Professional Summary

• 8 years of professional experience as QA/EDI Analyst/Tester in various Integration and Business Applications like Health Care and Retail domains.
• Expertise in B2B standards, Implementation of Integrated EDI and XML applications and Enterprise Application Integration EAI for business processes across applications.
• Created companion guides for EDI transactions for both 4010 and 5010 versions and also created crosswalks and also experience in using EDIFECS Spec builder.
• Strong knowledge on HIPAA standards, ICD9/ICD10, EDI transactions 4010/5010 versions, Medicare and Medicaid Services.
• Strong Knowledge on claim processing and EDI transactions i.e. Claims Inquiry and Response 276/277 , Receipt and Verification of claim forms 837 , Claim Payment and advice 835 , Eligibility Inquiry and Response 270/271 , Certification Request and Response 278 , Benefit Enrollment 834 , Order and Payment Remittance 820 , Functional Acknowledgement 997/999 .
• Have good knowledge of HIPPA 4010 /5010 versions.
• Experience of QMF and SPUFI in extracting the queries.
• Checked the HIPAA compliance of the manually created 27X transactions using the Edifecs Analyzer tool.
• Experienced on
• healthcare domain.
• Linked business processes to organizational objectives, performed critical path analysis, and identify opportunities for business process improvement
• Expertise in COBOL, CICS, DB2 LUW, VSAM, JCL, File Manager, QMF, SPUFI and File-Aid.
• Strong experience in Mainframe Batch Cycles Online Real-time Processing.
• Expertise technically with database development and data warehousing concept/tools.
• Involved in testing the claims conversion from Mainframe to Facets. Also involved in testing the EDI transactions 834, 837, 835. 270/271 276/277 conversion to Facets.
• in creating requirements traceability matrix for tracking the requirements.
• Experienced in BABOK principles and techniques
• Experience infor Insurance claims processing and payment
• Experienced in QTP using selenium tool.
• Worked in the performance tuning of the programs, ETL Procedures and processes.
• Competent in Creating Unified Modeling Language UML diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams.
• Experience in testing Web Based and Client Server Facets, Healthcare Payer Application applications on different platforms.
• Experience in CLAIMS, MEMBERSHIP, ENROLLMENT, BILLING.
• Experienced work in with X12 version 4010/5010 transactions, GAP analysis, design and migration strategy.
• Having good knowledge
• Experienced in project management skills like scheduling, monitoring
• Experienced in principles and techniques in Requirement Elicitation Management, Enterprise Analysis, and Solution Analysis Validation
• Experienced in electronic health information exchange.
• Extensive experience with testing Multi-Tier application architecture.
• Expertise in Data Driven Testing and creating reusable functions.
• Efficient in delivering tasks, team player with good communication and interpersonal skills.

TECHINCAL SKILLS:

Professional Experience

Confidential

EDI Analyst

Responsibilities:

• Successfully lead EDI implementation team and conducted several training session on EDI systems

• Automated and customized the scripts for the entire application using Quick Test Professional QTP
• Reviewed the Business Requirement specification Document and the technical specification of the application
• Assisted in working in establishing EDI system security by suggesting the solution and getting the solution implemented.
• Hands on experience in working on designing and reviewing the EDI system applications.
• Reviewing System Requirements to define testing scope for various levels of testing Functional, System, Regression, and UAT .
• Worked as a liaison between the Technical and Business partners for getting the EDI systems readily available.
• Experience testing Transaction processing system for End Users during UAT and ensuring that payments made and received were calculated based on all the Business rules.
• Experienced in configuring, backing up and recovering all EDI transactions
• Worked on Amisys sytem - Testing of Enrollment and Claims Services for upgrade of AMISYS 4.0 to 6.0 Developed a System Breakdown of the Billing Cycle in order to create quality management testing in Amisys.
• Created manual and automated Test Cases and Test Scripts using HP ALM.
• Provided technical support, managing change requests, and the development of customizations including workflows, templates and reports for single, enterprise-wide HP Quality Center environment using software development lifecycle SDLC processes.
• Analyzed current and future business needs in relation to HPQC / ALM requirements, identified potential gaps, evaluated options, and ensured delivery of solutions.
• Analyzed, tested, and implemented new HP Quality Center functionality and processes.
• Designed and supported HP Quality Center integrations with other software products.
• Provided support that may include working with vendor support and other infrastructure groups such as database and server administration mentor and coach technical team members on tools.
• Involved in QNXT production support
• Provided client consulting on use of HP Quality Center tools, both technical and non-technical, using best practices and QA processes.
• Involved in data mapping document and functional design document and worked with stakeholders and helped during the project.
• Performed QTP administrative duties and Quality Center integration.
• Benefit configuration and coordination, data abstraction and data mining via AMISYS
• Performed Load Runner / Performance Center administrative duties as well as vendor management duties of relationship building, roadmap and licenses. Created Standard, Image, Table, Page, Text/Text Area Checkpoints.
• Parameterized the test s and modified steps affected by parameterization.
• Worked with developers to communicate regarding issues in the application.
• Coordinated the testing effort towards End-to-End testing to verify the proper functioning.
• Created several compiled modules.
• Performed Regression Testing.
• Wrote SQL queries to test the application for data integrity.
• Tested User Interface inconsistency and application functionality.

Environment:

QCARE MF, PPO MF, Windows 2000, EDI X12N 4010 5010,HTML, Java, MS SQL Server, Test Director 7.0

Confidential

EDI Analyst/BUSINESS ANALYST

Responsibilities:

• Worked on User Acceptance Testing in the ESC application.
• Worked Extensively with Inbound 837 I and 837 P, 835s Outbound claims processing systems.
• Executed and validated data mapping for Claims via EDI into RDC through Oracle PL/SQL.
• Used Quality Center for preparing the test plans and manual test scripts.
• Extensively involved in real time testing with All scripts.
• Created Requirements v/s Test Case Matrix in Excel Spread Sheet template.
• Coordinated and prioritized outstanding defects and system requests based on business requirements.
• Used SQL statements for Back-end testing.
• Good understanding of Agile software development lifecycle.
• Performed System Integration Testing on Medicare Bad Debt project.
• 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.
• Performed tests on various features of Agile development process.
• Hands on experience in QTP and other open source automation tools.
• Interacting with the developers on resolving the reported bugs and various technical issues.
• Experience in working on Crystal reports for consolidated balancing reports for Cash posting team.
• Once the testing part is completed, it has to meet the test plans acceptance and sign off.

Environment: EDIX12N 5010, EDIX12N 4010, Oracle PL/SQL, Microsoft SQL Server 2008, XML, QTP, Windows 7, HP ALM Quality Center 11.00.

Confidential

QA EDI ANALYST

Responsibilities:

• Worked closely with the project team in planning, coordinating and implementing QA methodology
• Participated in Quality Circle meetings with the management and development teams
• Used QNXT in data conversion projects to and from QNXT
• Managed test planning for Functional testing, Integration testing, Systems testing, Acceptance testing, Regression testing for the Health Care application
• Wrote and distributed reports to describe automation program evaluation problems found, corrections needed, and problem areas.
• Tracked overall test coverage for application.
• Linked the test cases and defects in Quality Center and generated reports
• Created, Setup and Implemented end-to-end test environment including QA Methodologies, Policies, Procedures, Standards and Tools for the Health Care application
• Automated test cases using QTP and worked on BPT component of Quality Center to create quality scripts
• Enhanced script by creating standardized, text and XML checkpoints, parameterized scripts for data-driven tests
• Automated and tested software programs, including test case design and execution of alpha, beta, functional, regression, and smoke tests.

Environment: QC, BPT, Quick Test Pro, Oracle, AS 400, QTP

Confidential

QA Tester

Responsibilities:

• Developed maps using AI Mapper for various transactions.
• Used Data Manager for Routing, Archiving and Translation of data.
• Developed various EDI documents for 837, 820, 270/271 and 835.
• Involved in resolving daily Production support issues.
• Developed various maps using HIPPA standards.
• Performed backend testing using SQL queries and sub queries to check backend data and checked data integrity.
• Developed automated regression tests in Win Runner for functional and regression testing
• Worked with development team members to better understand system functionality in order to improve testing quality.
• Assured that all QA Artifacts are in compliance with corporate QA Policies and guidelines.
• Used Test Director to detect defects, communicate to the developers and tracking the defects.
• Coordinated and communicated the whole QA effort by effectively working with different teams

Environment: Gentran Server 5.1 for UNIX, Oracle 9i and HIPPA.