SUMMARY

• Experienced Healthcare Consultant with 16+ years of diverse Information Technology experience, with emphasis on Data Analysis, Business Analysis, System integration, and Quality Assurance.
• I have significant exposure to EDI, ETL, Data Analysis and reporting with an emphasis on Confidential and HIPPA requirements.
• I have excellent communication and interpersonal skills and is looking for an opportunity to contribute his expertise to an established healthcare organization.
• Vast experience in gathering, analyzing, and documenting functional/business requirements and writing use cases, based on information gathering sessions with clients/stakeholders and technical team members.
• Vast experience in data analysis, data validation and data profiling, ETL and data warehousing.
• Experienced in creating Test Plans, thorough hands on experience with designing test cases covering all test conditions and eliminating redundancy and duplications.
• Experienced in System specification analysis, testing methodology and test plan formulation from Business requirements.
• Expertise in planning and managing projects based on Rational Unified Process (RUP) covering the full range of the software development life cycle (SDLC).
• Vast knowledge and experience in Health Care industry, experienced in testing different healthcare ERP solutions such as FACETS, MedPlus, EPIC and other claim processing solutions.
• Experience in testing Electronic Data Interchange (EDI) according to HIPPA Compliance in X12 and HL7 formats.
• Good understanding of ICD - 9 and ICD-10 Codes.
• Experienced in Black Box testing, Database and Backend testing.
• Good experience in creating, modifying, and enhancing manual Test Scripts and Test Scripts created by Test Automation tools- Load Runner, Quick Test Pro, Rational Robot.
• Experienced in Web-based and API testing using Postmen, REST & SOAP.
• Expertise in using data modeling tools like SQL Diagrams, Erwin.
• Experienced in ETL testing using Data Stage, Informatica and BW.
• Experience in BI Tools (Reporting Services, Integration Services and Analysis services).
• Experienced in SQL, PL/SQL, data ware housing, Oracle, and MS SQL Server.
• Ability to understand & analyze business processes & workflows with the objective of providing recommendations for the best use of technology to improve the process.
• Extensively involved in Performance Testing, Load Testing, and Stress Testing.
• Experienced in Data Driven Testing, Batch Testing, Upgrade, Configuration, Functionality Testing GUI Testing, Regression Testing.
• Exclusively used Security Testing, Usability Testing, Positive Testing, and System Testing.
• Experience in Backend Testing using SQL queries and Unix Shell Scripts. Experienced in using ALM, qTest, Clear Quest, and other bug reporting tools.
• Experience in interacting with business analysts, developers, and technical support and help them base line the requirement specifications.
• Proven ability to work cooperatively & effectively with business, team, & systems partners.
• Strong communication skills, both verbal & written, with emphasis on the production of clear and detailed written Test Plans, Business Requirements, & Functional Specifications.

PROFESSIONAL EXPERIENCE

Confidential, Louisville, KY

Sr. Quality Engineer/Coordinator

Responsibilities:

• Worked as a Test Coordinator to coordinate End to End testing efforts among the different testing teams such as SIT, UAT and Performance Test Team to validate TDM de-identification across the enterprise.
• Created Test Strategies and Test plan, worked with different application teams to make sure PHI De-Identification is according to the profiling documents and there is no impact of PHI De-Identification on any application.
• Coordinated Testing efforts with different outside vendors such as SS&C/Argues.
• Worked with TDM Management, Coordinated and Tracked the ETA’s, Status Reports and Signoff’s.
• Lead different status and functional meetings with different Development, Business, Infrastructure and Testing teams.
• Lead EDW Testing for De-Identification Project, to makes sure all the de-identified tables in EDW have no impact of de-identification.
• Lead EDI testing with different Confidential Testing Teams such eHub, HIT, CarePlus, Puerto Rico, SS&C to make sure X12, HL7 and other priority transections de-identified by TDM are properly de-identified and there is no impact of this de-identification on their existing systems.
• Worked with different UAT teams to make sure there is no impact of de-identification on end users.
• Extensively involved in Data Profiling, Source to Target Mappings, Data Validation, EDI X12 and HL7 formats profiling.
• Performed Back end testing using SQL queries to verify and validate data.
• Worked with all the major Claim Processing, Pricing, Customer Service and Enrollment applications in Non-Production Confidential environment to validate TDM De-identification.
• Provided TDM Testing inputs and status updates in Scrum Meetings.
• Logged Defects in qTest and in ADO board and Coordinated defect review meetings.

Confidential, San Francisco, CA

Sr. EDI/QA Analyst

Responsibilities:

• Involved in Data Modeling, Table structures and View creation.
• Performed Data Profiling for each line of business such as Facets Membership. Claims, Clinical and Providers to address critical measures.
• Created STTM’s from Source to Target for Clinical, Membership
• Involved in designing of data warehouse, worked with different source systems such as Facets, Amasys and some in house source systems.
• Profiled and mapped different Data Marts mapped different end user reports based on each line of business such as Membership, Claims, and Provider etc.
• Conducted JAD sessions with business to design reports.
• Created source to target mappings for reports requirements.
• Studied the functionality and confirmed the columns with Primary keys and Foreign Key and worked closes with the DBA in implementing the Database objects in Operations.
• Worked with senior analysts and ETL experts in discussing requirements, complex data problems and provided solutions to resolve the Data issues.
• Involved in the data movement between systems and validating the business requirements.
• Performed data mapping from supplemental database to reporting layer.
• Created four square report to evaluate team performance as a lead.
• Involved in UAT and created test scenarios for UAT
• Performed Usability testing as an End User.
• Performed Post Validation testing.
• Logged defects in ALM, triaged defects with development lead.
• Provide systems expertise (training) to system users, business partners, and other internal/external customers including trouble shooting issues, as well as identifying and correcting inefficiencies
• Validated requirements for new functionalities and facilitated Facets system testing support

Confidential

Senior QA Analyst

Responsibilities:

• Analyzed, documented, and maintained business, functional and systems requirements for the enrollment and reconciliation process in SharePoint.
• Acted as the POC EDI Coordinator/Liaison to interact with the internal and external customers.
• Performed extensive GAP Analysis and Data Analysis to understand the AS-IS and TO-BE conditions and determine the feasibility of the new project with the existing system.
• Analyzed functional requirements and translated them into test cases and assisted QA lead to prepare detailed test plans
• Trained different user groups during implementation of the system and prepared supporting documents related to the new system
• Documented workflow diagrams for the enrollment and reconciliation process.
• Created various testing documents such as test plans, test cases, test scripts, and facilitated User Acceptance Testing (UAT).
• Worked closely with the Confidential business owners to gather the initial ER&R requirements.
• Extracted data from the SQL database to verify pre and post deployments.
• Mentored and delegated subtasks to the Junior EDI Business Analysts to assist with the validation of the “orphan records” issues by triaging, researching, and applying technical knowledge to resolve 834 transaction and processing issues.
• Worked with the QA to develop Master test plan, test cases, and the complete defect correction processes.
• Developed the Quality Assurance (QA), and Quality Control (QC) processes and procedures.
• Traced Requirements using Requirement Traceability Matrix.
• Consulted with developers and test leads to ensure products were compliant from initialization through final functional testing.
• Reviewed, analyzed, and evaluated EDI requirements and processes for improvements or enhancements as needed.
• Conducted weekly defect review meetings with the team members.
• Audited the 1095A interim process to monitor no PII information about the customer was being stated under the HICS cases (severity 1 and 2). Maintained confidentiality and complied with Health Insurance Portability and Accountability Act (HIPAA).

Confidential, Waltham, MA

Sr. QA

Responsibilities:

• Translated the business needs into system requirements, communicating with the business users on a non-technical level and with the system analysts on a more technical level
• Created Business Requirement Document (BRD) and documented business rules by communicating directly with various user groups in the company
• Developed test strategies, test plan, test cases and prepared use case specification document explaining interactions between the user and the new system
• Involved in administration activities migrating the repository from development to testing environment, and assisting the production support team
• Modified the existing Screens, Views and Applets to meet the business requirements
• Analyzed functional requirements and translated them into test cases and assisted QA lead to prepare detailed test plans.
• Developed and executed test cases based on requirements within the predefined timeframe.
• Involved in daily data load process, data quality checks, and data extractions from database using SQL for the data analysis user groups.
• Performed UAT and System Integration testing.

Confidential, MA

Sr. QA / Clinical Data Analyst

Responsibilities:

• Analyzed Clinical Quality Measures under the Meaningful Use EHR Incentive Program of the Centers for Medicare and Medicaid Services ( Confidential ).
• Analyzed Clinical Data and from Confidential and based on EMeasures Guide created test strategies and test plan.
• Worked with BA’s, Developers and End Users to create test data according to Clinical Quality EMeasures Logic and Implementation Guidance.
• Worked in Agile Scrum environment.
• Outlined testing approach, test scope, Entry Criteria and Prerequisites, Exit Criteria and Deliverables and testing environment.
• Prepared Clinical Data to test Clinical Quality Measures in Confidential Analytical tool Collabra.
• Analyzed Confidential Analytical tool Collabra for EMeasures Calculation.
• Provided Clinical Data to different cross functional teams for testing EMeasures.
• Tested 2014 CQMs release according to the Confidential standards certifications.
• Performed both System Integration and User Acceptance Testing.
• Created and maintained PL/SQL Scripts and UNIX Shell scripts to perform back-end testing on the oracle database.
• Prepared testing reports, test matrixes, progress reports, and defects reports to coordinate status of the project with different stalk holders.
• Performed Regression and User acceptance testing.

Confidential, New York, NY

Sr. QA Analyst

Responsibilities:

• Worked on Professional, Institutional and Dental Claims. Involved in data preparation of both 4010 and transactions. Worked with both Errata and Non-Errata 5010 transactions.
• Tested HIPAA transaction sets for both 4010 and 5010 A1/A2 versions and specifically tested the crosswalks which highlight the additional elements added in 5010.
• Worked with different Trading Partner Setup.
• Wrote complex SQL queries to perform backend testing.
• Worked with test plans and created test cases for ETL loads from X12 files to target Databases and then from Databases to output X12 files.
• Extensively involved in validation of one to one mapping and Complex routines based on Cross walk data mapping.
• Validated data loads from X12 files to Main Frame.
• Created data mapping spreadsheet for the user stories as per the Implementation Guide to capture the business process.
• Wrote defects in Quality Center, created reports and graphs using Quality Center.

Confidential, Bloomfield CT

EDI Consultant

Responsibilities:

• Extensively involved in Electronic Data Interchange (EDI) designing and Implementations. Analyzed different HIPPA transactions such as 837 inbound/outbound, 835, 997, 999, 270,271, 276,277 etc. Involved in implantation of both HIPPA X12 4010 and HIPPA X12 5010.
• Performed System Testing and System Integration Testing, Retested Confidential priority defects assigned to HP.
• Validated different X12 transactions based on X12 Cross Walk data mapping, used both companion and Implementation guide for analysis.
• Tested ETL processes built in Data Stage.
• Performed End to End testing of ETL processes from Source X12 files to databases and from databases to Outbound X12 files.
• Tested Direct Mapping and Complex Routines bases on ETL Cross Walk Mappings.
• Conducted the drop & load and incremental testing of source and destination databases.
• Performed Regression testing.
• Performed Report testing build in Cognos and validated the data quality by running the SQL Queries using TOAD for pre and post baseline.
• Wrote defects using Mercury Quality Center, analyzed test results using reports and graphs generated in Quality Center.

Confidential, Waltham, MA

Sr. Software System Analyst/EDI Analyst

Responsibilities:

• Analyzed system requirements.
• Validated ICD-9 Codes in Risotto Networks pricing engine.
• Wrote Stored procedures, Functions, Triggers and Complex SQL queries in Oracle 10g
• Performed data mapping of EDI flat files to oracle Data bases.
• Performed the Backend integration testing to ensure data consistency on front-end by writing and executing SQL statements on the Database.
• Performed Sanity and Smoke, User Acceptance, Load, Functional, EDI and Data Driven testing.
• Performed ETL testing and validation of End User Reports.
• Worked to resolve customer issues with proactive support, developed point solutions and prototypes components, created factory with best practices and reusable components
• Performed Verification and Validation and wrote defects using Mercury Quality Center

Confidential, Phenix, AZ

Facets System Analyst

Responsibilities:

• Worked with Business team, Development team and externals Vendors to review BRD’s in order to define test strategies and test plan.
• Lead FACETS QA team in MS CHIP, defined test scope, setup up test environment and test data.
• Performed System and System Integration testing from core Facets to different UHG and external vendor’s subsystems.
• Prepared state review documents to get approval on respective tasks from states.
• Perform Extensive EDI testing on X12/, 835, 270 etc., worked with state vendor ACS to validate inbound /outbound EDI transactions to Facets.
• Adept at working with the quality analysis team to create test plans, test cases, test scripts, facilitating User Acceptance Testing (UAT) and ensuring timely resolution of defects
• Skillful at black box testing/manual testing for validating end user requirements and adept at managing change requests
• Tested various Membership reports built in Cognos.
• Provided Facets related systems expertise (training) to system users, business partners, and other internal/external customers including trouble shooting issues, as well as identifying and correcting inefficiencies.
• Extensively performed System and System Integration testing.
• Facilitated User Acceptance Testing by creating UAT test scripts in order to test end-user functionality and to ensure that business requirements were met.
• Extensively performed Partner Testing to make sure all the external components are receiving data from FACETS according to new MS CHIP plan configuration.
• Used Mercury Quality center for defect tracking and prioritizing defects and for enhancements after base lining the requirements.