SUMMARY

• Over 6 years of diverse experience inthe field of Software Quality Assurance with web - based,Client server and stand alone applications with complete life cycle development of software projects.
• Experinced in preparing the test Plan, Test Cases, executed the test cases, linking the test cases with the requirements, Logging the defects and tracking the defects, and developing the ug Report.
• Specialized in Healthcare Insurance Domain by providing Impact Analysis, Gap Analysis, Risk Analysis and Risk Mitigation using Compliance Document Management Skills and Tools as per requirement and issues.
• ExecutedBusinessAnalysis Methodologies and Iterative Software Development Life Cycle (SDLC) especially in relation with all the phases of Rational Unified Process (RUP) and Agile Processes.
• Developed Test Cases and scripts for different HIPPA, EDI ASC X12 message formats.
• Strong experience in database testing which includes Data Validation, Data Mapping, Data Conversion, Data Analysis using SQL Queries and verified EDI data transactions going fine in the database.
• Good understanding of the process for developing, defining and documenting clinical scenarios and the corresponding ICD 9 and ICD 10 codes.
• Expert in claim submission, claims inquiery, claim review and ICD 9 and ICD 10 conversion.
• Experienced in GAP & IMPACT Analysis of HIPAA with particular attention to Qualifier, Length and required field and situational rules.
• Revitalized requirement elicitation techniques - conducting user interviews and JAD sessions and managed the requirements using Rational Requisite Pro and Use Case Modeling with all phases of SDLC.
• Produced and utilized Use Cases, Functional Specifications, User Interface Specifications and Requirements Traceability Matrix to define the changes in client's system snecessitated byICD 10-CM, ICD 10-PCS Codes and ICD Code Set Mapping.
• Excellent understanding of the Software Development Life Cycle(SDLC) and QA Agile Scrum Methodologies.
• Planning UAT test activities, test estimation, conducting walk-throughs. Reviewing UAT deliverables(Test cases and test results) with the business owners, project director and getting their sign-offs.
• Scheduled meetings and reinforcedbusinessanalysis with developers, system analysts and testers to collaborate rescore allocation and project completion using MS Project.
• Extensive experience in performing Application System Analysis, Preparing Test Strategy, Test plan, Test Cases, Modification/Change Requests, Test Metrics and other Test Documents for QA Testing & well experienced with Project Administration and Test Management tools such as Quality Centre/Test Director, and QTP.

TECHNICAL SKILLS

EDI Transactions: 834, 835, 837 (P.I.D), 270, 271, 276, 277, 278

Operating Systems: Windows 95/NT/2000/XP, Unix, Mac OS9/10

Databases: MS SQL Server, Oracle 9i

Methodologies/Frameworks: RUP, UML, E/R Diagram

Languages: J2EE, COBOL, UML, SQL, HTML, and Visual Basic

Software Tools: Mercator, Rational Rose, Rational Requisite Pro.

Office Tools: MS Access, Excel, Power Point, Word, MS Outlook Express, Outlook Exchange

Project Management: MS Project 2002/2003 (PERT, GANTT Charts), MS Navision

Testing Tools: QC 10, ALM 11.52, QTP, LoadRunner

Data Modeling Tools: Erwin 4.0, MS Visio

Claim Engines: Facets, Diamond

PROFESSIONAL EXPERIENCE

Confidential, GA

Sr Test Analyst

Responsibilities:

• Gathered and documentedbusiness, data and reporting requirements for various departments impacted by ICD codes transformation.
• Validated claims/encounter form as per HL7 format applicable in compliance with ICD.
• Worked extensively on Facets Claims Processing Platform.
• Partnered with solutions architect, SMEs, technical consultants, project managers and the customer to analyze and build business processes, create data and drive the implementation and integration of applications.
• Worked with the management for improving and giving new ideas for designing future processes of the HIPPA transactions dealing out with EDI'S 271, 276 and 270, 470, 835, 837, 834, HIPAA claim adjustments, 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 and also well versed with ICD codes,Facets
• Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) includes facility claims and professional claims.
• Well versed with HIPAA,FacetsSystem, claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Ensured artifacts complied with specifications of HIPAA and corporate SDLC policies/guidelines followed HIPAA compliance.
• Confirming CPSi Modules Impacted by ICD-10 which needs to be tested for system testing.
• Confirming Interfaces which were impacted by ICD-10 for integration tested.
• Defined Functional Test Cases, documented, Executed test script inFacetssystem.
• Used my previous knowledge of SOA to define the orchestration of various internal and external web services and the web methods to save the cost and time of the project.
• Created static and dynamic prototypes using my Visio, html, CSS and XML skills.
• Wrote use cases defining the alternate and exception flows as well.
• Definedbusinessrules for client side and server side validations for the security aspects of the application.
• Performed data mapping, data migration and ETL transactions using my previous SQL experience and conducting meetings with Database admins of internal as well as external databases.
• Defined Functional Test Cases, documented, Executed test script inFacetssystem.
• Writing test cases from the scratch as CPSi has never been tested so there are no existing Test cases.
• Performed various brainstorming sessions to meet and satisfy company's mandated Consumer Transparency Initiatives.
• Validated the requirements for all Mappings, Working Sessions and Workflows for Data accuracy using EDIFECS MAPFORCE.
• Attended daily CPSi touch point meeting as well as weekly status meeting
• Applied Agile SCRUM and facilitated Sprint meetings, stand up meetings, retrospect meeting and created sprint backlogs.

Environment: SOA, Agile Scrum Methodology, SQL Server, MS Project, HP ALM, SharePoint, MS Visio,Facets.

Confidential, Dayton, OH

Tester Analyst

Responsibilities:

• Responsible for developing and reviewingbusinessrequirements, functional specifications, project schedules, documentation and test plans.
• Provided full life cycle support for company’s Facets enhancement to Facets e2 Workflow and Network Management Suite with Pricing Modeler and Network Modeler application--including Business Requirement gathering, Functional Design, Technical Design, and Production Support documentation for multiple outgoing interfaces.
• Worked on ICD conversion from 9 to 10 with respect to the claims related to Medicare (Part A, Part B, Part C, Part D)
• Closely interacted with designers and software developers to understand application functionality, navigational flow and updated them about end-user sentiments.
• Coordinated with Project Managers to resolve risk issues and ensure compliance of Security System-Related to the HIPAA.
• Active member of the team dealing with complex mapping semantics.
• Participated in all phases of theFacetsExtended Enterprise(TM) administrative system implementation including the planning, designing/building/validation (DBV), testing, and Go-live support phases.
• Used Facets 4.71 to receive, store and send HIPAA-standard transactions (835, 837, 270, 271, 276, 277) and to administer HIPAA privacy rights.
• Mapped provider data from source to target Facets 4.71 data layout for the claims and benefit configuration.
• Participated in Facets Table data modeling; planning, designing, implementation of the data warehouse and conducted testing by developing complex SQL queries.
• Responsible for executing User Interface Testing, System Testing, Data Quality Testing on the configuration design and prototypes in Facets 4.71.
• Analyzed and DocumentedBusinessRequirement Document (BRD), Functional Specification Documentation (FSD), and System Requirement Documentation, using UML methodologies
• Established a regular communication flow with the payer during the conversion process and to be at pace with them.
• Further analysis of the requirements was performed using Rational Rose through the Process Flow & Use Case Diagrams.
• Led both internal peer review and external reviews of use case specifications and in the process clarifying the critical requirements.
• Met withbusinessteams as well as test teams to review the requirements as outlined in the use cases.
• Involved in developing test plans, test conditions and test cases to be used in testing based on businessrequirements using Quality center.
• Created and maintained the Requirement Traceability Matrix between the requirements and other products such as design documents and test plans.
• Familiar with User acceptance testing (UAT), System testing, Integration testing and Regression Testing.

Environment: Requisite Pro, Rational Rose,FacetsExtended Enterprise(TM), Oracle, Mainframe, XML, Windows 2000/NT, Ms Access, Ingenix, SQL Server, Crystal Reports, QC, MS office Suite, MS Project

Confidential, Phoenix, AZ

QA Analyst III

Responsibilities:

• Execute System Integration test cases as well as unit test cases and logging defects in HP ALM Quality Center 11.
• Handle the entire Defect management throughout its life cycle in HP ALM Quality Center 11.
• Working directly with the client to resolve test script issues.
• Perform test script reviews of offshore team members and provide feedback appropriately.
• Worked on test scripts comparison project for Southern Nevada and Sacramento facilities.
• Update test scripts based on client specific requirements/workflow.
• Reverse engineer Cerner related system test scripts to requirements, upload requirements and test scripts into HP ALM, complete requirement coverage map, create test lab ready for execution.
• Responsible for verifying data integrity from several distributed systems toFacetssystem.
• Prepare testing-related estimates of effort, duration and resource utilization, ensure testing deliverables.
• Extensively performed System and System Integration testing.
• Designed Regression Test Bed for regression testing in order to check coreFacetssystem after changes made due to MS CHIP plan implementation.
• Worked on IT, UAT and HIT testing support at the client to accomplish the project successfully.
• Played a critical role in testing Pharmacy, Laboratory, Surgery and Radiology charge Trigger points to ensure charges are dropped successfully.
• Identify test requirements from specifications, map test case requirements and design test coverage plan for Cerner applications, Star McKesson and 3M.
• Used ALM for defect tracking and prioritizing defects and for enhancements after base lining the requirements.
• Coordinated defects with different stake holder, assigned defects to different resources across UHG as well as to external vendors for regression testing.
• 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 toFacets.
• Performed extensive testing inFacetsSubscriber/Member, tested Groups, Eligibility, and Enrollment and validated outbound 834 Extracts to different Vendors.
• Develop, analyze, review, summarize and provide testing results to management.

Environment: MS Office, Visio, SharePoint, UNIX, SQL,Facets, UNIX, Java, XML, Oracle, Sybase,Citrix, MS Outlook.

Confidential, Nashville, TN

Software Analyst

Responsibilities:

• Gathered requirements and created BRD and FRD.
• Worked in Healthcare Claims Administration - Healthcare Claims Processing (837/835) including the facility claims and professional claims.
• Involved in the day-to-day implementation of the Rational Unified Process (RUP) methodology of application development with its various work flows, artifacts and activities.
• Worked on HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Worked on claim processing module which involved Receipt and Verification of Claim Forms (837) and Claims Attachments (275), Claims Enquiry and Response (276/277), Adjudication, Healthcare Claim Payment/Advice (835) as per HIPAA guidelines.
• Knowledge of the complete EDI format used in the electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Assisted the UI architect in developing a new UI for the claims reimbursement process.
• Thorough understanding of thebusinessprocess to help determine the user needs.
• Prepared Dataflow diagrams,BusinessFlow diagrams, UML Activity diagrams and Use Case diagrams.
• Performed GAP analysis and documentedbusinessand system level use cases to derive the requirements illustrating the functional behavior.
• Organized use case documents and developed RTM using Rational RequisitePro.
• Submitted change requests and worked with change request records in Clear Quest.
• Participated in entering, tracking system defects in Rational Clear Quest.
• Followed Six Sigma discipline and methodology for eliminating defects in process.
• Actively participated in the Weekly Defect Status meetings to review and prioritize the defects within a functional area.
• Involved in the different phases of test effort like Integration testing, Black Box testing, User Acceptance testing, Regression testing, and Back End testing.

Environment: UML, MS Word, Rational RequisitePro, Rational Clear Quest, Quality Center, SQL, FTP

Confidential, Baltimore, Maryland

Business Analyst

Responsibilities:

• Implemented business optimization projects that reduced the cost, improved efficiency and quality.
• Involved in monthly busines sreviews with the program/project managers and management teams.
• Involved in tracking business goals, performance and status across the projects.
• Developed Business Requirement Documents (BRD) and Functional Requirements Document resulting from JAD sessions and translated requirements to development teams.
• Developed Implementation Plan.
• Having cross functional review where in required for setup.
• Designed Use Cases, Use Case diagrams, Sequence diagrams in UML methodology using MS Visio.
• Tracked Business requirement traceability matrix (RTM)
• Assisted the QA team, by testing web applications using Quality Center.
• Maintained a good working relationship with departments such as, Research, Clinical Trial, and Regulatory departments and often communicated with them and provided technical support throughout the product development.
• Liaised and Coordinated in resolving EDI mapping issues arising from the third party systems.
• Customized an off the shelf supplemental Billing software that generated HIPAA compliant claims.
• Design specifications and Test Case usages for the HIPAA 837, 270/271, 276/277, 835, 824, 275 and others.
• Responsible for updating monthly status to the Project Manager.

Environment: UML, MS Visio, MS Office, MS SharePoint