
• Guided Business users to executed several Access database applications and Excel spreadsheets for Win7 & Office 2010 migration;
• Worked within published study/system project timelines and attend meetings as necessary
• Worked on Sponsor assigned special IT projects (For example) create metric collection/reporting tools, etc)
• Performed UAT duties and responsibilities as outlined above under UAT Focus.
• Developed and executed UAT test documentation (test scripts, test plans, etc.) in a GMP environment according to regulations (e.g., 21-CFR Part11)
• Multi-tasked in several projects from POMs, JDE till IVRS Vendor Issue guidance project;
• Worked on clinical trials;
• Worked on Interactive Voice/Web Response System (IVRS and IWRS) in a clinical supply chain management environment;
• Worked on teh Software Development Life Cycle (SDLC) for Global Clinical Supply (GCS);
• Lead meetings with internal and external stakeholders to present UAT material;
• Guided/instructed participants during teh execution of User Acceptance Testing (UAT)
• Managed multiple projects/timelines

Confidential

QA Analyst/Validation Engineer

Responsibilities:

• Sending email to development team regarding teh issues raised during teh Validation testing for SalesLogix system;
• Wrote approximately 85 Manual Scripts for SalesLogix application by using Quality Center.
• Wrote several queries to do detailed of backend testing
• Generated several queries to validate data with teh front-end application
• Created approximately 85 test Plans based on functional specifications and user requirements.
• Created more than 95 test case scenarios for System and Regression testing.
• Wrote manual test scripts by following Confidential Standards.
• Consulted with teh business team to build a robust environment for implementing teh test plans.
• Coordinating and conducting test plan review meetings with Business and application development groups.
• Identified test cases.
• Wrote several SQL queries for backend testing to validate teh search result
• Involved in gathering and analyzing functional specifications and user requirements from Business analysis group.
• Preparation of test environments required for various type of testing to provide bug free application.
• Responsible for creating and validating test data.
• Performed Functional & Regression testing.
• Used Quality Center for creating central repository, building test cycles, running tests, components, reporting and tracking defects.
• Executed test cases, verified results and reported results in defect manager of Quality Center (QC) for SalesLogix system.
• Executed test cases, verified results and reported results in defect manager of Quality Center (QC) for StemLab system.
• Conduct Dry Run for 75 scripts for StemLab system.
• Prepared 125 test data to execute test scripts for SalesLogix application.
• Prepared 25 test data to execute test scripts for StemLab application.
• Prepared detailed test cases by understanding teh business logic and user requirements for manual testing.
• Performed end-to-end functionality testing of SalesLogix Application.
• Performed Regression Testing to assure dat fixes are working fine and not creating another issues.
• Involved in reviewing and analyzing Functional Requirement, Use Case and Design Documents.
• Involved in entire life cycle of testing teh application.
• Bug reporting and tracking was done using QC.
• Reversion certain test scripts after fixing teh defects in QC.
• Wrote 7 manual test scripts for StemLab system.
• Conduct peer reviews of Business Requirements written by other team member and provide feedback for SalesLogix system for 750 business requirements whether these are testable or not.
• Conduct peer reviews of Configuration Specification written by other team member and provide feedback for SalesLogix system.
• Assist preparing configuration specification document for 30 screens in teh StemLab system.
• Wrote 48 UAT test scripts based on Business needs.
• Currently observing UAT test execution for SalesLogix which is conducting by Business team.
• Attending weekly project status meeting on teh regular basis.
• Re-test certain functionalities when it is being fixed by teh development team.
• Updating teh team members, Business lead and management while teh issue is being fixed in SalesLogix system.
• Worked close with teh Business Lead and users to execute teh UAT test scripts for SalesLogix system.
• Reviewed teh performance script which is written by other team member.
• Observed teh Performance testing which was conducted by teh Business Team.
• Executed teh Performance script in Quality Center 10.

Confidential

Business Analyst/QA Analyst/System Analyst

Responsibilities:

• Liaised with business and functional owner during risk engineering and high-level review sessions to derive and execute action plans, meeting deadlines and standards.
• Wrote several queries to do detailed of backend testing
• Generated several queries to validate data with teh front-end application
• Wrote more than 5000 business requirements for MedAZ application based on different customer needs.
• Worked on ICD9 with teh internal team and also with teh client team to explain teh conversion of ICD9 to ICD10;
• Wrote several SQL queries for backend testing to validate teh search result
• Tested Application settings to setup ICD9 to ICD 10 conversion;
• Testing ICD & CPT screen to verify ICD 9 conversion to ICD 10;
• Tested Billing screen to verify data converted from ICD 9 to ICD 10;
• Tested EDI screen for 837, 835, 270, 271 & 276 batch file upload;
• Validated teh following: 837 (Healthcare Claims or Encounters), 835 (Healthcare Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan)
• Tested electronic 1500 HCFA form for medical professional inpatient claim to upload in EDI as 837 format;
• Worked on EDI transactions: 270, 271, 834, 835, and 837 (P.I.D) to identify key data set elements for designated record set
• Interacted with Claims, Payments and Enrollment hence analyzing and documenting related business processes
• Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270/271, 276/277, 834, 835, 837
• Reviewed teh Assessment Business Rules Comparison (BRC) document to identify any new, changed, or deleted data elements as a result of teh 5010 transaction changes, implementation of additional HIPAA transactions, and ICD-10 changes
• Tested electronic UB04 form for Hospital claim to upload in EDI as 837 format;
• Tested DRG (Diagnostics related group) codes in teh Hospital electronic claims;
• Wrote several scripts to test DRG (Diagnostics related group) codes, APC(Ambulatory payment classification) code, ASC(Ambulatory surgical codes) code for teh electronic Hospital claims to verify teh payment rates and codes;
• Wrote manual scripts to test HIPAA form;
• Executed manual & UAT scripts to test EDI screen for 837, 835, 270, 271, 276 and 277 files;
• Wrote Configuration Specification document for MedAZ application.
• Involved in various business operations and halped teh organization to achieve cost-TEMPeffective production with increased quality, efficiency and satisfied customer service.
• Involved in documenting teh business process by identifying teh requirements and also involved in finding teh system requirements.
• Conducted interviews with key business users to collect requirement and business process information.
• Took part in teh preparation of Project plan, user acceptance testing.
• Got a detailed understanding of business functionality and took teh responsibility of preparing teh Functionality Test Plan which was used by testing team while doing their testing process.
• Worked very closely with several Business leads to understand teh business needs and transfer this information to teh development team in India.
• Prepared Integration Test Plan which was used by functional team as well as development team for doing a detailed testing on teh business application.
• Wrote test plans and test cases of teh business process or application.
• Reviewed and edited requirements, specifications, business processes and recommendations related to proposed solution.
• Developed functional specifications and system design specifications for client engagements.
• Takes input from supervisor and appropriately and accurately applies comments/feedback.
• Communicates and applies project standards.
• Manages resources in accordance with project schedule.
• Consistently delivers high-quality services to our clients.
• Interfaced with business users to prepare and update Business Process Requirements (BPR) and Software System Requirements (SSR). Created test cases and test scripts.
• Ensured all artifacts complied with corporate SDLC Policies and guidelines.
• Prioritized outstanding defects and system problems, ensuring accuracy and deadlines were met.
• Performed GAP analysis of business rules, business and system process flows, user administration, and requirements. Ensured cGMP and compliance requirements (Title 21 CFR Part 11) were met.
• Developed use case with UML for new product functionality. Updated SOPs and WIs.
• Identifies client organization’s strengths and weaknesses and suggests areas of improvement.
• Coordinated with teh developers and management to layout teh project schedule and deadlines for teh testing phase for each content group.
• Worked closely with development team in India to halp them to understand teh Business needs.
• Involved in preparing a simple and detailed User manual for teh application, for an intended novice user.
• Ensured all artifacts complied with corporate SDLC Policies and guidelines.
• Identified test cases to be automated using QTP.
• Wrote several VB scripts for global use for QTP test scripts; this saved lot of time.
• Used Quality Center (Test Director) for creating central repository, building test cycles, running tests, components, reporting and tracking defects.
• Prepared detailed test cases by understanding teh business logic and user requirements for manual and automated testing
• Responsible for preparation and submitting teh performance Report for teh entire production environment.
• Wrote and execute SQL statements to validate Reports.
• Performed Regression Testing to assure dat fixes are working fine and not creating another issues.
• Created a Regression Testing questionnaire template for developer and performance team to gather information from developer like prerequisites, environment for application, security patches on server, transaction distribution and frequency, expected performance cross line time, etc.
• Played key role in performance analysis and tuning of teh application under testing. Identified issues involved with application performance like memory leaks, complex database queries.
• Changed test plan according to teh checkpoints required for teh functional testing and regression testing.
• Responsible for testing teh ePrescription(electronic) interface to verify compliance with CFR Part 11 requirements for electronic signatures.
• Written test cases, test plan and Test scripts in Quality Center 9.2.