SUMMARY

• Over 7+ years of experience in the field of IT with focus on QA and testing of Client - Server and Web based and web services with effective use of QA practices.
• Strong knowledge of all phases of SDLC (Software Development Life Cycle) and the Health Care Sector with prime focus on testing of claims, eligibility, provider and membership enrollment in Facets.
• Extensive experience in using Test Management tools such as HP Quality Center (QC) and Test Director for organizing and managing all phases of application testing process, including specifying testing requirements, planning tests, executing tests and tracking defects.
• Extremely proficient in Manual Quality Center (QC), Automation QTP (Quick Test Pro) and database testing tools to troubleshoot systems, integration, user acceptance, positive and negative, functional and non-functional and regression in the specific field database.
• Extensive testing experience in all phases and stages of testing with good working knowledge of testing disciplines, tasks, resources and scheduling.
• Professional experience in writing Test Scenarios, Test Conditions, Test Cases and Test Scripts for Functional and non-functional requirements.
• Expertise in Performance measurements, HIPAA 5010/4010A Conversion, ICD9 to ICD10, EDI and ASCI X12 Standards, Administrative Services Only (ASO).
• Experienced in HIPPA 4010/5010 EDI transaction. Experience with writing various test cases for FACETS interfaces and tracking/explaining bugs to development teams
• Designed and executed test cases for the black box testing and perform boundary value analysis, decision table analysis for business rules, and state transition verification.
• Experience in automation testing using QTP for functional and regression testing of complex web based andmainframeapplications.
• Experience in building test cases using structure-based techniques (White Box) covering statement, branch (decision), Condition and path coverage.
• Experience with Medicare, Medicaid, Medigap/Medsupp & commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 270,271, 276, 277, 835, 837, 997, NPI, ICD 9, ICD 10 codes.
• Worked withTriZettos FacetsApplication Groups: Claims Processing, Customer Service, Guided Benefit Configuration, Medical Plan, Enrollment, Pricing Profile, Provider, Subscriber/Member, and Workflow Configuration.
• Experienced in testing Health Care applications and ability to think through the requirements to identify the ambiguities and build test cases for effective test coverage.
• Knowledge of industry compliance standards like HIPAA and EDI X12 transactions (834, 837, 835, 270/271, 276/277).
• Excellent knowledge in creating Test Strategy, Test Plan, Test Input Data for positive and negative testing, Test matrix creation and Defect Analysis.
• Review and analysis of Business Requirements, Development, Functional Specifications, and Detail Design of the Application.
• Extensive experience in testing Facets applications mainly in Provider, Group, Subscriber/Family, membership and billing.
• Formulating Test Plan based on the Design Document, Use Case and User Requirement Document.
• Ability to interact with developers and Business Analyst regarding Testing Status, Defects and change tracking using Quality center and Clear Quest.
• Expert-level experience in writing SQL queries using DDL and DML commands like Select, Create, Joins (inner and outer) and sub-queries.

TECHNICAL SKILLS

Methodologies: Waterfall, Agile, RUP

Project Management: MS Office, MS Project

Version Control System: Rational Clear Case, CVS, Visual Source Safe

Process/Modeling Tools: Rational Rose, MS Visio, Rational Requisite Pro, Clear Quest

Testing Tools: Rational Enterprise Suite, Test Director, Win Runner, Load Runner.

Languages: SQL, JAVA, XML, UML, .NET, HTML

Databases: MS Access, SQL Server, Oracle 9i/10g, Sybase Accelerator

PROFESSIONAL EXPERIENCE

Confidential, Chicago, IL

Sr. Test Engineer

Responsibilities:

• As a Facets Software Taster Involved in FACETS Implementation Testing, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Performed impact analysis on applications for deadliness ofICD-10conversion.
• Responsible for decomposition of the requirements based on the functional specifications, design, development, coding, testing, debugging and documentation of applications to satisfy requirements.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Claim Processing and Subscriber/Member module.
• Wrote Automated Test scripts using QTP/UFT.
• Involved in the testing of claims module and claims adjudication process ofFACETS.
• Assisted EDI team with the testing of maps for HIPAA transactions 835 and 837.
• Performed Data mapping and Data migration testing from ICD9 to ICD10.
• Tested the Claims system through the 837 HIPAA X12 Formats (837D, 837P, 837I).
• Involved in migration testing of FACETS and good understating on different domains.
• Prepared Test cases, according to the business specification and wrote scripts using QTP according to the test cases. Designed and updated Test Matrix and Traceability Matrix. Ensure that all the Test Cases are updated in the Quality Center along with Master Test Plan.
• Extensively tested 7 out of 12 Administrative Services Only (ASO)products for 2014 health plan renewals.
• Exposed to using ICD-09/ICD-10 coding standards in Medicare and Medicaid domains of the healthcare systems.
• Was Responsible in finding the eligibility of the members and filing claims for the States Disability Insurance benefits for both short term disability who are not eligible for the Social security benefits and for the Long term disability customers who are qualified under Social security plan for the payment of benefits as a result or injury
• Prepared test matrices based through defect status in Quality Center.
• Executed test cases manually as well as using Automation tool Quick Test Pro.
• Designed and developed user defined functions of QTP with well-versed VB scripting.
• Logged defects in Quality Center and interacted with the developers to resolve technical issues.
• Used Quick Test Pro for creating inquiries from E-Leads, Online Application and Internal Referral form.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Individually plan, coordinate, and test the conversion of Client data to ASO (Administrative Services Only - new application being developed)
• Involved in providing education about theICD-10codes and 5010 standards, its requirements, complexity and accuracy to Physicians and Nurses of the hospital. Figured out the requirement of training in various departments of the hospital based on their daily work
• Involved in testing HIPAA EDI Transactions and mainly focused Eligibility Transactions.
• Involved in writing extensive SQL Queries for back end testing oracle database.
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction.
• Tested the NetworkX, NetworkX area, NetworkX group in Facets.
• Performed Front-End Testing, Functionality Testing, and Data Driven Testing using QTP.
• Used Descriptive programming in scripting dynamic objects and reusable actions in defining scenario flows in Quick Test Professional (QTP).
• Performed Manual Testing using Quality Center (QC) and User Acceptance Testing (UAT)
• Performed UAT Testing Manually in coordination with UAT group to ensure correct business logic.
• Monitored workflow of the Resolution/Adjustment Unit, delegate tasks accordingly, and ensure that quality, quantity, and efficiency standards are met or exceeded.
• Created different checkpoints in QTP.
• Performed SOA / Web Service testing using Soap UI. Created Data for XML Requests in Soap UI.

Environment: EDIX12N 5010, EDIX12N 4010,QTP, ASO, ICD 10 FACETS, NetworkX, SQL Server 2008, HIPAA tool Kit, XML, Windows, Quality Center. Agile,XP,UNIX

Confidential, Philadelphia, PA

QA Tester/Test Engineer

Responsibilities:

• Elicit requirement to be able to generate the tools and info needed to process the ICD-10 information by 2013 (Claims Processing, Training etc.)
• Mapping of ICD-10 codes to procedure and diagnostic codes in Facets.
• Conduct meeting with the stakeholders and assess their accurate involvement with ICD-10.
• Develop and coordinate implementation timelines with Trading Partners including readiness assessment and coordinated testing.
• Identify processes and systems to enable to trade files with non ICD-10 complaint trading partner.
• Help in preparing the ICD-10 context diagram. Developed standardized FACETS testing, implementation and QA processes.
• Analyzed the ICD conversion information provided by the CMS and Gained understanding of ICD-9 versus new ICD-10 codes sets.
• Handled Enrollment, Benefits, Claims, Medicare,ASO, Traditional, and Dental lines of business.
• Responsible for conducting Regression Testing based on the automated Test Scripts using QTP/UFT.
• Performed manual testing to conduct backend testing using UNIX shell scripts and SQL Queries
• Experience with EDI transactions like EDI 834 (Benefit Enrollment and Maintenance), 276/277(Health Care Claim Status Request and Response), 835(Health Care Claim Payment/Advice) and 837 (Health Care Claim: Professional, Institutional and Dental).
• Multiple 837 map set developed for each client (clearinghouse, internal, and external trading partners), as well unique mappings were needed in each map to accommodate various conditions dealing with Provider, Subscriber, PAY-TO and BILL-TO Provider information needed to identify multiple conditions dealing with batch processing of claims.
• Design, analyze and performed Integration and System testing on FACETS to test all the different software components under one complete system.
• Performed both Positive Testing and Negative Testing in QTP.
• Used QTP for automated testing, modified VB Scripts to meet requirement.
• Help the developers to understand the requirements in order to design the software modifications needed to support the requirements.
• Defect Management&triage, provide expertise to resolve defects that raise business issues.
• Actively involved in documentation of UAT (User Acceptance Test), Functional Test, Integration Test Scenarios and Bug Log.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Actively participated in weekly status meeting with Team members, Team managers, Business analysts & Technical team and also generated Weekly Status Reports to the Team manager.
• Tracking Software defects collected from different sources and categorized severity in HP Quality center.

Environment: MS SQL Server,, Flat Files, DB2, QTP,SQL Profiler, TOAD, ASO, MS Office, Facets, XML, Windows Server 2003, Mercury Quality Center, Win Runner, Lotus Notes, Agile Scrum, Test Plan, Test Cases, Test Scripts

Confidential, Nashville, TN

QA Tester

Responsibilities:

• Acted as a primary contact in all the phases of Software Development Life Cycle SDLC including Quality Assurance Testing, Performance & User Acceptance testing.
• Performed GAP analysis for ICD - 10 and EDI Message Structure with the 4010 Structure.
• Developed End-to-End Quality Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrollment and Maintenance), 835 (ERN-Electronic Remittance Notification) and 837 (Claims Submission) Transactions.
• Acting as liaison between end user and Facets for user problems, outstanding issues, training needs and new software releases.
• Created the “AS-IS” as Current Quality Process Model and the “TO-BE” as the Intended Model, to analyze and improve the Quality processes.
• User Acceptance Testing (UAT) - Performed UAT tests using the MORAE Usability Testing Tool using the Observer and the Manager Mode.
• ICD 9 - ICD 10 Conversion Project - Worked in the analysis of the ICD 9 - 10 codes conversion Project. Expertise in GEM processes and concepts.
• Performed manual Back-End testing on the application by writing complex SQL queries.
• Wrote INNER, OUTER JOINS to retrieve desired or expected data from tables of database with and without comparison operators to perform Backend testing in QTP.
• Performed extensive testing in Facets Subscriber/Member, tested Groups, Eligibility, and Enrollment and validated outbound 834 Extracts to different Vendors.
• Created Text area Checkpoints to test the properties of the text in the application using QTP/UFT.
• Worked onUNIX Platformand experienced inback end testingby executing SQL Queries.
• Checked the data flow through the frontend to backend and usedSQL Queries to extract the data from the database.
• Responsible for inserting Check points to verify Functionality of the application using QTP/UFT.
• Involved in writing extensiveSQL Queriesforback end testing oracle database.
• Retrieved files usingSQL statementsandUNIX commands.
• By using QTP Created, maintained, Executed Test Scripts and Conducted GUI Testing.
• Created and maintainedSQL Queries for back-end testing.
• Involved in using QTP forVB scripting, by using object repository, expert view, Object spy and other main functionalities.
• Involved in testing Facets for Group Information, Enrolling Subscribers, adding members, Related Entities, Class/Plan definition and Premium Rate Tables.
• Used Rational Clear Quest to track and report system defects and bug fixes
• Analyzed and evaluated User Interface Designs, Technical Design Documents and Quality Assurance Test Conditions the performance of the application from various dimensions.

Environment: Quick Test Pro, Quality Center,Rational Clear quest, QTP, HIPPA 10, EDI, Facets, Oracle UNIX,SQL.

Confidential, Philadelphia

QA Analyst

Responsibilities:

• Involved in preparing Test Plan and Test Cases based on business requirements.
• Wrote Test Cases based on Technical Specifications, Functional Specifications and Business rules for online application system.
• Authored and executed Test cases manually for Tiered Benefit and mapped from website to PMHS.
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and Technical Specification in Excel and exported them in Quality Center/Test Director.
• Analyzed research on operational procedures and recommend changes for improvement with an emphasis on automation and efficiency.
• Performing quality assurance functions covering the full software development life cycle, including development and implementation of test plans, test infrastructure and project plans.
• Conducted Data Integrity Testing using Backend Testing techniques in QTP.
• Conducted overall quality assurance responsibilities including writing test plans, detailed test cases, test scripts, and test automation development, test execution, defect reporting and tracking, full documentation, and supervision.
• Wrote Test Plans in MS Word for Manual Testing, System Testing, Integration Testing, Performance Testing, Regression Testing & reviewed their consistency with the business requirements.
• Performed White Box, Black Box, and Usability Testing
• Performed Integration, Regression, UAT and Database testing
• Performed Integration Testing, System Testing and Regression Testing.
• Logged errors reported defects, determined repair priorities, did regression testing and close by using Quality Center.
• Executed Detailed and Risk Based testing for New Functionality.
• Documented and tracked Defects in Clear Quest.
• Retested fixed defects and approved code fixes.
• Used SQL Plus to query the oracle database
• Conducted functionally and Regression testing during the various phases of the application using Rational functional tester.

Environment: Windows, UNIX, Oracle, SQL, QTP, Quality Center/Test Director.