SUMMARY:

• 6+ Years of experience in the Field of Quality Assurance relates to Healthcare Industry
• Conducted Smoke, Functional, System integration, Backend Testing, Regression Testing.
• Created & maintained Test Plan, Test Schedule, Release Notes, Exit Report, and Cycles run analysis.
• Created Status report and participated in Defect Status meetings.
• Prepare baseline Test data to share among the team.
• Extensive experience working on Facets Claims Processing, Billing and Medical Provider application groups.
• Strong systems experience with various FACETS ( ), Health rules, and QNXT.
• Worked on Data migration, FACETS version upgrades 4.71/5.01, Reports Implementation, letters, Inbound/outbound Interfaces and FACETS Extensions.
• Experience creating inbound/outbound files for Confidential transactions, specifically 834 & 837.
• Worked with BA & the development team during design phase.
• Extensive knowledge in Back - End Testing using SQL queries.
• Thorough knowledge of the SDLC phases and various models: Agile, Waterfall, Scrum, RUP.
• Expertise in translating user requirements and technical specifications into test cases and mapping the process design.
• Analyzed Enhancement requests and Change requests.
• Experienced in using various tools for defect management and test case management such as ALM (quality center) and SharePoint.
• Experience with Medicare, Medicaid, & commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 834,835, 837 for interfaces & images to clearinghouses/ trading partners applications.
• Strong HIPAA Confidential 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from payers, providers and exchanges perspective, with primary focus on Coordination of benefits

TECHNICAL SKILLS:

Testing/Management Tools: Quick Test Pro, Rational, ALM

Defect Reporting Tools: Quality Center (ALM), Rational ClearQuest, Global Remedy

Software/Operating Systems: Windows XP/Vista/7/8, UNIX, MS Office, Visual Basic, Filezilla, VPN, CSV

SQL: HTML, XML

Databases: MS SQL Server, Oracle, MS Access

Web Servers: IIS, Web Sphere

PROFESSIONAL EXPERIENCE:

Confidential, Woonsocket, RI

Sr.QA Analyst

Responsibilities:

• Performed Regression, Systems, end-to-end testing to maintain the quality of the application.
• Reviewed and created test scripts and executed test cases.
• Helped with building ICD-9 to ICD-10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves.
• Used Quality Center for Requirements Documentation, Test Plan, Execution and Bug Tracking.
• Performed data validation, field verification and data display.
• Produced bug reports based on priority and severity of the problem.
• Attended bug tracking and problem escalation meetings.
• Effectively identify, testing, report, monitor issues using Jira system and communicate risks to the Product team and suppliers.
• Create and track defects in JIRA. Responsible for retesting the functionality after the issue is fixed by the Development Team.
• Expertise in Bug Tracking and Bug Reports using Bug tracking Tools like PVCS / JIRA & Quality Center.
• Interact with developers and business analyst.
• Maintained Bugzilla bug tracking system eventually migrating to Jira for integration.
• Performed batch jobs to upload all the patient opportunities to Rx Connect from different sources Like EOMS, RXDW.

Environment: Quality Center, Java, UNIX, Windows XP, XML, Oracle, Team Track, JIRA

Confidential, Nashville, TN

Sr. QA Tester

Responsibilities:

• Analyzed the system requirement specifications and developed appropriate test plans, test cases test scripts and executed testing.
• Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
• Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Strong experience in working in Windows and UNIX environments.
• Worked on claim processing module, which involved Receipt and Verification of Claim Forms (837) and Claims Adjudication, Health Claim Payment/Advice (835) as per HIPAA guidelines.
• Used Claim Test Pro 4.44 to perform a claims payment system upgrade to a newer release.
• Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
• Designed and documented test plan, test strategies, test cases in Test Manager by evaluating the requirement document in RequisitePro and performed hands-on testing for complex test conditions, scenarios and scripts so HIPAA transactions in Confidential formats are verified.
• Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Served as a point of contact for CMS and trading partners to do the testing for various types of claims and real time transactions like 270/271/276/277 for Medicare and Medicaid programs in FACETS .
• Worked on customizing the claim module of FACETS for repricing Nursing home claims.
• Worked on ICD-9 to ICD-10 conversion in FACETS .
• Data mapping on Enrollment Module ( Confidential 834) of FACETS .
• Validated and analyzed Confidential outbound and inbound Transactions.
• Executed test cases for the existing market’s various lines of business. (The test cases covered: Authorization of claims, Accumulator, Benefits, Claim Payment and Pricing, as well as member and provider data updates)
• Queried for claims and members using Claim test pro.
• Validated the application against the expected results by inserting Database, Bitmap and GUI checkpoints.
• Performed data-driven testing to read test input data from an Excel File so as to test the application with different positive and negative data.
• Analyzed the functionality and came up with test scenarios for split-billing process on FACETS .
• Performed QA Acceptance testing for test workflows with business users and performed data encryption testing as per HIPAA guidelines to ensure the privacy, security and confidentiality.
• Extensively used QC for defect reporting and tracking and prioritizing defects and enhancement requests after base lining the requirements.
• Attended change request meetings to document changes and implemented procedures to test changes.
• Involved in continual improvement of automation test scripts to provide improved QA of testing processes and to reduce whole testing cycle time.

Environment: HP Quality Center, Zephyr, Claim Test Pro, Facets, Oracle SQL Developer, Compass, PEGA, Claims look-up Environment (CLUE), Optum Encoder Pro, Pre-Certification look-up tool (PLUTO)

Confidential, Buffalo, NY

Quality Analyst

Responsibilities:

• Analyzed system requirements and developed detailed Test Plan.
• Performed Manual Testing for the Confidential transactions.
• Conducted GAP analysis and filling gap according to the format set by HIPAA.
• Involved in FACETS Implementation, involved end-to-end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Elicit requirement to be able to generate the tools and info needed to process the ICD-10.
• Work on coordination of benefits (COB) in a claim processing.
• Developed Test Script for Functionality, Security, and Regression testing.
• Ran the scripts on multiple environments (QA, UAT and Production) to ensure that requirements were still met.
• Performed GAP analysis for HIPAA .
• Wrote Test scenarios and test cases for testing the migration of Confidential and the processing of member enrollment and benefits, (834) batch jobs corresponding to the claims (837).
• Perform troubleshooting and resolve errors in 834 and 820 transactions for health insurance exchanges.
• Prepared Test Cases based on business requirements and business rules for HIPPA Confidential Transaction 834, 835, 837.
• Executed and validated data mapping for Claims via Confidential into RDC through Oracle PL/SQL.
• Assisted in working in establishing Confidential system security by suggesting the solution and getting the solution implemented
• Processed Confidential 834 with various scenarios and validate the related tables from database using SQL query.
• Hands on experience in working on designing and reviewing the Confidential system applications.
• Perform compliance testing on 834 and 820 Confidential transactions
• Application of Confidential 834 transactions in reinstating members, new enrollment, and terminating member enrollment
• Tested all HIPAA transactions for HIPAA 5010 and validate the database.
• Analyzed HIPAA 4010 and 5010 standards for 837P Confidential X12 transactions, related to providers for professionals.
• Perform Root Cause Analysis.
• Tested the HIPPA Confidential 834, 835, 837 transactions according to test scenarios and verify the data on different modules.
• Perform middleware testing between Front- end application and MIS (Members information system) database using SOAP UI.
• Responsible for continuous process improvement of the reconciliation process
• Transforming Analyst Notes in Preparation for outreach team to contact consumer
• Accessed Health Insurance Casework system for Membership coverage 834 & 820Enrollment reconciliation process
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 834,835 transactions.
• 834 Membership enrollment data mapping with the use of workbook Performed Back-End Testing to check database integrity by writing SQL queries.
• Set claim processing data for different Facets Modules.
• Tested HIPAA regulations in Facets HIPAA privacy module.
• Wrote test cases in HP ALM derived from the Design documents and generated a Traceability Matrix for testing purposes.
• Created Traceability Matrix to ensure implementation of all functionalities, identify all test conditions and test data needs.
• ICD 9- ICD-10 Conversion Analysis - Worked in the analysis of the ICD 9 - ICD-10 codes.
• Uploaded the diagnosis codes, procedure codes to the related tables in test environment to verify the changes related to ICD9 - ICD-10 changes.
• Tested the configuration of Claims, Enrollment and Customer Service Sub-Systems in Facets.
• Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound
• Validated member’s benefits against the benefits matrix.
• Validated SOAP and REST services using SOAP UI pro.
• Good experience as SOAP web services tester.
• Analyzed and tested data on claims manually and writing queries on DB database for validating data.
• Worked within a team to resolve Relational Database problems.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Investigated software bugs and interacted with developers to resolve technical issues using HP ALM.
• Verified the data transformations and loaded from external data sources in Teradata, Oracle and SQL Server to the data warehouse and from the data warehouse to data mart using SSIS.
• Used ALM to record documenting information useful in debugging process, evaluating test data.
• Created Automation Scripts for all online interfaces using Quick Test Professional (QTP)/UFT Wrote test cases, implemented ran and added versions and iterations using test manager for positive, negative and end-end test cases.
• Experienced in creating generic, reusable test functions and Automation scripts using VBScript in QTP to fully automate the application functionality.
• Worked with Large DB2 and Oracle, SQL Server databases doing loading, validation and manipulation of data
• Prepared and maintained the Test Matrix, Requirements Traceability Matrix.
• Participated in release meetings and also participate in Retrospective session.
• Extensively worked on any requirement upgrade and/or change request while doing UAT.
• Worked closely with development team to ensure the application performance and stability and also ensure the application completes the whole end-to-end process.
• Participated in weekly status meeting with Development and Management Teams.

Environment: Agile/Waterfall, MS Office Tools, Windows XP, ALM, Facets, Java, DB2, SOAPUI, MS SQL, UNIX.

Confidential

QA Analyst

Responsibilities:

• Created test plans and test procedure templates and guidelines to be used by the QA team
• Managed Offshore and Onshore QA resources.
• Responsible for assigning QA resources across Projects.
• Lead lessons learned sessions after each releases
• Participated in cross functional teams to developer a comprehensive functional and systems level solution test including cross functional review for such plans.
• Drive Test scoping of new features and releases with input from cross-carrier test team members
• Establishing, and managing test environments and test data
• Excellent written and oral communication skills required for business partner relationship management and customer facing
• Created Confidential Export and Import processes and work with Confidential Trading Partners, Payers or Vendors.
• Worked with providers and Medicare or Medicaid entities to validate Confidential transaction sets or Internet portals. This includes HIPAA 4010; 837, 835.
• Prepared files for validation for Confidential transactions 834, 835, and 837.
• Provided healthcare provider problem resolution. Work as a medical coding SME, including ICD-9, HCPCS; Procedures and diagnosis testing
• Worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets.
• Worked on Facets Claims Processing (Dental, Medial) and Subscriber/Member (Eligibility Inquiry, Enrollment) application groups.
• Involved in creating mappings for the conversion of Confidential X12 transactions code sets version and translation of ICD 9 codes into ICD 10 codes and Performed User Acceptance Testing (UAT) with the Business.
• Performed Functional, Integration, System Integration, Regression Testing.
• Extensively used complex SQL queries to extract data and also manipulate data during testing.
• Designed Test cases, test plan creation and Companion Guide development from stage to production
• Used Rational Tool & ALM for defect tracking and reporting
• Processed Testing files using Web services and make sure it’s converted into standard XML.
• Collaborated during web-services using QTP and SOAP UI.
• Conducted Back-End Testing and Regression Testing using various phases of the application
• 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-9 Confidential testing.

Environment: UML, Quality Center, MS Visio, SQL Server, Oracle, SOAP UI, QTP, Facets