SUMMARY:

• Around 5 years of diversified experience in Software Design, Development and Testing. Expertise in Designing and Developing Test plans, Test cases and generating Test Scripts.
• Experience in Agile and Waterfall models of SDLC.
• Hands on Experience using Tidal, Facet, SQL, Claim Test Pro, Claim Mockup tool,ICD - 09 to ICD10 Conversion Process (using converter tool).
• Extensive Knowledge in creating the EDI files from Production and mock them up according to requirements.
• Excellent knowledge of ICD-9/ICD-10 and HIPAA 4010/5010 Transaction requirements
• In-depth knowledge of all QA Phases that include Manual, Functional, System, Integration, End-to-End testing.
• Proficient in reviewing and documenting system test plans, and creating test cases on the basis of product release features, client’s requirements and related technical documents.
• Expertise in developing Test Plans, Test cases and importing Test cases to Quality Center.
• Hands on experience in using relational databases like MS-SQL Server.
• Effort Estimation during all cycles of release like Feature, System, Integration, Regression and Performance Testing.
• Knowledge in Using different Tools and applications such as Facet, Tidal, Ultra Edit,
• Strong experience working with HIPAA ANSI X12 Transactions( 837/835/834/ 270/271/276/277 )
• Excellent Knowledge in Regression Testing, Agile Methodology.
• Ability to work closely with developers and project managers to analyze the new features of the software application.
• Expert in Defect tracking and reporting using Quality Center (HPQC)
• Self-Motivated, team player with good communication, problem solving skills, analytical and Strong Presentation Skills.

TECHNICAL SKILLS:

SDLC Methodologies: Agile, Waterfall

Testing Tools: HP Quality Center, Unified Functional Testing, Claim Test Pro

Databases: Microsoft SQL ServerDatabase Tools: SQL Server

Operating System: Windows (XP, Vista, Win 7)

Other Application and Tools: MS Office Suite, TIDAL, FACET, Ultra Edit, ICD 9 to ICD 10 Converter

PROFESSIONAL EXPERIENCE:

Confidential

SQA (ICD 10\EDI Analyst)

Roles and Responsibilities:

• Verified and validated that trading partners and providers are following the CMS guidelines and sending us ICD 10 compliance EDI files.
• Involved in provider testing for ICD 10 compliance.
• Research, analyze, and produce relevant reports to support the regulations related to ICD-10 objectives.
• Involved end to end testing for different type of claims (professional, Institutional and Dental) for ICD-09 and ICD-10 codes and qualifiers changes.
• Supported user-acceptance testing of the changes from ICD 9 to ICD-10.
• Involved in the review of test results including, but not limited to: defect research, resolution, documentation, and action item tracking.
• Created different Metrics reports for providers and internal teams within a Confidential .
• Collaborated with the team to establish thorough documentation.
• Created, updated and maintain project plan for ICD 10, identifies and escalated issues to the leadership that may endanger milestone completion and implementation readiness.
• Created payer specific test plans and test files for 835, 837, 277, 278, transactions.
• Created and mocked up data for the ICD 9 and ICD 10 testing purpose.
• Worked on Tidal jobs to load data and analyzed claims behavior on every step.
• Used claims test pro and ICD 9 to ICD 10 conversion tool to mock up data.
• Wrote SQL queries to verify the data in database for ICD 9 and ICD 10 codes and qualifiers.
• Provide Test Lead with input for weekly status report about Distinct ICD-10 claims and codes.
• Created weekly accumulated distinct claims and codes report for steering committee.
• Very good understanding of claims and support claims team where it is required.
• Provided Provider’s pended claim report to Claim analyst.
• Conducted ICD-10 standup meetings.
• Attended SIS reporting and Encounters team’s meeting on behalf of my Test Lead.
• Involved in end to end testing with Instamed for Test Providers.
• Also involved for Financial Neutrality Testing.
• Trained and coordinated Onshore ICD-10 team for ICD-10 testing.
• Worked with EDI team on XSLT mapping related ICD-10.
• Created some Helping Documents which are helpful for ICD-10 and Claims
• Analyzed and test Claims in All four Environments which are INT, vINT,CERT and vCERT.
• Processed 837,835,278 (Preauthorization) files using Tidal.
• Created and Completed Change Management Process for ICD10.

Environment:: QC, Windows, SQL, and, Agile, Tidal, Ultra Edit, Facet, Claim Test Pro, Icd09 to ICD10 Converter, Integration, Certification, Production.

Confidential, Norcross, GA

QA Analyst

Roles and Responsibilities:

• Carried out positive and negative testing
• Tracked and logged defects in Quality Center.
• Logged defects using HPQC
• Used SQL queries for back end testing to validate the information with the database.
• Involved in Facets implementations and end-to-end testing of Facets, Claim Processing and Subscriber/Member module.
• Documented the test results and reported the status of assigned test tasks to Developer.
• Participated in weekly meetings, where test status and defects were discussed, wrote enhancement and modification requests.

Environment:: QC, Windows, SQL, and, Agile

Confidential, Dallas, TX

QA Analyst/Tester

Roles and Responsibilities:

• Involved in HIPAA/EDI Medical Claims Analysis, Implementation and Documentation
• Involved in HIPPA Complaint X12N837 Transaction testing.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Wrote multiple Test Cases (System, Integration) for multiple transactions include 837I, 837P, 835, (both inbound and outbound) transactions.
• Reviewed Business Requirement Document, Functional Design Documents and Technical Specification documents.
• Created Test Cases after analyzing the BRD’s.
• Performed Functional and UI testing on Facets.
• Prepared test matrices based through defect status in Quality Center.
• Logged defects in Quality Center & interacted with developers to resolve technical issues.
• Performing Backend Testing extensively by writing validation queries on DB database.
• Analyzed and tested data on claims manually and writing queries on DB database for validating data.

Environment:: Facets, SQL, MS Office, Quality Center, and QTP

Confidential, Bethesda, MD

QA Analyst

Roles and Responsibilities:

• Created test plans and test cases as they relate to testing project requirements to ensure the overall quality of software delivered.
• Tested the eligibility requirement criteria and other functionality with all possible negative and positive test data.
• Checked data flow through the frontend to backend and used SQL Queries to extract the data from the database in different phases.
• Followed the HIPAA Standards, Electronic Data Interchange (EDI) formats for processing of claims.
• Developed comprehensive test cases and executions to ensure proper operations of system.

Environment: Windows, QC, SQL, Agile,