SUMMARY:

• Nearly 8 years of extensive experience in the IT industry with emphasis on EDI Tester and Software Quality Assurance with Data validation, ETL and Testing using SQL Server.
• Good knowledge in various phases of Software Development Life Cycle (SDLC) including Requirement Analysis, Logical design, Resource Planning, Code Development and Testing Life Cycle (TLC).
• Very good understanding of Data Warehousing concepts, Data Analysis, Data Warehouse Architecture and Designing.
• Solid understanding of Agile Scrum model that allows us to focus on delivering the highest business value in the shortest time.
• Excellent knowledge of EDI transaction files such as 270/271, 276/277, 470, 835, 820, 837 and 834.
• Expertise in various SDLC methodologies like Waterfall, V - model and Agile.
• Experience in testing the HIPAA EDI transactions 834, 837/835, 276/277, 273, 270/271 according to the requirement test scenarios.
• Experience in Facets implementations and end-to-end testing of Facets Billing, Claim Processing and Subscriber/Member module.
• Automate data extraction and data masking to support an iterative, repeatable process that supports end to end testing of key business processes - Establish and Manage TDM Strategy.
• Experience in Black Box Testing, Integration Testing, Usability Testing, Smoke Testing,
• Functional Testing, System Testing, Regression Testing, Performance Testing & UAT Testing
• Experience in analyzing requirements - Business requirements, Functional requirements and Technical specifications and created test strategies.
• Worked on Data migration, Facets version upgrades, Reports Implementation, letters, Inbound/outbound Interfaces and Facets Extensions. Implemented EDI transactions 837, 835, 270/271, 276/277 and 834.
• Demonstrated experience in creating and developing test Plan, test cases & test data.
• Hand on experience in Creating and Managing Defect Cycle, traceability Matrix and eliminating redundancy and duplications
• Extensive experience working on healthcare projects.
• Experience with Medicare and Medicaid: Claims processing, Membership, and Eligibility Verification
• Familiar with HIPAA EDI transactions
• Solid Back End Testing experience by writing and executing SQL Queries.
• Experience in MMIS (Medicaid Medicare Information System), FACETS.
• Proficient experience in different Databases like Oracle, MS SQL and MYSQL.
• Versatile Team player with good communication, Leadership and interpersonal skills

PROFESSIONAL EXPERIENCE:

Confidential - Alexandria, VA

QA Tester/ EDI Tester

Responsibilities:

• Prepared Test Plans, Test Cases for both positive and negative scenarios in accordance with the System Requirement Document.
• Data Creation in Test Data Management (TDM) Created 834 and 837 I/P/D data files for various states that Well Care handles. Also, TDM team creates data upon request for different teams like Encounters, Claims and 834.
• Validated EDI Claim Process according to HIPAA compliance.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Performed testing for Medicare, Medicaid ; Tested EDI X12 transactions like 270/ /
• Participated in analyzing and defining the testing requirements based on the application Functionality.
• Involved in gathering test data for data conditioning from Business Units to test full application functionality.
• Wrote Automated Test scripts using QTP.
• Participated in testing various interfaces (Inbound and Out bound)for Facets
• Involved in organizing Daily Status meetings with QA manager. Conducted test plan. Reviews
• Created test scenarios for System testing and Regression testing.
• Responsible for escalating the data between Test Data Management (TDM) Team and QA Team.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals.
• Extensively worked on any requirement upgrade and/or change request while doing UAT.
• Wrote EDI related test cases to test inbound (270/837/ transactions) and outbound files (271/277/835 transactions).
• Performed Online Security testing of different profiles in Facets.
• Identify business scenario, write / execute test scripts, automate; and drive for success criteria & management of the Test Data Management (TDM).
• Wrote Modification Request for bugs found during test execution using Quality Center
• Created test cases, executed and recorded results of test cases using Quality Center
• Analyze the functional requirements, writing test cases for each and every object. Using test specs and test frames created, automated the test cases using Quality Center.
• Responsible for inserting Check points to verify Functionality of the application using QTP.
• Monitored the defect tracking process, trouble shooting and generating customized graphs and reports for the client.
• Performed Functional and GUI testing on Facets Billing, Customer service and Subscriber application under Facets
• Wrote and enhanced test cases and test scripts to meet new functional requirements as per the new business requirements for ETL process verifications as well.
• Executed automated test scripts using Quick Test Professional for all Lines of Business.
• Involved in full life cycle testing including Regression test on new builds of the application.
• Creating, reviewing and maintaining a comprehensive regression test suite.
• Attended meetings with Developers and Team Lead in resolving the issues.
• Tested Web page presentation manually for different browser compatibility.
• Involved and supported User Acceptance Test.
• Backend testing of the DB by writing SQL queries to test the integrity of the application.

Confidential, St Louis, MO

QA/EDI Tester

Responsibilities:

• Involved in conducting Smoke and Sanity Tests
• Used Rational Robot for GUI tests and tested GUI standards of this application
• Involved in Functionality, Regression Testing, Integration Testing, System Testing, User Acceptance Testing, Positive Testing and Negative Testing on Application.
• Prepared test plans on various Facets modules such as Membership, Claims, Providers, Finance, Customer Service and according to MS CHIP plan requirement.
• Performed extensive testing in Facets Subscriber/Member, tested Groups, Eligibility, and Enrollment and validated outbound 834 Extracts to different Vendors.
• Responsible for creating UAT, SIT & Regression Test cases in the test plan module of Quality Center'
• The Agile process was followed throughout the project; all artifacts are generated for each discipline.
• Extensively worked on all Apollo Inbound and Outbound Interfaces; involved in creating the test conditions for Member, Member Coverage, Member PCP, Member
• Risk Groups, Provider/Facility, Provider/Facility Address, Provider/Facility Plan.
• Performed Functionality and GUI testing using QTP.
• Members - Add/Modify/Delete of members/subscribers information.
• Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 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).
• Claims - Add/Modify/Delete/Adjudication/verified claim information.
• Providers - Add/Modify/Delete of Provider information.
• Created a work request to keep DataBase backup/ restore in order to make a changes in data to apply TDM(Test Data Management)
• Tested various inbound/outbound EDI transactions like 837 (claims), 835 (remittance),270/271 (eligibility benefit inquiry/response), 276/ 277 (claim status inquiry/response) HIPAA compliance using Spec Builder.
• Worked on FACETS batches like XPF and MMS to upload bulk data into the FACETS Business through the HIPAA gateway by generating keyword files to enroll, modify or terminate providers and members Analysis of the data.
• Performed back end testing by writing SQL queries to review the returned data to ensure that the correct data was retrieved.

Confidential - Alexandria, VA

QA Tester

Responsibilities:

• Managed, Documented and Controlled all the Test Cases, Test Scripts and Test Results
• Performed Back End testing using SQL queries to verify the integrity of database.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction.
• Executed various ETL test cases to check the integrity of Data warehouse Data Mart, and created and edited jobs in Data Mart.
• Assisted EDI team with the testing of maps for HIPAA transactions 834, 835 and 837.
• Wrote Structured Query Language (SQL) statement against Claims, Claim Status and updating Personal Information modules by Joins, Unions and Aggregate Functions.
• Using HP Quality Center (QC) and also in a status update report using MS Excel.
• Implement Enterprise Data Management using IBM Info Sphere Optim tool for Test Data Management (TDM) and Data Growth Solutions.
• Worked closely with (TDM) Test Data Management team for data scrubbing. Used to send work order requests to Test Data Management team when sensitive data exists in source tables.
• Reported defects when defects were discovered during the test case execution.
• Intensively involved in project testing efforts by doing Integration Testing, Regression Testing.
• Worked with Facets data models for Claims, Membership Eligibility
• Involved in new development, support, enhancement of application.
• Involved in FACETS Implementation, involved end to end testing of FACETS Claim Processing and Membership Eligibility module.
• Logged the errors, reported defects, determined repair priorities and tracked the defects until resolution using ALM.
• Identified the bugs and kept track of the defect report using ALM Quality Center, and analyzed the root cause for defects.
• Used SQL queries to test the integrity of data by querying the database
• Logged defects in Quality Center and interacted with the developers to resolve technical issues.
• Set claim processing data for different Facets Module.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Participated in various kinds of testing like (UAT) User Acceptance Testing, Functional Integration, System, Regression and Black Box.
• Involved in writing extensive SQL Queries for back end testing oracle database.

Confidential, Owings Mills, MD

EDI Tester

Responsibilities:

• Performed Manual Testing for the EDI transactions.
• 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.
• Co-Ordinated with TDM (Test Data Management) team for data needs to test the functional requirements and in times of need created test data.
• Involved in testing methodologies throughout the Software Development Life Cycle.
• Assisted in writing Test Plan, Test Strategy, System Testing and End-to-End Test.
• Worked on migrating ICD-10 codes and mapping ICD-9 and ICD 10 codes
• Tested the ETL process that loaded the data into target database after performing all the transformations according to the business requirements.
• Processed claims in Facets and verified 835X12's are generated and sent to Provider.
• Ran the scripts on multiple environments (QA, UAT and Production) to ensure that requirements were still met.
• Involved in testing the EDI transactions 834, 837, 835. 270/271 & 276/277 conversion to Facets.
• Performed functional testing using Quality Centre.
• Developed SOL Queries for backend testing.
• Experience with developing HIPAA Companion Guides for 834 Enrollments, 270/271 Eligibility Inquiry/Response & 820 - Health Plan premium payments for MMIS.
• Evaluated and implemented QA process improvements for ongoing testing.
• Worked on UNIX platform and experience in backend testing by executing SQL Queries.
• Involved in maintaining the test matrix and RTM.
• Participated in QA meetings and defect tracking meetings.
• 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.
• Tested the HIPPA EDI 834, 270/271, 837/835 transactions according to test scenarios and verify the data on different modules.
• While working on requirements of the 835 HIPAA project, jumped half way in the 820 report project, continued working on 835 7 and HIPAA EDI Transactions across enterprise
• Experiences working in ANSI x12 EDI Transaction.
• Developed Test Script for Functionality, Security, and Regression testing.
• Performed Back-End Testing to check database integrity by writing SQL queries.
• Involved in FACETS Implementation Testing, involved end to end testing of
• FACETS Billing, Claim Processing and Subscriber/Member module.
• Set claim processing data for different Facets Modules.
• Wrote test cases in Quality Center derived from the Design documents and generated a Traceability Matrix for testing purposes.
• Uploaded the diagnosis codes, procedure codes to the related tables in test environment to verify the changes related to ICD9 - ICD-10 changes.
• Used Quality Center to record documenting information useful in debugging process, evaluating test data.
• Participated in release meetings and also participate in Retrospective session.

Confidential, Chicago, IL

EDI Tester

Responsibilities:

• Wrote test cases manually and using automation tools to validate the functional and non-functional part of the application.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, 270/271, 273, 278, and others.
• Performed configuration Testing, end to end testing, regression testing.
• Authorized Test Cases for HIPAA EDI transactions specifically 837.
• Tested HIPAA Transactions and code sets standards.
• Worked with FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Logged the errors, reported defects, determined repair priorities, did regression testing and closed bugs using Quality Centre.
• Wrote test cases, executed them and Report Defects in ALM and manage UAT
• Tested HIPAA Transactions and Code Sets Standards such as 837/835, 270/271, 276/277 transactions.
• Tested 837/ 835, 270/271, 273, 276/277,278, transactions with File Aid.
• Documented XML file processing use case as well as identified XML file level processing errors.
• Extensively worked on different kinds of joins and operators to fetch data from multiple tables.
• Conducted data integrated and data validation.
• Involved in ETL Process Validation for data completeness, data correctness and data transformations according to the requirements.
• Involved in testing HIPAA Transactions & Code Sets Standards like (820- Premium Payment for enrolled health plan members, 834(X12) - Enrollment /Dis-enrollment to a health plan, 835, 837 ...etc.)
• Perform Header and Body Testing as a part of Regression Test using SOAP UI
• Used SOAP over HTTP as the transportation protocol to create a test SOAP request very quickly.
• Functional Testing of Member Portal UI for Accident forms and Admin screen which are developed on Grails to handle Human intervention workflow process.
• Planning for and reviewing the Test cases for Functionality, Security, Performance, Database and User Acceptance testing.
• Checked the data flow from front end to backend and used SQL queries to extract the data from database.
• Identified Test cases to perform Regression Testing.
• Set claim processing data for different FACETS Module.
• Involved in maintaining the test matrix and RTM.
• Participated in QA meetings and defect tracking meetings.