SUMMARY:

• 8+ years of experience in Quality Assurance and software testing in Health Care industry.
• Highly experienced in SDLC (software development life cycle) system.
• Experienced on FACETS and used different modules (application): claim, provider, utility managements, member/subscriber and others.
• Experienced in different types of Methodology (Waterfall, Agile, Rup and Scrum).
• Experienced in writing test plan, creating test scenario, writing and executing the test cases and test script
• Expertise in RTM (Requirement Traceability Matrix) and gap analysis.
• Extensive experience in Manual and Automated testing using QC, JIRA and QTP/LR such as load runner, win runner. And create a repots (standard, tabular and test summary) and have knowledge in performing stress, load and volume test.
• Expertise in Bug tracking and reporting using Jira, ALM Quality Center and Rational Clear Quest. And experience of Bug life cycle system.
• Experience in SIT and UAT Test Case preparation and Execution.
• Expertise in different types of testing such as black box, sanity, smoke, positive, negative, integration, configuration, and regression testing as well as UAT(User Acceptance Testing).
• Experienced in testing Client - Server and Web-Based Application. Front-end and back-end tests.
• Expertise on back end testing using SQL on oracle, MS SQL server environments running on UNIX or Window platform to verify data integrity. And knowledge of ETL testing.
• Experienced in Selenium automation using Selenium Web Driver, Selenium IDE, Java, Junit.
• Well versed with Automation Frame work developing POM classes using java in Selenium Web Driver.
• Strong Knowledge of HIPAA and their regulation. Knowledge of Medicare and Medicaid.
• Knowledge in HIPAA Implementation. Have been involved in a variety of HIPAA related projects. Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side.
• Worked on conversion from ICD-9 to ICD-10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D).
• Understood EMEVS, the NY state's electronic Medicaid eligibility verification system & the Medicaid & Medicare intermediary along with their roles in claim processing.
• Did Presentations making Stakeholders understand how the changes would affect different modules w.r.t. Medicare and Medicaid.
• Proficiency in EDI 4010 to EDI 5010. Involved in conversion and mapping HIPAA ICD9 to ICD10. Expert in COB (coordination of benefits).
• Extensive knowledge of health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, and EDI
• Expert in EDI and HIPAA testing privacy with multiple transaction exposure such as new Member enrolment 834inbound, claim 837 inbound or claim adjudication, response to claim 835 outbound, 276 status inquiry, 277response, 270 eligibility/271 benefits. Tested accordingly.

TECHNICAL SKILLS:

Operating System: Window (2000, Me, XP, Vista, 7), Linux, Sun-Solaris, UNIX and MS-DOS

Databases: Oracle, Toad, Db2, MS SQL Server, My SQL, MS Access

Test Management Tools: ALM Quality Center, JIRA, Rational Clear Case, Test director.

Testing Tools: QTP, Selenium(IDE/Web driver), Load Runner, Team Foundation Server, SOAPUI, Microsoft Test Manager

Bug Tracking Tool: ALM QC, JIRA, Clear Quest, Bugzilla. PVC Tracker.

Programming Languages: C, C++, SQL, PL/SQL, Visual Basic, and Java, Oracle.

Application and Web Servers: Apache, Tomcat, IIS, Web Sphere

Methodology: Waterfall, Agile, Rup, Scrum

Web Methodologies: HTML, XML, XSL, XSLT, JavaScriptProductivity Tools

MSWord, MS Excel, MS: Project, MS Visio, MS Outlook.

PROFESSIONAL EXPERIENCE:

Confidential, VA Beach, VA

Sr. Quality Analyst / ETL Tester

Responsibilities:

• Developed Test Plans, Test Cases, and Test Scripts for SIT and support for UAT tests.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Conducted Black Box Testing on the application and validated the dataflow in the application.
• Written multiple Test Cases (System, Integration) for multiple transactions include 837I, 837P, 835, (both inbound and outbound) transactions.
• Imported preexisting Microsoft Word and Excel-based requirements and tests for analysis in ALM.
• Promoted Unix/Informatica application releases from development to QA and to UAT environments as required.
• Involved in testing of multiple applications with QA, SIT and UAT testing by documenting, reviewing, resolving defects, follow up with interface sign-off.
• Executed SQL Queries to retrieve data from tables and to perform back end testing.
• Created Test Cases after analyzing the BRD’s.
• Experience with Trizetto Facets System implementation, Claims and Benefits configuration set-up testing, Inbound/Outbound Interfaces and Extensions, Load and extraction programs involving HIPAA 837 (Claims) and proprietary format files and Reports development.
• Worked with FACETS edits and EDI HIPAA Claims (837/835/834) processing.
• Prepared test matrices based through defect status in HP ALM.
• Enhanced, modified and executed QTP scripts.
• Involve in testing of FACETS Implementation, involve in end-to-end testing of FACETS Claims. Processing module, Membership and benefits.
• Involved in testing Web services and XML using SOAP UI. Verified the response received by updating the request XML.
• Recommend on implementation of HIPAA 5010 (EDI X12 837,834, 820, 278,270,999) in the new System.
• Involved in end-to-end testing of FACETS Enrollment Processing and Subscriber/Member module.
• Prepared and executed different SQL Queries against the Oracle and Sybase Database.
• Verified and Validated the Rates Calculations and Rate Renewal Calculations for different Products and benefits by Preparing and executing different SQL Scripts.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Performing a wide range of QA duties in an Agile (Scrum) development environment.
• 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.
• Worked in SIT and UAT environments to assists end users.
• Tested the claims processing and Adjudication (EDI 837I, 837P, 837D& EDI 835).
• Skilled knowledge of understanding and validating the X12 EDI format files 834 benefits and enrollment.
• Tested Regression EDI834, 820 Transactions following the HIPPA compliance EDI Standard of X12.
• Used TOAD Software for Querying ORACLE. And Used Teradata SQL Assistant for Querying Teradata.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, transactions.
• Involved in testing Web services and XML using SOAP UI. Verified the response received by updating the request XML.
• Extensively used ETL methodology for testing and supporting data extraction, transformations and loading processing in a corporate-wide-ETL Solution using Informatica.
• Worked on Informatica Power Center tool - Source Analyzer, Data warehousing designer, Mapping & Mapplet Designer and Transformation.
• Responsible to design, develop and test the software (Informatica, PL SQL, UNIX shell scripts) to maintain the data marts (Load data, Analyze using OLAP tools).
• Responsible for testing packages using SSIS (ETL) to verify Data Completeness, Data Transformation, Data Quality, Integration Testing, UAT & Regression Testing.
• Involved in Integrating and Functional System Testing for the entire Data Warehousing Application.
• Created and uploaded Requirements and Test Cases on HP ALM.
• Conducted Functional, Positive/Negative Testing, Unit, Integration Testing and System Testing for different modules of application.
• Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing).
• Worked as ETL Tester responsible for the requirements / ETL Analysis, ETL Testing and designing of the flow and the logic for the Data warehouse project.
• Created new, and modify existing SQL queries for use in the data integrity testing of the data warehouse application's ETL process.
• Led and managed the User Acceptance Testing (UAT) for the implementation of Facets Extended Enterprise administrative system with emphasis on ensuring that the HIPAA regulations are met across all the modules.
• Developed test scenarios and implemented test plans for Product test, integration test, system test and user acceptance test (UAT).
• Participated in system testing and user acceptance testing worked with System Test Review team and developers to resolve

Confidential, Raleigh, NC

QA Analyst/ ETL Tester

Responsibilities:

• Directly involved in download data from production environment to different test environment, defined in Oracle Database.
• Participated in weekly meetings to keep up to date with issues and business changing elements.
• Involved in mentoring specific projects in application of the new SDLC based on the Agile, especially from the project management, requirements and architecture perspectives.
• Worked on agile methodology.
• Executed System Test cases during the SIT (System Integration Testing) phase.
• Developed Test Cases for Deployment Verification, ETL Data Validation, Cube Testing and Report testing.
• Performed analysis of the business requirement (functional and technical) and developed user stories, acceptance criteria, screen mock-ups, functional specifications, use cases, etc. for the assigned area of the client’s system.
• Used QTP for automated testing, modified VB Scripts to meet requirement.
• Planned the UAT testing, test plans, test cases and worked with the business users for UAT test execution in developing the training documentation.
• Managed Testing for multiple projects through SIT, Regression, End to End, and UAT testing.
• Authored test case scenarios in Excel spread sheet and export them into ALM.
• Tested EDI transaction 834 enrollment file into Facets.
• Prepared Test Strategy, test plans and Test Cases, Scenarios as per requirements and executed as and when needed.
• Tested the enhanced FACETS, evaluating claims adjudication needs and creating HIPAA-compliant business rule configurations.
• Authored Test cases for HIPAA EDI Transactions 270/271, 276/277,837/835.
• Responsible for Back-End Testing Using SQL Commands using TOAD.
• FACETS version upgrade implementation project and worked extensively on 837i (Institutional Claim), 837p (Professional Claims), 837D (Dental) and 834 (Enrollments).
• Tested the front end price in facets application through backend testing.
• Executed Test cases manually by composing 270, 276,837 EDI files and dropped inbound and check response 271,277,835 using interleaves and outbound.
• Experience in creating different Test Scripts for BAT, SIT and UAT.
• Configured, testing, quality assured and documented configuration solutions for all applications in the FACETS system.
• Involved in the error checking and testing of the ETL procedures and programs Informatica session log.
• Performed numerous data extraction requests using SQL scripts to prepare ad hoc reports.
• Performed Data Analysis, Data profiling and Data validation by writing SQL queries using TOAD
• Developed SQL queries, functions, stored procedures and triggers to perform the backend testing of the data
• Worked with relational databases, and developed PL/SQL queries to interact with Databases.
• System Integration testing for Facets core modules with external systems.
• Validated 835, 837, 276, 277, Institutional and Professional HIPAA Transaction and X12 format messages.
• Test Case design and Test execution using HP ALM.
• Executed Functional and Regression testing using application QTP/UFT.
• Actively involved in documentation of UAT (User Acceptance Test), Functional Test, Integration Test Scenarios and Bug Log.
• Involved in Data Analysis, Data Validation, Data Modeling, Data Profiling, Data Verification, Data Mapping, Data Loading, and Data Warehousing/ETL testing.
• Responsible for updating the QA manager on weekly updates regarding the progress of testing efforts and open issues t be resolved.
• Tested data warehouse ETL process using SSIS (Integration Service).
• Involved with ETL test data creation for all the ETL mapping rules.
• Verified the SOAP message delivery to the web services and verified the XML formatted response using the SOAP UI.
• Involved in Unit Testing, System Integration Testing (SIT) and User Acceptance Testing (UAT).
• Used HP ALM (defects management tool) for defects/bugs tracking.

Confidential, Bethesda, MD

QA Analyst

Responsibilities:

• Reviewed the Use Case Requirement, Functional Design Documents and Technical Specification documents.
• Developed Test Cases after analyzing the BRD’s.
• Wrote Test Cases in Excel based on Technical Specifications, Functional Specifications and Business rules for online application system.
• Used QC for writing Test Plans, defining Test Cases, developing and maintaining Test scripts, analyzing the results of scripts, interaction with developers in fixing the errors.
• Wrote Test Plans in MS Word for Manual Testing, System Testing, Integration Testing, Performance Testing.
• Proficient in soliciting client Requirements through interviews, workshops, existing system documentation.
• Developed requirements specifications via User Stories utilizing AGILE.
• Conducted Manual Testing for checking the flow of the application functionality in QC (Quality Center).
• Analyzed user requirements and prepared test approach document.
• Performed black box testing including smoke, Unit, regression, integration and functional testing.
• Performed GUI testing manually.
• Involved in System Integration Testing (SIT) and User Acceptance Testing (UAT).
• SQL server Integration Service Package Testing
• Involved in creating documents and diagrams for Membership Enrollment according to the HIPAA 834 Compliance Standards for Membership Enrollment.
• Performed 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 EDI Transaction 834, 835, 837.
• Executed and validated data mapping for Claims via EDI into RDC through Oracle PL/SQL.
• Hands on experience in working on designing and reviewing the EDI system applications.
• Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Authorization, etc.).
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers for professionals.
• Performed Root Cause Analysis.
• Tested the HIPAA EDI 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data on different modules.
• Conducted Functional, System Integration (SIT), Regression, UAT, Smoke and System Testing
• Involved in integration testing on FACETS system to verify HIPAA compliance from .
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets.
• Involved with ETL test data creation for all the ETL mapping rules.
• Tested the ETL Informatics mappings and other ETL Processes (Data Warehouse Testing).
• Tested and Quality Center for version control, tracking defect, enhancement request, assign work activities and asses the status of the project.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 276/277, 270/271, 837/835.
• Involved in Functional, Black Box, Usability and Regression Testing for UAT (User Acceptance Testing) using QTP.
• Performed system integration test, system test, functionality test (positive and negative), and re-test and regression test.
• Testing the ETL data movement from Oracle Data mart to Teradata Data mart on an Incremental and full load basis.
• Analyzed ETL mapping from source database to target database.
• Created Test Plans, SQL scripts for verifying the ETL process as part of the Enterprise Data Warehouse (EDW).
• Performed UAT manually till user satisfaction.
• Uncovered issues related to the data population in the backend database queried using SQL.

Confidential, Dayton, OH

QA Tester

Responsibilities:

• Created Test Documentation and Test Plans.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Entered numerous claims for testing purposes to ensure accurate and quality adjudication and implementation of business and operational requirements.
• Performed Requirement Gathering & Analysis by actively soliciting, analyzing and negotiating customer requirements and prepared the requirements specification document for the application using MS Word.
• Conducted interviews and workshops for soliciting customer requirements.
• Worked on Data Mapping to map Facets data to outbound eligibility extracts.
• Wrote SQL queries to extract and validate the data from the Facets database.
• Used Quality Center to create to create Test Plan, Test cases and test scripts as well as steps for manual and automated implementation of test cases in Quality Center.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Tested the HIPAA EDI transactions 820, 834, 837/835, 276/277, 270/271 according to the requirement test scenarios.
• Created test data for 837I, 837D, 837P to have Segments/loops information with different combination of Submitter, Receiver, Billing Provider, Pay-To-Provider, Subscriber, Payer, Patient, Claim Information, Physicians, Referring Provider, Service Line Info, Adjudication Information.
• Worked on batch processing of EDI transactions like 270/271 - Eligibility Benefit Inquiry/Response and 276/277 - Claim Status Request / Response.
• Performed Backend testing on Membership Enrollment of Facets functionality.
• Involved in testing HIPAA Transactions & Code Sets Standards (820- Premium Payment for enrolled health plan members, 834- Enrollment /Dis-enrollment to a health plan, 835, and 837.)
• Developed and maintained complex SQL queries for MS SQL Server and MS Visual SourceSafe for extensive back end testing purposes.
• Analyzed and worked with HIPAA specific EDI transactions for Claims, member enrollment, billing transactions. Worked specifically with 837, 835, 999 and 834.
• For testing purposes, manipulated Members information in the QA environment through Facets front-end application.
• Prepare test data in HIPAA compliant X12N format for both inbound and outbound healthcare EDI transactions.
• Intensively involved in project testing efforts by helping testers perform System Integration Testing, Regression Testing and by helping UAT team in User Acceptance Testing (UAT)
• Monitoring the performance of the system on a day-to-day basis.
• Performed GAP analysis of 4010 and 5010 EDI transactions 270, 271, 276, 277 and 999 using implementation guide to identify the changes in the segments and data elements.
• Regression testing on weekly builds. Performed weakly Walkthroughs and Inspection meetings.
• Performed Black Box Testing. Performed Positive and Negative testing for the system.
• Conducted Back End Testing to test the connection between Store’s system and the database in order to verify data integrity.
• Gathered requirements from the user and prepared functional specifications along with data flow diagrams for the Member/Group configuration, Enrolling subscribers and members, Configuring different sections of members like Eligibility, Address, Medicare and Claims data.
• Created new UAT scripts based on requirements.
• Worked on creating templates for UAT test execution.
• Excellent knowledge of Health Insurance Portability & Accountability Act (HIPAA) standards, Medicaid and Medicare regulations, Health Care Reform (HCR), Electronic Medical Record (EMR) and Electronic Health Record (EHR ) and Medicaid Management Information Systems (MMIS).
• Determined the requisite ICD 10 training for both internal staff and Medicaid provider groups and assisted in the development of training materials.
• Reviewed Functional Specifications and Unit Test Designs and attended for Formal Walk Through meetings.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment.
• Formed advanced SQL Queries and used Microsoft Excel to investigate data issues in the Data Warehouse and worked with the Users and Technology Team to formulate a solution to resolve the issue
• Bug reporting using Quality Center.
• Involved in manually testing the application from the backend to carry out data validation.