OBJECTIVE

• To work in a fast paced, dynamic environment in the field of Software Quality Assurance/Testing, dat would enable me to utilize my 6 years of extensive experience in healthcare domain and strong ethics to enhance a company’s quality goals.

SUMMARY

• Over 6 years of experience in creating innovative and cost effective Quality Assurance solutions wif expertise in Healthcare processes, applications using manual testing procedures.
• Extensive experience in all phases of SDLC processes and methodologies like Waterfall, Agile and RUP.
• Development of Test plans, execution of Test cases and Test scenarios to meet the product’s business requirements and managing the Defects as per the Business requirements.
• Proficient in both Manual Testing and Automated Testing using ALM, Quality Center, QTP, Load runner.
• Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of FACETS.
• Experienced in different types of testing like Black box testing, positive testing, negative testing, functional, GUI testing, and regression, integration, and performance testing.
• Participated in Walkthrough and Inspections wif the Test Lead and Development team.
• Experienced in Reporting Bugs using Bug tracking tools such as QC and Rational Clear Quest and Created QA Analysis and Weekly status reports, including test results by dates, test script summary (coverage, pass, fail), Defect Status and Defect trending.
• Facets support systems were used to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
• Tested software applications including Client - Server and Web based applications.
• Involved in developing and maintaining Requirements Traceability Matrix and performing GAP analysis.
• Experienced in documenting Test Plan, Test Objectives, Test Strategies, Test Scenarios and Test Cases.
• Experience running SQL queries for data validation and comparison to perform back end testing.
• Extensive experience in writing complex queries in using inner join, outer join, Sub-queries, and different functions.
• Experience working wif HIPAA EDI 837 transactions which include both 4010A1 and 5010 versions.
• Knowledge and understanding of MITA network.
• Tested the HIPAA EDI transactions 834, 837/835, 276/277, 270/271 according to the requirement test scenarios.
• Experience wif TriZetto Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.Strong Knowledge and working experience on ICD-9 and ICD-10 conversion and expertise in forward and backward mapping using GEM.
• Worked extensively on Claims and have a good understanding of COB, EOB and EOP.
• Excellent team player wif strong written, communication, interpersonal and analytical skills.
• Experience leading team to meet deadlines and goals set by clients.

TECHNICAL SKILLS

Business Methodology: Waterfall, Agile, RUP

Business Modeling Tools: Microsoft Visio, Rational Rose, Balsamiq.

Project Management Software: MS Project.

Testing tools: ALM, HPQC, QTP + Descriptive Programming, Load Runner, Clear Quest, and JIRA

Database: MS Access, SQL-Server, Oracle, TERADATA.

Other tools: TOAD, DB Visualizer, Squirrel. Putty, Synchrony Notepad++

PROFESSIONAL EXPERIENCE

Confidential, Tampa, FL

Facet Analyst

Responsibilities:

• Coordinated wif different teams and prepared Test Plans and Test Strategy documents and halped other QA members wif Business Requirements.
• Extensively worked wif 837 me and 837 P Claim files.
• Reviewing Test plans, Test conditions, Test scripts, and Test results.
• Involved in black box testing, data driven testing, security testing, performance testing.
• Translated Use Cases into Test Cases and Test procedures and actively participated in brainstorming and walkthrough sessions.
• Involved in FACETS Implementation, involved end to end analysis of FACETS Billing, Claim Processing and Subscriber/Member module. Supporting Team members in Preparation of Test Plan, Scenarios and the Testing procedures.
• Prepared Traceability Matrix and mapping Requirements and Test cases
• Performed regression, integration and functional testing on the builds of the application
• Conducted Backend test using SQL queries to verify the Integrity of the Database.
• Responsible for creating and uploading the project artifacts in Share point site and providing release support.
• Implementation and knowledge of HIPAA code set ICD-9, ICD-10.
• Ensured dat EDI files were in compliance wif ICD-10 standards.
• Performed analysis of ICD 9 Procedure and Diagnosis Codes in accordance wif ICD 10 CM and ICD 10 PCS conversion compliances
• Experience of Facets in Billing Entity, Premium Rates, Product Billing Component, Billing Group, Fees and Discounts, Adjustments, Claims, Provider, Member.
• Involved in Testing Out-Bound Transactions (835 Health care claims Payment, 277 Claim Status Response).
• Used Facets Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Experienced in Health Informatics and HL7 standards.
• Developed Test plans and scripts using Quality Center and utilized use cases as a basis for performing Integration and System testing.
• Reported defects and bugs to development team using ALM.
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Assisted in User Acceptance Testing (UAT), developing and maintaining quality procedures, and ensuring dat appropriate documentation is in place.
• Extensively used Parameterization of data from Excel as well as using MS SQL Server Database for Data Driven testing.

Environment: ALM, Teradata, XML, SQL, UNIX, Windows 2000/XP, TOAD, Facets, Win SCP, MS Office suite, SharePoint, SOAPUI PRO, SQL, ORACLE,HP QTP/UFT(VBSCRIPT)

Confidential, Tampa, FL

QA Analyst

Responsibilities:

• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Developed various test cases for testing HIPAA 837I/P and 277(5010).
• Validated the reports and files according to HIPAA X12 enforced standards.
• Created Test Plan dat defines the test environment, phases of testing, entrance and exit criteria into different phases of testing.
• Designed High level design, for New process, integrating wif legacy and Facets
• Defined Functional Test Cases, documented, Executed test script in Facets system.
• Worked closely wif the other members of the Development Team and review the designs of systems, implement test plans, and test the quality of software products.
• Performed validation testing on the application for various scenarios and reported the errors.
• Assisted EDI team wif the testing of maps for HIPAA transactions 834,835 and 837.
• Validated Business rule Edits for 5010 HIPAA transactions 837I/837P, 277 and 835.
• Worked on projects independently and also managed a Facets testing effort.
• Executed the 5010 system test scenarios for 5010 HIPAA transactions 837I/837P, 277 and 835 after loading and adjudication.
• Ensured dat EDI files were in compliance wif ICD-10 standards.
• Worked wif the outbound team to halp replicate the issues in production, giving data support to the team and running different types of claims by request.
• Intensively worked on claims wif different Trading Partners.
• Created test scenarios for claims wif different snip levels of errors.
• Worked on the Trading Partner migration to production by submitting different claims wif specific levels of errors.
• Tested the Members, Claims, Providers and Services in FacetsPerformed Regression testing and Smoke testing.
• Supported BA in the user acceptance testing (UAT).
• Manually tested all the interfaces.
• Tested for eligibility, Gender mismatch, Clean claim edits, Membership Edits, Medicare, New born and Behavioural claims.
• Automated testing using QTP and Load runner, test scripts execution and reporting.

Environment: HIPAA X12, IBM Mainframe, JCL,Teradata, MS Office, Aetna Gateway, Edifecs, ALM, QTP. REST,ORACLE,SQL SERVER,HP QTP,SOAPUIPRO,Loadrunner

Confidential, ND

QA Analyst

Responsibilities:

• Being the QA Analyst my responsibilities included documenting and developing Test Plans for the Product using several SDLC methodologies.
• Assisted in writing efficient and effective Master Test Plan, Test Strategy, System Testing, End-to-End Testing and User Acceptance Test Plan.
• Performed end-to-end System Integration testingwhich covered the entire business process flow to all the downstream systems and XML output files, including apps interfaces.
• Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Established and maintained test cases and test data in Quality Center.
• Used MS Visio to prepare flow-chart, process model and architectural design of the application.
• Strong experience in conducting Gap Analysis (GAP), Functional testing, User Acceptance Testing (UAT), and System Integration testing (SIT).
• Involved in implementation of HIPAA EDI Transactions ( 835,837,820,276)
• Facilitated Electronic Data Interchange.
• Performed GAP Analysis for HIPAA 4010.
• Used EDI tools to verify mapping to X12 format.
• Responsible for integrating wif Facets .Designing test scripts for testing of Claims in Development, Integration and production environment.Assisted business users in defining test plans and UAT test cases.
• Participated in changes for system design, methods, procedures, policies and workflows effecting Medicare/Medicaid claims processing in compliance wif government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Worked wif Claims, enrollment, eligibility verification for members and providers, benefits setup, and backend payment cycle in facets.Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and looked for defects.
• Evaluated claims adjudication needs and created HIPAA-compliant business rules configuration.
• Involved in assessment of tools for use in future HIPAA 4010/5010 migration and compliance by performing GAP Analysis. Provided business and technical process flow recommendations.
• 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
• Mapped EDI /837 from clearinghouse sources to ASC X12 formats.
• Extensive testing of EDI Eligibility/Inquiry/Response (270/271) transactions via reports generated by the Gateway.
• Logged defects in Quality Center and maintained track of the defects throughout the life cycle.

Environment: MS-Visio, MS Office, MS Project, Quality Center, HIPAA/ EDI X12, FACETS, SQL, Load runner, Edifecs, FTP,SOAPUIPRO,SQL SERVER,HP QTP(Descriptive programming)

Confidential, Memphis, TN

QA Analyst

Responsibilities:

• Reviewing the Use Case Requirement, Functional Design Documents and Technical Specification documents.
• Interacting wif users for verifying user requirements, managing change control process, updating existing documentation.
• Involved in preparing the Test Plan based on business Requirements.
• Design and execute Test Cases, Generate Test Scripts and Test Scenarios.
• Developed test cases both manually and using Automated Tools.
• Performed Regression Testing.
• Conducted Functionality, GUI, and Back-End testing during the various phases of the application.
• Developed base line scripts using QTP.
• Extensively involved in writing and executing SQL queries for Back end Testing.
• Executed the tests Scripts and analyzed the results.
• Execution of test cases and reporting bugs using Quality Center
• Participated in Walkthroughs and Inspection
• Performed regression testing on the modified build to ensure correctness and completeness.
• Conducted Backend testing using QTP.
• Performed Negative and Positive Testing manually.
• Tracked and reported bugs using Quality Center.

Environment: QC, QTP, Java, SQL, Oracle, Windows 2000, MS Office suite, REST, SQL SERVER,Perl