SUMMARY

• Over 8+ years of IT industry experience with a proven skills in teh field of Software Testing/ Business Analysis and Quality Analysis.
• Strong knowledge of Software Development Life Cycle (SDLC) as well as Testing Methodologies and teh Role of QA/ EDI Specialist.
• Experience and Familiarity working with Waterfall, Agile and Scrum methodologies.
• Experienced in developing scenario based test cases based on Use Cases, User Requirement Documents (URD) and developing acceptance test cases from teh Business Requirements Documents (BRD) and System Requirement Specifications (SRS).
• Strong experience in all levels of Testing such as Positive testing, Negative testing, Integration Testing, Functional Testing, System Testing, Regression Testing. And User Acceptance Testing
• Experience in SOA based Testing, worked extensively on TIBCO, a SOA tool for Data Integration.
• Experience with ALM 11.0 for test planning, functional testing and performance testing
• Experience with business case development in application lifecycle management.
• Expertise in BizTalk06/10 schemas, mapping and administration console
• Expertise in gap analysis of 4010/5010 of all transactions such as 837, 835, 999.
• Expertise in EDI transactions used in healthcare industry and good knowledge of HIPAA X12.
• Experience as an EDI analyst performing verification and validation of teh EDI transactions.
• Possess strong knowledge of healthcare terminology and extensive experience working on healthcare projects. Specialized experience in healthcare insurance domain. Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 4010/5010 EDI transaction codes such as 270/271(inquiry/response health care benefits), 276/277(Claim status), 999 (Functional Acknowledgment)
• Thorough understanding on ICD9/10 codes
• Attended meetings on cross walking between ICD9 and ICD10.
• Gathered, analyzed and documented business requirements for ICD10.
• Expertise in working with direct submitters, clearing houses and providers in regards to all teh issues with EDI setup, claim submissions, eligibility transactions and ERA’s.
• Expertise in claim processing and claim adjudication processes.
• Expertise in writing SQL scripts used in manual testing both front - end and back-end.
• Expertise in developing QA Test Plan, Test Conditions, and Test Cases; ensuring adequate testing of software both before and after completion; conducting and documenting UAT.
• Extensive knowledge on teh Inbound and Outbound HIPAA transaction sets with both 4010A and 5010A HIPAA versions.
• Experienced with health care Systems: FACETS, Medicare, Medicaid systems and Facets for Group, Eligibility and Claims.
• Expertise in TOAD, SQL Server Management Studio.
• Experience testing Back End and Front End databases like Oracle 9i, 10g and AS 400, Confidential 9000 systems.
• Excellent troubleshooting, tracking bugs and issue resolution skills.
• Experience managing and working with On-Site and Off-Shore teams.

TECHNICAL SKILLS

Operating System: UNIX, Windows 9x/NT/2000, MS-DOS

Language/Tools: SQL, PL/SQL

Database: MS SQL Server, MS Access, Oracle 8i/9i, DB2, LDAP, OLAP

Testing Tools: Manual Testing, Mercury tools, QTP, IBM Rational Testing Tool, Confidential ALM 11.0

Networking Tools: UNIX, Telnet, FTP, ETL - Data Staging, LDAP Server (SSE enabled)

GUI Tools/Internet Programming Tools: Tibco, Edifecs, Visual Basic, Developer 2000, Power Builder and Crystal Reports, Cognos Reports, HTML, XML

PROFESSIONAL EXPERIENCE

Confidential, Quincy, MA

Senior EDI Business/QA Analyst

Responsibilities:

• Created 5010 companion guides to teh state by using teh X-walks, Mapping Documents.
• Created monthly/weekly status reports to update teh project schedules & deliverable plan.
• Extensive HIPAA EDI 4010 and 5010 transactions knowledge - 835,837,277,270,271
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270/271 for Eligibility inquiry, and 276/277 for claims status.
• Created Test Files and Test Cases for teh migration project.
• Worked closely with teh Development teams to resolve major issues during testing and production phases of teh project
• Actively involved in 837IB mapping for teh clients. Mapped existing database with Facets database.
• Extensive knowledge on Sybase and EDI GATEWAY applications.
• Supported Post Production Implementation and Production Support for all EDI transactions.
• Worked closely with Trading Partners and Service Centers in halping them to resolve issues with submitting their EDI transactions over teh VAMMIS gateway.
• Reported directly to teh Manager of Outreach and Planning activities.
• Extensive knowledge on teh complete process orientation of all EDI transactions me.e. Batch transactions and Real time transactions.
• Handled Confidential ALM components such as quality center, load runner, performance runner
• Involved in Facets Claims Module and analyzed teh Claim edits, Claim adjudication and creating teh status report as well as creating teh reject reports
• Conducted sessions with teh Service Centers and teh VAMMIS teams to ensure teh smooth transitioning of all Providers and Submitters to migrate from 4010 version of HIPAA standards to teh new 5010 standards.
• Involved in meeting with Clinical Users and Clearing Houses to determine teh format of teh ICD-10 CPT codes and NCDPD Codes.
• Resolved tickets dat were opened by Service Centers in a timely manner to ensure Quality of teh product.
• Performed and assisted various phases of testing which include: System Testing, Smoke Testing, UAT, Parallel Testing to ensure dat both 4010 and 5010 EDI files are processing as per teh Business requirements and no existing functionality TEMPhas been disturbed.
• Tracked teh Defects in Quality Center RQM Quality Manager and Clear Quest.
• Developed standardized FACETS testing, implementation and QA processes
• Participated in defect meetings and team meetings.
• Worked as integration and test engineer.
• Met with teh Provider Communities and Trading Partners to ensure dat HIPAA transactions pass teh EDI gateway and interpret technical difficulties into simple language.
• Helped to make decisions on Providers who were submitting EDI files both in 4010 and 5010 standards on teh impact for downstream processing.

Environment: EDI X12N 4010, EDI X12N 5010, MS Outlook, UNIX, Windows95/98/NT/2000/XP Sybase, Mainframe AS/400, TSO, SQL Server, SharePoint, Confidential ALM 11.0, Confidential Quality Center, QTP, Facets, IBM Rational Testing Tool, FTP2 Gateway tool, Mainframes, Web services, SQL Navigator, Oracle and DB2.

Confidential, Engle wood, NJ

Senior EDI Business/QA Analyst

Responsibilities:

• Conducted user interviews, gathered requirements, and analyzed teh requirements for teh new health insurance product.
• Solid Experience in documentation of User Requirements, as well as organizing interviews, User meetings, workshops, JAD sessions and requirement elicitation sessions.
• Involved in writing Test plans, Test cases and responsible for executing teh Test Scripts.
• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Transactions focused on were 270,271, 834, 835, and 837.
• Worked Extensively with Inbound 837 me and 837 P, 835s(Out bounds) claims processing systems
• Created and executed test cases for testing HIPAA compliancy using Spec Builder 6.8.1.
• Created Base Files for 5010 Transactions and mocked up data to create Test files based on test scenarios and conditions.
• Set up Trading Partners within teh TPM Management tool.
• Experience validating XData created by Xengine for data mapping of X-12 to XML format and in turn to TRLog format.
• Validated X-12 files sent by external vendors to ensure dat they are passing EDI Gateway level using SpecBuilder.
• Worked collaboratively with BI and ETL resources to design and develop effective solution.
• Experienced with high-volume load processing into Data warehouse database.
• Prepared and Created Test Cases /Test Data according to 5010 Business requirements.
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating teh database to file elements.
• Involved in teh development of web platform for online transactions through E-commerce.
• Implemented Data ware house strategies to build teh enterprise architecture.
• Worked with other data analysts in creating and maintaining Data functional design documents.
• Responsible for database designing, system analysis, and overall system.
• Documented a detailed Gap analysis for financial management systems (FMS) and EDW systems.
• Closely worked with development team to enhance and standardize teh ETL Process to load underlying system dat supports UI.
• Modifying JCL's accordingly to run teh required tests submitting teh batch jobs
• Use of QMF and SPUFI in extracting teh queries.
• Using with XPEDITOR debug teh COBOL programs, and see teh runtime values for teh COBOL variables.
• Used File Manager to edit teh datasets.
• Changes to necessary JCL’s, PROC’s were done to test teh programs concerned with teh project.
• Worked on analysis of teh Facets claims processing application in order to gather requirements to comply with HIPAA 5010 requirements.
• Worked with batch jobs, monitoring and scheduling jobs using JCL.
• Executed UNIX Shell scripts to enable and disable teh environments.
• Hands on experience in manual testing of teh application on mainframes for claims processing.
• Created Requirements v/s Test Case Matrix in Excel Spread Sheet template.
• Developed teh Reports for Manager Using Crystal Reports.
• Participated in user acceptance testing for teh UDD application.
• Worked closely with teh AGL Ops team to monitor client transmissions and reviewed reports for Group benefit records.
• Worked on 837, 835, 276 and 277 Institutional and Professional, EDI Gateway.
• Analyzed existing processes, Extracted XML/COBOL files, for successful FACETS implementation and integration with other proprietary tools/application.
• Researched teh existing client processes and guided teh Vendors in aligning teh HIPAA compliance output with teh client systems.
• Worked with different functional groups to arrive at teh common business and technical specifications.
• Designed and delivered HIPAA training material regarding information security and best practices
• Worked to build extensions for FACETS Members, Claims, and Billing and enrollment applications.
• Supervised teh work of junior technical writers and worked in collaboration with them
• Reviewed and edited teh TO BE documents
• Worked as teh primary liaison between teh business user and teh developers throughout teh project cycle
• Works closely with internal auditors, public accountants, federal tax examiners and others as required in performing assigned investment accounting functions.
• Used teh Facets framework for claims and involved in Member/Subscriber Module.
• Used SharePoint to store document and version control.
• Lead as well participated in JAD sessions and interacted with various functional leads and analysts.
• Responsible for preparing Software Requirement Specifications (SRS), Functional Specification Document (FSD) and final Design Document as per SEI CMM standards.
• Created and managed project templates, Use Case project templates, requirement types and trace-ability relationships in RequisitePro.
• Well versed with Claim processing from point
• Participated in risk sessions to address teh risks and addressed of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions project impacts to bring to light teh possible workaround.
• Traced Requirements using Requirement Traceability Matrix.
• Used SQL statements for Back-end testing
• Performed User Acceptance Testing, developed Test logs and opened/closed as and when teh issue is fixed and Quality checked with teh assumed company data with all teh possible Test Scenarios.
• Trained Implementation managers to work on teh new application.

Environment: EDI X12N 4010, EDI X12N 5010, ICD 10, MS Outlook, UNIX, Windows95/98/NT/2000/XP, Internet Explorer. EDIFECS Suites: SpecBuilder 6.8.1, Xengine, TM 6.8, COGNOS, FileZilla, Lotus Notes for Bug Tracking, Quality Center 9.2, Facets, Oracle 10g, Reflection, IBM Mainframe.

Confidential, MA

Senior Business / QA Analyst

Responsibilities:

• Involved in writing Test plans, Test cases and responsible for executing teh Test Scripts.
• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Experience working with FDA regulatory process and standards.
• Transactions focused on were 270,271, 834, 835, and 837.
• Worked Extensively with Inbound 837 me and 837 P, 835s(Out bounds) claims processing systems
• Experience in documenting Electronic Medical records submitted for audits to teh Department of Federal Drug and ensuring dat teh Part 11 is met with all teh necessary rules as established by teh FDA.
• Extensively used teh MVS utilities like File-Aid, QMF and DB2 Load for scheduling teh jobs.
• Used Clarity tool to verify mapping to X12 format.
• Modifying JCL's accordingly to run teh required tests submitting teh batch jobs
• Base-line and Regression tests were scheduled and performed on every Release and build.
• Use of QMF and SPUFI in extracting teh queries and File Aid to edit Data sets
• Extensively involved in real time testing.
• Review FTP processing jobs using with Core FTP Lite tool.
• Extensively involved entire Reference subsystem with COBOL and JCL jobs.
• Extensively involved in Reference Interface (In bound and out bound) testing.
• Used IBM Mainframes- CICS, ISPF, File Aid, IMS, and TSO for mapping Datasets and fields.
• Worked on JCL to run teh batch during teh end of teh business day
• Used Quality Center for preparing teh test plans and manual test scripts.
• Worked extensively with Quality Center for requirements, Preparing Test cases, Executing, Defect openings and closings.
• Involved In loading teh flat files into Oracle Database and involved in writing Complex SQL Queries.
• Involved in generating Reports using Oracle Report Builder and testing teh reports using Oracle Run Time.
• Involved in writing Complex SQL Queries using TOAD to validate teh loads for Caremark and DEA.
• Involved in writing UNIX shell scripts.

Environment: EDI X12N 4010, Sybase Paper Free HIPAA Toolkit, DB2, LDAP, TSO/ISPF, JCL, Visual Basic, ASP, XML, SQL, MS Access, UNIX, Oracle Run Time, Windows95/98/NT/2000/XP and Internet Explorer, me-Frame Portlets, Siteminder, SQA Manager, Toad, SpecBuilder, Tibco BC, Lotus Notes for Bug Tracking.

Confidential, PA

Senior Data Analyst

Responsibilities:

• Created UML Use cases out of BRD document prepared by teh Business.
• Created Test Plan, dat defines teh test environment, phases of testing, entrance and exit criteria into different phases of testing and resources required.
• Identified, built and executed Test Cases and Test Sets for Functional, Error Handling, Navigation and Regression in Test Director.
• 3 Junior Testers reporting to me.
• Manually tested teh entire application along with teh junior testers before teh tests were automated.
• Worked as solution Architect.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Validated teh reports and files according to HIPAA X12 enforced standards.
• Created test cases for Accounts, Activities, Opportunities, Contacts, and Plans.
• Performed validation testing on teh application navigation for various scenarios and reported teh errors.
• Assisted EDI team with teh testing of maps for HIPAA transactions 835 and 837.
• Involved in testing maps and translated data.
• Verified teh relationship between accounts, contacts, opportunities, and activities.
• Performed thin client testing for teh remote users.
• Performed custom tables testing to check if they are resolving teh foreign key.
• Involved in teh user acceptance testing (UAT).
• Supervised Automated testing using WinRunner, test scripts, execution and reporting
• Created projects, groups and multiple sets of logins depending on teh privileges to be given in Test Director Administrator module.
• Manually tested all teh interfaces.
• Wrote SQL queries to perform backend testing.

Environment: IBM Mainframe, DB2, Test Director 8.0, HIPAA X12, MVS/JCL, Aldon CMS, TIBCO.