SUMMARY

• 7 + years of Rx Claim (As400), Web Applications, Health care pharmacy benefit management and IT Consultant experience.
• Worked as a system and benefit analyst and QA lead in various core areas of PBM & Medical Coding industry (Integrating to different PBM systems into single platform PBM system).
• Strong experience in client interaction and understanding business application.
• Experienced working on various development, maintenance, and enhancement projects for the clients in the Medical Coding.
• Strong experience in developing detailed Test Scenarios and Test cases using requirements and design documents while specifying Testing Overview, Approach, Strategy, Scope, Roles and Responsibilities.
• Hands on Experience in preparing Test plan, Test methodology, Test scenarios, Test summary reports, Test Tool Usage, Test Scripts, Test cases, Test documents, Test Execution and Defect Management for both automated and manual testing based on User requirements, System requirements and case documents.
• Experience working as a Technical and Functional lead in various core areas of PBM industry (Integrating to different PBM systems into single platform PBM system).
• Good experience on Client server architecture based AS400 applications with traditional approach of accessing data from actual Physical/Logical files and Dynamic approach (Embedded SQL) of accessing data from virtual file/tables that can act like Physical/Logical file, except it doesn’t really exist.
• Good exposure towards mentoring, handling a team and successfully delivering projects involving high complexities involving offshore and onshore co - ordination.
• Excellent Inter-personal skills and a quick learner.
• Ability to get along with the team well with proven leadership qualities.

TECHNICAL SKILLS

Languages: SQL, PL/SQL

Operating System: Windows 95/98/2000/NT, UNIX

Applications: Quality Center, HP ALM, Jira, IBM AS/400, Rx Claim, HP Quality Center, Rational Clear quest, SharePoint

Business Knowledge: Pharmacy benefits management, EDI Eligibility, Health insurance and Medical devices

PROFESSIONAL EXPERIENCE

Confidential, Secaucus, NJ

Sr. QA Analyst

Responsibilities:

• Participate all requirement meeting for upcoming Change Request (CR).
• Playing role of Test Lead and coordinating work from multiple projects under the same cluster.
• Collaboration with Programmers, Project Managers and Business Analysts to review business and functional requirements.
• Lead test design and execution for Functional test cases.
• Estimating testing effort and communicating the same to stake holders
• Co-coordinating User Acceptance Testing.
• Create high level test scenario based on requirement. Once the requirement is finalized, create test cases for Smoke/BVT and Regression test.
• Writing test cases as per requirement and executing test cases.
• Playing role of Test Lead and coordinating work from multiple projects under the same cluster.
• Collaboration with Programmers, Project Managers and Business Analysts to review business and functional requirements.
• Run SQL query to validate the date.
• Prepare and update Daily Status Report (DSR), Weekly Status Report (WSR) and different test related report and documents.
• Implement manual test cases after server migration, server Patch upgradation and whenever necessary.
• Logging defects in TFS (Visual Studio) and linking it to requirements and test cases to complete RTM.
• Work in a large team environment with offshore team members.

Environment: RxD Application (PBM).

Confidential, Richardson, TX

QA Analyst

Responsibilities:

• Providing the estimates to the client for various projects and get the concurrence.
• Responsibilities include reviewing EMRs to sequence appropriate ICD-10 with CPT codes, auditing claims for accuratecoding, physician consulting, data entry of codes and charges, and resolving claim denials and appeals.
• Coordinating with offshore team in India and get the deliverables done.
• Performed 100% re-enrollment and certification of providers prior to start of operations and implemented additional enhancements that include ICD-10.
• Conducting test case walkthroughs with Optum QA and Business and finalizing the test case documents.
• Support the offshore team in clarifying the requirements and technical challenges.
• Writing/ Updating the test cases based on BRFR documents and from the feedback by business.
• Supporting the execution and document the results
• Reviewing the results documents and finalizing the Test results & Requirement traceability documents.
• Working as a QA Lead and SME.
• Performing Data Query using SQL*Plus from multiple relational databases & data warehouse.
• Conducting walkthrough for test results with Optum Business and QA and get their approvals to get a closure on projects.
• Resolving the issues and concerns raised by Optum Business/ QA analysts.
• Supporting release night testing and conduct smoke testing after the prod deployment is completed.
• Participating in the weekly/bi-weekly status calls to discuss the status, risks and issues. improve safety, privacy, and healthcare outcomes for patients and healthcare consumers, while reducing costs in the system using bright ideas.

Environment: IBM AS/400, RxClaim, SAP (Billing System), HP Quality Center, Rational ClearQuest, SharePoint, SQL.

Confidential

Pharmacy benefit associate/Business system analyst/Quality reviewer

Responsibilities:

• Assisted in the development of automated business solutions in accordance with company System Development Methodology.
• Performed thorough analysis for requirements, design, and program specifications.
• Prepared detailed logic flowcharts of solutions.
• Coded programs utilizing structured and modular techniques.
• Created unit test plans and effectively execute.
• Researched and analyzed offerings that client can provide to increase business in the market.
• Query data using SQL*Plus from multiple relational databases & data warehouse.
• Participated in project testing activities as outlined in SDM.
• Prepared program, system, and run-time documentation (text or diagram).
• Prepared user reference materials, training materials and, when appropriate, conduct formal training.
• Adhered to IT Systems Development Methodology and conform to IT standards and procedures.
• Led the creation of project plans, time estimates, project schedules, and status reports and handled the testing team of 18 members.
• Researched, documented, coordinated, and tracked problems to resolution.
• Investigated and recommended system, policy and/or procedural improvements.
• Performed workflow analysis, created workflow diagrams and made recommendations for procedural improvements.
• Performed thorough analysis to ensure effective implementation of project requirements.
• Performed ad hoc research and query projects as requested. Platform: IBM I (ISeries, AS400) and Windows Development.
• Created an Excel VBA internal tool that generated and displayed the capital gained for each year of service with the company.
• Convinced the senior executive the wealth to be gained by staying onboard which helped maintaining customer relationships adding 40% more projects and revenue.

Environment: IBM AS/400, RxClaim, SAP (Billing System), SQL, HP Quality Center, Rational ClearQuest, SharePoint.