SUMMARY

• 10 years of experience in Quality Assurance and software testing in the Health Care industry. Highly experienced in SDLC (software development life cycle) system.
• Experienced in different types of Methodology (Waterfall, Agile, Rup and Scrum).
• Experienced in writing test plan, creating test scenario, writing and executing the test cases and test script
• Extensive knowledge of health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, and EDI
• Expert in EDI and HIPAA testing privacy with multiple transaction exposure such as new Member enrolment 834 inbound, claim 837 inbound or claim adjudication, response to claim 835 outbound, 276 status inquiry277response, 270 eligibility/271 benefits.
• Validates professional, Institutional and dentist claims in FACETS, verify codes with description and requirements verify adjudication process of claim in FACETS.
• Expertise in RTM (Requirement Traceability Matrix) and gap analysis.
• Extensive experience in Manual and Automated testing using QC, JIRA and QTP/LR such as load runner, win runner. And create reports (standard, tabular and test summary) and have knowledge in performing stress, load and volume test.
• Expertise in Bug tracking and reporting using Jira, ALM Quality Center and Rational Clear Quest. And experience of Bug life cycle system.
• Expertise in different types of testing such as black box, sanity, smoke, positive, negative, integration, configuration, and regression testing as well as UAT (User Acceptance Testing).
• Good Knowledge of Object - Oriented programming Concepts (OOPS) and Java Skills
• Good experience in creating test scripts using WebDriver, Selenium RC, Selenium - IDE, Selenium Grid in Java.
• Experienced in testing Client - Server and Web-Based Application. Front-end and back-end tests.
• Expertise on back-end testing using SQL on oracle, MS SQL server environments running on UNIX or Window platform to verify data integrity. And knowledge of ETL testing.
• Experienced in Selenium automation using Selenium Web Driver, Selenium IDE, Java, Junit.
• Well versed with Automation Framework developing POM classes using java in Selenium Web Driver.
• Strong Knowledge of HIPAA and their regulation. Knowledge of Medicare and Medicaid.
• Knowledge in HIPAA Implementation. Have been involved in a variety of HIPAA related projects. Medical Claims experience in Process Documentation, Analysis, and Implementation processes of Medical Claims Industry from the Provider/Payer side.
• Proficiency in EDI 4010 to EDI 5010. Involved in conversion and mapping HIPAA ICD9 to ICD10. Expert in COB (coordination of benefits).
• Experienced on FACETS and used different modules (application): claim, provider, utility management, member/subscriber, and others.
• Excellent comment skills along with verbal and written.

PROFESSIONAL EXPERIENCE

Confidential

QA Automation Engineer

Responsibilities:

• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation. Involved in HIPPA Complaint X12N837 Transaction testing.
• Developed and implemented EDI applications to process Health Care transactions as per the HIPAA implementation. Wrote SQL Queries for Back End Testing.
• Conducted Black Box Testing on the application and validated the dataflow in the application.
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270/271 for Eligibility inquiry, and 276/277 for claims status.
• Create Test Plans, Test Cases and responsible for executing the Test Scripts.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions. Transactions focused on is 83x and 27x.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Written multiple Test Cases (System, Integration) for multiple transactions include 837I, 837P, 835, (both inbound and outbound) transactions.
• Performed thorough analysis of the companion guides from each trading partners both Medicaid as well as Commercial clients and identified the changes that specific clients need.
• Designed, executed, and maintained Selenium Web Driver (TestNg, JUnit) automated test cases for regression test cases.
• Selected the Test Cases to be automated and performed functional testing of the front-end using Selenium (IDE and Web Driver) & created Data Driven framework using JUnit.
• Executed parallel browser testing on various machines using Selenium Grid and performed cross browser testing.
• Performed web-based performance testing and analysis using JMeter.
• Executed SQL Queries to retrieve data from tables and to perform back-end testing. Creating Test Cases after analyzing the BRD's. Performing Functional and GUI testing on Facets.
• Worked on 837, 835, 276 and 277 Institutional and Professional, EDI Gateway
• Tested the claims processing and Adjudication (EDI 837I, 837P, 837D& EDI 835).
• Extensively used Selenium IDE to record, playback and debug individual test cases, using Selenium WebDriver provided more flexibility in automating test cases.
• Used automated scripts and performed functionality testing during the various phases of the application development using Selenium IDE.
• Involved in testing HIPAA EDI Transactions and mainly focused Eligibility Transactions.
• Worked on distributed test automation execution on different environments as part of Continuous Integration Process using Selenium Grid and Jenkins.
• Performed Integration and Regression testing to check compatibility of new functionality with the existing functionalities of the application using Selenium.
• Prepared test matrices based through defect status in Quality Center/ALM.
• Involved in testing of FACETS Implementation, involve in end-to-end testing of FACETS Claims. Processing module, and benefits.
• Analyzed FACETS data model to ensure optimal system performance and tuning.
• Involved in testing Web services and XML using SOAP UI. Verified the response received by updating the request XML.
• Recommendation on implementation of HIPAA 5010 (EDI X12 837,834, 820, 278,270,999) in the new System.
• Prepared and executed different SQL Queries against the Oracle and Sybase Database.
• Verified and Validated the Rates Calculations and Rate Renewal Calculations for different Products and benefits by Preparing and executing different SQL Scripts.
• Validated SSRS reports and ETL testing with use of complex SQL queries and UNIX scripting. Performed data validation of reports created by SSRS. Validate EDI Claim Process according to HIPAA compliance.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Performing a wide range of QA duties in an Agile (Scrum) development environment.
• Expertise in ICD 9 and ICD 10 Conversion Analysis. Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers.
• Entered Claims and Customer Service Tasks into FACETS.
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270/271 for Eligibility inquiry, and 276/277 for claims status.
• Conducted HIPAA Gateway Testing. Tested the claims processing and Adjudication (EDI 837I, 837P, 837D& EDI 835).
• Skilled knowledge of understanding and validating the X12 EDI format files 834 benefits and enrollment.
• Responsible for creating the test plan and designing test cases for the EDI 834 members' enrollment file loading Created reports that included a general overview, open bugs, new bugs and enhancement requests. Entered new bugs and maintained the current status of those bugs.
• Tested Regression EDI834, 820 Transactions following the HIPPA compliance EDI Standard of X12.

Confidential, Sacramento, CA

QA Automation Engineer

Responsibilities:

• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation. Involved in HIPPA Complaint X12N837 Transaction testing.
• Developed and implemented EDI applications to process Health Care transactions as per the HIPAA implementation. Wrote SQL Queries for Back End Testing.
• Conducted Black Box Testing on the application and validated the dataflow in the application.
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270/271 for Eligibility inquiry, and 276/277 for claims status.
• Create Test Plans, Test Cases and responsible for executing the Test Scripts.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions. Transactions focused on is 83x and 27x.
• Involved in preparing the Test Scenarios for Health Care Claim Payment/Advice.
• Written multiple Test Cases (System, Integration) for multiple transactions include 837I, 837P, 835, (both inbound and outbound) transactions.
• Performed thorough analysis of the companion guides from each trading partners both Medicaid as well as Commercial clients and identified the changes that specific clients need.
• Designed, executed, and maintained Selenium Web Driver (TestNg, JUnit) automated test cases for regression test cases.
• Selected the Test Cases to be automated and performed functional testing of the front-end using Selenium (IDE and Web Driver) & created Data Driven framework using JUnit.
• Executed parallel browser testing on various machines using Selenium Grid and performed cross browser testing.
• Performed web-based performance testing and analysis using JMeter.
• Executed SQL Queries to retrieve data from tables and to perform back-end testing. Creating Test Cases after analyzing the BRD's. Performing Functional and GUI testing on Facets.
• Worked on 837, 835, 276 and 277 Institutional and Professional, EDI Gateway
• Tested the claims processing and Adjudication (EDI 837I, 837P, 837D& EDI 835).
• Extensively used Selenium IDE to record, playback and debug individual test cases, using Selenium WebDriver provided more flexibility in automating test cases.
• Used automated scripts and performed functionality testing during the various phases of the application development using Selenium IDE.
• Involved in testing HIPAA EDI Transactions and mainly focused Eligibility Transactions.
• Worked on distributed test automation execution on different environments as part of Continuous Integration Process using Selenium Grid and Jenkins.
• Performed Integration and Regression testing to check compatibility of new functionality with the existing functionalities of the application using Selenium.
• Prepared test matrices based through defect status in Quality Center/ALM.
• Involved in testing of FACETS Implementation, involve in end-to-end testing of FACETS Claims. Processing module, and benefits.
• Analyzed FACETS data model to ensure optimal system performance and tuning.
• Involved in testing Web services and XML using SOAP UI. Verified the response received by updating the request XML.
• Recommendation on implementation of HIPAA 5010 (EDI X12 837,834, 820, 278,270,999) in the new System.
• Prepared and executed different SQL Queries against the Oracle and Sybase Database.
• Verified and Validated the Rates Calculations and Rate Renewal Calculations for different Products and benefits by Preparing and executing different SQL Scripts.
• Validated SSRS reports and ETL testing with use of complex SQL queries and UNIX scripting. Performed data validation of reports created by SSRS. Validate EDI Claim Process according to HIPAA compliance.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Performing a wide range of QA duties in an Agile (Scrum) development environment.
• Expertise in ICD 9 and ICD 10 Conversion Analysis. Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers.
• Entered Claims and Customer Service Tasks into FACETS.
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment, and 820 for premium payments to insurance products, 270/271 for Eligibility inquiry, and 276/277 for claims status.
• Conducted HIPAA Gateway Testing. Tested the claims processing and Adjudication (EDI 837I, 837P, 837D& EDI 835).
• Skilled knowledge of understanding and validating the X12 EDI format files 834 benefits and enrollment.
• Responsible for creating the test plan and designing test cases for the EDI 834 members' enrollment file loading Created reports that included a general overview, open bugs, new bugs, and enhancement requests. Entered new bugs and maintained the current status of those bugs.
• Tested Regression EDI834, 820 Transactions following the HIPPA compliance EDI Standard of X12.

Confidential

QA Automation Engineer

Responsibilities:

• Manually tested each module of the application and verified against expected results in QC. Analyzed user requirements and prepared test approach document.
• Performed black box testing including smoke, regression, integration, and functional testing. Performed GUI testing manually.
• SQL server Integration Service Package Testing. Wrote Test scenarios and test cases for testing the migration of EDI and the processing of member enrollment and benefits, (834) batch jobs corresponding to the claims (837).
• Performed troubleshooting and resolve errors in 834 and 820 transactions for health insurance exchanges.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 835, 837.
• Executed and validated data mapping for Claims via EDI into RDC through Oracle PL/SQL.
• Assisted in working in establishing EDI system security by suggesting the solution and getting the solution implemented.
• Processed EDI 834 with various scenarios and validated the related tables from database using SQL query.
• Hands on experience in working on designing and reviewing the EDI system applications.
• Integrated Automation scripts (Selenium Web Driver API) in Continuous Integration tools (Jenkins) for nightly consignment run of the Script. Designed Project plan on Jenkins, configured scheduled using Cron job.
• Created and executed CALISA & SOAPUI Scripts for the Web Services testing.
• Performed Data driven testing using Junit functions and Selenium WebDriver which examines the data properly from XML files.
• Used Apache POI API to register the test data from the excel sheet.
• Examined the Business Requirements Document (BRD), designed Test cases and Test scripts for the application under examination.
• Designed the test scripts and analyzed the results in various levels of the application including integration, regression, functional and acceptance testing using Selenium.
• Implemented Regression and Smoke test execution as a discrete step of the deployment process by using WebDriver.
• Performed functional testing to identify several critical points in the application and automated it by using Selenium WebDriver.
• Developed Test Frameworks in Selenium for UI Regression Test Automation and when necessary, and potentially execute Unit Test Automation (Java/TestNG) prior to agile release.
• Perform compliance testing on 834 and 820 EDI transactions.
• Application of EDI 834 transactions in reinstating members, new enrollment, and terminating member enrollment
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers for professionals.
• Tested the HIPPA EDI 834, 835, 837 transactions according to test scenarios and verified the data on different modules.
• Extensively used Claims processing, Provider, Subscriber/Member, Utilization Management and Network Applications in FACETS, verified Co-pays.
• Performed Backend Testing extensively by using SQL Queries. Involved in testing HIPAA Transactions & Code Sets Standards
• Involved in testing HIPAA Database, which incorporates all the HIPAA (Health Insurance Portability and Accountability Act) transaction sets.
• Tested and Quality Center for version control, tracking defects, enhancement request, assign work activities and asses the status of the project.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 276/277, 270/271, 837/835.
• Validate the date from EDI transaction. Performed UAT manually till user satisfaction. Uncovered issues related to the data population in the backend database queried using SQL.
• Participated in requirements, Test Scenarios, and Test Conditions walkthroughs and reviews.
• Participated in the meetings to follow up on Defects/Issues. Performed UAT manually till user satisfaction.