OBJECTIVE:

Accomplished health insurance professional with over Eight Plus years' experience. Thorough health insurance knowledge with a broad background in systems testing (including all versions of Facets). End to end knowledge in testing/auditing and processing hospital and medical claims. Extensive expertise of provider, claims benefits, configuration and UM testing. System conversion, SIT & UAT experience.

SUMMARY:

• Over 8+ plus years of experience as Facets QA Tester with excellent understanding of Software Development Life Cycle (SDLC), Software Testing Life Cycle (STLC) and Development Methodologies like Waterfall and Agile process with project management skills.
• Extensive experience in all phases of SDLC processes.
• Professional experience in Software Tester on various domain as a manual testing in web and mobile application testing.
• Experience working with HIPAA EDI 837 transactions which include Medical (Institutional), Professional and Dental claims for both 4010A1 and 5010 versions.
• Good experience working with Claims Processing ITS, Member enrollment, Billing and Provider applications in FACETS.
• Thorough knowledge on 270/ 271, 276/ 277, 278 transactions.
• Expertise in Manual Testing in different testing methodologies like Agile and Waterfall etc.
• Hands on experience with Manual Testing with Web & Mobile app at Android platform
• Experience in Testing facets core application and UAT modules.
• Experience in working with FACETS application.
• Experienced in defining the QA Strategy to cover Functional, Performance, Regression, System integration testing and Interface testing
• Executed various types of testing including: Functional, System, Regression, Black Box, Smoke, Positive, Negative, End - to-End, Frontend and Back End testing etc.
• Having Good experience on FACETS /Claims processing module in both Paper claims /Electronic claims, ICD-10/CMS-1500/UB-04 documents
• Extensively worked on Claims Adjudication Process, Benefits, Membership, Member Eligibility, Pricing, Pharmacy, Enrollment and Benefits applications.
• Strong Knowledge and working experience on ICD-9 and ICD 10 code sets and the conversion.
• Experienced in presenting demo in front of the direct client.
• Solid knowledge of Facets claims processing system.
• Successfully collaborated as part of product teams for the launch of various projects that involved both front-end applications and back-end servers
• Experienced in writing test plan, creating test scenario, writing and executing the test cases and test script
• Good experience working with Claims Processing ITS, Member enrollment, Billing and Provider applications in FACETS.
• Experienced in Tools Upgrades to latest versions it is QC 9.0 & QC 10 - ALM 11.5, ALM 11.50, ALM 12.50, JIRA 6.4.5 to JIRA 7.0.
• Experience in testing and validating the database tables using SQL queries and Stored Procedures and performed Data Validation and Data Integration.
• Skilled knowledge of understanding and validating the X12 EDI format files 834 benefits and enrollment.
• Proficient in Developing and executing Test Plans, Test Case, FRD, TriZetto Facets and Medical Billing, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Experience in both Manual and automation testing process and in creating automation environment using Quick Test Pro (QTP), Test Director, and Quality Center. Extensively used SQL queries/Unix commands for data verification and backend testing.
• Experience in Data Profiling, Data Extraction, Data Integration, Data Testing and Data Cleansing.
• Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 4010 EDI transaction codes such as 270/271(inquire/response health care benefits),276/277(Claim status), 834(Benefit enrollment), 835(Payment/remittance advice), 837(Health care claim).
• Experienced in project management skills like scheduling, monitoring in gap analysis, risk analysis.
• Expertise in testing Enrollment, Billing and claims processing in FACETS
• Strong understanding experiences for testing creating test cases for different EDI transaction like 271, 277, 834, 835 837
• Experience in Backend testing of SQL Queries using Oracle, SQL Server and DB2.
• Manual Testing skills include White Box Testing, Black Box Testing, User Acceptance Testing, System Testing, Regression Testing, Integration Testing, Load Testing, Security Testing, Joint Alliance testing and Smoke Testing.
• Experienced in CLAIMS, MEMBERSHIP, ENROLLMENT, BILLING.
• Hands on experience in validating data from Flat files, Excel spreadsheets and external RDBMS.
• Strong ability to write SQL queries to test ETL process and PL SQL.
• Performed pre and post validation of data files using vi editor commands on Unix.
• Possess strong computer and office administration skills with a good knowledge of Microsoft Office Suite (Word, Excel, PowerPoint, Access, and Visio).

TECHNICAL SKILLS:

Defect tracking: Quality Center 11.0 (ALM)/ 10.0/9.5/9.2, ClearQuest 7.0

Testing Tools: QTP 10.0/9.5

Open source tools: SoapUI 2.5/3.0/4.0

Claims Software tools: Xcelys, TriZetto's Facets 4.51/4.71/4.81, Diamond and NASCO

Languages: Java, J2EE, ASP, C#, VB.Net, SQL, PL/SQL, T-SQL, XML

Operating Systems: Windows NT/2000/2003/XP/VISTA/7 and UNIX

RDBMS: Oracle 11g/10g/9i, SQL Server 2008/2005/2000, Access 2007

Version control: TFS, VSS, PVCS, Rational ClearCase

IDE's: Visual basic, Visual Studio 2005/2008, Visual Studio Team System (VSTS)

Other Tools: SQL*Plus, SQL Developer, SQL Navigator, TOAD

Methodologies: Agile, Waterfall, SDLC and RUP

Web/Application: server IIS, Apache Tomcat, WebSphere, WebLogic.

MSOffice: Outlook, Express, Word, Excel and Power point

PROFESSIONAL EXPERIENCE:

Confidential, Boston, MA

Software QA / Test Specialist

Responsibilities:

• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Performed extensive Functional Testing, Regression Testing, GUI testing, End-to-End testing, Usability testing and Comparison Testing.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Analyze and document Medicaid EDI transactions issues related to implementation of HIPAA 5010 and ensure these issues are documented and addressed in the approach to the HIPAA 5010 version.
• Analysis of inbound and outbound interfaces and extensions to FACETS Claims Processing system.
• Manual front-end testing of apps to find the obvious and non-obvious bugs.
• Tested the HIPPA EDI 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data on different modules.
• Application of EDI 834 transactions in reinstating members, new enrollment, and terminating member enrollment
• Created end to end solution testing scenarios and data integration validations.
• Checked error log in back end server when functionality fails from the front end and include when reporting defect for functional failure.
• Supported the subject matter expert on quality and compliance issues related to clinical trials
• Prepared detailed technical design documents for Data Integration Interfaces.
• Conducted Validations for different FACETS modules Providers, Claims and Membership.
• Wrote test plans to in corporate the testing needs of the data warehouse using HP ALM.
• Developed and maintained Test Strategy and Test Plans across multi project fast paced environment.
• Providing draft Test Estimates and Test Schedules to the project team.
• Created test cases and performed manual front-end testing, tracked defects, then collected, analyzed, and documented data for evaluation on the possible success
• Performed manual testing through all phases of development life cycle (Usability, Functional and Regression Testing) using Black Box Testing methods, White Box Testing & Grey Box Testing
• Tested the Inbound / Outbound Interfaces to Facets and populated XML files.
• Tested the Members, Claims, Providers and Services in Facets.
• Participated in manual front-end testing to check all functionalities of different modules.
• Responsible for testing all new and existing ETL data warehouse components.
• Ensuring a high level of quality in all testing deliverables, including conducting QA reviews. Identifying and reporting project risks logged against Clarity.
• Performed front/end testing using various tools, analyzing results, providing feedback to developers and business analysts
• Prepared Test Scenarios, Test Cases and Test Data for FACETS enrollment.
• Conducted business validations, covering the following deliverables: Facets Providers, Facets Claims and Facets Membership and Operational reports.
• Facilitated knowledge transfer sessions & design reviews for the front end
• Maintained knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations. Maintained Test Matrix and Requirement Traceability Matrix.
• Executed the UNIX shell scripts that invoked SQL loader to load data into tables.
• Ability to manage change during the test process.
• Analyzed and worked with HIPPA specific EDI transactions for claims, memberships, enrollments, billing transactions,
• Assisted extensively on HIPAA EDI 837 (I & P), 835 and 820, 820s, 270/271 for different business users.
• Maintained knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
• Communicated with Users, Managers and business analyst along with Team Leader for understanding the business and database flow.
• Tested all HIPAA transactions for HIPAA 5010 and validate the database. Created members through express claim test pro for testing purposes
• Developed and upgraded EDI maps for transactions 810, 830, 850,852,855,856 and 857 using the X12 standard.

Environment: Facets 5.01, HP ALM, DB2, sFTP, Visual Basic, ASP, XML, SQL, MS Access, UNIX, SQL Server, networks pricing, Windows, UFT, Selenium, Load Runner

Confidential, MN

Healthcare QA/Facets Tester

Responsibilities:

• Wrote test script for Business Object report testing
• Developed Test Strategy/Test Plan, Test Cases & Test Scenarios based on Functional Requirement Documents and business requirement document.
• Tested/audited day-to-day system configuration changes to ensure functionality and maintain a versatile claims adjudication system, accurate eligibility and claims processing, and tested system upgrades.
• Set claim processing data for different Facets Module.
• Performed manual Mobile Application Testing through Beta phases of Functional& Black Box Testing of Android platform.
• Provided technical guidance to data integration team and Perform Unit tests and System Integration testing.
• Performed claims/benefit review, claims adjudication, adjustment, batch process
• Analyzed Business Requirements Documents to get better understanding of the system both on technical and business perspectives.
• Prepared Test Plans, Test Scripts and Test Cases based on functional specifications and user requirements.
• Involved in FACETS Implementation, involved in end to end testing of FACETS Claims, Billing and Subscriber/Member modules.
• Utilized Benefits Matrix to translate Business Requirements and build Medicaid and Medicare Advantage Plans in Facets.
• Executed and Validated Test Cases for Benefits and Enrollment applications.
• Created Test data for validation like member's creation, Providers, and for processing Claims in Facets.
• Verified clinical information and tested electronically received patient data.
• Developed and maintained automated regression test cases in Selenium Web Driver using Java programming language and Junit Framework.
• Performed manual front end testing on web app and Native app using mobile platform android devices.
• Written Complex SQL scripts and analyzed them for effective Data validation and Data Integration
• Created end to end solution testing scenarios and data integration validations
• Work closely with PMs, developers, QA leads and managers in multiple different process related facets.
• Experience in working with open source tools such as Selenium (Selenium IDE, Selenium RC, Selenium Web Driver and Selenium Grid), Cucumber, JUnit, JIRA, and Eclipse.
• Performed manual front end testing on web app and Native app using mobile platform android devices.
• Responsible to check whether interfaces and extensions are properly integrated with facets applications.
• Conducted trainings for the end users about the best practices and processes for HP QC/HP ALM.
• Performed backend testing of Facets tables. Validated claim process workflow in Facets.
• Worked in the agile environment with frequently changing requirements and features set.
• Prepared Test Scenarios, Test Cases and Test Data for FACETS enrollment
• Prepared Test Plans, Test Scripts and Test Cases based on functional specifications and user requirements.
• Developed test code in Java language using Eclipse IDE and Test NG framework.
• Performed exhaustive data integration testing using SQL.
• Performed front/end testing of Web based reporting applications, analyzing results, providing feedback to developers and designers
• Processing claims in Facets and resolved the errors before the claim can adjudicate.
• Designed and Developed UAT Regression automation script and Automation of functional testing framework for all modules.
• Automate the Test cases with Selenium Web driver, JavaScript framework and run it on different Browser's and Cross Plat-Form.
• Worked on verifying and analyzing runbooks for Facets Core jobs by passing various parameters.
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270/271 for Eligibility inquiry, and 276/277 for claims status.
• Conducted HIPAA Gateway Testing. Tested the claims processing and Adjudication (EDI 837I, 837P, 837D& EDI 835)

Environment: TriZetto Facets 5.01, UFT, SQL Server, Oracle, XML, SOA testing, JAVA, J2EE, JIRA, WARP, Shell Scripting, Test Plans, Quality Center, End to End Testing, Jenkins, UAT, SOAP UI, REST, JAVA Script, Regression Testing, JUnit, HP ALM, Windows, Agile Methodology, networks pricing, Selenium, Load Runner

Confidential, NY

Mainframe Facets QA Tester

Responsibilities:

• Compared the allowed amount with the same claims in Facets source environment to make sure the pricing is same, and it hits the same term
• Developed code libraries and tests for TriZetto’s Personal & Clinical Care Advanced applications (PCA & CCA) using descriptive programming.
• Created end to end solution testing scenarios and data integration validations
• Worked on testing data migration, data integration and data transformation.
• Performed data validation in clinical and management reports using Win SQL
• Analyzed the differences between Facets and Modeler claims pricing.
• Collaborated with Clinical Operations to ensure inspection readiness
• Provided technical guidance to ETL team and Perform Unit tests and System Integration testing.
• Tested via database comparisons and through manual front end testing
• Performed manual front-end testing to check all functionalities of different modules.
• Analyzed and worked with HPAA specific EDI transactions for claims, memberships, enrollments, billing transactions.
• Assisted in working in establishing EDI system security by suggesting the solution and getting the solution implemented
• Processed EDI 834 with various scenarios and validate the related tables from database using SQL query.
• Hands on experience in working on designing and reviewing the EDI system applications.
• Performed compliance testing on 834 and 820 EDI transactions
• Tested via database comparisons and through manual front end testing
• Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
• Assisted business users in defining test plans and UAT test cases.
• Established and maintained test cases and test data in Quality Center.
• Coordinated with the QA Offshore team for testing activities across multiple systems and managed test execution.
• Used MS Visio for flow-charting, process model and architectural design of the application.
• Strong experience in conducting Gap Analysis (GAP), Functional testing, User Acceptance Testing (UAT), and System Integration testing (SIT).
• Used Load Runner and put rendezvous points to test the Performance of the application under heavy load, and finding out the bottlenecks within the application
• Developed and execute test scenarios, and test cases for each built process
• Prepared the suitable test cases for all environments to conduct the Performance, and Load testing
• Participated in 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.
• Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and looked for defects.
• Tested the enhanced FACETS, evaluating claims adjudication needs and creating HIPAA-compliant business rules configuration.
• Involved in assessment of tools for use in future HIPAA 4010/5010 migration and compliance by performing GAP Analysis. Provided business and technical process flow recommendations.
• Performed comparative analysis and gap analysis to identify variation in the process as per HIPAA X12 4010 and 5010 guidelines to in corporate updates as per 5010 guidelines

Environment: EDI X12N 5010, MS Outlook, UNIX, and Internet Explorer, UFT, ALM, Load Runner, TriZetto Facets 5.01.

Confidential - Richmond, VA

Manual Quality Assurance Tester

Responsibilities:

• Reviewed the Requirements document for 4010 and prepared the test plan and test cases.
• Worked on existing clinical web portal application
• Created test cases and performed manual front-end testing, tracked defects
• Responded to inquiries regarding EDI issues with enrollment, claims, payments, and/or clearinghouse activities.
• Transactions focused on were 270,271, 834, 278, and 837 in 4010 and 5010 versions of HIPAA standards.
• Worked Extensively with Inbound 837 I and 837 P, 835s (Out bounds) claims processing systems
• Created and executed test cases for testing HIPAA compliancy using Spec Builder 6.8.1.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 837/835.
• Analyzed HIPAA 4010 and 5010 standards for 837i EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Validated end to end clinical work flow
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets, value fields and definitions.
• Enhanced Test Scripts for Data Driven testing using QTP.
• Performed black box testing including smoke, regression, integration and functional testing.
• Performed GUI testing manually.
• During the Progress of the Project Participated in walkthroughs and reviews.
• Used teleconferencing to have a clear understanding of the business change request.
• Used the Quality Center to create and maintain Test Requirements and to communicate the bugs with the Developers.
• Participated in the meetings to follow up on Defects/Issues
• Performed Functional and Regression testing using automation tool QTP and validating, documenting the actual results.
• Participated in UAT along with the business users after the application was deployed.
• Maintained Metrics participated in weekly status updates showing the progress of the testing effort and open issues to be resolved

Environment: XP, Quality Center