SUMMARY:

• IT Professional with 7 years of experience in the related field with emphasis on Business solution and Quality Assurance Analysis.
• Worked as Business, Quality, Data Analyst
• Worked in the Healthcare Insurance, Banking, Commerce and Hydropower Industry
• Design, development and implementation of Claim Processing for Health Insurance exchanges
• Analysis of discrepancies in data reconciliation process for multiple stakeholders
• Experienced on SDLC process
• Hands on experienced on Defect Lifecycle Management
• Experienced in EDI 837 transactions
• Acted as liaison for the test data management team
• Performed Data Migration/Data Masking/ Data Obfuscation
• Acted as a liaison between Data Management (TDM)
• Experienced in X12 transactions
• Worked with different Stake Holders and Vendors parties
• Data Response and Reconciliation transactions
• Provided Training support and Mentoring
• Performed Data Reporting and Documentation
• Leaded the offshore team and Onshore Remote team
• Worked in Matrixed environment and a Good Team Player

TECHNICAL SKILLS:

Testing Tools: DIAMOND, XCELYS, Autosys, Team Foundation Server, ICD Manager, Informatica 9.1.0 Quick Test Professional, Rational Team Test, MOJO Version 3, Enterprise Tool Lookup (ECL), Unix, JIRS, Microsoft Test Manager (MTM), Loadrunner

Bug Reporting: HP Application Lifecycle Management (ALM), Rational Clear Quest, Diamond Quest Entry

Application: Application Lifecycle Management (ALM), Diamond, Gateway Access Portal (GAP), Enterprise Audit Service (EAS), .NET, JAVA, Availity, PIP (Provider Information Platform), HIPAA Claim Repository, Quick Test Pro, .Net, Xcelys 6.3, EDI Translator

Databases: Oracle, SQL Server, MS - Access, Filezilla

Operating System: Windows (XP, 2000, 98)/Vista, iOS, Unix, Linux

MS Office Tool and Environment: MS Office, MS Share Point, Team Foundation Server (TFS) and HP Screen Recorder, Ultra Edit, Lync, Snagit Editor, Agile and Waterfall.

PROFESSIONAL EXPERIENCE:

Confidential

Sr. Quality Analyst

Responsibilities:

• Worked on End to End Claim Processing and claim Validation and validated EDI 837I/P/D, 999, 277CA, 277U
• Performed functional system/integrated testing of software delivered from Applications Development
• Worked closely with the Business group to interpret test needs as requirements are being developed and ensures standard of testing supports business needs
• Created the summary of test report and coordinated and leaded the offshore team.
• Contributed and adhere to Requirements Tractability Matrix ensuring quality delivery
• Identified and logged Defects and worked with application programmers to resolve defects identified during the system test
• Performed the root cause analysis after identifying the defect
• Executed each script to identify defects prior to delivery of software in a production environment
• Assisted in capturing and documentation of metrics in support of software testing
• Created Test data, Input files to ensure it complies with specifications and presents sound recommendations through thorough analysis
• Performed System Integration, Regression, Parallel and Security Testing
• Developed Test Strategy, Test Plan, Test Cases (Functional and Non-Functional) and Test Scenarios from Functional Specifications Document (FSD) and Business Requirement Document (BRD) in a reusable state.
• Performed extensive (Institutional, Professional, Dental), E2E testing, ACK 999 and 277U Reconciliation process.
• Worked freelance as a sole QA tester on problem solving KY Focus group in a WAR Room as an AGILE team.
• Generate X-12, flat flies for different states and Validation of X-12 837 files with HIPPA Compliance and companion guides.
• Worked closely with offshore and onshore development teams, Business Analysts on attaining testing goals, defect logging process and UAT support.
• Performed extensive back end testing on ORACLE and MS-SQL Server Databases using PL/SQL and MS-SQL SERVER
• Use of automation tools including Autosys scheduler and Work Load control center to perform job execution, ALM and Quality center for development and execution of test cases.
• Using Informatica 9.1.0 to monitor, track and report various states of the code including success rate, failure reports and performance issues.
• Prepared Application Understanding Documents (AUDs) and share with the various work groups.
• Prepared Learning Documents and various Knowledge Transfer Documents and shared with the various work groups onshore and offshore.

Confidential, McLean, VA

Data Analyst

Responsibilities:

• Involved in the State Project of 1095A project and reconciliation and
• Approved or denied the cases according to the Approved Decision Matrix and re-send the corrected 1095A forms to the consumer’s MEDICARE claims.
• Worked on the primary and secondary data and analyze the data to validate the output file for the CMS
• Determined the Advance premium tax credit, premium amount, Enrollment Date, Termination Date and Retro Termination Date.
• Performed Data Analysis, Data mining and the Data extraction for the HICS cases.
• Performed the root cause analysis after identifying the defect while data analysis
• Performed data cleanup on Pending case status, gathering data, loading data into the template.
• Done Reconciliation and auditing for the EDI 834 and 820 transactions for Medicare claims
• Worked on various HICS cases type such as Premium, APTC, and Policy Start and End date of a Member.
• Validated all the data points and sources like MIDAS, FFM and Issuer according to the decision matrix.
• Validate all the data in the template HICS cases and do the Analysis according to the disputes
• Gathered the data from Federally Facilitated Market and Issuer to verify the data consumer has presented
• Used FileZilla and SQL server to extract the data from Oracle and worked on .NET applications testing
• Updated the data and analyst note on the company's portal for the issuer outreach consumer outreach and the COT (Consumer Outreach) agent can use that data to issue and send another 1095A to the consumer
• Mentored, trained new hires and Prepared the learning documents Knowledge Transfer Documents for the new hires

Confidential

Sr. Quality Assurance Analyst

Responsibilities:

• Worked on E2E Encounters Claim Processing System.
• Worked on EDI 837, 999, 277CA/U, X12 transactions validation for both Medicare and Medicaid.
• Worked on Void and Replace module and Reconciliation of the EDI transactions
• Worked on the HIX Denial letters and eligibility Reconciliation for the members with the valid unique patient control number and Provider reference number
• E2E testing of the Correspondence Tracking System manually and by using CTS Automation Tool. Each Action Codes represents each type of letter.
• Attended the BRD/FSD walkthrough and providing the approval and consent for BRD/FSD on behalf of QA team
• Prepared and mocked up data for User Acceptance testing.
• Using the SQL query to find the members from the Oracle Database as per the constraint need of the members on the basis of Plan Code, LOB, Eligibility Status, Term Date, Effective Date, and Premium Logic, Address Logic
• Generate the PDF of the letters to the members and send it out to the UAT and group of business people as a part of UAT support and performed testing for UAT
• Checked the Data Cross walk table and Rule IDs after deployment and matching with the Spec Sheet available for the validation and followed the different Triggering Mechanism to trigger the Tagger File into the system.
• Performed the enhancement testing of the company Logo from the effective date 3/1/2014 and its aspects of company disclaimer, company logo, effective date, LOB and rider code of the member
• Defect Tracking in ALM 11.52 includes Opening, assigning, following up, retesting and closing the defect.
• Updated the status in Team Foundation Server (TFS) Version 8.1.0 for the deployed Work Item Number (WIT) and tracking each steps of progress
• Worked in the WAR room with the team of BSA, Developer, UAT and QA during critical timing of release date
• Worked on Rx Denial Load Modules - DER Application This module pulls information from the new DER system; this is an online application that triggers members with specific action codes and NDC information into the CTS application tables.
• Worked as UAT Support for the Pharmacy Letters from the DER Application

Confidential, Jacksonville, FL

Business Solution Quality Analyst

Responsibilities:

• Worked on End to End Claim Processing and claim Validation for both Medicare and Medicaid for EDI 837/825, 270/271
• Involved maintaining Test Matrix and Requirement Traceability Matrix and performing Gap Analysis and Data Mapping
• Gathered information and requirement from the business stake holders and Prepared BRD and FSD
• Conducted JAD sessions including all the interested and effected group and conducted walkthrough for the approval of the requirement.
• Performed Unit, Integration, Smoke, functional, Regression and system testing.
• Participated in Walk through of test plans and test cases and created Regression test Beds
• Gathered requirement from various vendors and stake holders and prepared the business requirement document as a part of responsibility of Business solution Quality Analyst.
• Involved in testing the mappings for the conversion of EDI X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes.
• Validated and done the pricing for Diagnosis Related Group (DRG) Pricing and ICD 9 and ICD 10 pricing
• Performed E2E claim Processing in MOJO and Diamond (older Version of XCELYS)
• Worked on Change Request Management synchronizing the changes on different environment.
• Worked on the Data Migration/Data Masking/ Data Obfuscation
• Acted as a liaison between Data Management (TDM) Team and QA Team
• Responsible for writing test cases from BRD and tracking the Requirement Traceability Matrix (RTM) to cover the expected result, System Specification Document, User stories and Functional Design Specifications.
• Tracked the TFS for the source code deployment, status report and again to update the status of the execution
• Identified, analyzed, and documented Defects, errors, and inconsistencies in the application using ALM and tracking the defect in defect lifecycle.

Confidential, Americus, GA

Data Analyst

Responsibilities:

• Collected the data from the end users and database and compiled it for the reporting purpose
• Done Gap Analysis and data mapping between the old legacy system and the new system and prepared the report on that analysis.
• Worked independently with various Vendors and stake holders.
• Responsible for creating "as is and to be" conditions and data mapping
• Have experience designing and writing training manual templates, design formatting, project planning and writing technical documents.
• Worked for the data validation using MS Access
• Conducted GUI/Usability Testing according to Functional specifications.
• Ensure that products and changes are fully documented.
• Updated data in the new system 'Chamber Master' from the old existing system
• Analyzed system to point out gaps between the new and the Legacy system
• Participated in conducting System testing and End to End testing Manually

Confidential, Americus, GA

Ast. Support Analyst

Responsibilities:

• Support for the technical issue of students regarding the application Career Master.
• Updated the Data and preparing the report in Xcel sheet and reporting to director
• Collected data and statistics from various classes in a specific format and creating the report of student feedback
• Helped for the password set up and other technical issues
• Updated the portal for the new job requirements, lectures and notes of professors, study materials for students
• Organized training and workshops and collecting the data and analyzing them for the creation of new techniques to meet students need

Confidential

Data Analyst

Responsibilities:

• Data were gathered through interactions and meetings and periodic walkthroughs with loan analysts, credit analysts and other potential users of the application.
• Communicate with all IT departments on all activities related to the Public Affairs, Corporate Communications and Records Management departments and projects assigned.
• Participates in design sessions with business leads, BA's and Technical analysts and business.
• Attended and contributed feedback during walkthroughs
• Created different Traceability views to maintain the Traceability of the requirements.
• Involved in test planning, writing test cases looking Use Case diagram, discussing with developers and system engineers.
• Executed complex SQL queries to retrieve data from Oracle DB and prepare the report for the various purposes.
• Coordinated with other vendor team for Modification Requests and Document Management request.

Confidential

Quality Analyst

Responsibilities:

• Parameterized data tables using Quick Test Pro for data driven testing.
• Performed backend testing by executing SQL statements.
• Wrote SQL Scripts to insert regression test data into the database.
• Validated some of the reports, using complex SQL queries, generated during the process.
• Used Test Director for error reporting and communicating between developers, product support and test team members.
• Manually tested functionality and integration of prototype.
• Involved in writing Test plan, Test cases & Test scripts.
• Used Load Runner to generate test scripts for Regression Testing.
• Attended regular walkthroughs and inspections.