SUMMARY:

• Around 9 years of professional experience in Testing and out of 7+ years experience on US Healthcare Insurance in Testing and implementation of projects, user interaction and systems gap analysis.Hands on experience with EDI, Claims/Encounters, Drug Rebate, Recipient, Provider, Reference and Provider Portals, Financial, and Security.
• Strong experience in Health, Banking, Financial, Transportation, and Hospital domains.
• Analysis of complex Health Information technology, Confidential Management Information System databases, reports and system processes
• Proficient in healthcare EDI systems and electronic claim transaction technology.
• Tested new developments of X12 837 claim & 835 and ensured timely and quality delivery of Financial Cycle product releases.
• Supported the implementation of Statewide Confidential Management Information System, Web Portal and integration of 38 sub - systems.
• Played a major role in integration team for TN MMIS claims processing system from legacy to HIPAA compliant system by researching, designing, modifying system components, identifying the required steps and recommended solutions for them to comply with HIPAA rules. The tool used was Specbuilder HIPAA Validator, which produces functional acknowledgement 997.
• Used extensively SQL to perform backend testing, Data integrity and Data mapping.
• Able to apply technical and functional expertise to organize and implement Black-box and White-box test efforts to analyze requirements for software design, development, and validation.
• Expertise in developing Test Plans, Test Case Design and Test Scripts based on User Requirements Specification (URS) and System Requirements documents.
• Actively participated in BSD and TKD meetings to make sure Client Expectations.
• Preparing gap analysis & Issues documents, scheduling meeting with BA’s, SE’s and Business users
• Work closely with system analysts to understand user's system requirements, map process flow, design the processing steps, and analyze new systems.
• Active role in Requirements review, Functional document review, Testing review and key resource for UAT phase and production rollout.
• Setup test environment and test data for a timely and exhaustive project testing so that debug and errors can be eliminated from the system.
• Excellent knowledge of Software Development Life Cycle (SDLC), Quality Assurance Life Cycle (QALC) and Defect Management Life Cycle.
• Strong communication and interpersonal skills. Strong Team player and contribute towards the team goals. Ability to work productively and effectively in a team as well as individually.

SPECIALTIES:

• Hands on experience with HC tools like SpecBuilder, Edifices, Ramp Manager, EDIPAL, Test Transaction Generator and PES tools
• Actively worked on Claims/Encounters - Non Claims EDI transactions like 837,834,820,270,271 & NCPDP files.
• 4010 and 5010 transactions.
• Claims & Non-Claim mappings.
• Step-UP Step-Down Maps.
• State wide Severity files understanding.
• Paper & Web Claims.
• Report & Letter Generator.
• Database Testing

TECHNICAL SKILLS:

Quality Center 9.0, Test Director, Rational Clear Quest. SQL, Oracle., Windows, SFTP & UNIX(Minimal usage)

EXPERIENCE:

Confidential

Test Manager & Module Lead

Skill/Tools: Functional and UI Testing, X12’s, XML’s, RRI & Quality Centre.

Responsibilities:

• Designed and created the entire Quality Assurance strategy from the ground up Test Strategy and Test Plan, Test Data, Test Case Matrix, Requirement Traceability Matrix.
• Involved in implementation of HIPAA EDI Transactions ( 837,835).
• Facilitated Electronic Data Interchange.
• Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Used EDI tools to verify mapping to X12 format.
• Recommended changes for system design, methods, procedures, policies and workflows affecting Confidential claims processing in compliance with government compliant processes like HIPAA/ EDI formats.
• Analyzed HIPAA EDI transactions in XML and X12 responses and looked for defects for amendment.
• Did data analysis for various version changes of EDI messages on different sub-systems.
• Providing the required test data for the developers in order to fix the defects.
• Participating in QA team meeting and bug tracking meetings.
• 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.
• Extensive testing of EDI Eligibility/Inquiry/Response (270/271) transactions via reports generated by developers.
• NCPDP claims processing.
• Performed testing on National Provider ID project. Ensured valid segments were generated for providers sending NPI and/or legacy numbers. Tested NPI for billing, attending, referring, operating and other physician types as well as group provider for 837I & 837P.
• Logged the defects in Quality Center and maintained track of the defects throughout the life cycle.
• Attended design reviews, requirements sessions, core team meetings, and technical team meetings to understand business requirements and business operating processes/procedures in order to identify test scenarios.
• Co-ordination with Business Analyst, Bureau, SE team and Testing Team
• Provided mentorship to the less experienced but growing test team in regards to test plan writing, test case writing, bug writing, bug investigation, specification review and the over all QA process.
• Performed Unit, Functional, Integration, System, validation and Regression Testing.
• Interacted with Development Engineers to design new product features to ensure testability, when necessary
• Performed documentation reviews for documents developed by QE engineers
• Responsible for Functionality, and Regression Tests to insure successful integration with existing products.
• Managed all verifications and validation activities for all Production modifications including projects, releases and changes.
• Actively participated and involved in all the areas of Encounter/Claims testing.
• Encounter claims submission through Edifces (to check HIPPA compliancy and Translation)Actively participated in Ohio Confidential
• FFS Claims validation through RGRP using UNIX test and process it through claim engine.
• Provider claims submission through TNAnytime portal
• Actively involved in all the areas of Confidential systems like Provider, Recipient, Managed Care & Reference.
• Actively involved in Letters & Report testing.
• Managing Claims Test data which includes Recipient, Provider & Reference subsystems
• Managing Restoration of same data in multiple test environment copied from Production
• Managing centralized data for all the subsystems which will restrict to use same data by different users.
• Managing EDI files of one test environment and running and verifying same set in multiple environment.

Environment: Power builder, UNIX &C, Oracle, PL/SQL

Confidential

Skill/Tools: Functional and UI Testing/TTG, and PES

Test Lead

Responsibilities:

• Designed and created the entire Quality Assurance strategy from the ground up Test Strategy and Test Plan and Test Data.
• Attended design reviews, requirements sessions, core team meetings, and technical team meetings to understand business requirements and business operating processes/procedures in order to identify test scenarios.
• Co-ordination with Business Analyst, Bureau, SE team and Testing Team.
• Performed Unit, Functional, Integration, System, validation and Regression Testing.
• Interacted with Development Engineers to design new product features to ensure testability, when necessary
• Performed documentation reviews for documents developed by QE engineers
• Responsible for Functionality, and Regression Tests to insure successful integration with existing products.
• Managed all verifications and validation activities for all Production modifications including projects, releases and changes.
• Submission of Results to Bureau and involved in meetings to review on test results.
• Actively participated and involved in the areas of Encounter/Claims testing.
• Encounter claims submission through PES tool
• FFS Claims validation through Test Transaction Tools(TTG)
• Recipient Enrollment & Eligibility system

Environment: .Net, UNIX &C, Oracle, PL/SQL

Confidential

Module Lead

Environment: .NET

Skill/Tools: iTRACE, Clear Quest, Quality Centre

Responsibilities:

• Communicating with the application team and understanding the requirement, deciding on the appropriate testing module, test plan and scheduling the test.
• Identifying smoke test cases across the system which will be executed in Test Environment after every Build Release
• Coordination with different teams like App/Web/DB/Server/Network while performing the test and resolving issues during tests.
• Actively taken lead in the project and lead the team from onshore by assigning the task to offsite and getting it done.
• Managing defect status in the Quality Centre

Environment: .Net, UNIX &C, Oracle, PL/SQL, Quality Centre.

Confidential

Module Lead

Environment: .NET

Skill/Tools: Black box & Database Testing/ iTRACE

Responsibilities:

• Communicating with the application team and understanding the requirement, deciding on the appropriate testing module, test plan and scheduling the test.
• Coordination with different teams like App/Web/DB/Server/Network while performing the test and resolving issues during tests.
• Actively taken lead in the project and lead the team from onshore by assigning the task to offshore and getting it done.
• Managing defects and resolutions.

Confidential

Module Lead

Environment: .NET

Skill/Tools: Black box & Database Testing/ iTRACE

Responsibilities:

• Tested the functionality of the application manually to test the business process.
• Functionality testing is performed manually.
• Involved in writing Test Scripts for the main application functionality such as validation, business workflow.
• Actively taken lead in the project and lead the team from onshore by assigning the task to offshore and getting it done.
• Used HP-In house tools for defect reporting and tracking.
• Involved in Functionality and Regression Testing.
• Created Testable requirements and generated traceability matrices to ensure that all the requirements are covered by the test cases
• Attended business meetings and coordinated with developers and business analysts.
• Worked with System Test Review Team and Developers to resolve system test issues and re-test

Environment: Manual Testing, Java

Confidential

Module Lead, Onshore-Offshore Co-Ordination

Environment: Java

Skill/Tools: Black box & Database Testing/ iTRACE

Responsibilities:

• Tested the functionality of the application manually to test the business process.
• Functionality testing is performed manually.
• Involved in writing Test Scripts for the main application functionality such as validation, business workflow.
• Actively taken lead in the project and lead the team from onshore by assigning the task to offshore and getting it done.
• Closely worked with Client BA team.
• Involved in Test Execution for business related scenarios like Letter Generators & Image Testing sitting at client place
• Used HP-In house tools for defect reporting and tracking.
• Involved in Functionality and Regression Testing.
• Created Testable requirements and generated traceability matrices to ensure that all the requirements are covered by the test cases
• Attended business meetings and coordinated with developers and business analysts.
• Worked with System Test Review Team and Developers to resolve system test issues and re-test

Environment: Manual Testing, Java

Confidential

Module Lead, Offshore support

Environment: Java

Skill/Tools: Black box & Database & Batch Testing/ iTRACE

Responsibilities:

• Tested the functionality of the application manually to test the business process.
• Functionality testing is performed manually.
• Involved in writing Test Scripts for the main application functionality such as validation, business workflow.
• Actively taken lead in the project and lead the team from Offshore by assigning the task to team and getting done.
• Closely worked with Offshore Client BA team.
• Used HP-In house tools for defect reporting and tracking.
• Involved in Functionality and Regression Testing.
• Created Testable requirements and generated traceability matrices to ensure that all the requirements are covered by the test cases
• Worked with System Test Review Team and Developers to resolve system test issues and re-test

Confidential

Tester, Offshore support

Environment: Java

Skill/Tools: Black box & Database & Batch Testing/ iTRACE