SUMMARY

• Over 7 years of professional experience as EDI QA Analyst/Software Tester in health care industry.
• Extensive knowledge of all phases of Software Development Life Cycle and Software Testing Life Cycle
• Strong experience in both Agile and Waterfall project methodologies.
• Good knowledge of ACA program initiative and involved in testing of CMS 834 Enrollment and 834 Confirmation transactions.
• Experience in creating Test Strategies, Test plans, Test Scenarios, Test Cases and Test data.
• Performed various types of testing like Functional Testing, Integration Testing, User Interface Testing, System Integration Testing, Regression Testing, User Acceptance testing (UAT) and End to End Testing.
• Strong knowledge on HIPAA standards, ICD9/ICD10, EDI transactions 4010/5010 versions.
• Strong experience in testing 837, 835, 834, 278, 820 transactions, TA1/999 acknowledgements and Care and Disease Management application.
• Experience in using EDIFECS Specbuilder and validated SNIP errors and transactions flow using EDIFECS Transaction Management.
• Performed various types of testing like Functional Testing, Integration Testing, System Integration Testing, User Interface Testing, Performance Testing, Regression Testing, User Acceptance testing (UAT) and End to End Testing.
• Extensive experience in creating and analyzing business requirements and system specifications.
• Highly skilled in documenting, tracking and managing issues/risks. Supported project metrics analysis, team communication, and resource planning and report generation.
• Hands on experience with Test Management tools like JIRA and HP ALM/Quality Center.
• Hands on experience with file transfer tools like WinSCP, SSH Tectia.
• Hands on experience with SoapUI to validate web services.
• Hands on experience in creating Requirements traceability matrix, defect status report and Change requests forms.
• Good knowledge of testing tools like QTP and LoadRunner.
• Experience in writing SQL queries using PL/SQL developer.
• Excellent communication and interpersonal skills and a good team player.

TECHNICAL SKILLS

Transaction sets: 835,837,270,271,276,277, 278, 834, 820, 999, TA1

Testing Tools: HP ALM, JIRA, QTP, LoadRunner, SoapUI

Databases: Oracle 11, SQL

PROFESSIONAL EXPERIENCE

Confidential, FL

Sr. EDI QA

Responsibilities:

• Involved in end - to-end and transactional testing of Cigna's own in-house Pharmacy Benefits Manager tool Argus which combines medical, behavioral & drug benefits.
• Participated in all requirements gathering meetings for pharmacy benefits and pharmacy claims adjudication.
• Interpreted and tested claims activity based upon pharmacy benefit set-up to ensure accurate processing
• Prepared test plans, scenarios, and executed end-to-end testing of claims processing
• Managed all testing activities for validation and reporting
• Processed pharmacy claims transaction requests
• Generated queries for the team within the tool
• Identified benefit configuration issues or discrepancies with regression testing related to benefit plans
• Trained new QA team on end-to-end claims testing and transactional testing
• Tested end to end scenarios, change files and enter the defects and reported to business daily.
• Scheduled daily meetings with team lead to go over the defects and report to carriers.
• Updated user stories in Rally in a timely manner.
• Attended daily stand ups and sprint planning and retrospective meetings.
• Scheduled meetings with business users to go over the test results and get sign off.

Environment: Argus GUI 180w, Argus’ General Online Table Maintenance (GOTM), iVista, Reporting tool Vista 3.58.0, Drug Utilization Review (DUR), Vendor Feeds Online System (VFOS), ePro, SharePoint, SQL, IBM Content Navigator, MS Office 2013

Confidential, FL

Sr. EDI QA

Responsibilities:

• Worked with Aetna and Coventry Healthcare Carriers and involved in meetings with business owners to gather business requirements.
• Worked on EDI 834 HIX transactions for Benefit Enrollments for various states.
• Validated Agency member IDs, Total Premium, APTC and CSR amounts in 834 files.
• Validated Plan IDs for Aetna and Coventry Carriers and Special Enrollment Period reason code.
• Validated Additional Maintenance Reason Code for staging and financial & billing purpose.
• Created test files and check whether the payment was made for the files and pay the binder payments for every test file in Service Link Protocol.
• Created test scenarios based on the requirements and created test cases for approved scenarios.
• Expertise in using HP ALM including entering and executing test cases into ALM.
• Logged defects in ALM and maintain the life cycle of defects created.
• Used EDI TRACKER tool to check whether the file was seen in both inbound and outbound.
• Wrote SQL queries in GATEWAY tool to extract the required test files from any testing environments.
• Worked on CMS TAGLINES project and created test plan and test scenarios.
• Manually tested different types of letters for TAGLINES project.
• Validated content, font and format of the letters for various states and corresponding languages.
• Performed manual testing including Functional, Regression and Integration testing.
• Tested end to end scenarios, change files and enter the defects and reported to business daily.
• Scheduled daily meetings with team lead to go over the defects and report to carriers.

Confidential, NY

Sr. EDI QA

Responsibilities:

• Involved in meetings with business owners and users for gathering business requirements.
• Wrote specifications for enhancements by using existing legacy system documentation and procedures.
• Wrote requirements for case management upgrade application and integration of 278 application with case management.
• Worked on different transactions including 278 for Referral Authorization and Certification, 834 for Benefit Enrollment.
• Created test plans for individual projects and test strategies for programs.
• Created test scenarios based on business use cases and requirements and created test cases upon approval of test scenarios by business.
• Involved in manual testing including functional, system integration, regression and end-to-end testing and developed automated regression suite for multiple applications.
• Logged defects and conducted defect triage meetings.
• Attended daily stand up calls and reported testing status and defects identified to the team.
• Tracked test cases, test execution and defects in HP ALM and responsible for maintaining the life cycle of defects.
• Wrote SQL queries using PL/SQL developer to extract test data from different environments.
• Involved in ICD10 testing for 278 transaction and case management application.
• Interacted with third party vendor in providing requirements and coordinated testing results.
• Used EDIFECS Transaction Management to validate SNIP errors (EDI and HIPAA guidelines) and end-to-end cycle of 834 transaction.
• Validated company specific proprietary format for 834 transactions and different input gateways for 278 transactions.
• Validated request and response files for business rules
• Performed user interface testing for case management, referral authorization and enrollment applications.
• Validated XML files and business rules for enrollment and referral authorizations.
• Provided test cases and assisted business users for User Acceptance Testing phase.
• Lead for a team of offshore and onshore QA resources.
• Provided testing and defect metrics to management in a timely manner.

Environment: EDIFECS Transaction Management, Microsoft Office, UAT, HP ALM, PL/SQL Developer, SOAP UI, XML

Confidential, PA

Sr. QA

Responsibilities:

• Worked with Healthcare commercial payers and Medicare entities to validate EDI transactions.
• Designed test strategies and test plans for validating HIPAA I claims.
• Assisted in creating test procedures for testing HIPAA 837I claims paper and electronic based transactions.
• Created crosswalks for upgrade project and created companion guides for 5010 version
• Involved in functional, Integration and regression testing of transactions
• Created new test scripts and modified existing scripts to improve the testing process.
• Involved in testing of proprietary code changes for ePremis, company’s claim management software, change/updates
• Participated in regression testing of Focus/ePremis releases quarterly or as often as the versions are released by the vendor.
• Assisted the team in streamlining and improving processes by providing feedback and writing updated policies and procedures
• Documented QA results thoroughly in HP Quality Center in a timely fashion and made sure that all the test execution results are traced back to requirements.
• Tested all types of SNIP errors including integrity, requirement, balancing, situational, code set and company specific rules.
• Wrote SQL Select queries to retrieve claims information of patients and validate the new and updated entries.
• Regenerating the defects and resolved them and maintained log files for every test.
• Involved in smoke testing and resolving the defects when required.
• Sent weekly reports to the Director with the updated status information on the tasks assigned.

Confidential, FL

QA Analyst/Tester

Responsibilities:

• Tested the requirements and created mapping specifications based on functional requirement specifications.
• Involved in preparing the testing methodology document for big programs
• Participated in requirements gathering meetings, provided assessments based on the requirements which include testing estimates.
• Created test plan for individual projects and at program level and presented to team and QA program lead.
• Created test scenarios based on requirements, built test cases for loan process upgrade application.
• Created use cases and UML diagrams with the help of business requirements document.
• Organized documents use case documents using Rational Requisite Pro.
• Performed functional testing, integration testing, acceptance testing, regression testing and smoke testing
• Developed a regression test guide based on the existing cases for the older version and new upgraded application test cases
• Generated periodic reports using Report Builder Tools like Microsoft Word and Excel.
• Worked with QA organizations to figure out the best possible ways to improvise testing procedures
• Tested end-to-end scenarios, change requests and defects and reported to business daily.
• Used Quality Center to store requirements, test plans, test cases, track test execution and logged defects.
• Involved in defect triage meetings with business and technical teams
• Used SoapUI to validate web services and integration between various applications

Environment: RUP Methodology, MS Visio, UML Modeling, Microsoft Word, Microsoft Excel, Rational Requisite Pro, Quality Center, SoapUI

Confidential, CA

Software Tester

Responsibilities:

• Worked on Java based user interface application.
• Worked with business analyst and technical team to build user cases for different flows in the application
• Documented various key elements of application and made sure that they are understood by the development teams.
• Provided use cases to testing team and business users and conducted meetings
• Created test strategy and test plan based on Functional Requirement Specifications and User Requirement Specifications.
• Used Microsoft excel to build traceability matrix.
• Created dynamic test plans and test cases to make changes based on the upgrades to the application in a timely manner.
• Performed Smoke Testing, Functional Testing, System Integration testing on various modules of the application
• Participated in UAT sessions with business users and provided assistance to them with test cases and coordinating issues to the technical team.
• Logged all the defects in excel spreadsheets and conducted meetings to get inputs from business and technical teams
• Reported weekly metrics, monthly metrics, status report documentation and performance metrics to the team.
• Participated in program level testing and manually tested end-to-end applications.
• Maintained test matrix with the test results obtained.

Confidential

Quality/Business Analyst

Responsibilities:

• Created Software Development Life Cycles (SDLC) processes, procedures and policies.
• Developed test plans after gathering business requirements and analyzing the system.
• Analyzed, Defines, and Documented the business processes and user requirements in accordance with current policies and procedures
• Conversion of data from different database environments, while performing Back End Testing.
• Responsible for weekly walkthroughs and inspection showing the progress of the automation testing effort and open issues to be resolved.
• Involved in tracking, reviewing, analyzing and comparing bugs using a Defect Tracking Database.
• Organized individual and group Joint Application Development (JAD) sessions with business sponsors and IT team.
• Established the business analysis methodology using Rational Unified Process technique.
• Developed Use Cases, Project Plans, Activity Diagrams and Requirements Traceability matrix.
• Created test plan, test cases and test data for the application.
• Performed GAP analysis of business rules, business and system process flows, user administration, and requirements
• Performed Unit Testing, Integration Testing and Requirements Testing and assisted Test Lead and other testers understanding business process and help them successful completion of testing
• Provided strategic support in development of detailed project plans, work assignments, target dates etc…
• Research operational procedures and methods and recommended procedures for improvement with an emphasis on automation and efficiency.
• Discussed with the users and prepared project and system requirements report

Environment: Microsoft Word, Microsoft Excel, UML Modeling Tool, Microsoft PowerPoint, Rational Rose, MS Visio