PROFESSIONAL SUMMARY

• 11 years of progressive experience in Healthcare/Pharmacy Benefit Management (PBM) domains as a Quality Assurance (QA) Analyst, QA Lead, System Analyst, Business Analyst in Implementation, Upgrade, Migration, New Business, Partner Plans Testing, Web Portal and Data Integration Projects.
• Managed a team size of up to 29 resources (20 Offshore and 9 Onshore resources)
• Experience in interviewing, selecting and allocating QA resources to appropriate projects
• Extensive work experience in HIPAA X12 EDI transactions - 834, 837, 835 (ERA), 820, 999, TA1, 270/271, 276/277 and 278-13/278-11.
• Expertise in TriZetto Products - FACETS (4.71, 5.01, 5.10) and Claims Test Pro (CTP) 4.4
• In-depth knowledge of Software Development Life Cycle (SDLC) and Software Testing Life Cycle (STLC)
• Sound Knowledge in Project Planning, Project Cycles, Test Strategy, Test Planning (SIT/UAT), Test Cycles, Test Cases Design and Execution.
• Expertise in leading System Integration Testing (SIT), User Acceptance Testing (UAT), Regression Testing, Performance Testing, and Cross-functional testing efforts.
• Experience in ICD-10 and expertise in Health Exchange (Obamacare) implementation- California Health Exchange.
• Extensive experience in Medicare and Medicaid projects.
• Proficient in both Manual and Automated Testing Techniques using HP Quality Center (QC), and Quick Test Pro (QTP) tools.
• Experience in ClaimCheck/ClaimsXten software for clinical edits rules check.
• Proficient in writing complex SQL queries for creating and validating Back-End database tables.
• Well versed in Agile Methodology and Scrum meetings.
• Extensive experience in Software Defect Tracking and Reporting using HP QC, HP Application Lifecycle Management (ALM), Serena Business Mashups (SBM) and Service Now.
• Extensive experience in creating Test Management Plan and IRAAD logs
• Sound knowledge in Requirements gathering by facilitating JRD/JAD sessions, Stakeholder Interviews and Questionnaire.
• Involved in maintaining Requirement Traceability Matrix (RTM) and performing GAP Analysis
• Well versed in delivering SDLC test metrics and executive level test reporting to internal, external stakeholders.
• Motivated self-starter wif exceptional team building, leadership, and interpersonal skills.
• Excellent Analytical, Communication and Organizational skills wif the ability to adapt to multicultural work environments.
• Strong Work Ethics and Time Management Skills

TECHNICAL SKILLS

TriZetto Products: Facets (4.31, 4.51, 4.7, 5.01, 5.10), Claims Test Pro (CTP) 4.4

Claims Processing: Facets, QNXT, Argus IPNS, RxClaim, ClaimCheck/ClaimsXten

Requirement Tracking: HP Quality Center (9.2, 10.0), HP-ALM, SBM, IBM Rational RequisitePro

Operating Systems: MS Windows 98/2000/XP Professional, Windows 8, UNIX

MS Office Tools: MS Office (2003/07/10/13), MS Project, MS Outlook, MS Visio

Relational Databases: Oracle 11g, IBM DB2, Sybase, MS Access and MS SQL Server

Methodologies: Agile, Waterfall, SDLC, STLC, JRD, SWOT, IRAAD, RUP, UML

PROFESSIONAL EXPERIENCE

Confidential, Jessup, PA

Sr. QA Analyst / Lead

Responsibilities:

• Member Enrollment (Add, Change, Term, Reinstate) and Eligibility
• Claims Processing (Institutional, Professional and ITS) - both EDI and Manual
• Billing 27x Implementation - 270/271, 276/277 MOOP (Max Out of Pocket)
• Montana MED HELP (Health and Economic Livelihood Partnership Act) Rules Testing
• Montana HELP Void Check Register
• McKesson ClaimsXten Clinical Edits
• Created scenario-specific Member Enrollment (834 X12 EDI) files and processed to FACETS 5.10
• Created scenario-specific Medical (837P X12 EDI) and Hospital (837I X12 EDI) claims files and processed to FACETS 5.10
• Validated 834, 837, 270/271 and 276/277 files in EDIFECS, reviewed error logs and updated files as needed
• Verified FACETS data tables in backend database and prepared daily load reports for projects
• ActiveBatch - Processed claims files to FACETS using sequence of batch jobs using ActiveBatch
• Troubleshot FACETS batch jobs by analyzing runbooks, .XML batch job logs and input data
• Opened HP Service Manager (HPSM) tickets for Provider, Enrollment and Claims batch jobs processing wif 834, 837 EDI Test Data
• Assisted team members wif their X12 EDI data needs for different scenarios
• Verified Clinical Edits in McKesson ClaimsXten application and cross-checked the rules in FACETS
• Wrote test cases on ALM and executed test cases on HP ALM
• Coordinated State Readiness testing wif Montana Department of Public Health and Human Services (DPHSS), Health Care Service Corporation (HCSC), Change Healthcare (formerly Emdeon Inc.) and Confidential
• Interviewed and trained newly hired team members on HIPAA X12 EDI files
• Working wif client and functional requirements wifin ServiceNow.
• Service Catalog and Request Workflow Design and Configuration
• Designing the Content Management System for Varian system which involved layout, CSS and service catalog work.
• Created various workflows for Incident Management, Change Management, Service Requests and SLA's.
• The service we also provide to clients is a semi managed service for administering their Service desks that has been implemented. This includes various administration tasks wifin Service desk software.

Tools Used: FACETS 5.10, HP ALM 12.0, TMGEnroll Application, ActiveBatch Admin V9, MS SQL Server 2012, SQL, EDIFECS, McKesson ClaimsXten, HIPAA EDI X12 (837I, 837P, 834, 270, 271, 276 and 277), Clarity, Service Now, Request Management, Change Management, Citrix, Notepad++, XML, HTML, TMG RTS (Request Tracking System)

Confidential - Owings Mills, MD

QA Testing Lead

Responsibilities:

• Wrote test cases for Subscriber/Member, Spouse and Dependent Enrollment (021), Modification (001), Cancellation/Termination (024), and Reinstatements (025)
• Prepared test data for Enrollment scenarios using HIPAA Electronic Data Interchange (EDI) standards.
• Validated 834 Inbound/Outbound files.
• Validated Membership Enrollment Eligibility against LOB, Plans, Products and Benefits.
• Validated various Membership of Enrollment, Adding, Changing, Termination, Reinstatement, Etc. for commercial, Medicaid and HIX.
• Created test scripts, benefit configured, unit testing, defect management using HP/ALM
• Reviewed edits, analyzed and created detailed documentation of business systems, BRDs and user needs
• Monitored project and requested status and workload, and ensured deliverables of high quality
• Managed assigned enhancements, automations and implementations from concept through implementation
• Reported and updated FACETS data to ensure proper configuration process
• Created Defect Statistics Reports and Test Metrics Reports using Mercury Quality Centre
• Wrote and updated Business Requirements Document (BRD) and Functional Design Document (FDD)
• Performed end-to-end testing and troubleshot issues as required
• Maintained Issue Log and communicated to business on a daily basis
• Used Hibernate for persistence logic, which consisted of creating XML mapping files
• Responsible for preparing the foundation of web projects by coding specific Java data objects, Java source files,
• XML files and SQL statements designed for graphical presentation, data manipulation and security

Tools Used: FACETS 5.01 and 5.10, HP Quality Center10, C#, V.B, .NET, XML, SQL*Plus, SQL Server 2000, MS Access 2000, MS-Word, Ms-Excel, MS Office 2010 (Project, Visio, Outlook) SOAP UI, XML files

Confidential, Buffalo, NY

Sr. System Analyst/Sr. QA Lead

Responsibilities:

• Migration and re-architecture of FutureScripts portal. I assisted wif the product implementation, configured the application.
• Migration and stabilization of Prior Authorization work flow and FutureScripts Eligibility (FSE) systems.
• Creation, review, and audit of SEPY Files, SEPY Prefix, Service Rule, Business Rule, Variable Components and BDDS for accuracy utilizing HR (Health Rules.)
• Product build and development
• Created test scripts, benefit configured, unit testing, defect management using HP/ALM
• Documented claims error and provide recommendations and resolution
• Creation, audit, and review of new and existing products
• Reviewed edits, analyzed and created detailed documentation of business systems, BRDs and user needs
• Monitored project and requested status and workload, and ensured deliverables of high quality
• Managed assigned enhancements, automations and implementations from concept through implementation
• Ran SQL queries to validate Benefits Configuration
• Reported and updated FACETS data to ensure proper configuration process

Tools Used: HR (Health Rules)4.6.2, Oracle Database, Oracle SQL Developer, SQL queries, ServiceNow, JIRA, SharePoint, Eclipse JAVA EE IDE, SOAP UI 4.6.4, EDI Transactions, UltraEdit Pro 17.00, Notepad++, Snipping Tool, Snagit 10.0, FTP, CISCO AnyConnect, IBM Sametime 8.5.2, Windows 7, MS Office Suite.

Confidential - Buffalo, NY

QATester

Responsibilities:

• Facets 5.01 Upgrade: Worked on Billing and Enrollment Applications
• Facets 5.01 Hosting Technical Upgrade: Worked on Member, Provider, Claims, Workflow,
• Facets 5.01 Upgrade: Worked on functional testing of FACETS Applications including Member, Provider, Billing, Claims, Workflow as well as NetworX and TriZetto Communication System (TCS)
• Updated and integrated LCF4, LL01, XLF1, XMF2, XSA1 member letters using Trizetto Communication System (TCS)
• Validated above member letters for the following applications in Facets - Medical Claims Processing, Group, Subscriber /Family and Subgroup
• Some of the Medical Claims Processing member letters include, COB Medicare Letter 96s, Non ER Comm Denial - mbr under 18, Infertility Over 18, Infertility Under 18 etc
• Some of the Group member letters include, MHP Letter over 50 and MHP Letter under 50,
• Some of the Subscriber/Family member letters include, Cal-COBRA Subsidy notice, COBRA NOT AVAILABLE, Early Termination Letter W/HIPAA Certificate, Federal Cobra Letter for 36MO Qualifying Event etc
• Built templates in Microsoft Word using TCS template builder tool
• Drafted letters BCBS and BCN using Trizetto Communication System.
• Managed implementation of a prototype HIPAA 834 Member Enrollment project for Western New York(WNY) members in FACETS 5.1
• Worked on Benefit Focus - eBilling Application
• Wif the addition of the HealthNow-generated invoices to the eBilling application, users will be able to view, adjust and pay invoices quickly and efficiently online.
• eBilling will reduce the time and expenses it takes HealthNow to distribute invoices and receive and process payments
• Validated aMax (Broker Info), Payment File (ps Max), Group Info (c Max), and Billing Invoice files (bMax) using BF application.
• Worked on Facets - Billing application and validated different groups invoices wif that of Benefit Focus application (Billing Summary and Billing Entity)
• Plan, design, and develop portal solutions using IBM WebSphere Portal
• Perform requirement analysis in association wif business analysts to design and develop the server according to client’s business requirements
• Design and develop efficient and reliable application components according to business needs
• IBM WebSphere Process Server 6.x Administration Experience in Installation, Configuration, deployments and troubleshooting.
• Experience in SOAP, JAXB, JAXP, JAX-RPC, XML/XSLT and WSDL for developing Web Services.
• Expertise in Web Services architecture in SOAP and WSDL using JAX-WS. Used SoapUI for Web Services testing.

Tools Used: FACETS 5.01, HP QC 11.0 (HP ALM), Citrix, MS Office 2010 (Word, Excel, PowerPoint, Visio, Outlook), XML, SQL*Plus, SQL Server 2000, Snipping Tool, GoToMeeting (GTM), Microsoft Lync, JSP 2.0, Servlets 3.0, EJBs 3.0, Struts 2.0, Spring 3.0, Web services, Hibernate 2, BEA WebLogic Server & Portal 9.2.3, IBM WebSphere Portal

Confidential, Chattanooga, TN

QA Tester

Responsibilities:

• Prepared Budgetary Guidance Estimate (BG) and Design Estimates (DE) for QA hours for each assigned project.
• Facilitated Weekly and Daily progress meeting wif both onshore and offshore team members
• Delivered STLC test metrics and executive level test reporting on a weekly basis
• Approved software and hardware access requests for team members.
• Prepared Test Management Plan and Test Execution Plan for each project
• Reviewed Project Requirement Documents (PRDs), Solution Summary Documents (SSDs), Technical Specification Documents, High Level Design Documents (HLDD), and Detailed Design Documents (DDDs)
• Wrote System Integration Test (SIT) Test Scripts and prepared Test Data
• Facilitated Test Plan and Test Scripts walkthroughs wif cross-functional teams
• Uploaded test scripts to FACETS Application Development Repository (ADR) and sent sign-off requests to stakeholders
• Updated and maintain Requirement Traceability Matrix for the projects
• Acted as a liaison among Developers, Business and Test Analysts
• Uploaded closing artifacts to FACETS ADR, created approval package and submitted for approval
• Provided support in executing Post-Production Change Controls

Tools Used: Trizetto FACETS 4.71, HP QC 9.2, Sybase DB, SQL Advantage, Interactive SQL, ClaimCheck/ClaimsXten, MS SQL Server 2008 R2, WebEx, SnagIt, Citrix, PeopleSoft, XML Notepad 2007, TextPad 5.4, MS Office 2010 (Project, Visio, Outlook).

Confidential - Buffalo, NY

Responsibilities:

• Wrote Test Management Plan for HIPAA 5010 Front End Edits Project
• Helped to organize and update diverse project documents in Microsoft’s enterprise content management system ‘Sharepoint’
• Interviewed candidates and selected candidates based on their skill sets for the QA team.
• Led a team of 7 Resources.
• Worked closely wif various project managers on budget estimates for various FACETS implementation projects.
• Helped EDI Business to update Test Requirements for Medicare/Medicaid Claim Edits (837I & P) during System Integration Test (SIT), as needed.
• Provided guidance on writing Test Cases, preparing Test Data, and executing Test Cases for Smoke Test, SIT, Regression Test, and User Acceptance Test (UAT)
• Converted CCF files to XML as necessary to test the Edits Logic.
• Created daily and weekly Defect and Testing Status Reports from HP QC 10.0 and reported to Project Manager and to business owners.
• Helped Developers to troubleshoot and fix the defects as needed.
• Facilitated defect resolution meetings between Test Analysts and Developers
• Helped business to write UAT Test Cases for 837 (I & P) Regular and Crossover Scenarios.
• Imported UAT Test Cases to HP QC 10.0 and helped business to execute Test Cases.
• Coordinated claims dropping and loading to Test Environment in FACETS 4.71.
• Provided support and Executed UAT Test Cases in FACETS 4.71 for 837 Crossover and Regular (I & P) claims.
• Utilise the Service Now Service Catalog for users to create Service Requests and Service Items.
• The service we also provide to clients is a semi managed service for administering their Service desks that has been implemented. This includes various administration tasks wifin Service desk software.
• Worked on the integration of ServiceNow wif Siebel, in which integrated Service Catalog and Incident module. Used JMS integration to fulfill this requirement, worked on Scheduled Jobs and Mid Server Script Includes to fulfill the requirements.
• Tools Used: FACETS 4.71, HP QC 10.0 (Enterprise Edition), UltraEdit, XML Notepad 2007, TextPad 5.4, MS Office 2010 (Project, Visio, Outlook), Service Now, Request Management, Change Management, Citrix, Notepad++, XML, HTML, TMG RTS (Request Tracking System)

  Confidential - Rochester, NY

  Sr. QA Analyst

  Responsibilities:

  • Worked on 27x Implementation as a Sr. QA Analyst and coordinated Partner Plans Testing.
  • Assisted in building estimates and budgets prior to the start of the project based on QA timeframes and resources.
  • Managed a team of 5 resources and reported executive test summary to the Delivery Manager.
  • Managed all project documents on ‘Sharepoint’
  • Facilitated meetings among developers, business and test analysts to discuss outstanding defects.
  • Involved in the implementation of various HIPAA 5010 EDI transactions (834, 270/271, 276/277, 278-13/278-11, 837/835) in Facets 4.7 System.
  • Assisted test analysts to update Requirements, write Test Cases, prepare X-12 (EDI) Test Data, and to validate HIPPA EDI 834, 270/271, 276/277, 837/835 transactions as per requirements.
  • Triaged defects in HP Quality Center 9.2 and used Serena Business Mashups (SBM) team track for process management.
  • Worked on provider, subscriber, NetworX, Medical Fee Schedule modules.
  • Validating claims based on legacy claim information by using allowed amounts based on agreements.
  • Processed claims manually based on service category like Lab, Ref Lab, ER, ASC, PT, Certified Home Care, Urgent Care etc.
  • Worked on APRDRG Inpatient claims.
  • Worked on Medical NetworX Configuration under NetworX module in Facets to gather agreement information while processing claims like allowed amount and contract terms and Pricing details to process claims and for successful adjudication.
  • Verified members class plan details, group details and benefit details.
  • Extensively used SQL statements to query Oracle database for test validation.
  • Prepared Test Plan, Test Sing-off Documents as well as Test Summary Reports from QC
  • Assisted analysts to write requirements, prepare Test Cases, prepare FDB MS test data, execute and validated SIT.
  • Provided support in resolving post-production issues.

  Tools Used: Facets 4.7, HP Quality Center 9.2, Oracle database, SOAPUI; WebSphere; EWS, Tidal Scheduler, SQL Plus, MS Visio, MS Outlook, MS Project, Requisite Pro, UltraEdit.

  Confidential, WA

  Sr. Test Analyst

  Responsibilities:
• • Followed all the phases of Software Development Life Cycle (SDLC) and Quality Assurance Life Cycle (QALC)
  • Performed Gap Analysis between existing Legacy System and FACETS System.
  • Prepared Test Plan and Test Cases based on the functional requirements for system migration and enhancements.
  • Participated in meetings to set up SIT and UAT Test Environments.
  • Prepared Medical (837P) and Hospital (837I) Claims data for System Integration Test (SIT).
  • Performed End-to-End testing of Subscriber/Member, Provider, Claims Processing, Billing modules on FACETS 4.31.
  • Reviewing the business requirements and working wif business Analyst and requirements team for gaps found during the review
  • Analysis and Writing the test scenarios based on business requirements and Business use cases
  • Test Cases were written in detailed for all the Subscriber /Member, Claims Processing ITS, Customer Service and for Billing Application
  • Created Claims in Medical Claims/Hospital and DentalProcessingapplication
  • Logged Software Defects/Bugs in Quality Center (QC) and prepared defect reports every day.
  • Interacted wif Developers, Business Analysts and Test Team members to discuss existing defects and find out root cause of the issues.
  • Triaged defects in QC to the right Development resource
  • Assisted Test Lead in preparing Test Summary documents at the end of the testing phase.

  Tools Used: FACETS 4.31, Quality Center, Sybase database, SQL, MS Visio, MS Outlook, MS Excel.

  Confidential - Owings Mills, MD

  QA Analyst

  Responsibilities:
• • MS Access and the use of Query Analyzer. Master Spreadsheet: Versed in utilizing the master spreadsheet furnished by NASCO for variegated Plan updating, including adding new requests. Knowledgeable in using master spreadsheet as a foundational source for accompanying Plan Variable Requests, such as:
  • Creating new selections
  • Adding new values to existing variables
  • Changing the class (i.e., DED, Limit, COINS, etc.)
  • Changing Service Type (i.e., Emergency room Mental & Nervous, Home Health Care, Orthodontics, etc.)
  • Update Variable Description (editing the description of a variable)
  • Removing a variable (requesting a deletion of a variable)
  • Creating a variable (requesting a new variable be made from scratch)
  • Adding a variable (requesting an existing variable be added to a specified string)
  • Identified issues/defects in SIT, logged them in Test Director.
  • Participated in walkthroughs and defect report meetings periodically.
  • Thoroughly reviewed Business Requirements Document (BRD) for each new release/enhancements
  • Validated the data flow through the front end to backend database, and involved in writing complex SQL queries to extract the data from SQL Server database
  • Reviewed Stored Procedures for reports and wrote test queries against the source system (SQL Server) to match the results wif the actual report against the Data mart (Oracle).
  • Assisted business wif writing and validating User Acceptance Test (UAT) test cases and prepared UAT test data when requested.

  Tools Used: Facets 4.51, Mercury Quality Centre 9.0, MS-office, XML, SQL Server, MS-Office, Windows NT/XP.

  Confidential, Providence, RI

  Sr. QA Analyst

  Responsibilities:

  • Testing the in-house and the association software and also to ensure that the association software integrates seamlessly wif the in-house LRSP Claims processing system.
  • Tested the encode and decode tables in LRSP
  • Validate the modified software; test the Association code for ITS (Inter Plan Teleprocessing System).
  • Participated in System, Regression and Acceptance Testing.
  • Tested the Various Claims and Payment Patches in LRSP.
  • Tested the CICS (Mainframe) Screens.
  • Worked wif JCL extensively to schedule and execute the jobs in Mainframes.
  • Tested the database integrity by writing SQL Queries using QMF on Mainframes.
  • Worked wif batch jobs (JCL) and validated the reports.
  • Tested the TSO/ISPF and CICS applications.
  • Traced Defects and prioritized them.
  • Worked wif all levels of management and resolved the issues found.

  Tools Used: Mainframes (JCL, CICS, DB2), Java, J2EE, JSP, Servlets, Web logic, MS-office, MS-Excel

  Confidential - Portland, OR

  Sr. QA Analyst

  Responsibilities:

  • Facilitated meetings among developers, business and test analysts to discuss outstanding defects.
  • Assisted test analysts to update Requirements, write Test Cases, prepare X-12 (EDI) Test Data, and to validate HIPPA EDI 834, 270/271, 276/277, 837/835 transactions as per requirements.
  • Conducted Integration, System, Functional, GUI, Regression, Smoke, Database Integrity, User-Acceptance (UAT) and Performance testing.
  • Created test scripts using Rational Robot and performedfunctionality, and regression testing on new builds of the software
  • Developed Test Cases and Test Design using Test Manager
  • Created Traceability between Requirements and Test Cases
  • Tracked the defects using Rational Clear Quest and generated defect summary reports
  • Maintained Test Logs, Test Summary reports and participated in defect review / Status / GO-NOGO Meetings.
  • Triaged defects in HP Quality Center 9.2 team track for process management.
  • Extensively used SQL statements to query Oracle database for test validation.
  • Prepared Test Plan, Test Sing-off Documents as well as Test Summary Reports from QC
  • Assisted analysts to write requirements, prepare Test Cases, prepare FDB MS test data, execute and validated SIT.
  • Provided support in resolving post-production issues.

  Tools Used: Java, J2EE, JSP, Servlets, Web logic, Facets 4.31, Rational Suites (Manual Tester, Test Manager, Clear Quest), Sybase, MS-office, XML, HP Quality Center 9.2, Oracle database, SOAP UI; WebSphere, SQL Plus, MS Visio, MS Outlook, MS Project

• Confidential - Chandler, PH

  QA Analyst

  Responsibilities:

  • Reviewed the Business and System requirements. Attended core team meeting and walk-through for review and resolution of Business and System requirements
  • Created Test Plan, gatheird test data and created Test Cases, Matrices and scripts. Coded and executed automated test scripts using Quick Test Pro.
  • Involved in User Interface Testing, Negative Testing, Positive testing,
  • Acceptance Testing, Conducted the functionality testing for the application
  • Executed Test Cases and verified Actual Results against Expected Results.
  • Created test scripts using Rational Robot and performedfunctionality, and regression testing on new builds of the software
  • Developed Test Cases and Test Design using Test Manager
  • Created Traceability between Requirements and Test Cases
  • Tracked the defects using Rational Clear Quest and generated defect summary reports

  Tools Used: QTP 8.2, UNIX, Web Methods 6.2, Payment Manager, Oracle