- Over 5 years of experience EDI Tester, Software Quality Assurance (QA) experience testing Data Warehouse, Database ETL, Data Analysis.
- Excellent knowledge of Health Insurance Portability and Accountability Act HIPAA transaction, code set rules such as EDI 837, 835, 834, 270, 271, 276, 277 and ICD9 - ICD10
- Experience in ETL, Data Warehousing, front-end and BI testing. Strong experience in Data Analysis, Data Migration, Data Cleansing, Transformation, Integration, Data Import, and Data Export through the use of multiple ETL tools such as Informatica.
- Exposed to using ICD 9/ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology.
- Good working knowledge of HIPAA ICD10 and HIPAA transaction requirements.
- Experience with healthcare system, Medicaid and with prime focus on claims adjudication, provider, eligibility and prior authorization.
- Strong working experience in the Data Analysis, Data Verification and Validation of an ETL Applications Experience in Medicaid Management Information System (MMIS). Expertise in various subsystems of MMIS- Claims, Provider, Recipient, Procedure Drug and Diagnosis (PDD), Explanation of Benefits (EOB).
- Experienced working in Pharmaceuticals companies with Oracle Clinical Trials in FDA validated environment.
- Experienced in full System Development Life Cycle (SDLC), from requirements gathering and business case development to rollout and maintenance using Waterfall, Agile/Scrum, and Rational Unified Process (RUP) Methodologies.
- EDI MedicalClaims experience in Process Documentation, Analysis and Implementation in 835/834/837/270/271 processes ofEDI Medical ClaimsIndustry from the Provider/Payer side.
- Good knowledge on CPT/ICD diagnosis codes and Procedure codes.ICD version 9 and 10.
- Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
- Expertise inEDI transactionsused in healthcare industry and good knowledge ofHIPAA X12.
- Experienced in payer rules, requirements, governmental regulations and HIPAA compliance. Interacted with claims payment and enrollment to review, analyze and document business processes.
- Used FACETS for various health insurance areas such as enrollment, member, Products and otherFACETSrelated modules
- Responsible for EDI strategies enabling Health Care Providers and Insurance Careers to communicate effectively.
- Proficient in the implementation of production change management techniques and service delivery disciplines
- Good Working Knowledge of HIPAA Regulations and Claims Processing.
- Created design documents like data flow diagrams, process flow charts using MS Visio and UML.
- Strong Object Oriented Analysis and Design using UML, Rational Unified Process, Rational Rose.
- Actively involved in developing, executing and managing User Acceptance Testing (UAT).
- Good hands on experience testing of inquiry screens to support EDI transactions.
- Extensive experience in using Test Management tools such asHP Quality CenterandQTPfor organizing and managing all phases of application testing process, including specifying testing requirements, planning tests, executing tests and tracking defects.
- Involved in projects which usedData Mapping and DataConversion tools.
- Proficient inSQL and PL/SQLProgramming for testing database integrity.
Databases: MS ACCESS, MS SQL Server
Methodologies: Waterfall, Agile
Modeling Tools: MS project, MS Visio, MS office package.
Operating Systems: Windows 2000/XP/VISTA, LINUX,UNIX
Office Tools: MS WORD, MS EXCEL, MS POWERPOINT, MS PROJECT 2002/2003
Quality Management: HIPAA
Confidential, Grand Rapids MI
- Analyze and plan testing efforts for various business projects.
- Perform Smoke, Integration, Functional, Regression and System testing.
- Interact with Business users and Technical Team in providing clear solutions to the requirements.
- 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.
- Create Test Plans, Test Cases and responsible for executing the Test Scripts.
- Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions. Transactions focused on is 83x and 27x.
- Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team.
- Worked on Edifecs for Rule level implementation and relaxation
- Test PL/SQL code including stored procedures, functions and triggers using TOAD.
- Involvement in Smoke Testing for every GUI application before Handheld to System Testing for acceptance from the Development team.
- Create status reports for all the Testing executed /planned to the Project Manager on a Weekly basis and the QA Manager on a Bi-Weekly basis.
- Create UAT Test Plan and Test strategy for the Users/ Departments during UAT Testing.
- Analyze and Create Test Data Scenarios to be tested by the Business users during UAT Testing and supporting the UAT Team when required.
- Authored Test cases for HIPAA EDI Transactions 270/271, 276/277,837/835.
- Worked to build extensions for FACETS Members, Claims, and Billing and enrollment applications.
- Supported Post Production Implementation and Production Support for all EDI transactions.
- Design and Author Test Plan, Test Cases, Test Data and Test Files as required.
- Execute Functional, System and Integration Test cases.
- Log and tracks all defects.
- Helped to make decisions on Providers who were submitting EDI files both in 4010 and 5010 standards on the impact for downstream processing.
Confidential, Dublin OH
ETL Tester/ EDI Tester/ Data warehouse Tester
- Analysis of Business requirements & Design Specification Document to determine the functionality of the ETL Processes.
- Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
- Tested the ETL Informatica mappings and other ETL Processes (Data Warehouse Testing).
- Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions. Worked with Agile Methodology.
- Performed HIPAA Analysis and Testing on 4010/5010, including Claims handling, with Payer and Provider experience and EDI file generation and testing
- Involved in code changes for SAS programs and UNIX shell scripts
- Tested SAS Programs, to create customized ad-hoc reports, processed data for publishing business reports.
- Involved in testing the Cognos reports by writing complex SQL queries.
- Created flow charts to exhibit the flow of data from source datasets to the final reports using MS VISIO.
- Interacted with end users to obtain specific system requirements and for User Acceptance Tests (UAT).
- Day-to-day Cognos administration activities like monitoring Scheduled jobs like Cube refresh, Impromptu scheduled reports, Backup and recovery maintenance
- Created Test input requirements and prepared the test data for Data Driven testing.
- Generated reports using Informatica Power Analyzer. Prepared extensive set of validation test cases to verify the data
- Tuned stored procedures/scripts, SQL queries to improve the system performance
- Developed Test Plan and Test Cases using HP Quality Center to test the application for the new code.
- Prepared Test Cases for the mappings developed through the ETL Informatica tool and executed those Test Cases.
- Used Quality Center as central repository to maintain the test scripts and print the status report of the same.
- Worked with Rational Clear Quest for bug tracking. Wrote several UNIX scripts for invoking data reconciliation.
- Involved in extensive DATA validation using SQL queries and back-end testing
Confidential, Southfield MI
QA EDI Analyst
- Worked forVersion documentwith SME.Primary Liaisonbetween Business User and Development Team.
- Conducted GUI and functionality testing using QTP.
- Conducted datadriven testing using QTPto conduct backend testing.
- Deep understanding theBusiness Flow of Investment Banking, and extensively involved inPortfolio management and analysis, Mutual Funds, Securities trading
- Deep understanding ofStructured System DevelopmentMethodologies
- Assisted Project Manager in development and documentation ofProject Plan
- Closely worked with SMEs and Identified, researched, analyzed, and defined key issues of theBusiness flow.
- Worked on Documented for Version Controlling, to maintain up to date changes in the Documents.
- ConductedGap Analysis,and GatheredUser Requirements by Interviews, user meeting, JAD session, and Requirement Elicitation Sessions
- Involved in HIPAA/EDIMedical Claims Analysis, Design, Implementation and Documentation.
- Collected and documentedbusiness processesas well asBusiness Rulesand then translate to theBusiness Flow Chart
- Led project efforts for preparation/approval of test plans, test scripts testing matrices and all QA/UAT project documentation.
- Performed White Box testing by using Expediter tool and updated some of the PROCs,JCLs and SAS programs in the Test region. Submitted batchJCLs in order to create output datasets for verification.
- Analyzed and DocumentedBusiness Requirement Document (BRD), Functional Specification Documentation, and System Requirement Documentation, usingUMLmethodologies
- Designed and developedUse CasesusingUMLandBusiness Process Modelling.
- DevelopedQA Test Plan,test conditions and test cases, as well as assisted with QA team inSystem TestingusingMercury Test Director
- Involved in creating reports for the end users usingCrystal reportsfrom the gathered requirements.
- DevelopedUser Manualand ProvidedUser Training.
- ConductedUser Acceptance Testing
Healthcare Data Analyst
- Formulated procedures for data extraction, transformation and integration of health care data.
- Conducted assessment to ensure data quality and completeness with validation techniques.
- Assisted in designing and development of health related analytical products for overall enterprise.
- Provided assistance for quantitative data analysis with health care, biometric and survey data.
- Designed and developed continuous outcomes reporting for multiple intervention programs.
- Coordinated with technical teams for research and evaluation of healthcare and operational problem.
- Participated in critical review and revision of existing systems for updates and enhancements.
- Supported technical teams for development and execution of supplemental analytical tools and methods. Conducted independent statistical analysis, descriptive analysis, and hypothesis testing and logistic regression.
- Provided assistance for health care projects through SAS statistical and analysis software tools.
- Assisted in development of data formatting and cleaning criteria from various data sources.
- Generated database reports, presentation and documentation of analytical methods.
- Performed ad hoc analysis of data sources for all external and internal customers.
- Coordinated with clients for management of data mining and recovery projects.
- Supported technical team members for technologies such as SSAS, Confidential Excel and SQL server.
- Participated in refinement and technical documentation of database reporting requirements.