SUMMARY

• Six years of experience in Quality Assurance and Software Testing in healthcare industry.
• Extensive knowledge of all aspects of the Software Development Life Cycle and Defect life cycle.
• Experience in requirement analysis, creating traceability matrix, test planning, creating test data and implementation of test suite (test plan, test scripts and test cases).
• Extensive experience in testing Client/Server and Web - based Applications and Service based Architecture.
• Strong Knowledge of waterfall model, V-Model and Agile methodology of SDLC.
• Worked extensively on testing tools like ALM, Quality Center, QTP.
• Good knowledge on different modules within healthcare (Membership, billing, enrollment, Claims, capitation, providers).
• Diverse experience with Window, Unix and Mainframe environment in Quality Assurance(QA), User Acceptance (UAT) and production support, specialization in backend using DB2.
• Tested HIPAA regulations in Facets HIPAA privacy module.
• Experienced workingwith 5010 transactionschanges analysis, design and migration strategy.
• Have good knowledge of HIPAA versions.
• Profound understanding of insurance policies like HMO and PPO and proven experience with Medicare, Medicaid, & commercial insurances in HIPAA 4010 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).
• Expert in development and testing in Mainframe applications.
• Proven skills in developing system test plan and system test cases for the validation of healthcare applications used for both Provider and Payer services.
• Strong skills in Backend Testing using SQL queries onTeradata, SQL Server and Oracle.
• Proficiency in EDI 4010 to EDI 5010. And involved in conversion and mapping HIPAA ICD 9 to ICD 10.
• Worked on QC and HP ALM (Application Lifecycle Management) and QTP (Quick Test Professional) and provided training for the same to the end users.
• Good Understanding and Testing Knowledge onHedisNCQA measures.
• Expertise in executing, monitoring and validating ETL processes developed in Data stage and Informatica.
• Maintained Requirement Traceability Matrix and Test summery report.
• Experience with HEDIS measurements, annual reporting, medical record review and HEDIS auditing. Expert proficiency in Microsoft Excel, Access Word, PowerPoint and Visio. Knowledge of NCQA/HEDIS.
• Analyzed test results to ensure existing functionality and recommend corrective action where necessary.
• Participated in UAT and wrote Test Cases for UAT.
• Good experience with Sanity Testing, Smoke Testing, White Box testing, Black Box Testing, GUI Testing, Functionality Testing, Positive and Negative Testing, Security Testing, Integration Testing, System Testing, Load Testing, User Acceptance Testing (UAT) and Regression Testing of Web Based Applications and Client-Server Applications.
• Good working knowledge of major Operating Systems such as Windows and UNIX
• Experienced in ETL (SSIS) and data validation processes and proficient in reporting services such as SSRS as well as SSAS.
• Wrote SQL queries using Toad for Oracle for automation testing in the enterprise data warehouse (EDW)
• Ability to multi-task, prioritize and work with time constraints while paying attention to details
• Excellent communication and writing skills with the ability to adapt to new and dynamic environments
• Good team leader, Player and can work alone with minimal or no supervision
• Good problem-solving, judgment, and decision-making skill

TECHNICAL SKILLS

Testing Tools: Quality Center, Soap UI, Quick Test Professional and Rational Team Test

Bug Reporting: HP QC, Test Director, Rational Clear Quest, JIRA

Databases: MS-Access, Oracle,Teradata, DB2,MS SQL Server, MS Access

Operating System: Windows, Unix

MS Office Tool: Word, Excel, PowerPoint.

Defect Tracking Tools: Rally, JIRA, Quality Center, ClearQuest

PROFESSIONAL EXPERIENCE

Confidential, Bronx, NY

Quality Analyst

Responsibilities:

• Discussed enhancements and modifications with the Project Team
• Involved in developing Test Plan and created Test Cases as per the business requirements in Quality center for Patient Registration Module
• Involved in preparation of Test cases, Test data in Quality Center for Report Repository upgrade.
• Developed, maintained and executed Test scripts and Test scenarios on assigned products to assure product quality from a functional and qualitative perspective.
• Validated 835, 837, 276, 277, Institutional and Professional HIPAA Transaction and X12 format messages.
• Performed Database testing usingDB2Connect and Extra tools for verification of data tables in database.
• Performed Table, GUI, Database, and XML Check Points in Quick Test Professional scripts to check the validity of the data.
• Worked on FACET modules such as pricing,payer, eligibility under claims processing system.
• Involved in claims submission and payment (remittance) retrievals by using ASCX12N 820 for the In- bound premium payments; ASC x12N 834 for the Inbound Enrollment and Maintenance; ASCX12 276/277 for the claims status enquiry and response; and ASC X12 835 for the Health care Claim Payments.
• Worked on billing and payments in the provider module in Claims Test Pro (CTP) of Facets.
• Wrote and executed complex SQL queries to retrieve data from Facets-Membership Enrollment modules.
• Negotiated and managed multiple priorities, project plans, time frames and trade-offs while ensuring the clinical and administrative staff understood the final results of the projects, sharing detailed vision of cost-benefit analysis.
• Involved in QA / UAT Support during the Hardware Upgrade inTeradata.
• Responsible for validation of target data in Data Warehouse, which gets loaded usingInformaticaPower Center.
• Writing Test Plans/Test Scenarios/Test Cases/Test Matrix. Fine-tuning of the database queries for better performance plans.
• Monitored the systems process flow of the HIPAA Medicare/Medicaid transactions from subsystems interfaces, databases (SQL), mainframe (Unix)
• Worked in utilities likeBTEQ, FastLoad, Multiload, and Fast Export extensively to load to target database.
• Developed dataqualitytest plans and manually executed ETL and BI test cases.
• Wrote Test cases for Enterprise Data Warehousing (EDW) Tables and Data Mart Staging Tables.
• Developed System Integration and regression test plans.
• Analyzed test cases for automation and used UFT (Unified Functional Testing), Quick Test Professional (QTP) to automate manual test scripts for Regression and Functional testing.
• Logged the errors, reported defects, determined repair priorities and tracked the defects until resolution using ALM.
• Created the task and effort for the sprint and monitor task till closer using the test management toolRally.
• Prepared test matrices based through defect status in Quality Center.
• Involved in usingVBScripts in QTP to access webpage script variables. Responsible for Back-End Testing Using SQL Commands using TOAD.
• Executed the various SQL queries (like join, count, distinct, constraints, NULL, NOT NULL ) to ensure the data populated to Target table as business expectations by joining different sources tables for accurate data flow to the EDW in the SQL Server Management Studio (SSMS)
• Developed SQL queries, functions, stored procedures and triggers to perform the backend testing of the data
• Performed User Accepted Testing (UAT) and Production client support.
• Documented, tracked, and verified defects and enhancements by using Quality Center.
• Tested the ETLInformaticamappings and other ETL Processes (Data Warehouse Testing) for end to end testing.
• ValidatedSSRSreports and ETL testing with use of complex SQL queries and UNIX scripting.
• Created user-defined functions and output values for the content builder and appliance by using QTP/UFT
• Regularly troubleshoot unexpected circumstances.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Worked with the Developers, Infrastructure teams to resolve the issues.

Environment: Windows, Java, Eclipse, Teradata, UNIX, Rally,SQL,DB2, SSRS, ETL, Oracle, Facets, Informatica, MS office, Mainframe, QTP /UFT, VB Script, ALM.

Confidential, Nashville, TN

QA Tester

Responsibilities:

• Tested and delivered Inbound/Outbound Facets interfaces
• Manually entered additional test claims data for those scenarios where a specific claim is not found in Production
• Involved in Facets Implementation, end-to-end testing of FACETS Enrollment Claim Processing and Subscriber/Member module
• Data mocking for different Claim file formats.
• Conducted HIPAA Gateway Testing.
• Participated in developing and implementing End-End testing.
• Tested the GUI / User Interface of the Web applications.
• Performed Functional testing on Facets, Customer service and Subscriber application under Facets
• Participation in requirement / Use Case analysis, risk analysis and configuration management.
• Transactions focused on were 270,271,276,278,834, 835, and 837.
• Validated the reports and files according to HIPAA X12 enforced standards.
• Automated Claims & Members screens in Facets using QTP.
• UsedQuality center for test cases, defect logging and defect tracing.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Prepared Test Cases based on business requirements and business rules for HIPAA EDI Transaction 270/271, 834,837/835.
• 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
• Tested the subscriber and Member enrollment in association with class, plan and product.
• Tested the Registration process of common practitioner in Facets and validated the fields (Medicare or Medicaid billing number, License and DEA number).
• Identifying Test Scenarios, prepare Test Specification document and Test cases inMTM
• Performed Manual Testing using Quality Center (QC) and User Acceptance Testing (UAT)
• Performed UAT Testing Manually in coordination with UAT group to ensure correct business logic.
• Tested and validated the database tables using SQL queries and performed Data Validation and Data Integration
• Responsible to work on Healthcare Management Information System which includes two divisions: HIPAA compliance and Maintenance units division and Claim processing division.
• Monitored workflow of the Resolution/Adjustment Unit, delegate tasks accordingly, and ensure that quality, quantity, and efficiency standards are met or exceeded.
• Worked under HIPAA compliance standards.
• Created and maintainedSQL Queries for back-end testing.
• Performed SOA / Web Service testing using SoapUI.
• Created Data for XML Requests in SoapUI.
• Designed and developed user defined functions of QTP with well-versed VB scripting.
• Used descriptive programming in scripting dynamic objects and reusable actions in defining scenario flows in Quick Test Professional (QTP).
• Maintained Test Matrix which gives overview of the Testing Effort.
• Worked onmainframe, web based and GUI frontend Claims Systems.
• Tested Claims intake/Logged claims/Failed claims data from Pulse tables to Oracle Financials.
• Monitoring the defect life cycle, generating customized graphs and reports for the client, using Quality Center.
• Used Quality Center to record documenting information useful in debugging process, evaluating test data.
• Used Quality Center for reporting and tracking bug and generating reports.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.

Environment: ICD, Agile, FACETS, HP Quality Center, SQL,ANSI X12,MTM, JavaScript, HTML, XML, HIPAA, EDI, UML, MS Office, Windows, Java/J2EE,.

Confidential, Philadelphia, PA

QA Analyst

Responsibilities:

• Conducted GUI and functionality testing using QTP.
• Conducted data driven testing using QTP to conduct backend testing.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Verifying Healthcare Eligibility, Claim, Benefit and Service using ANSI ASI X12 Standards.
• Monitored the compliance mapping of transactions to the EDI transactions standards ANSI -X12.
• Developed SQL queries, joins, functions, stored procedures and triggers to perform Back- End testing in Oracle Database.
• Designed and developed Use Cases using UML and Business Process Modeling.
• Developed QA Test Plan, test conditions and test cases, as well as assisted with QA team in System Testing using Quality Center
• Created and executed test documentation formainframesystem enhancements.
• Used DB2 client to write SQL's to validate the test data.
• Involved in creating reports for the end users using Crystal reports from the gathered requirements.
• Developed User Manual and Provided User Training.
• Conducted User Acceptance Testing

Environment: RUP, UAT, UNIX, Java, SharePoint, Sybase, SQL, Microsoft Word, Project, Excel, PowerPoint, GAD (Gap Analysis Document), HTML, XML, SQL, MS Visio.