PROFESSIONAL OBJECTIVE:

Highly motivated professional seeking an Enterprise, Quality Assurance Manager, Test Manager or Project Manager position with a progressive organization utilizing Information Technology standards and methodologies.

SUMMARY:

• Over 20 years of Information Technology experience: EDI Performance Test Architect, Manager of Testing and QA, Project Manager, Development and Testing, and EDI Electronic Data Interchange Test Coordinator.
• Writing and executing test plans
• Managing a team of functional testers to get test scenarios, test cases and test data prepared.
• Review of functional and technical requirement documentation and defining scope for testing project.
• Review of test scenarios, cases and test data from QA perspective.
• Managing the work plan (project plan) for testing activities including testing kick - off, dividing the test cases in manageable test cycles, ensuring that team follows the QA standards, validating that the development is following the plans for software promotion.
• Ensuring coverage to all types of testing including (functional, installation, usage intent, user acceptance, browser compatibility, load, stress, performance, volume etc.)
• Managing testing cycles, coordinating between development, test and QA teams for bug fixes and software re-promotion and retesting
• Preparing reports on testing projects as part of deliverables to the top management of IT
• Identifying risk areas and consulting about which issues may be acceptable and which may not be acceptable. Getting the issues fixed in the timely manner by co-ordination with development.
• Identifying risk areas and consulting about which issues may be acceptable and which may not be acceptable. Getting the issues fixed in the timely manner by co-ordination with development.
• Experienced in health insurance claims process, and benefit coverage applications, premium payments from employer groups, and payments to providers etc.
• Experienced in RDBMS (Oracle, DB2, MS-SQL) applications and client server applications deployment and testing.

TECHNICAL SKILLS:

MVS, Unix/Linux OS, Edifecs, Mercator, Extol, Gentran, Websphere, BizTalk, Sybase translator tools. RDBMS Analysis /Modeling / Mapping/ implementation. IBM DB2/UDB, AS/400 Operations Navigator. Microsoft SQL Server. ORACLE Database Designer. Case Tool Technology.

PROFESSIONAL EXPERIENCE:

Implementation Test Manager

Confidential, Plano, TX

Environment: s: IBM Mainframe, Windows, DB2, IBM-ITCAM, Oracle, EDIFECS EDI toolset.

Responsibilities:

• Performance test planning for HIPAA EDI 5010 standards, generation and execution of test cases, and report performance issues.
• Manage, test, document, evaluate, and ensure compliance with service level agreements.
• Design Quality Assurance procedures, standards, metrics, and documentation.
• Develop test services related to implementation of 5010 mandates to fully exploit usage.
• Engages in the pre-sales activities for the related service offerings.
• Manages client ICD-10 implementation tests.
• Create technical documentation.
• Develop ICD-10 client implementation guides and courses.

Migration/Integration Consultant

Confidential, Phoenix, AZ

Environment: s: Windows, QNXT, .NET architecture, Microsoft SQL Server 2008, BizTalk, C#, Visio.

Responsibilities:

• Develop HIPAA 5010 and ICD-10 migrations.
• Manage, document, evaluate, and ensure compliance of the Technical Architecture.
• Drive project task, design deliverables and the resolution of technical issues.
• Coordinate and synchronize technical design with data and process design.
• Perform quality assurance reviews of project technical designs and reports for accuracy, integrity and conformity to standards.
• Ensure the development of system documentation including appropriate policies & procedures for each assigned project.
• Coordination and management of off-shore Development team.
• Establish, manage, and coordinate SDLC migration and integration testing.

HIPAA EDI Implementation Manager

Confidential, Bellevue, WA

Environment: Windows, MVS, Gentran (GIS) translator tools, RDBMS (Oracle, DB2) Analysis /Modeling / Mapping/ implementation.

Responsibilities:

• Establish NCPDP Pharmacy transactions, policies, procedures and test plan.
• Establish HIPAA Test Plan for EDI X12 transactions, 820, 835, 837.
• Execute test cases and test scenarios.
• Provide troubleshooting and defect management reporting.
• Manage quality processes and HIPAA regulatory standards.
• Perform ad-hoc testing for research and analysis.
• Develop automated methods for EDI transactions and HL7 interfaces.
• Coordination and management of off-shore Development team.

EDI Supply Chain Test Manager

Confidential, Dallas, TX

Environment: Windows, MVS, Gentran (GIS) translator tools, RDBMS (Oracle, DB2) Analysis /Modeling / Mapping/ implementation, Changeman (Change Management system).

Responsibilities:

• Establish Quality Assurance procedures, and test for EDI X12 Supply Chain transactions version 0, 820, 850, 855, and 856).
• Work collaboratively to insure successful deployment of EDI implementations.
• Provide troubleshooting for missing data entities to assure valid sales and purchase order requisitions.
• Manage quality processes and standards of EDI Supply Chain system functions.
• Develop and utilize productivity measures to assess efficiency of Supply Chain EDI.
• Oversee regulatory compliance issues.
• Improve analytical effectiveness and insure professional presentation of EDI Supply Chain Information.
• Prepare EDI Supply Chain budget and report on a monthly basis to ensure compliance.

IT Quality Assurance Test Manager

Confidential, Irving, TX

Responsibilities:

• Design Quality Assurance procedures, standards, metrics, and documentation in accordance with health care best practices methodologies.
• Test projects through all phases of the software development life cycle. Work with the business teams to gather business requirements and document the requirements into standardized document templates.
• Coordinate efforts with the technical development team in order to provide technical requirements.
• Perform various testing tasks and responsible for test planning, generation and execution of test cases, reports and retesting of defects and scripts for the various company systems included but not limited to trading partner EDI systems.
• Validate functionality and business rules in calculation, financial planning based on requirements and use cases.
• Responsibilities include execution of end-to-end testing, integration and functional testing; tracking and reporting on test case execution.
• Generate test data per use case and per test case; find, report and retest defects.
• Work closely with teams of developers throughout the entire development life cycle, to elicit and manage requirements, develop test strategies, test plans, ensure product quality, provide consulting on quality techniques, and ensure adherence to proper software development procedures.
• Work in department-wide activities such as process improvement efforts, gather and report on quality metrics, participate in pre-and post-implementation reviews.

HIPAA EDI Transaction Project Manager

Confidential, Topeka, Kansas

Responsibilities:

• Design, test, and develop HIPAA Electronic Data Interchange (EDI) transaction set compliant procedures, utilizing Gentran Integration Suite (GIS) in coordination with Linux SuSE O.S., and MySQL as the database translator/mapping tools.
• The electronic exchange of administrative and financial health care transaction procedures between Confidential, and health care providers, insurance companies, and Billing Services utilizing the ANSI ASC X12.HIPAA formats.
• In order to facilitate the overall claims processing and claims workflow in SDLC (Healthcare legacy) environments.
• Provide detailed documentation and implementation of the transaction sets by defining data content, identifying valid code tables, and specifying values that are applicable for electronic health care service review requests and responses.
• Capture and store all inbound / outbound EDI transactions and maintain parent-child relationships between these transactions in a Transaction Data Warehouse.
• Create interfaces to the Transaction Data Warehouse, as well as establish archival processes.
• EDI Test Manager- Prepare detailed HIPAA compliance EDI Test Plan utilizing best practices methodology for HIPAA testing published by WEDI-Snip.
• Conduct complete HIPAA EDI transaction test utilizing Claredi test software for HHS purposes. Write test plans,
• Define test scripts/scenarios, Defect tracking and resolution testing strategies.
• The testing includes pre-testing recommendations and the actual testing guidelines as applied specifically to the client.
• Prepare detailed reports to identify and assess all customers of Confidential, which are HIPAAcovered entities.
• Also, covered entities performingEDI processes as applicable to HIPAA, specifically the X12 835 Remittance Advice & 837 Claims Submission formats and processing.
• Review detailed Gap Analysis Reports comparing the current (baseline) EDI transactionprocesses to the HIPAA Implementation Guide requirements.
• Review detailed data models / data mappings utilizing Gentran Integration Suite in coordination with Linux Redhat O.S., and MySQL as the database translator/mapping file structures of entities required for HIPAA transactions.
• Create data flow diagrams of current processes vs.
• HIPAA remediated process diagrams. Identify “Gaps” for all covered transactions. Identify Gaps in data definitions.
• Identify all transaction code sets needing cross-walked to HIPAA compliant codes. Report and document the findings.

HIPAA Test Manager

Confidential, California

Responsibilities:

• HIPAA and EDI Test Manager
• Responsible for creating and managing a software QA program,
• Supervise outsourced testing staff, Manage defect reports
• Manage test case development and execution
• Coordinate testers with setting up test plans and test cases, Manage testers in creation of test data in various XML and EDI standards.
• Manage establishing HIPAA Electronic Data Interchange (EDI) transaction set compliant reporting procedures, utilizing MS-SQL /BizTalk Server in coordination with DB2, as the databases translator/mapping tools in an AS/400 environment to satisfy the electronic exchange of administrative and financial health care transaction reporting procedures between Sacramento County, health care providers and insurance companies utilizing the ANSI ASC X12.HIPAA formats.
• Provide detailed documentation and implementation of the transaction sets by defining data content, identifying valid code tables, and specifying values that are applicable for electronic health care service review requests and responses.

HIPPA EDI Test Manager

Confidential, Omaha, Nebraska

Responsibilities:

• Review functional requirements for a PowerMHS (Computer Science Corporation) HIPAA EDI Transaction content details to business systems and practices.
• Interact with test engineers, developers, and business analysts etc. to develop a test plan. Get test scenarios developed from testers. Ensure transaction content correctness and third party integration testing project.
• Review of mapping requirement from point of view of Testing and QA program with BizTalk developers. Testing and ensuring the content requirements, including proper selection of EDI field code values to BizTalk developers.
• Coordinating the process of creation of detailed EDI Transactions test plans, detailed test scenarios & test scripts as well as establish the EDI testing procedures. Working closely with test engineers and Coordination and implementation of EDI Trading Partner Agreements and Trading Partner testing.
• Assist in organizing HIPAA EDI support from quality perspective. Participate in EDI End-User Guides and trading partner guides. Ensure knowledge transfer to users for future testing work.
• Prepare detailed analysis of HIPAA compliance EDI document utilizing methodology for HIPAA published by WEDI-Snip.

HIPPA EDI QA Manager

Confidential, Harrisburg, PA

Responsibilities:

• Coordinate the activities of 4 testers in correlation with other transaction teams to analyze, test and implement the HIPAA EDI Transactions, for an electronic insurance clearinghouse operation utilizing Mercator as the translator software tool. Implement all HIPAA Transactions, in an AS/400, IBM Mainframe environment. The successful outcome is to effectively process all electronic transaction procedures in a compliant manner.
• Prepare detailed HIPAA compliance EDI Test Plan utilizing best practices methodology for HIPAA testing published by WEDI-Snip. Conduct complete HIPAA EDI transaction test utilizing Claredi test software for HHS purposes. Write test plans, Define test scripts/scenarios, Defect tracking and resolution testing strategies. The testing includes pre-testing recommendations and the actual testing guidelines as applied specifically to the client.
• Prepare detailed reports to identify and assess all customers of Confidential BCBS, which are HIPAAcovered entities. Also, covered entities performingEDI processes as applicable to HIPAA, specifically the X12 835 Remittance Advice & 837 Claims Submission formats and processing.
• Review detailed Gap Analysis Reports comparing the current (baseline) EDI transactionprocesses to the HIPAA Implementation Guide requirements.
• Review detailed data models / data mappings utilizing AS/400, IBM Mainframe, COBOL, DB2, BPCS file structures of entities required for HIPAA transactions. Create data flow diagrams of current processes vs. HIPAA remediated process diagrams. Identify “Gaps” for all covered transactions. Identify Gaps in data definitions. Identify all transaction code sets needing cross-walked to HIPAA compliant codes. Report individual Agency findings.
• Prepare detailed HIPAA compliance “roadmap” reports for individual identified customers. Issues involved in implementation of HIPAA EDI Transaction Code Set processes. Recommendations / resolutions to issues involved in HIPAA transaction remediation/implementation.

Project Manager

Confidential, Puerto Rico

Responsibilities:

• Prepare detail reports to identify and assess all Confidential, which are HIPAAcovered entities.
• Also, covered entities performingEDI processes as applicable to HIPAA.
• Prepare detail Gap Analysis Reports comparing the current (baseline) EDI transactionprocesses to the HIPAA Implementation Guide requirements.
• Prepare detailed data models / data mappings of entities required for HIPAA transactions.
• Create date flow diagrams of current processes vs. HIPAA remediated diagrams.
• Identify Gaps for all covered transactions.
• Identify Gaps in data definitions. Identify local codes needing cross-walked to compliant codes. Report individual Agency findings.
• Prepare detailed HIPAA compliance “roadmap” reports for individual identified Agencies.
• Issues involved in implementation of HIPAA TCS processes.
• Recommendations / resolutions to issues involved in HIPAA transaction remediation/implementation.

Project Manager

Confidential, Phoenix, AZ

Responsibilities:

• Prepare detail reports to identify and assess all Arizona State Agencies utilizing QMACS, which are HIPAAcovered entities. Also, covered entities performingEDI processes as applicable to HIPAA.
• Prepare detail Gap Analysis Reports comparing the current QMACS (baseline) State EDI transactionprocesses to the HIPAA Implementation Guide requirements.
• Prepare detailed data models / data mappings of entities required for HIPAA transactions for usage in MS-BizTalk. Create date flow diagrams of current processes vs. HIPAA remediated diagrams, utilizing QMACS, & MS-BizTalk. Identify Gaps for all covered transactions. Identify Gaps in QMACS data definitions. Identify local codes needing cross-walked to compliant codes. Report individual Agency findings.
• Prepare detailed HIPAA compliance “roadmap” reports for individual identified Agencies. Issues involved in implementation of HIPAA TCS processes. Recommendations / resolutions to issues involved in HIPAA transaction remediation/implementation.
• Implementation of integrated HIPAA TCS processes into QMACS utilizing MS-BizTalk as translator.