SUMMARY:

• QA/Test Manager QA Lead QA Analyst Sr. System Analyst Business Analyst Data Analyst IT Consulting Project Planning, Execution & Leadership
• Over 12 years of progressive experience in Healthcare/Pharmacy Benefit Management (PBM) domains as a Sr. System Analyst, Business Analyst, Quality Assurance (QA) Analyst, QA Lead,, Scrum Master in Implementation (hosted and licensed), Upgrade, Migration, New Business, Partner Plans Testing, Web Portal and Data Integration, Data Migration Projects.
• Managed a team size of up to 29 resources (20 Offshore and 9 Onshore resources)
• 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/Mock Go-Live), Design and Execution.
• Expertise in leading System Integration Testing (SIT), User Acceptance Testing (UAT), Regression Testing, Performance Testing, Vendor Integration and Cross-functional testing efforts.
• Extensive functional work experience in Eligibility, Benefits, Claims, Prior Authorization, Referrals, ID Cards, Pricing testing on Payer platforms.
• Extensive work experience in API Testing using SoapUI, Postman.
• Extensive work experience in HIPAA EDI transactions - 834I, 834O, 837/835, 820, 999, TA1, 270/271, 276/277 and / .
• 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 auditing rules check.
• Proficient in writing complex SQL queries for creating and validating Back-End database tables.
• Well versed in Agile Methodology, JIRA, Kanban and Scrum ceremonies.
• Extensive experience in Software Defect Tracking and Reporting using JIRA, HP QC, HP Application Lifecyc

PROFESSIONAL EXPERIENCE:

Confidential

Test Manager/Test Lead

Responsibilities:

• Managed all aspects of testing, including SIT, UAT, CSIT, Regression Test and Mock Go - Lives. Interviewed and set up onshore/offshore test team from the beginning. Prepared test strategy, test approach, and defect triage methodologies. Hands on testing Facets Front End,
• Backend, Facets API Testing for Portals. Reviewing and implementing best testing practices, such as implementing JIRA, Agile Methodology (Scrum, Kanban), Adaptavist Test Management. Set up several projects and workflows in JIRA and coached cross-functional business users, PMs, developers and SAs on using JIRA. Coached team members (QA and business) to build claims (837s) and enrollment (834) EDI transactions. Worked with multiple vendors, such as RedCard, PBM Magellan, HealthX, Huntington Bank, BCBSMI, CIGNA, HAP, JMS, Zelis,
• Cognizant to exchange files and worked with them to resolve issues. Reviewed batch schedule and assisted in automating the schedule for mock go lives. Hosted UAT leadership calls, Sprint Planning, Sprint Stand-ups, Sprint Review (Demo) and Retrospective meetings in each
• Sprint. Worked with BAs, SAs and QAs to define testing scope for each project. Hands on testing involvement as needed in several key functional areas related to Enrollment (834), Claims (837), Billing. Playing a pivotal role in triaging and troubleshooting issues across multiple projects and teams. Reviewed testing and approved code promotion to higher environments (PPMO, PROD) as a CAB member.Tools Used:
• Facets 5.6, 5.7, JIRA, Adaptavist Test Management, SOAP UI, MS SQL Server 2017, HIPAA EDI X12s (837I/P/D, 834I/O), Notepad++, UltraEdit, GlobalScape, Service Now, OptumEDI, Smartsheet.

Confidential, St. Louis, MO

QA Project Lead/Test Lead

Responsibilities:

• Crossover and Behavioral Health plans. Query multiple databases using SQL queries and retrieve test data for complex scenarios. Validate TA1, 999 and 277CA transactions in EDIFECS Transaction Management. Assist Business Analyst and QA Analysts to write Test Cases in Q - Test and execute assigned JIRA User Stories. Log defects in Q-Test and report status to business. Adhere to Agile best practices and attend
• Scrum, Backlog Grooming and Retrospective meetings. Assist developers in troubleshooting Production issues. Assist team members with X12 EDI data needs for various scenarios. Provide recommendations for improving testing approaches, processes and procedures. Provide guidance on complex issues to team members as needed.Tools Used: Amisys, EDIFECS Transaction Management, EDIFECS SpecBuilder 6.7, QTest, Golden6, Teradata SQL Assistant, MS SQL Server 2012, EDW, HIPAA EDI X12 (837I, 837P, 834, and 277CA), Notepad++, UltraEdit, Core FTP, JIRA

Confidential, Jessup, PA

Sr. QA Analyst

Responsibilities:

• ActiveBatch Troubleshot FACETS batch jobs by analyzing runbooks, .XML batch job logs and input data Assisted team members with 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 with Montana Department of Public Health and Human Services (DPHSS), Health Care Service Corporation (HCSC), Change Healthcare (formerly Emdeon Inc. ) and TMG
• Health Interviewed and trained newly hired team members on HIPAA X12 EDI filesTools 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, Citrix, Notepad++, XML, HTML, TMG RTS (Request Tracking System)

Confidential, Englewood, CO

QA Lead

Responsibilities:

• Delivered SDLC test metrics and executive level test reporting on a weekly basis Prepared Test Plan for FACETS enrollment using Madison College group as a prototype Prepared Test Scenarios, Test Cases and 834 Test Data for FACETS enrollment Wrote and updated Business
• Requirements Document (BRD) and Functional Design Document (FDD) Mentored business on HIPAA 834 EDI files creation and enrollment testing Validated FACETS Enrollment jobs (BinB, 834M and MMS0) Performed Custom XSLT mapping testing for Madison College group
• Performed Ctrl+M jobs testing and troubleshot issues Performed end - to-end testing and troubleshot issues as required Maintained Issue Log and communicated to business on a daily basisSystem and Tools Used: Facets 5.01 and 5.10, Ingenix Claredi,, Oracle, SQL Advantage, SQL Queries, HIPAA 834 EDI, GoToMeeting, UltraEdit, NotePad++, WinMerge, MS Office 2010 (Project, Visio, Outlook).

Confidential

Sr. Systems Analyst

Responsibilities:

• Performed data analysis on monthly member X - walk files received from Independence Blue Cross and monthly LDAP Extracts received from Catamaran Authenticator Team for FutureScripts Portal Account Migration. Performed 644 Prior Auth X-walk activities on Eligibility files received from Argus every month.
• Updated QA Process Matrix with latest crosswalk data received from IBC and Highmark. Created Oracle database tables every month for LDAP Authenticator and Member crosswalk files prior to portal migration activities. Wrote complex SQL queries to generate member extracts and Prior Authorization Smart System (PASS) extracts from FSE database. Provided resolution to external stakeholders for new requests for product enhancements including system design Documented, tracked and troubleshoot production issues to ensure proactive recognition of defects and performed root cause analysis Communicated with various stakeholders from Client,
• Customers and Vendors to gather system inputs and answered questing to resolve production issues Reviewed error logs, updated Budget Codes (Coverage Code) and Deduct IDs on FSE front end, and verified Oracle database using SQL queries. Wrote Business Requirement
• Documents (BRDs), Functional Specification Documents, Customer Support User Guide and Authenticator User Guide for FutureScripts portal enhancement. Prepared Test Plans and Test Summary documents for each phase of system enhancement Prepared Test Cases and Test
• Data for System Integration Testing (SIT) and User Acceptance Testing (UAT). Performed regression test to ensure none of the existing code base was broken. Validated post deployment business checkout to ensure desired changes took effect.System and Tools Used: Argus IPNS, RxClaim, SoapUI 4.6.4, Oracle SQL Developer, SQL queries, ServiceNow, JIRA, SharePoint, Eclipse JAVA EE IDE, LDAP Authenticator, SSO, MyFS Customer Support, EDI Transactions, UltraEdit Pro 17.00, Notepad++, Snipping Tool, Snagit 10.0, FTP, CISCO AnyConnect, IBM S

Confidential, Englewood, CO

QA Lead

Responsibilities:

• Acted as an interface between client and TriZetto, and reported progress to senior management. Worked as a Sr. QA Lead at Confidential Headquarter at Denver. Led a team of 5 QA Resources. I was responsible assigning tasks to team members and overseeing daily progress. Prepared Budgetary Guidance Estimates (BG) and Design Estimates (DE) for Quality Assurance (QA) resource hours for both Fixed and Time & Material (T &M) projects. As a Sr. QA Lead, I hosted daily stand up and defect triage meetings, as well as weekly progress meetings.
• Worked closely with Project Managers (PMs) to develop project schedule, Testing Cycles and timeline. Prepared Master Test Management Plan and Test Execution Plan for each project. Act as a peer - leader for the testing efforts of QNXT and FACETS Implementation and Upgrade projects. Provided guidance to the QA team to create and validate HIPPA EDI Transactions for Enrollment (834I, 834O), Payment (820) and
• Claims (837, 835) processing. Provided guidance to the QA team to validate Functional Acknowledgements (999) and Interchange Acknowledgements (TA1) Worked as a QA Lead for California Health Exchange (Obamacare) implementation for Valley Health Plan of Santa Clara County, CA. Assisted in the implementation of Eligibility for Denver Health Exchange for the State of Colorado. Worked in planning phase of ICD-10 Implementation for LHP health plan. Revi

Confidential

Claims QA Lead

Responsibilities:

• Assigned tasks to QA resources based on their best skillsets. Led up to 4 - 5 different projects simultaneously. Prepared Budgetary Guidance
• Estimate (BG) and Design Estimates (DE) for QA hours for each assigned project. Facilitated Weekly and Daily progress meeting with 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) Worked closely with Project Managers (PMs) to develop project schedule, estimated QA resource hours for testing and software deployment Facilitated meetings among Claims Quality Assurance (CQA), Quality Management Office (QMO), Enterprise Project Management Office (EPMO) and Development team to come up with Deliverable Plan Wrote System Integration
• Test (SIT) Test Scripts and prepared Test Data Facilitated Test Plan and Test Scripts walkthroughs with cross-functional teams Uploaded test scripts to FACETS Application Development Repository (ADR) and sent sign-off requests to stakeholders Performed Facets Webservices testing using SoapUI. Uploaded Test Scripts to Test Plan and linked Test Plan to Test Lab, and executed Test Scripts in HP Quality Center 9.2 (QC 9.2)
• Assisted in new Software code, Break-fix code and Change Control (CC) code deployments in SIT and User Acceptance Testing (UAT) test environments Opened HP Service Manager (HPSM) tickets for Provider, Enrollment and Claims batch jobs processing with 834, 837 EDI Test Data Validated SIT results in FACETS front end and Sybas

Confidential, Baton Rouge, LA

QA Lead

Responsibilities:

• Test Cases for Smoke Test, SIT, Regression Test, and User Acceptance Test (UAT) Created nearly 400 Test Cases for 50 Medicare/Medicaid Edits for End - to-End testing. Tested Edit logics through iLink Blue web portal, and verified in Test Harness Tool. 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 with the offshore team to convert 4010 claims to 5010 using Felix tool. 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. Checked claims status in EDIFECS (Transaction Management) and assisted business with error reports (as needed)System and Tools Used: Facets 4.71, HP QC 10.0 (Enterprise Edition), EDIFECS, 5010 Test Harness, UltraEdit, ExamDiff, WinMerge, XML Notepad 2007, TextPad 5.4, MS Office 2010 (Project, Visio, Outlook)

Confidential

Sr. Test Analyst

Responsibilities:

• 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 / 7/835 ) in QNXT 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. 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 Managed implementation of First DataBank MediSpan (FDB MS) Data Integration project. Assisted analysts to write requirements, prepare Test Cases, prepare FDB MS test data, execute and validated SIT. Provided support in resolving post-production issues. After successfully implementing x, MAPD 2012 and First Databank-MediSpan Data Integration projects as a Test Manager, I was involved in planning stages of
• QNXT 5.0 upgrade and ICD-10 implementation projects.System and Tools Used: QNXT 4.7, HP Quality Center 9.2, Oracle database, Serena Business Mashups (SBM), EWS, Tidal Scheduler, SQL Plus, MS Visio, MS Outlook, MS Project, Requisite Pro, UltraeditPlanView.

Environment: Facets 4.71, Mercury Quality Center, Citrix, Tidal Scheduler, QTP, SQL Plus, MS Visio, MS Outlook, MS Project, Requisite Pro.