SUMMARY:

• Have around 7 years of experience as a Quality Assurance and Software Test Engineer. Well versed in Quality Assurance of Client/Server and Multi tier Web Based applications. Proficient in various testing methodologies and hands on experience in all stages of software development life cycle (SDLC). Documentation experience in writing test plans, defining test cases, designing test strategies, developing and maintaining automated test scripts. Well versed with backend testing by creating SQL scripts to validate and verify data.
• Experienced on testing Internet and Intranet applications.
• Good Healthcare domain knowledge
• Proven ability of BA experience and analyzing the business requirements and capable of establishing the best methodologies to break software builds.
• Skills and experience include acquiring the traceability matrices of the business requirements.
• Through understanding of QA methodologies. Expertise and experienced in performing black box testing, white box testing, GUI testing, integration testing, interface testing, end to end testing, backend testing, regression testing, UAT, performance testing, load, stress and Volume testing.
• Strong knowledge and experience in Healthcare industry. Functional knowledge of Medicaid Management Information System (MMIS).
• Expertise in writing SQL Queries using Oracle , SQL Server and Teradata in validating data into Data Warehouse/ETL applications.
• Strong working experience in the Data Analysis , Data Verification and Validation of an ETL Applications using Backend/Database Testing.
• Excellent Documentation skills to prepare Test documents like Test Plans and Test Strategies and control processes in accordance with SOX compliance. Experienced in working CMM standards.
• Experience in extentive execution of Test Scenarios without dropping quality standards.
• Good Experience in Back - end testing using sql server Enterprise Manager and Toad
• Knowledge of ETL tool Informatica
• Experience in Healthcare with mandatory HIPAA compliance checks, EDI transactions 837,835,834, 270/271 and 276
• Good knowledge of Trizetto Facets
• Knowledge of Member/Subscriber and claims module in Facets
• Experience in testing web applications using different browsers. (IE6, 7 & 8, FireFox3, Safari 4, S60)
• Experience on Migration, Implementation of the software releases.
• Delivered the tasks which were assigned in Agile environment on a daily basis.
• Good communication and co ordination skills to interface with clients or end users.
• Excellent presentation skills for documentation using MS Office in specific Excel and Word.

TECHNICAL SKILLS:

Operating Systems: Windows95/98/NT/2000/XP, UNIX.

Automated Testing tools: HP/Mercury and Rational (RFT and RPT), Test Partner, Silk

Test Management tools: Test Director 8.x,QTP, SOAP UI, Rational Test Manager, Quality Center, Load Runner

Others: Facets, PEGA

Database: Oracle7.x/8.0/8i/9i,SQL and MySQL server, MVS/ DB2

DB Editors: SQL server Enterprise Manager, Toad, QMF, PG Admin

PROFESSIONAL EXPERIENCE:

Confidential, Nashville, TN

Sr. QA Tester

Responsibilities:

• Analyzed the system requirement specifications and developed appropriate test plans, test cases test scripts and executed testing.
• Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
• Lead Business Intelligence reports development efforts by working closely with Microstrategy, Teradata, and ETL teams
• Strong experience in working in Windows and UNIX environments.
• Worked on claim processing module, which involved Receipt and Verification of Claim Forms (837) and Claims Adjudication, Health Claim Payment/Advice (835) as per HIPAA guidelines.
• Used Claim Test Pro 4.44 to perform a claims payment system upgrade to a newer release.
• Analyzed System Impact including MMIS Tables, Windows, Reports and Interfaces to external entities.
• Designed and documented test plan, test strategies, test cases in Test Manager by evaluating the requirement document in RequisitePro and performed hands-on testing for complex test conditions, scenarios and scripts so HIPAA transactions in EDI formats are verified.
• Designed DataStage ETL jobs for extracting data from heterogeneous source systems, transform and finally load into the Data Marts.
• Served as a point of contact for CMS and trading partners to do the testing for various types of claims and real time transactions like 270/271/276/277 for Medicare and Medicaid programs in FACETS.
• Worked on customizing the claim module of FACETS for repricing Nursing home claims.
• Worked on ICD-9 to ICD-10 conversion in FACETS.
• Data mapping on Enrollment Module (EDI 834) of FACETS.
• Validated and analyzed EDI outbound and inbound Transactions.
• Executed test cases for the existing market’s various lines of business. (The test cases covered: Authorization of claims, Accumulator, Benefits, Claim Payment and Pricing, as well as member and provider data updates)
• Queried for claims and members using Claim test pro.
• Validated the application against the expected results by inserting Database, Bitmap and GUI checkpoints.
• Performed data-driven testing to read test input data from an Excel File so as to test the application with different positive and negative data.
• Analyzed the functionality and came up with test scenarios for split-billing process on FACETS.
• Performed QA Acceptance testing for test workflows with business users and performed data encryption testing as per HIPAA guidelines to ensure the privacy, security and confidentiality.
• Extensively used QC for defect reporting and tracking and prioritizing defects and enhancement requests after base lining the requirements.
• Attended change request meetings to document changes and implemented procedures to test changes.
• Involved in continual improvement of automation test scripts to provide improved QA of testing processes and to reduce whole testing cycle time.

Environment:: HP Quality Center, Zephyr, Claim Test Pro, Facets, Oracle SQL Developer, Compass, PEGA, Claims look-up Environment (CLUE), Optum Encoder Pro, Pre-Certification look-up tool (PLUTO)

Confidential, PA

Sr. QA ANALYST

Responsibilities:

• Tested the Web based application built on Java for exchanges
• Reviewing Business Requirement Documents and Functional specifications & systems Requirement and Maintain the Requirement Traceability Matrix.
• Managed the systems development and built the business processes to activate Medicare parts A-B-C & D, Special Needs Programs (SNP) and Private Fee For Service (PFFS) plans on FACETS version 4.41 platform.
• Conducting the Requirement review meeting with business and Analyzing the Gap Analyses and Create High Level Use Case Scenarios as needed.
• Created and maintained SQL Scripts and UNIX to perform back-end testing on the oracle database.
• Performed manual testing in the UNIX environment.
• Define the High Level Testing Scope and preparing the Test Plan and Test Strategy and Provide Test Estimation for the project.
• Used SQL to test various reports and ETL load jobs in development, QA and production environment
• Analyzed the existing work flow and functional accepts for preparing the Automation frame work
• Prepared the Test Plan by define the scope of System Testing, Integration testing, Performance testing, Regression Testing, Back-end Testing, User Acceptance Testing (UAT) and End to End Testing
• Conduction Test cases Review meeting with team and make sure all the business and functional scenarios are covered and get the business sign off.
• Facilitate System Integration Testing on FACETS system verify to HIPAA compliance from 4010 to 5010.
• Worked on different Health Care modules Like Member and Provider Enrollment Process, Claims Payment System, Customer Service and Creating the Group, subgroup and subscriber in Enrolment
• Create and maintain the Testing Traceability Matrix to keep track the Test cases status.
• Coordinating with Data Management Team for Test data and make sure we have all positive and negative test data for testing.
• Conducting Defect Meeting with Delivery and Business for defect analyses and bugs fixe date.
• Used Mercury Quality Center 10 to store all testing results, metrics, implemented Test plan, created Test Cases, Defect Tracking & Reporting.
• Involved in database testing by writing and executing SQL queries to validate that provider and member data on Data Base (oracle 11g) in Different Testing Environments.
• Analyzed HIPAA 5010 impact on external Data Warehouse and data warehouse extract process and mapping of MMIS database and data warehouse.
• Involved in claim adjudication process of facets application
• Followed the testing progress during project status meetings and prepared contingency plans when required.
• Coordinating with Offshore and Onsite Testing Team’s to understand the status and issues and work with relative towers to fix it.
• Coordinating with Manager for status for the project schedule and update priorities accordingly as per the Testing mile stones.
• Initiated and participated Defect meetings, conference calls and review meetings as needed.

Environment: FACETS 5, ICD-10, Java, SQL Server 2008, QTP, Quality Center, QTP, Soap UI, TIBCO, SQL Developer, VPN, Citrix, Windows, MS Office

Confidential, ME

QA Analyst

Responsibilities:

• Part of dedicated UAT Test team
• Worked with Use-Cases and wrote test cases.
• Tested the functionality in various subsystems like Claims Adjudication and pricing, PA, PAS, Provider, Member management.
• Involved in adjudicating the claims for testing purposes using Facets.
• Tested the edit and audit processing to ensure that claim records are edited and audited in accordance with the claim processing policy.
• Did gap analysis and impact analysis for the facets up gradation system 4.48 to 4.60
• Involved in testing the claims pricing methodology for Professional, UB04 UB92(Institutional), Dental and crossover claims.
• Extensive performance tuning of Informatica Powercenter ETL, EPIC Clarity ETL.
• Conducted Functional and System Integration testing.
• Worked on developing the business requirements and use cases for Facets batch processes; automating the billing entity and commission process
• Involved in Developing test scenarios and test cases for Data conversion interfaces.
• Involved in Developing test scripts and execution using Rational Manual Tester and CQTM
• Tested the ETL work flows and batch logs.
• Used Rational Clear Quest for defect tracking
• Involved in defect validation and regression testing
• Tested interfaces and ANSI X12 / EDI Version 4010/5010 transactions for (270, 271, 276, 277, 278, 837P, 837I, 837D, 835, 834, TA1, 997 and 824 BRR)
• Tested the HIPPA infrastructure.
• Involved in the testing of the UI Interface and cross browser testing.
• Worked on customization screens/reports related Enrollments, and Providers in Facets.
• Maintained Test Logs, Test Summary reports and participated in defect review / Status Meetings.
• Proactive interaction with the client for the resolution of issues.

Environment: COTS, Rational Suite 7.0, .NET, ASP, SOAP, Toad, MS-Office, Oracle 10g, Trizetto Facets, ANSI X12, Message Broker, Edifecs and Quality Center.

Confidential, PA

QA Analyst

Responsibilities:

• Performing the Onsite-Offshore Coordination for the SIT team and is a single point of contact for offshore testing team to execute the test team activities.
• Collection of queries to be posted for clarification of functional behavior of application
• Developed Test Cases bases on Functional Specifications and Design Documents.
• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Involved in processing claims and validated the full payment cycle process until it generates 835’s
• Involved in testing Medical claims, Hospital claims, Dental claims.
• Captured all HIPAA-related EDI data in the repository using FACETS.
• Analyzed MMIS system impact for Windows and Interfaces.
• Accepted inbound transactions from multiple sources using FACETS.
• Supported integrated EDI batch processing and real-time EDI using FACETS.
• Verified the RA’s files once the payment cycle is generated.
• Involved in testing the efficiency of healthcare delivery by using HIPAA
• Involved in testing HIPAA EDI Transactions and mainly focused on 837 and 835.
• Load claims with different test scenario in Facets and validate claim scenario
• Involved in testing the EDI transactions 270 & 271 routing to Blue Exchange for Out of state member inquiries from local providers and responses for local member inquiries from Out of state providers.
• Involved in preparing 837 HIPAA Format files and uploaded them thru Scenario Manager
• Involved in writing SQL queries in SQL Navigator to validate the payment files.
• Followed the Mapping documents and HIPAA implementation guides for HIPAA Transaction Mapping.
• Involved in processing claims in Diamond and validating the full cycle process to make sure the checks are generated and 835’s are generated.
• Responsible for QA status in release meetings.
• Used Quality Center for preparing the test case and for tracking defects.

Environment: Facets 4.7(ICD-9/10), HP Quality Center, SQL, JAVA, Oracle9i, Clear Case, UNIX, Windows NT/2000/XP and MS-Excel.

Confidential

QA Tester

Responsibilities:

• Reviewed the Business requirement, Functional Design Documents and Technical Specification documents
• Created Test Cases and Test data after analyzing the BRD
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Involved in Up-gradation of HIPAA X12 4010 transactions to HIPAA X12 5010.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/834/835 transactions.
• Tested the interface between database and the application
• Document step by step Facets configuration steps for Quality Assurance team.
• Tested Client/Server and Web-based Applications
• Participated in requirement walkthroughs and creation of test plan
• Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
• ICD 9- ICD 10 Conversion Analysis - Worked in the analysis of the ICD 9 - ICD10 codes.
• Uploaded the diagnosis codes, procedure codes to the related tables in test environment to verify the changes related to ICD9 - ICD10 changes.
• Verified the field length & character, which was impacted by ICD9 - ICD10 changes.
• Modified the existing claims with new ICD10 codes and ran through the changes to ensure that claims are getting paid as expected.
• Developed gap analysis and risk assessments for the FACETS upgrade project including effects on internally developed extensions and third party software for pricing and contract configuration.
• Supported production batch processing of dental and life insurance claims on a TriZetto Facets platform; created and maintained batch input/output transfer scripts to handle processing of data extracts via FTP and VPN.
• Reviewed analysis of call center’s achievements of key client goals, ensuring continuous and consistent performance
• Data mapping on Enrollment Module (EDI 834) of FACETS.
• Experience in integrating claims, eligibility, provider and data information using facets.
• Involved in writing extensive SQL Queries for back end testing oracle database.
• Involved in the processing of the claims on the NASCO and then sharing the test results with the business according to test acceptance criteria during their UAT phase.
• Gathered Data Hub requirements and responsible for creating test cases and test scripts under Quality Center Test Plan and Test Lab modules, developed automation test scripts in Quality Center
• Retrieved files using SQL statements and UNIX commands.
• Worked on legacy conversion data base systems on claims processing.
• Maintained Traceability matrix and Test Matrix
• Reviewed EDI 837 claims and flagged HIPPA non­compliant claims received from the Payer side
• Maintained various versions of Test Scripts
• Performed Sanity Testing and Smoke Testing
• Investigating software bugs and reporting to the developers using Quality Center Defect Module
• Analyzed system requirements and developed detailed test plan for testing
• Identified and remediated system testing defects related to test claims as noted above.
• Tracked and reported defects using Quality Center.
• Generated defect reports using Quality Center for the developers.

Environment: Quality Center, HIPPA, EDI 5010, QTP, Windows, Db2, SQL, PL/SQL, Oracle 9i