SUMMARY

• 7+ years of experience in both in Quality Assurance with EDI in Healthcare domain.
• Strong working exposure in AGILE,SCRUM and Waterfall SDLC methodologies.
• Proficient in analyzing and creating User Stories and Story Boards.
• Knowledge on HIPAA Compliance EDI Transaction Sets 834, 837 and Good understanding of the EDI transaction sets 834, 837.
• Excellent analytical skills for understanding the business requirements, business rules, business process and detailed design of the application.
• Expertise in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound Claims 834 - Membership Enrollment, 837-Institutional, 837-Professional, 835-Claim Payment/Remittance Advise, 270/271-Eligibility Benefit Inquiry/Response, 276/277-Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.
• Extensive experience in Backend Testing on distributed databases using SQL queries.
• Proficient experience with project management tools like MS-Project, JIRA for status reporting, planning and error tracking and correcting
• Developed and executed overall UAT testing process including coordination between UAT, business, and technology.
• Analyzed the FACETS Requirements and conducted gap analysis.
• Extensive experience inwritingBusiness requirements documents, test strategy, test plans, test cases, test execution, Risk assessment, and test matrix for upper management, test environment setup, bug reports, & traceability matrix for web based application.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA.
• Expertise in EDI files transferred to Trading Partners in HIPAA standards
• Experienced in troubleshooting and resolving errors in 834 and 820 transactions for health insurance exchanges and performing root cause analysis.
• Extensive knowledge of Facets Billing, Enrollment and Claims processing.
• Used Facets support systems to enable inbound/outbound HIPAA EDI transaction in support of HIPAA 834, 835 /271 transactions.
• Experienced on Web Services to combine component-based development and internet standards and protocols that include HTTP, XML, SOAP and Web Services description language
• Developed Test Scenarios and Test cases for Data Conversion, Functional, Integration, Security and UAT testing.
• Performed Black Box Testing, Regression Testing, Integration Testing, Sanity Testing, Smoke Testing, of Web-Based applications and Data warehouse testing.
• In depth knowledge of Medicare/Medicaid Claims processes.
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets and evaluating the impact of proposed changes in rules and regulations.
• In-depth knowledge of creating use cases, functional design specifications, activity diagrams, logical, component and deployment views to extract business process flow.
• Facilitated as UAT (User Acceptance Testing) lead and worked closely with users and supported in test execution and defect management during UAT.
• Strong understanding of project life cycle and SDLC methodologies Waterfall and Agile.
• Worked in close co-ordination with the testing team in developing test plan and test cases from functional and business requirements.
• Highly motivated team player with excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross-platform environment.

TECHNICAL SKILLS

Testing Tool: Quick Test Professional

Bug Reporting Tools: Test Director, Quality Center/ALM, JIRA

Databases: Oracle, MS Access, MS SQL Server

Project Management Tools: MS Office, MS Project, Excel, Confluence

Operating Systems: UNIX, Windows

PROFESSIONAL EXPERIENCE

Confidential - Dublin, OH

QA Tester

Responsibilities:

• Worked with Business Analyst and QA Lead in reviewing and analyzing the business requirements Documents and functional requirements.
• Developed detail Test Plans for different benefit packages according to Business requirements documentation.
• Perform testing of software applications and other types of applications based on defined requirements.
• Manually created members in Facets in different environments using GCP document as well the requests raised by other teams.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Experiences working in ANSI x12 EDI Transaction.
• Perform front-end and back-end analysis of applications without detailed instruction.
• Contribute actively in technical and functional requirement review meetings.
• Extensively used Agile Methodology in the process of the project management based on SDLC.
• Analyze requirements and create/update test cases.
• Created cases on CalWIN application to determine the EDR (Eligibility Determination Response) and DER (Determination of Eligibility Request) for Medi-Cal eligibility.
• Interacted with the technical team for the 837 claims transactions design.
• Claims processing and 837 Claim transactions.
• Managed and modified theEDIapplication and ensured that all configurations were correct in SAP and Dynamics AX.
• Tested 837/ 835, 820, 270/271, 276/277 transactions with File Aid.
• Use SQL queries skills to perform test data preparation and data verification. Use SQL to extract data about claims, providers, members, subscribers and others.
• Acting as liaison between end user and Facets for user problems, outstanding issues, training needs and new software releases.
• Evaluated and imported projects to look up EDR and DER in Soap UI and ran SQL query in TOAD to determine the eligibility.
• Preparing the 837 I&P Claims and validated these in Facet System.
• Created T-SQL statements and procedures for data mining related to 837 transactions.
• Set claim processing data for different Facets Module.
• Log and review defects with developers and other project team members to assist with resolution.
• Provide status to test leads/managers.
• Designed and development of test cases based on functional requirements for Institutional and Professional claims forEDIand HIPAA Transactions 837/835, 834, 276/277, 270/271 testing.
• Provided overall project management to multiple projects successfully completing them on-schedule and on-budget.
• Perform test case peer reviews.
• Apply QA and Testing processes and best practices to projects.
• Actively participated in walkthroughs and enhancement meetings.
• Maintained Test Matrix and Requirement Traceability Matrix

Confidential, Mountlake Terrace, WA

Facets QA TESTER

Responsibilities:

• Wrote Test Plans, Test Scenarios, Test Cases and the Test Matrix.
• Analyzed and worked with MS SQL Server Test databases.
• Created T-SQL statements and procedures for data mining related to 837 transactions.
• Involved in testing various healthcare applications and migration of plans from legacy system to FACETS application.
• Provided support during the integration and UAT as well as conducted root-cause analysis
• Preparing the 837 I&P Claims and validated these in Facet System.
• Set Automation standards, practices designing the framework Procedures to analyze test results.
• Manual Testing for checking the flow of the application functionality.
• Used FACETS Analytics for fast and easy retrieval, display and grouping of information for performing queries and generating reports.
• Analyzed and worked with HIPAA specific EDI transactions for claims, member enrollment, billing transactions. Worked specifically with 837, 835, 834, 270/271
• Developed design specifications writing Test Reports and documenting test results.
• GUI, Performance, and Backend Tested for Pulse application developing in Java on Oracle Database.
• Conducted Backend testing, writing extensive SQL queries.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 276/277, 270/271, 837/835.
• 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.
• Responsible for Processing claims using EDI 835, 270/271, 278, 837.
• Tested modified / new Oracle forms and database using SQL for its functionality.
• Involved in web services testing and validating the xml.
• Monitoring nightly ETL process from various highly different source systems. Sources included SQL based databases and Excel Files.
• Used complex SQL queries to perform Back End Testing manually with UNIX Shell Scripting.
• Develop the SQL codes as well as use ETL tools to Data Cleansing, Data Mapping and conversion rules and applications.
• Used ETL methodology for support in extracting data, transforming and formatting the data as per needs, loading the data to Data Warehouse.
• Performed Test execution and wrote and executed Test scenarios /Test Scripts
• Create SQL queries using the physical data model as guide to validate new tables (e.g. table structure, field constraints, uniqueness, not null, etc.)
• Prepared all documents necessary for knowledge transfer such as ETL strategy, ETL development standards, ETL processes, etc.
• Tested SOAP request and response in XML format using SOAP UI.
• Tested the changes for the front-end screens in FACETS related to following modules, test the FACETS batches (membership, Billing, Provider, etc.).
• Wrote complex SQL queries for data validation for both ETL and BI testing. Wrote SQL queries for data validation.
• Created Data Stage jobs to extract, transform and load data into data warehouses from various sources like relational databases, application systems, temp tables, flat files etc.
• Documented and reported bugs using HP ALM.
• Tested web services by generating XML SOAP requests and validated the corresponding XML SOAP responses.

Confidential, Virginia Beach, VA

Facets Tester

Responsibilities:

• Conducted GAP analysis and filling gap according to the format set by HIPAA.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Involved in validation of the data in 837 transactions in accordance to companion guide.
• Responsible for customer interface, requirements definition, general and detailed design, testing, maintenance and training programs and managed requirements using Rational Requisite Pro.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Work on EDI X12 transactions, HIPAA standard transaction codes including 837, 834, 835, 270, 271, 276, 277 and perform analysis of such transactions.
• Performed Back-End testing manually for database integrity using SQL statements on UNIX platform.
• Used the Rational Unified process methodology for the application development and created Use cases, activity diagrams and drafted UML diagrams using MS Visio
• Tested HIPAA regulations in FACETS HIPAA privacy module.
• Validated Claims process using Facets
• Determined eligibility benefits for customers with EDI Health Care Eligibility/Benefit Inquiry (270).
• Performed Back-End Testing to check database integrity by writing SQL queries.
• Performed Back-End testing
• Set Claim processing data for different FACETS Module.
• Assisted the development team during the second and third iteration using the RUP model
• Developed design Specification writing Test report s and documenting Test results
• Used RUP to create use cases, activity, class diagrams and workflow process diagrams
• Analyzed the FACETS Requirements and conducted gap analysis.
• Gathered requirements and supported the technical operation requirements for the health plans and providers by coordinating file exchanges, file format, EDI 7 Incoming/OutgoingEncounter submissionprotocol, test plans, analyzing and adjusting data, and ensuring timely and accuratesubmissionof EDI transactions.
• Conducted interviews and workshops for soliciting customer requirements
• Performed Test execution and wrote and executed Test scenarios/Test Scripts
• Defect Tracking and Bug Reporting was performed using Quality Center

Confidential, Downers Grove, IL

Facets QA

Responsibilities:

• Prepared Test Plans for each release, written Test Cases and executed them as part of Functional Testing.
• Analyzed and test configuration changes in FACETS
• Performed Black Box testing and conducted Functionality and Regression testing on various phases of the Management software.
• Support UAT testing and created defect guidelines documents for users using MTM.
• Performed User Acceptance Testing (UAT) & Regression testing.
• Gained Knowledge of EDI transaction code sets including, 276/277, 834, 835, 837.
• Reviewed Software and Functional Specification documents for Test Planning.
• Worked with medical Payment/billing system which kept track of various payment and bills issued to authorized medical care providers.
• Extensively used Scrum/Agile Methodology in the process of the project management based on SDLC.
• Involved in testing of Facets Implementation, Tested end to end testing of FACETS Membership and benefits module
• Work in the Agile testing environment with frequently changing requirements and features set.
• Executed SQL queries to validate the backend data using SQL Developer.
• Conducted Smoke Testing of the new ICD UAT region and recorded testing results in RTM.
• Generated the test defects report and reported it to the development team for Bug fixing through Microsoft Test manager (MTM)
• Performed Testing on Web Services, SOAP and Rest API Testing using data transfer and SoapUI.
• Developed and executed test cases for XML/SOAP services usingSOAPUItool.
• Involved in setting up different configuration environment for compatibility testing and manual testing.
• Upgraded the existing Test Scripts and created new scripts for client application to be able to work for new versions and patches, which improved product quality.
• Worked effectively on Member/Subscriber Benefit in Facets and functionality of new features, new enrollment, enhancements and Data validation in Facet
• CreatedSQL QueriesusingOracle, SQL ServerandDB2in validating data into Data Warehouse applications.
• Involve in preparing Trace Matrix to design test cases