CAREER SUMMARY

• Over 7 years of experience in creating innovative and cost effective Quality Assurance solutions with expertise in Insurance, Healthcare processes, applications using manual testing procedures & test automated tools
• Extensive experience in all phases of SDLC processes.
• Experience working with HIPAA EDI 837 transactions which include Medical (Institutional), Professional and Dental claims for both 4010A1 and 5010 versions.
• Work experience on 820, 834, 835 and 277CA transactions for both versions (4010A and 5010)
• Thorough knowledge on 270/ 271, 276/ 277, 278 transactions.
• Strong Knowledge and working experience on ICD - 9 and ICD 10 code sets and the conversion.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835, 837 270/271 transactions.
• Experience with TriZettos Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Experienced in different types of testing like Black box testing, white box testing, functional, GUI testing, Systems testing, regression, integration, UAT and performance testing
• Expertise in reviewing requirements,
• Business requirements gathering, Data warehousing, evaluating data sources, translating requirements into specifications and application design.
• Experience with QNXT 3.4, QNXT 4.6, Facets 4.71, Inbound & Outbound interfaces, EDI configuration, and data mapping using ANSI X12 4010 and 5010 (834, 835, 837)
• Worked on the Business Process Testing (BPT) of the Quality Center using the input and output parameters, creating different components on the BPT tab.
• Experienced in documenting Test Plan, Test Objectives, Test Strategies, Test Scripts, Test Scenarios and Test Cases.
• Verified application functionality against business requirements, manually and by using Win Runner.
• Experience with structured QA Methodology and QA Process to ensure the Quality Assurance Control.
• Used Quality Center to prepare Test cases, Requirements Traceability Matrix and managing the Defects as per the Business requirements.
• Strong experience in capacity planning, load test configuration.
• Expertise in Black Box, Sanity/Smoke, Integration, Regression, Performance/ Load/Stress, System and Functional Testing.
• Strong experience in Quality Assurance of multi-tier systems, Client/server systems and Web Applications/Sites including testing large enterprise software applications.
• Excellent team player with strong written, communication, interpersonal and analytical skills.
• Extensive experience on Testing of Java, .Net, ERP, PL/SQL, Oracle, DB2 and Mainframes Applications.
• Good Experience in Analysis of Business Requirements, Use Cases, Functional Specifications and Design Documents.
• Internet, mainframe, AS 400, client serve and PC application experience
• Good knowledge in Backend Testing of the applications by executing SQL commands.
• Strong IBM Mainframe/AS400 technical background and programming skills
• Proficiency in testing the applications compatibility on UNIX and Windows platforms
• Executed the job files in mainframe system and maintained the reports.
• Experience in Performance testing of Web applications and Client/Server by using Load Runner
• Experienced in data driven testing by importing data from DB2 and Oracle databases.

TECHNICAL SKILLS

TESTING TOOL: SWin Runner, Load Runner, QTP, SOAPUI,UFT

BUG REPORTING: Test Director, Mercury Quality Center, CQTM

REQUIREMENT MGMT TOOLS: CaliberRM, Rational Requisite Pro

PROGRAMMING LANGUAGES: SQL, TSL (Test Script Language), VB Script

RDBMS: Oracle 8.0/8i/9i/10g/11g, MS Access, My SQL

OFFICE SOFTWARE: MS Office (Word, Excel, PowerPoint)

OPERATING SYSTEM: Windows 95/98/XP/2000/VISTA/7, UNIX/LINUX, MAC

WEB TECHNOLOGIES: J2EE, JAVA, HTML, XML,.NET, ASP.NET, HTML, BEA WEBLOGIC, BEA WEBLOGIC PORTAL FRAMEWORK

PROFESSIONAL EXPERIENCE

Confidential, Minneapolis, MN

Configuration Tester

Responsibilities:

• Responsible for coordinating and performing functional and data-related testing.
• Worked extensively on Member Conversion from four Legacy systems for states (OR, WA,UT and ID) to FACETS 4.x.
• Unit Tested 837 (Institutional, Dental, and Professional), 835, 270/271, 276/277, 820, and 277U transactions with TSO, ISPF, and File Aid.
• Involved in writing Test plans, cases and Test Scripts for Healthcare Claims EDI X12 837 and performed Test Execution on it.
• Data flow for the automated process is validated using a JUNIT provided by the Development team
• Validated compliant batch X12 270/271 transactions, which come in to the Transaction manager, which is in CPSS.
• Validated Inflow of the batch 270/271 will allow trading partners to inquire on multiple Medicaid recipients within a single transaction, versus the interactive limit of inquiring on only a single recipient.
• Validated Junit to test the automated enrollment and Auto recalculation
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Test Manager.
• Tested the 837 Institutional and Professional Claims and 835 payments for HIPAA Compliance.
• Tested member conversion from Mainframe Legacy systems to facets 4.71
• Tested the Import BHCS CDHP (Common direct health Plan) Enrollment.
• Developed IT SOX compliance internal audit controls, procedures, testing, and reporting documentation.
• Performed User Acceptance Testing (UAT).
• Tested and delivered Inbound/Outbound Facets interfaces
• Performed Load, stress and Performance Testing.
• Co-ordinate with the UAT testing team and created UAT Test Strategy, UAT Test Plans and UAT defect reporting.
• Created and maintained the Requirements Traceability Matrix (RTM).
• Created business and work flows to comply with Internal Controls for the SOX regulatory requirements.
• Support full System Development Life Cycle (SDLC) with understanding of various technologies and platforms such SOA (Service Oriented Architecture), ESB (Enterprise Server Bus), BOD (Business Object Document), web, client/server and mainframe, entity-relationship diagrams (ERDs) and relational database concepts, and object-oriented programming.
• Was responsible for UAT execution and tracked and managed defects and enhancements
• Worked with business to create controlled UAT input data
• Created tickets for all defects and enhancements identified in UAT
• Created daily status reports during UAT execution. Involved in regular reports, feedback and communication with the management
• Coordinated the IT SOX change management, service level agreements, disaster recovery and contingency planning efforts.
• Involved in project planning, coordination and implemented QA methodology.
• Involved in preparation of Test strategy document that defines the test environment, phases of testing, entrance and exit criteria into different phases of testing and resources required conducting the effort
• Involved in the review of requirements with functional manager and technical specialists
• Created an end-to-end integrated test script that meets business functionality.
• Defect detection, reporting and tracking was done using MQC.
• Updated defects report to expedite the system test process time.
• Involved in the meeting with SME (subject matter experts) and Technical Lead and Project Director.
• Involved in preparation of Test Cases, Test Scripts and API level Testing (functional).
• Participated in the test environment setup and in ensuring that the facilities, test tools and scripts are in place to successful perform the required testing effort
• Developed test cases and scripts for Functionality, Security and GUI Testing.
• Conducted Load testing to generate the load on the server by creating Database User scripts
• Performed Database integrity testing by executing SQL statements.
• Performed extensive Regression Testing for subsequent versions of the application using QTP.
• Involved in Configuration testing.
• Used Mercury Quality center for documenting the test scripts and to track, analyze and document the Test Plan.
• Participated in various meetings and discussed Enhancement and Modification Request issues.

Environment: - Windows, Unix, Mainframe, Sybase, Onyx, TriZetto FACETS 4.71,Mercury Quality center, UFT, Load runner, Web services, JUNIT, Web logic,, MS Office, Crystal reports, JavaScript, HTML and Lotus Notes.

Confidential

QA Tester

Responsibilities:

• Testing both inbound and out bound and XML files and prepare analysis document with various results.
• Responsible for working with the State to review and modify process flows to increase productivity and effectively utilize QNXT features not provided by the legacy systems.
• Wrote test plans and tested individual transactions for Medicare / Medicaid transactions (837I, 837P, 835 and 834).
• Developed regression test scenarios based on mapping specifications and compliance guidelines of the EDI System.
• Participated in Automated regression and Non-Functional test plans.
• Assisted informational needs in mapping of Test Cases.
• Maintained Test Matrix with the test results obtained.
• Analyzed inbound X12 HIPAA files and execute Trading partner testing and integration.
• As a point person need to train and guide the testing team during test script preparation.
• Involved in identifying the base testing efforts on a prioritized feature schedule.
• Addition of a new provider, Attaching Pay to/PCP affiliations to a provider. Modifying Org Policy for an employer and fee tables i.e. making changes in fee amount, effective and terminate fields etc.
• Tested Crossover claims for Coordination of benefits between different health plans e.g. Medicare, Medicaid and Private insurance plans
• Involved in the review of requirements with functional manager and technical specialists, and mapping the requirements to test cases using CQTM.
• Troubleshoot any problems found within QNXT when testing the SQL database while validating against the business rules.
• Assisted business in developing requirements and test cases for submitting Trizetto Product Enhancement Requests.
• Assisted informational needs in mapping of Test Cases.
• Performed GUI testing, Integration testing, Regression testing, Ad -hoc testing, Negative testing, End to End testing, Load testing, User Acceptance testing on multiple projects
• Wrote Test Scenarios, Test cases in excel sheet and imported them to Quality Center.
• Logged defects in Quality Center, re-tested defects, analyzed defect with Users and Developers.
• Involved in writing the positive and negative test cases.
• Working closely with User group and Developers.
• Used SQL Plus to query the oracle database.
• Reviewed Performance/Stress testing results done by analyzing Task distribution diagram, Transaction Profile and User profile, creating virtual users and analyzing different reports.

Environment: .Net framework 2.0, SQL Server, Oracle 9i., ClearQuest Test Manager, Mercury Quality center, MS office suites, Trizetto QNXT, EDI gateway, FlexiFinancials.

Confidential, NY

ICD Tester

Responsibilities:

• Worked on all phases of SDLC (Software Development Life Cycle) and Quality Assurance methodologies of Agile
• Served as a lead for the Facets testing effort, involved in the Reviewing of Requirements Specification with functional manger and technical specialists.
• Develop testing strategy and test plan, outlined various capabilities of the testing process.
• Describe the tasks of each testing capability, outlined roles and responsibilities related to the testing process.
• Wrote test cases in Quality Center derived from the BRD and generated a Traceability Matrix for testing purposes.
• Implemented manual testing of a web-based application, including backend, functional and integration testing
• Did gap analysis forHIPAA4010 to 5010 and 837 transactions, and analyzed error.
• Wrote Test scenarios and test cases for testing the migration of EDI4010 to 5010 and the processing of member enrollment and benefits, (834) batch jobs corresponding to the claims (837).
• Involved in forward mapping from ICD 9 to ICD10 and backward mapping from ICD10 to ICD9 using General equivalence Mappings (GEM).
• Experience with Networx pricer-testing and figuring pricing for procedures and claims based on information inputted into NetworX.
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets.
• Involved in end-to-end testing of FACETS Enrollment Claim Processing and Subscriber/Member module.
• Identify scope systems that will be modified by the ICD-10 project to accommodate ICD-10code and /or downstream impacts steaming from ICD-10 codes.
• Tested the HIPPA EDI 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data on different modules.
• Involved in Black box testing, System testing, integration testing, Functional testing, Smoking testing, Regression Testing and User Acceptance Testing (UAT) manually and Automation tool.
• Executed Automated Test scripts using QTP
• Experiences working in ANSI x12 837-835 EDI Transaction.
• Resolved issues with member attributes, enabling multiple rules associated with member lookup process in Facets.
• Managed defect tracking process, which include prioritize bugs, assign bugs and verifying bugs using QC.
• Handling/Tracking defect in the Quality center and export in to Excel by using filter.

Environment: Agile, MS Office Tools, Windows XP, HP ALM 11, Facets, web based application, MS SQL, Oracle, DB2 and UNIX.

Confidential, Denver

QA Tester

Responsibilities:

• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Unit, Integration, Smoke, functional, Regression, and system testing.
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Used Quality Center for preparing the test plans and manual test scripts.
• Reported defects using Quality Center.
• Involved in loading the flat files into Oracle Database and involved in writing Complex SQL Queries.
• Involved in writing Complex SQL Queries using TOAD to validate the loads & Extracts.
• Processed claims in Facets & QNXT and verified 835X12's are generated and sent to Provider.
• Processed 837P, 837I & 837D transactions, verified those 837 transactions converted correctly to XML file format & XC keyword file format and verified the claims data loaded to Facets & QNXT for further processing.
• Enrolled members through online screens and 834 transactions to Facets & QNXT..
• Tested the portal application to make sure the claims, members are loading to Facets & QNXT and Providers can check the member eligibility and claim status.
• Involved in testing the Pharmacy Claims.
• Involved in testing the Medical Claims & Dental Claims in QNXT.
• Involved in creating rules (eg: copay, deductible, quantity limits) for Pharmacy Claims testing.
• Processed NCPDP transactions to make sure Pharmacy claims routed to Facets.
• Followed the HIPAA implementation guides for preparing the EDI files.
• Used Desktop Validation tool to check the EDI files for HIPAA errors.
• Executed commands in Unix to view the files and FTP the files to Unix server for processing.
• Assisted in the development and maintenance of Testing Procedures and adhere to all business processes.
• Ability to work from functional specifications to write test plans.
• Managed test plan and schedule
• Automated Claims & Members screens in Facets & QNXT using QTP.
• Performed backend testing using SQL queries and verified data integrity
• Interacted with developers & various members of team to discuss and resolve defects and their priorities.
• Performed backend testing using SQL queries and verified data integrity

Environment: Java, Java Script, Oracle 11i, Facets, QNXT, SQL, UNIX, COBOL II, DB2, CICS, TSO/ISPF, JCL, Windows/NT/2000, Quality Center, QTP and TOAD

Confidential, Louisville, KY

QA Tester

Responsibilities:

• Participated in setting up testing environment.
• Involved in reviewing and enhancing the codes for applications.
• Involved in decision making to launch new builds.
• Prepared Test Plans and Test Cases based on the functional requirements and
• Understanding of the EDI transaction sets 837, 835 and standards on data exchange process in the Healthcare Industry between various covered entities. Knowledge of ICD-9 & ICD -10 codes for diagnosis and procedures.
• Wrote test cases for Endorsements, Cancellations and Reinstatements.
• Participated in the management of testing project with the help of WinRunner.
• Performed Manual Testing to check the usability of the application.
• Executed Configuration Testing to check if the application was compatible in different environment for each module of the application.
• Performed “Rate Quote” check according to Medicaid Policy and verified if the system prompts proper response for the customers who are not qualified for Medicaid program.
• Developed WinRunner Automation Test Scripts to perform Functionality, Security, UAT and Regression Testing for 4 different modules of Confidential web application.
• Part of a team for testing FACETS Accumulators
• Involved in FACETS Implementation, involved end-to-end testing of
• Set claim processing data for different FACETS Module.
• Tested HIPAA regulations in FACETS HIPAA privacy module.
• Performed Data Driven Testing using WinRunner by inserting different values manually.
• Analyze LoadRunner test results using merge graphs and reported Bottlenecks.
• Used Ramp up and Ramp down options to simulate real time scenario.
• Developed LoadRunner scripts and inserted Rendezvous Points at various places in script
• Conducted Back-End Testing manually for the purpose of Database Integrity.
• Defect tracking and bug reporting using Quality Center.
• Conducted result analysis and interacted with developers to resolve bugs.
• Interacted with developers, business analysts and discussed technical problems and reported bugs.
• Met with the developers and technical content writers on a daily basis to update the test documents

Environment: Windows, Oracle, UNIX, WinRunner, Quality Center, FACTES, HIPAA regulations.