SUMMARY

• 10 years of extensive experience in the field of Quality Analyst, working wif teh technical staff to implement management and staff's business requirements into teh software application in Industry.
• Highly motivated team player wif excellent communication, presentation and interpersonal skills, always willing to work in challenging and cross - platform environment.
• Excellent noledge of HIPAA standards, EDI claims processing (Medical/Dental), EDI (Electronic data interchange) Transaction syntax such as ANSI X12
• Experience Testing on Healthcare Reform Projects such as Health Insurance Exchange (HIX), ICD-10 Remediation and HIPAA 5010 Implementation.
• Experienced in different SDLC methodologies such as waterfall model, Agile and RUP model.
• Working experience in Finance, Retail and Insurance Domains.
• Knowledge of and ability to apply a wide range of software test engineering concepts: testing principles (Testing Methodology) and concepts, building a test environment, tracking defects n Quality Center
• Expert in Develop Test Plans, Test Designs, Specifications, Test Scenarios/Cases and Test Scripts.
• Extensively involved in SIT and UAT by supporting Testing and implement QA Process.
• Extensively tested on analysis & compliance of ICD 9 to ICD 10 and HIPAA (Health Insurance Portability and Accountability Act) 4010 and 5010 EDI transactions.
• Worked wif Medicare, Medicaid and commercial insurances in HIPAA ANSI X12 formats.
• Good Knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing. Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Well Known wif HIPAA, claim adjudication, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions using best practice model and principles.
• Interviewed SMEs and Stakeholders to get a better understanding of client business processes and gather systems requirements.
• Strong noledge of EDI Claims, EMR, ECR, member enrolment, billing transactions, claims management process, Medicaid and Medicare Services
• Experience in Testing on EDI transactions, HIPAA Compliances, Claims processing, identified and analyzed gaps between current processes and teh proposed new system changes.
• Knowledge of healthcare standard Health Level Seven (HL7) and having expertise in preparing Business Process Re-engineering Models
• Responsible for successfully delivering Cerner Millennium Solutions end-user training for physicians, nurses, technicians, other clinicians and familiar wif HIPAA EDI 874
• Developed a detailed work plan structure for successful project completion of teh SPM database upgrade and Operating System migration
• Worked at UAT and exposure to User Certification Testing (UCT) and Operational Readiness Testing (ORT).

TECHNICAL SKILLS

• Rational Rose
• Rational Enterprise Suite
• MS Visio
• MS Project
• Rational Requisite Pro
• WebLogic
• Crystal Reports
• Lotus Notes
• SDLC
• Test Director
• WinRunner
• LoadRunner
• Quick Test Pro
• SQL
• Oracle
• MS-Word
• Quark Express
• Load Runner
• MS PowerPoint
• GUI
• UI
• Erwin
• HTML
• DHTML
• AJAX
• PHP
• CSS
• Quality Center
• Cerner Millennium itko lisa
• Dream Weaver Java
• Java Script
• Apache interwoven
• AS400
• Web 2.0
• C#
• .Net
• Silverlight
• Ajax
• Sharepoint
• Documentum
• E-Commerce
• Visual Studio Team System
• MS SharePoint 3.0
• ASP
• HL7
• CaliberRM
• XML
• Web Application Server (3.0B)
• Internet Transaction Server
• Business Explorer

PROFESSIONAL EXPERIENCE

Confidential, Minneapolis, Minnesota

Sr.Quality Analyst

Responsibilities:

• Created Test strategy and Test Plan document
• Created Functional Test Cases by reviewing through BRD and Functional Specification document.
• Review teh test cases wif business, development and QA team, record teh review comments and in corporate.
• Worked different type of testing like Smoke, Functional, Unit, System Integration and Regression Testing.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding.
• Used Quality Center/Application Lifecycle Management for tracking teh requirements, Creating Test Cases and Reporting Defects.
• Manage and lead day-to-day operations of system upgrade to comply wif new federal reporting requirements and security protocols including HIPAA.
• Was involved in performing load testing to verify how teh system performs under peak traffic.
• Write and Run teh SQL queries to fetch test data and backend (database) testing to validate teh data.
• Creating prior authorizations using HCPC/NDC codes.
• Was involved in internal audit to verify if teh testing process is meeting teh company standards.
• Generating weekly status report using teh data collected and providing teh higher management wif project level metrics and teh issues faces during a week and follow up wif team members on teh status.
• Involved in developing teh Test Strategy, Test Plan documents for System/Integration Testing.
• Prepared high level System Test Scenarios and Test Conditions for various functional segments. Worked on teh Test schedules, Test estimates for teh Test Script development and execution.
• Written Test Cases for various functional segments based on teh Detailed Business Requirement (DBR) documents, Detailed Technical Design (DTD) documents and Use Cases in Quality Center.
• Responsible for Test Case Design, Test Scenarios walkthrough wif Business and IT teams as part of review process and receive teh Signoff approvals.
• Performed teh access check for all teh databases, tools, servers and interfaces as Entry criteria for teh System Testing.

Confidential

Sr.Quality Analyst

Responsibilities:

• Created Functional Test Cases by reviewing through BRD and Functional Specification document.
• Analyzed teh BRD document, FSD documents, Use cases and design document.
• Responsible for teh full HIPAA compliance lifecycle from Gap Analysis, mapping, implementation and worked for TennCare processing of Medicaid Claims. Ensures MMIS projects adhere to Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security policies.
• Used teh Transaction Management and EDIFECS tool to see teh Transactions status and HIPAA 1-5 Edits
• Ensures project management policies are followed to ensure timely and cost effective completion of IT projects. Follows teh IT Division's System Development Life Cycle.
• Serve wif project implementation, facilitate training sessions, generate progress reports, configuration support, medical billing-and auditing, HIPAA mandate-implementation and monitoring; gap analysis and ICD-9 to ICD-10 mapping.
• Assisted in highlighting key aspects required for vendor solutions - HIPAA translators & testing tools & created vendor statement of work document.
• Identified & conducted mapping process for output from 5010 to proprietary UB92 & NSF formats for legacy payer systems. driven executive wif innovative conceptual ideology in teh Financial Accounting arena further enhancing individual and department efficiency
• Possesses exceptional communication skills essential for program development, training and team cooperation
• Captured key payer systems & HIPAA repository data flow issues & risks. Conducted Claim Adjudication (check for payer edits & rules), analyzed and identified any errors to generate 834.
• Conducted Gap Analysis & identified specific ICD 10 requirements & participated in development sessions capturing ERD diagrams, Workflows & Communication diagrams. Used Ultra Edit Professional to format ANSI X12 EDI 837I, P, D files, identified & changed duplicates, changed loops, elements & segments, wrapped & unwrapped files.
• Followed theTest Readiness Review (TRR)process.
• Followed Acceptance Criteria for Deliverables.
• Analyzed business requirements and developed a Test Plan.
• Developed and executed Test Cases in Quality Center based on teh requirement and design.
• Teh cloud point of teh lowest of their utility for certain applications.
• Wax crystals of sufficient quatity can plug filters used in some systems
• Reviewed test cases after requirement changes or enhancements, monitored requirement changes.
• Conducted manual backend testing to validate query results.
• Created functional routines and verity their reliability to ensure compliance of business rules and propagation of data definitions.
• Performed Sanity Testing, Smoke Testing, Positive and Negative Testing and Usability Testing for teh Affinity Banking module.
• Reviewed, analyzed & created BRD's identified Functional Requirements & Non Functional Requirements using Rational Requisite Pro.
• Conducted interview & brainstorming sessions, JAD sessions, presentation sessions to capture clear, concise & feasible requirements.
• Involved in remediation of teh legacy MMIS to meet teh minimal functionality necessary to electronically send, receive and process teh HIPAA compliant standard transactions, and fully implement all components of NPI Compliance.

Confidential

ETL Tester/QA Analyst

Responsibilities:

• Inspection for making system compliant wif HIPAA. Involved in making teh Medicare patient profiles being compliant wif teh HIPAA regulations. Management of patient profile transfer (PPT) reports created by data team by verifying teh associated data.
• Coordinated wif Business Owner, Application Vendor, Business Project Teams, Payers and Clearinghouses to bring all processes to a level of execution to mitigate any impact to current revenue flow under teh HIPAA 5010-compliancy requirements.
• Manage projects from initiation through delivery via. MS Project. Develop and Maintain SQL Server and Access tables for reporting and analysis.
• Maintain, update, manipulate and create queries in Teradata SQL and Business Objects to pull data from teh Enterprise Data Warehouse for reporting Build tables from Teradata SQL/Business Objects queries for SSRS/SSIS/ACCESS delivery.
• Tested wif vendors to ensure data accuracy establish and assemble project teams, and coordinate activities Develop detailed workplans, project estimates, status reports, project tracking and analysis via MSProject.
• Receive data sets from Programming team, analyze claims and authorization data to produce charts, graphs, and tables; work wif business owners to write detailed monthly, quarterly, and annual narrative analyses for NM State submittal.
• Effectively elaborated teh current process and gave a clear picture of teh proposed process for teh projects in teh organization and aggressively worked towards timely completion of high priority tasks.

Confidential, Whitehouse Station, New Jersey

QA Analyst

Responsibilities:

• Teh QTC (Quote to Card) IIA (Individual and Family Plan Installation Automation) project targets teh implementation of electronic technology for teh enrollment and maintenance process of teh Individual and Family Plan (IFP) line of business.
• Teh Member and Provider portals ofblueshieldca.com were Redesigned and built to support conventional, standard PPO and HMO plan designswif some slight modifications to teh existing functionalityto help Customers wif more clear understandingto display information based upon standard plans.
• Created Functional Test Cases by reviewing through IBM BPM process flow and BRD documents for Functional & Regression testing.
• Analyzed teh test scenarios and created teh test cases in Excel and upload them into Mingle.
• Performed different type of testing like Smoke, Functional, Unit, System Integration and regression Testing.
• Used Mingle and Quality Center for tracking teh requirements, Creating Test Cases and Reporting Defects.
• Analyzed application to find out which part can be automated and which can be manually tested.
• Worked in an agile technology wif Scrum.
• Used to attend teh daily scrum meeting for daily stand up and discussions on defect resolution wif teh development team.
• Helped teh developers wif Unit testing.
• Used Check Points, Regular Expressions, and Object Repository Administration extensively in QTP.
• Extensively worked on Kofax, Ascent capture for document processing and validation.
• Wrote several functions using Descriptive Programming and also managed object repository.
• Tested Jobs and ETL’s dat load data to Data Warehouse and Data Mart.
• Tested Transformations, Lookups as per Business Logic.
• Wrote SQL Queries for Inner Joins, Right and Left Joins to check for relationship between tables wifin a database as well as for teh communication/data flow between those tables.
• Validate and tested Reports dat run against Data Mart.
• Used HP Quality Center as Test Management and StarTeam as defect tracking tool.
• Executed teh test scripts wif attention to detail, and documented detected defects in teh defect tracking system.
• Assigned teh proper status to teh defects during teh entire bug reporting process.
• Performed teh Regression testing of teh application after teh defects were fixed.
• Designed and maintained Test Matrix, Traceability matrix and Gap Analysis.
• Developed common and application common reusable library functions using VB Script.
• Validated teh XML data.
• Run teh SQL queries to fetch test data and backend (database) testing to validate teh data.
• Helped teh client side wif User Acceptance Testing wif preparing teh test data and functional testing.
• Created Shared Object Repository using QTP.
• Imported Excel sheets into QTP wif VB Script library function, implemented data driven testing.
• Performed Automation testing on Claims Processing using QTP and Mercury Quality Center.