CAREER SUMMARY:

• An IT professional with 9 plus years of experience as a Sr. Quality Assurance Application Engineer and UAT Test Analyst with hand holding vast experience in Healthcare industry.
• Hands on experience gathering requirements, interviewing senior level company officials to gather requirements for documenting project functional specification.
• Excellent communication abilities and strong analytical and writing skills.
• Experience and understanding of software development process including Software development life cycle (SDLC), RUP’s Iterative System Development Life Cycle process, implementing the Rational Unified Process (RUP) in all four phases of a project Inception, Elaboration, Construction and Transition.
• Experience in capturing data requirements, data analysis & data mapping for Vendor feeds and Databases.
• Wrote Test Scripts, Technical Specification Documents, and worked on application’s input / output data definitions.
• Experienced in customer/client interaction, deep understanding of Business systems functionality and technicality.
• Used MS Excel spread sheet, PowerPoint, MS Visio, and MS Projects.
• Expert in agile software development and release management.
• Experience in creating and maintaining the Requirements definition documents that included Business requirements and Functional requirements.
• Coordinated with onsite/offshore resources to fix Quality Center queries during SIT and UAT.
• Vast knowledge and experience in Confidential industry experienced in testing different healthcare ERP solutions such as FACETS claim processing solutions.
• Involved in Processing QNXT 837 Healthcare Claims (Institutional and Professional) in PORTAL with valid TPI.
• Involved in testing QNXT Member, Provider, Claims Processing, Utilization Management, Accumulators, Contracts and Benefits with proper ICD - 9 and ICD - 10 and HCPCS/CPT codes.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
• Experience in Automation using Mercury Interactive Tool QTP/UFT.
• Performed Load Testing, Performance Testing and Stress Testing.
• Worked with EDI X12 5010 as well as ANSI X12 4010 including medical transactions such as 837 (medical claims), 835 (medical claim payments), 270 (eligibility inquiry), 271 (eligibility response), 276 (claim status), 277 (claims status response).
• Good knowledge of Health Insurance Plans (Medicare Part A, B, C and D), managed care concepts (Medicaid and Medicare) and experienced in determining the eligibility, billing experience within life and disability in health plans.
• Experience in developing XML requests for Web Service Testing and validate response XML
• Worked on healthcare standards such as HIPPA 5010,4010, ICD-9 and SOAP.
• Prepared unit test cases and performed unit testing.
• Extensive experience in Functional, Integration, Regression, User Acceptance (UAT), System, Load and Blackbox testing.
• Agile Management and Software development with Extreme Programming, Scrum, RAD and Agile RUP.
• Expertise in all areas of software development including client interaction, requirements gathering, analysis and tele-conferencing with the client during the progress of the project.
• Efficient in MS Project/MS Excel for planning/status reporting/writing test scenarios.

TECHNICAL SKILLS:

OPERATING SYSTEM: Windows 2003 Server, Windows 98/XP/Vista/Windows7, UNIX, LINUX

VENDOR/TESTING TOOLS: QTP, HP LoadRunner, TriZetto Facets 4.31,4.71,4.81, 5.10 QNXT, MCS Claim Test Pro (CTP)

TEST MANAGEMENT TOOLS: Quality Center, TestTrack, Zephyr

BUG TRACKING TOOLS: Bugzilla, JIRA, Rational Clear Quest, Quality Center, Zephyr, QA Complete, ALM

FRONT END TOOLS: Adobe Photoshop, MS Office, MS Project, MS Visio

LANGUAGES: C, C++, SQL, TSL, Visual Basic.NET, PL/SQL

WEB TECHNOLOGIES: HTML, XML, .NET

INDUSTRY STANDARDS: ANSI, HIPAA, ISO, CMMI

RDBMs: SQL, MS Access, Oracle 9i, Sybase, MS SQL Server 2000, IBM DB2, WINSQL

MISCELLNEOUS: VPN, Go-To Meeting, Live Meeting, Citrix, SnagIT9, Firebug, Smart Draw, Net Meeting, MS Communicator, Cisco Jabber, MS Lync, Cisco WebEx, Skype

PROFESSIONAL EXPERIENCE:

Confidential

QA Application Analyst

Responsibilities:

• Developing Test Cases bases on Requirement Specifications and Design Documents.
• Responsible for modification and executing of the Test Scripts.
• Involve in testing QNXT Member, Provider, Claims Processing, Utilization Management, Accumulators, Contracts and Benefits with proper ICD - 9 and ICD - 10 and HCPCS/CPT codes.
• Involve in manual claims Adjudication process.
• Creating, Approving and Modifying PA in both Portal and QNXT.
• Involve in Adding Contracts to the Provider in QNXT and associating Providers in Portal while creating claims.
• Involve in Functional, Integration, and Regression testing of the application.
• Process Medical claims and applied edits to the claims for testing purposes
• Involve in Processing QNXT 837 Healthcare Claims (Institutional and Professional) in PORTAL with valid TPI.
• Working in utilization management module for to create and test PA.
• Involve in uploading and processing of EDI 278, 276 claims in Portal.
• Prepare sample EDI test sets for files like 276/77, 278,837 and followed HIPAA implementation guide in preparing them.
• Coordinating with offshore people and updated the tasks to manager.
• Involve in analysis of Test Plans and Test cases, detecting bugs in the system, handling of defect tracking using Bugzilla reporting by interacting with developers for Debugging.
• Working with stakeholders in UAT environment to ensure Business requirements are tested properly.
• Utilizing RMT for running the tasks like uploading, modifying, executing and taking logs accordingly.
• Updating status report on weekly Basis and submitted to the team prior to weekly meeting.
• Participating actively in conference calls, project meetings and delivered input.

Environment: ASP.NET, VB.NET, QNXT, DB2, Oracle, SQL, QNXT, UNIX, Windows, Bugzilla, RMT.

Confidential, TN

Sr. QNXT Tester

Responsibilities:

• Reviewed the Business requirement, Functional Design Documents and Technical Specification documents using Unity Client Onbase.
• Created Test Plan, Test Cases, and Test data after analyzing the Onbase CCR.
• Analyzed change requirements for Benefit, Providers, Contracts and Claims processing modules configuration in QNXT system for Medicaid and Medicare Advantage for AL, FL, GA, IL (ICP &MMAI)MD, NC, SC, PA and TN plans in different environment UAT 4, ITE and UAT 3
• Performed Functional testing and adjudication on QNXT for claims.
• Using Claim Test Pro to retrieve Institutional and Professional claims by entering CPT/Rev Code and creating Test Batch
• Performed White Box, Black Box, and Usability Testing.
• Extensively used SQL Server Management Studio to get the Member data based on Benefit Plan and
• Network
• Tested various Diagnosis code ICD 9 and ICD 10 to pay various benefit terms correctly
• Tested Finance or Medical Code with Provider billing service code with allowable price rates
• Tested the changes for the front end screens in QNXT related to following modules, test the QNXT batches (member load, Billing, Provider, etc).
• Validated different region (Status C Code Arkansas, DC, Kansas, Alabama, Tennessee, Illinois, Floridaetc) to test Fee Schedule amount to test different contract and their codes.
• Validated different terms with different effective date so that service codes pay % correctly
• Created Claims to test various IPA Contracts to pay out correctly based on their Payment Fund
• Used CTP to retrieve various claims for different Benefit based on their Benefit Plan.
• Created different Institutional claims with their Bill Type and Rev Code to hit the correct term and contract which pay out correctly for different term type
• Planned, documented, evaluated and tracked testing results to ensure system applications are free from defects

Confidential, MN

QA Application Analyst

Responsibilities:

• Documenting and log all results and issues identified during each UAT phase, providing feedback to developers.
• Managing and track status of all UAT activities during each UAT phase.
• Conducting the test cases and logging the defects using Bugzilla based on their priority and severity.
• Providing work effort estimations for UAT scope, based upon established Entrance and Exit criteria, and maintain adherence to risk management guidelines
• Ensure the correct process (defect resolution, change management, and issue management) is Identified and followed to achieve timely resolution
• Analyze active system changes/updates to assess impact to, documentation, procedure, etc.
• Identify reports, and documents risks associated with testing and ensures proper mitigation
• Researching unexpected test results to identify root cause and ensures their proper resolution
• Applying methodology and processes with technology and tools to improve quality and efficiency
• Participate in User Acceptance Testing (UAT) for multiple functional work areas on varying applications and platforms
• Effectively analyze and decompose business requirements into testable components
• Ensure that quality processes are carried out through all phases of the Software Development Lifecycle, while meeting all project-related deadlines
• Working independently on projects, where tasks are self-determined and not specifically assigned
• Working closely with the Project Team to identify risks and UAT scope early in the project lifecycle
• Build positive professional relationships with internal and external customers
• Prepared test scripts for automated testing using UFT
• Conducted GUI Testing manually.
• Conducted backend testing using UFT and inserted different checkpoints in UFT.
• Performed Data Driven Testing, Functional Testing, System, Integration, and Regression testing using UFT for application releases.
• Inserted Check Points to check the broken Links, Text, and standard properties of an object using UFT.
• Performed Security Testing manually using Positive and Negative Testing to ensure appropriate user authentication
• Used Recovery Scenario Manager in UFT to handle exceptions
• Tested and detected bugs in the front end of the application
• Analyzed HIPAA EDI transactions in XML and X12 responses and looked for defects.
• Execute tests within Web-based, Windows-based, and/or mainframe applications & environments
• Monitor, measure and communicate test results
• Create, prepare, and obtain sign-off for UAT documentation

Confidential, Studio City, CA

QA Application Test Analyst

Responsibilities:

• Delivering quality testing effectively and on time, achieving department and business goals
• Writing and executing test plans and test scripts to support manual testing of new development platforms
• Effectively communicating the status of testing results, including risk assessment, both verbally and through documentation
• Involved in Business functionality review meetings and Use-Case Analysis.
• Analyze the System Requirements, Functional requirements and Business Requirement Documents.
• Extensively communicate with Business Analysts to come up with efficient test plans and test cases.
• Test cases will be develop based on the requirements supplied then scripts will be written to execute the testing steps.
• Expected results will be built on each test case during Systems testing. Every attribute on the table(s) for every case will have the data that’s expected to appear on the row documented.
• Maintain Test cases, Test scripts, and Expected results in HP Quality center.
• Mapping the requirements to test cases (Tractability metrics)
• Develop Test Plan and overall Test Strategy for the program using Test Manager
• Develop Test Cases and Test Scripts for System and UAT Testing.
• Involve in analyzing the requirements and understanding production volumes of Claims Processing.
• Exploring and documenting initial approaches working with new and emerging platforms
• Participating in scrums representing the needs of the QA team as a lead QA engineer for various projects
• Assisting other internal QA and development engineers testing multiple projects
• Implementing best practices and procedures for quality assurance
• Supervised the use of Quality center for Defect Reporting.
• Responsible for preparation of weekly status report.

Environment: QC/ALM, MS SQL Server 2005, MCS, Manual Testing, QNXT, CTP, Microsoft Office - MS Access, MS Excel.

Confidential, Detroit, MI

Quality Assurance Test Engineer

Responsibilities:

• Involve in gathering requirements for Business, System and Functional for the application.
• Participating in developing Test Plan, Test Cases and detailed test cases in Excel and importing as needed into TestTrack test management tool.
• Assisting in the development of quality assurance and testing policies, standards and procedures Assisting the Manager in test planning and execution tasks
• Coordinating with Business Analysts and IT Technical Delivery Leads to complete testing specifications and release requirements
• Assisting in the creation of Test Plans including UAT, SIT, E2E, and Regression
• Coordinating with IT Technical Delivery Leads on project test planning and test execution schedule
• Design, develop and execute test strategies/plans; debug and troubleshoot; collaborate with test resources on proper and testing procedures
• Performing QA status reporting to the Manager of Business Analysis & Quality Assurance
• Providing assistance in the coordinate of defect tracking, defect triage activities, and issue resolution for all assigned projects.
• Adjudicating claims testing via MCS claim processing.
• Ensuring that all system tests are successfully completed and documented and all problems are resolved prior to any production releases
• Supporting all quality initiatives that are implemented during each phase of the system development life cycle
• Assisting the Manager in test planning and execution tasks
• Coordinating with Business Analysts and IT Technical Delivery Leads to complete testing specifications and release requirements
• Assisting with creation of Test Plans including UAT, SIT and Regression
• Coordinating with IT Technical Delivery Leads on project test planning and test execution schedule
• Coordinating with Business testers and IT Technical Delivery Leads to schedule and execute UAT testing
• Designing, develop and execute test strategies/plans; debug and troubleshoot; collaborate with test resources on proper and testing procedures
• Performing QA status reporting to the Manager of Business Analysis & Quality Assurance
• Assist in the coordinate of defect tracking, defect triage activities, and issue resolution for all assigned projects.
• Ensuring that all system tests are successfully completed and documented and all problems are resolved prior to any production releases
• Supporting all quality initiatives that are implemented during each phase of the system development life cycle.

Environment: TestTrack, MS SQL Server 2005, MCS, Manual Testing, JIRA, Microsoft Office - MS Access, MS Excel.

Confidential, Long Beach, CA

Sr. QA Test Analyst

Responsibilities:

• Developed 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.
• Reviewed the test environments that will support the various testing capabilities, highlighted testing schedule across all testing capabilities.
• Implemented and standardized and Unified process throughout the software Development Life Cycle.
• Involved with other team members to set up testing tools, implementation and testing environments.
• Modified previously existing test cases that were driven by the manual testing within ALM
• Involved in Designing and Analyzing of Test Scope strategies with other Test Analyst.
• Wrote Unit, Integration and System Test cases using ALM from BRD - Functional, Technical and other high level documents.
• Performed manual testing using Test Management tool ALM.
• Manually Conducted Positive and Negative testing.
• Extensively involved in writing Test scripts using HP ALM to perform manual testing
• Performed Sanity and Smoke Testing of the application manually after each build.
• Involved in Health PAS-Administrator - QNXT Implementation testing, involved end to end testing of QNXT Billing, Claim Processing and Member module under Administration area.
• Set claim processing data for different QNXT Module.
• Validated EDI Claim Process according to HIPPA compliance.
• Tested HIPPA regulations in QNXT HIPPA privacy module.
• Conducted System, Integrated and Regression testing to the application.
• Conducted Functional, User Acceptance and Usability testing.
• Involved in creation and maintenance of Test Matrix and Traceability Matrix.
• Created and maintain SQL Scripts to perform back-end testing on the oracle database.
• Performed Backend testing by extensively using SQL queries to verify the integrity of the database.
• Used ALM for the reporting and tracking of defects.
• Outlined approach for documenting, tracking, and resolving issues found during testing, outlined approach for developing acceptance criteria.
• Utilized HealthPAS Trading Partner site for viewing and Submitting Auth s, Submitting Claims, Verify Member Eligibility, View Patient Roster, View Payment Details, and View and Submit Referrals.
• HealthPAS Online Trading Partner site used to upload the X12 files to process these batch files created within CTP and viewed them in Utilities menu under Process Log Browser for X12 batch files submitted through the TP claim portal site to obtain the claim number created for the 4.7 UAT project test cases as assigned by team lead within Health PAS Administrator - HPA 5.0

Environment: Microsoft Office (Word, Excel, Access), Citrix Applications - Claim Test Pro (CTP), Cypress, HPA 5.0/QNXT, SSRS Report Manager, SQL Server Management Studio, MS Outlook, Cisco Jabber, HealthPAS Trading Partner Claim processing, verify member, Citrix and HP ALM.

Confidential, Madison, WI

Sr. QA Test Analyst

Responsibilities:

• Performed regression testing for Invoicing and Tin Matching healthcare programs for which the Veterans Administration
• (VA) Authorizations were created using Confidential internal template and Claims within Facets.
• Wrote test script for Confidential VA Choice COB program within Excel spreadsheet.
• Queried within WINSQL both Production and Client database alongside to get VA Authorization and Member demographic information from backend to validate it onto the frontend within Facets.
• Wrote test scripts for VA COB Choice indicated with (V and L) category program
• Wrote test scripts for Hospital, Medical and VA COB Choice claims.
• Wrote test scripts for SIT testing and participated in the execution of these scripts
• Wrote test scripts and test case for VA Choice COB healthcare program testing.
• Wrote test scripts for integration testing.
• Tested Claims to using the new ICD10 format.
• Created Auths for Invoicing, Tin and VA Choice COB programs with the following types of claims Hospital, Medical, VA Choice COB with (V, L) indicators performing validation to get expected results.
• Afterwards as Auths were loaded planned by test lead to create claims for the above Invoicing, Tin Matching, VA Choice COB programs as needed.

Environment: Microsoft Office (Word, Excel, Access), TriZetto Facets 4.81, WINSQL, Citrix and HP Quality Center.

Confidential, Orange, CA

QA Test Lead

Responsibilities:

• Involved in analysis of business and system requirement documentations.
• Analyzed the Test Strategy composed by QA manager to ensure all activities and tasks timelines are closely followed and keep all testing activities coordination organized.
• Use Cases test scenario preparation to convert them into test cases in order to meet application functionality needs properly.
• Prepared status reporting to QA Manager as needed on weekly basis for ongoing project activities/tasks.
• Preparation of Test summary report
• Peer reviewed updated and modified test cases as needed from time to time.
• Identified test data and test scripts
• Executed Manual test cases for products within the Medical Expansion project.
• Prepared for internal team meetings to discuss and provide activities/tasks status twice a week on a conference call through go-to-meeting and Web-Ex.
• Analyzed software requirements and Functional requirements documents
• (FRD) to get better understanding of the application.
• Conducted Functional, Regression Testing and Integration Testing
• Recorded test result, documented issues in the defect tracking Bugzilla and along with that QA Complete test management tool.
• Performed backend testing of database files using SQL queries.
• Created keyword files for claims within the Medical Expansion project for the following products COD, HN, SRG.
• Performed claims data pull back within Claim Test Pro (CTP) for testing needs requested by Claims department for Professional and Institutional claims for the following areas as follows: COD, SRG, CrossOver, and OneCare.
• Analyzed data and input notes and comments within the spreadsheet and passed it over to the Claims department to conduct their application/functional testing.
• Ensured all system and production problems are recognized and appropriate action is taken to meet batch processing and delivering schedules.
• Provides for new/beginners operators on CTP in order to conduct and build a project/product, Test Cases selection Criteria, execute test cases, create keyword files, run batch files, and pull back claims data as needed.
• Adhered to standard data management practices.
• Ensured timely status documentation is written and kept updated on current procedures.
• Play a central role in coordinating with multiple teams to standardize the QA process.
• Assist with the operation, implementation, maintenance, upgrading, testing, and integration of software.

Environment: CTP, Facets, MS Word, MS Project, MS Excel, Bugzilla, QA Complete, MS SQL Server, MS Lync.

Confidential, VA Beach, Virginia

QA Application Analyst

Responsibilities:

• Wrote test cases and test scripts, execute test scripts and analyzed outcomes.
• Analyzed test results using reports and graphs generated in Quality Center.
• Involved in working with FACETS creating medical and institutional claims for various markets and also created members where needed.
• Set claim processing data for different Facets Module.
• Claim Processing and Subscriber/Member module.
• Created members within MDE and performed member and provider conversion.
• Created ad executed test cases for benefits regression, PCAC, SPCT, SRCT and updated the ICD 9 to ICD10 codes, roll the dates forward to current month, updated Diagnosis and procedure codes in order to match and meet the logic.
• Performed Reconciliation task within MDE- Claim Test Pro to existing claims in the failed status.
• Extensively worked with both Quality Center and Zephyr based on the project needs and leads choice.
• Worked in Compass and ran the test steps within Zephyr to perform the regression test execution for various state markets.
• Coordinate working sessions for testing; communicate risks/issues to ICD-10 project leads.
• Examined the test environments that will support the various testing capabilities, highlighted testing schedule across all testing capabilities.
• Defined approach for documenting, tracking, and resolving issues found during testing, outlined approach for developing acceptance criteria.
• Classified any other potential risks that exist in the current authorization and claim process related to claims overpayment.
• Recommended improvements to standardize authorization and claim process in order to increase auto-adjudication of pended claims related to Authorization Mismatch.
• Wrote test cases and test scripts, execute test scripts and analyzed outcomes.
• Generated and maintained SQL Scripts to perform back-end testing on the oracle database.
• Organized summary reports of configuration changes, test results and recommendations.

Environment: CTP- MDE, Facets, MS SQL Server, TOAD for Oracle, MS Word, MS Project, MS Excel, MS Access, MS Communicator, MS Outlook, PEGA, Compass, Quality Center, SnagIt, Zephyr.

Confidential, Owings Mills, Maryland

Senior QA Analyst

Responsibilities:

• Reviewed the Business requirement, Functional Design Documents, Technical Specification documents and Playbooks.
• Designed and executed Test Plans and Test Cases and generated Test Scripts and Test scenarios using Quality Center.
• Prepared Test cases, according to the business specification and wrote scripts according to the test case.
• Created Test Cases and Test data after analyzing the BRD and Playbooks.
• Monitored ETL batch jobs on batch servers and reviewing Log, Error and Output files.
• Performed Functional and GUI testing on Facets Billing, Customer service and Subscriber application under equivalence Mappings (GEM).
• Validated Load Receipt functionality, Cash Receipt functionality, FazalDupCheck functionality, Group Invoice functionality, Policy Details extract functionality.
• Analyzed Requirements and Design/tech-specs for testability
• Coordinated feedback from testability reviews to PM from the QA team.
• Involved in professional, Institutional and ITS claims adjudication.
• Provided day to day direction to testing activates, coordinated and managed dependencies, Facilities meetings and work sessions as needed
• Analyzed and Determine Test Data strategy.
• Experienced in Interplant Teleprocessing System ITS and Healthcare Claims.
• Extensively worked with EDI transactions such as 835, 837 following the HIPAA compliance EDI standard format of X12.
• Identified scope systems that will be modified by the ICD-10 project to accommodate ICD-10 code and /or downstream impacts steaming from ICD-10 codes.
• Completed several HIPAA 4010 and 5010 Projects, included Medicaid and Commercial entities. Projects include claims and enrollment testing as well as NPI and medical coding and ICD-10 EDI testing.
• EMR system and EDI transactions for claim process ICD 10 conversion knowledge from healthcare domain.
• Involved in testing of HIPPA 835 for the payment of claims and transfer of remittance information.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, 270/271, and others. Provided healthcare provider problem resolution. Work as a medical coding SME, including ICD-9, HCPCS; Procedures and diagnosis testing
• Assisted in identification of test data criteria as needed and follow up with Business teams on delivery of Loan Scenarios to Scenario Builder.
• Determined test environments involved, locations, support contacts for each, access, links, upgrade impacts to hardware/software
• Schedule, prepare and facilitate Test Planning session(s)
• Created Master Test Plan for all phases of testing
• Created and Maintained regression test set for future releases.
• Assisted UAT Business Leads with set up in tools and tool as needed.
• Coordinated UAT testing preparation, execution and reporting activities
• Attended UAT Release level status calls and provide support for defect monitoring or issue resolution
• Obtained final testing signoff from the Project team.
• Managed conflicts and resolving escalations & issues appropriately on time.
• SQL script execution for backend testing support using SQL Server 2008.
• Conducted Smoke, Functional, System Integration, Regression and Backend testing using SQL Queries.
• Created and maintained SQL Scripts and UNIX Shell scripts to perform back-end testing on the oracle database.
• Meet with the Business owners to analyze showstoppers or critical issues that needs to be fixed before go live
• Executed Performance test procedures to check to time span.
• Responsible for running ETL jobs in batch server and validating mapping rules.
• Validated member’s benefits against the benefits matrix.
• Analyzed and testing data on different billing and functionality manually and writing queries on database for validating data.
• Maintained requirement traceability matrix on daily basis and participating in daily defect triage and status meeting.
• Extensively involved in testing CMS Audit Reports and Daily Sales Report in Apex Reporting Portal.
• Created input test files as per the business requirements in Ultra edit and processing them in batch server to load data to respective tables in database and to generate the output.
• Updated Functional Specs as per the change request received from client.
• Provided technical support to the client after every release to production on hotline.

Environment: Facets 4.81, MS SQL Server, Batch Servers, JIRA, TOAD for Oracle, MS Word, MS Project, MS Excel, PEGA CM, Apex Reporting Portal, Quality Center.

Confidential, Wayne, PA

Sr. Quality Analyst/UAT Tester

Responsibilities:

• Involved in preparing “BRD” Business requirement Documents for 5010.
• Prepared “FSD” functional specification document for 5010 from 4010A.
• Involved in developing Test Methodologies, Test Strategy, Test Plans and test cases, Design and developed the manual tests for multiple modules.
• Analyzed system requirements specifications, developed Test Strategy, Test plans, Test Cases, Test Data for manual testing of the functionality, GUI, Compatibility, performance, usability and User Acceptance of the application.
• Conducted GUI Testing & Mainframe testing manually as well as using Quality Center.
• Performed Usability and Integration testing manually on different modules of the application.
• Used Quality Center and later JIRA for bug tracking, reporting and resolving purposes.
• Worked with Quality Center to trace the requirements, write the Test Cases in the test plan, execute the Test Sets in the test lab and track the Defects logged in the defects module.
• Performed the detail comparison between 4010A and 5010 to identify differences across loop Structures.
• Assisted the project manager in scheduling the tasks and allocating resources for the timely completion of the project and efficient usage of the resources.
• Performed the detailed business analysis across line of business (LOB), transaction types.
• Worked on EDI 834, 835,837 as per HIPPA guidelines.
• ICD 9- ICD 10 Conversion Analysis - Worked in the analysis of the ICD 9 - ICD10 codes.
• Uploaded the diagnosis codes, procedure codes to the related tables in test environment to verify the changes related to ICD9 - ICD10 changes
• Tested the workflow for EDI transactions like 276, 277 and response transactions (271, 277).
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers. The Claims were processed, co-pay is calculated, and the pricing is calculated using the IBM systems for both Retail and Direct Claims processing flow
• Conducted “JAD” sessions to understand detail requirements and performed “GAP” analysis.
• Involved in the data movement between systems and validating the business requirements.
• Followed the RUP methodology for the entire “SDLC”.
• Created Interfaces.
• Actively participated in status report meetings and interacted with developers to discuss the technical issues.
• Performed “UAT” from time to time based on multiple projects work-streams needs.
• Loaded test scripts into Quality Controls and evaluated with pass or fail.
• Retested and reevaluated after debugging applications.
• Developed testing plans and executed them.
• Collaborated with clients and business analysts to ensure high-value applications development.
• Worked in testing the Professional, Institutional Claims processing and adjudication and validate data with facets.
• Conducted walkthroughs and defect meetings periodically to assess the status of the testing process and discuss areas of criticality.
• Tested data to check HIPAA implementation.
• Extensively involved in Database testing by writing SQL queries using MS SQL Server and Toad.
• Used SQL Developer to execute Queries.
• Connected to SQL Plus in UNIX and created and executed SQL queries.
• Performed back-end testing by extensively using SQL commands to verify the database integrity.
• Analyzed the code changes for migration purpose. Also analyzed the effort and impact of merging the new code from changes done in production environment to the migrated environment.
• Batch Creation for testing purpose.
• Performed database testing on Oracle, MSSQL and MYSQL databases using SQL queries.
• Ability to write SQL queries with common knowledge of DB2.
• Exercised organized bug and issue tracking via JIRA.
• Interacted with Client to accommodate any new change in requirements as well to discuss the project status.
• Acted as a liaison between the project group and the operations group. Helped design scope document and the request for proposal after extensive analysis and coordinated with top management for the approval process.

Environment: Facets 4.31, Visio, MS SQL Server2005, Toad, DB2, JIRA, Windows XP, MS Office Suite, Quality Center, Oracle

Confidential, Raleigh NC

QA Software Engineer/UAT Tester

Responsibilities:

• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations and to discuss the different ways and means for the integration of Rational tools with the current system using an "adoption through execution" strategy.
• Created testing documentation as needed such as Test Plan/ Test Strategy and how to setup manual or automated test cases.
• Worked with both and provide for any new users using Mercury Quality Center, Quick Test Professional.
• Created Use Case diagrams using UML and Business Process Models using MS-Visio.
• Responsible for Business Process Management (BPM) for development of various projects.
• Participated in providing implementation assessment for Rational RequisitePro, Rational Clear Quest using Unified Modeling Language (UML) and Rational Unified Process (RUP).
• Developed Use Cases, Sequence Diagrams, Activity Diagrams and Class Diagrams.
• Assisting the project manager in creating detailed project plans and scheduling and tracking project timelines.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Set claim processing data for different Facets Module.
• Also worked on implementation of Patient Protection and Affordable Care Act for Medicaid.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Designed and implemented QTP scripting template for web application testing.
• Developed and enhance automated scripts using QTP.
• Optimized QTP scripts for Regression testing of the application with various data sources and data types.
• Worked as the primary liaison between the business user and the developers throughout the project cycle.
• Involved in gathering requirements, developing test plan, designing the test steps, writing test cases and running test scripts using Quality Center.
• Documented test cases and expected results.
• Ensured the appropriate parties review and sign-off on test cases prior to test execution.
• Responsible for conducting user Acceptance Testing (UAT).
• Worked with various Business Intelligence tools for reporting and decision making.
• Performed Gap Analysis to identify the deficiencies of the current system and to identify the requirements for the change in the proposed system.
• Proficient in using ICD 9 and ICD 10 codes.
• Provided healthcare provider problem resolution. Work as a medical coding SME, including ICD-10, HCPCS; Procedures and diagnosis testing.
• Extensively worked with EDI transactions such as 835, 837 following the HIPAA compliance EDI standard format of X12.
• Wrote various SQL queries to create, update, modify tables, create reports and retrieve information from the database.
• Extensively involved in Database testing by writing SQL queries.
• Used SQL Developer/SQL Server 2008 to execute Queries.
• Handled changes at each stage of project development.
• Documented Requirement Traceability Matrix in Requisite Pro for traceability of requirements.
• Scheduled meetings with developers, System Analyst's (SA) and testers to identify resource allocation and project completion using MS Project.
• Assisted the Project Manager in setting realistic project expectations, in evaluating the impact of changes on the organization and plans accordingly, and conducted project related presentations.
• Provided technical assistance in identifying, evaluating, and developing systems and procedures that were cost effective and met business requirements.

Environment: Rational Requisite-Pro, Rational Clear-Quest, RUP, MS Office, MS-Project, MS Visio, MS SQL Server 2005/2008, QTP, Quality Center.