PROFESSIONAL SUMMARY:

• Over Seven years of experience in Software Quality Assurance, Software Testing, Software Design, Development and Analysis in the Healthcare domain.
• Executed different types of testing like functional, regression and UAT testing for web services
• Experience in writing test plans, test scenarios and test cases
• Excellent understanding of software development life cycle (SDLC) and software testing life cycle (STLC)
• Proficient in writing queries in different SQL databases for backend testing.
• Worked extensively with manual test management tools like HP Quality Center & ALM
• Excellent knowledge of all phases of Software Development Life Cycle methodologies like Waterfall & Agile
• Strong aptitude in implementing Quality Assurance Standards and Testing Methodologies for Large Enterprise Client - Server and Web-Based applications using Use Case Documents, Functional Specifications and Business Requirements.
• Expert in analyzing system and functional specifications, Use cases, Business Requirements and Business rules to prepare Test Plans and design Test Cases from business requirements.
• Experienced in creating/maintaining Test Plans, Test Strategy, Requirement Traceability Matrices, Test Summary Reports and Test Cases for end-to-end (E2E) functionality testing and configuring Defect Management Process
• Skilled in creating test data including the Precondition Data, Test Input Data, and Regression Data for both positive and negative test cases
• Proficient in working with HSP claim processing systems
• Extensive experience in performing different kinds of testing End to End, Regression, Smoke, Functional, Sanity, Parallel, User Acceptance (UAT), Release validation testing of web and client/server applications.
• Proficient in writing advanced SQL Queries to retrieve data from databases for Backend Testing to check and analyze data integrity and validation.
• Expertise in working on various platforms like Windows
• Extensively used tools like HP Quality Center/ ALM for detecting, tracking defects.
• Experience with Medicare, Medicaid, & commercial insurances in HIPAA ANSI X12 4010, 5010 formats including 276, 277, 834, 999, 835, 837, ICD 9,ICD 10 CM & ICM PCS codes & NSF formats for interfaces & images to clearinghouses/ trading partners applications.
• Expertise in ICD 9 & CD 10 Clinical Modification (CM) & Procedure Classification System (PCS) conversion Analysis
• Expertise in HIX project & knowledge of different kind of Coverage such as Platinum, Gold, Silver & Bronze
• Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers.
• Excellent judgment and management skills acquired through experience in identifying areas of high risk early in development life cycle and prioritizing my tasks to focus my testing effort when time is limited.

TECHNICAL SKILLS:

Testing Tools: Edifecs, Remote Online Account Management (ROAM), BACS, Callidus Incentive Compensation management (ICM), Triple A (AAA), Gateway Access Portal (GAP)

Claim Management Tools: QNXT, Diamond Tool, PowerMHS, HSP Perfect ClaimDefect Tracking Tools: HP ALM, Quality Center, MTM

Modeling Tools: MS Word, MS PowerPoint, MS Excel, MS Access, MS Outlook, SharePoint

Web Technologies: HTML, XML

Databases: MS Access, Oracle, SQL, Advanced Query Tool (AQT), Microsoft SQL server 2014

Operating Systems: Windows, Linux

PROFESSIONAL EXPERIENCE:

Confidential, Rancho Cucamonga, CA

QA Engineer

Responsibilities:

• Attended meetings coordinated with business clients, developers, and management team to discuss the new Releases & Defects reporting.
• Developed and implement with QA team test plans for System validation, UAT and Regression Testing for HSP Products - Meditrac, Perfect Claim, Uniflow, HIPAA Gateway, HSP Admin, & Doc Transporter
• Executed Test Plans and Test Cases manually to verify the functionality of the application against the expected results
• Authored Test cases for HIPAA EDI Transactions 270/271, 276/277,837/835
• Execute Configuration Testing to check if the application was compatible in different environment for each module of the application
• Attended stand up meetings with QA manager, leads & engineers to discuss the new HSP Meditrac Releases & Status of available Software Requirements Specification (SRS).
• Created and documented the test plan, test scenario and test case from business requirement document (BRD).
• Created test scenario and test cases for business requirements, Functional requirements, and non-functional requirements from 834 Inbound Software Requirements Specification (SRS)
• Worked on EDI 834 transactions for Benefit Enrollments for CA State.
• Tested daily & monthly EDI 834 Inbound files received from California Department of Health Care Services (DHCS)
• Validated loops, segments, data elements, data fields, headers of EDI 834 inbound file according to California Department of Health Care Services (DHCS) companion guide.
• Validated EDI 834 Inbound files are received from DHCS without any errors.
• Validated EDI 834 file uncompressed decrypted in EDI management system.
• Tracked daily & monthly EDI 834 Inbound Files from point of receiving them automatically to file getting processed in HSP Core System.
• Generated CSV files from EDI Management system and pushed it into HSP Meditrac.
• Verified members, provider information and insurance to decision the request in MedHok
• Verified Patient’s authorization number matches provider authorization number in MedHok.
• Used SharePoint to organize the test documents with on-site QAs.

Environment: Microsoft Test Manager, EDIMS, HSP Perfect Claim, HSP MediTrac, ImageNet, Jive, WorkFront, Cisco Jabber, MedHok, SharePoint

Confidential, Philadelphia, PA

Sr. Quality Assurance Analyst

Responsibilities:

• Attended meetings coordinated with business clients, developers, and management team to discuss the new Releases & Defects reporting.
• Attended Daily meeting with QA Lead, Testers & off shore team to discussing about daily tasks
• Used SharePoint to organize the data with team members & offshore team
• Assisted the QA lead by giving the offshore team daily tasks that need to be achieved
• Created and documented the test plan, test scenario and test case from business requirement document (BRD).
• Created initial enrollments to prepare for executing test cases for OEP, SEP & Direct Enrollment (FFM) flows in different flows like Individuals and Brokers.
• Created/Testing new direct enrollments through Federal Marketplace (FFM) to start shopping from our products & to check the eligibility of subscriber
• Worked on EDI 834 HIX transactions for Benefit Enrollments for various states
• Tracked data to make sure it went through Full cycle starting from IEG through Edifecs/MHS/AEDW before & after executing test cases.
• Logged as an Underwriter to change pending acceptance status to Active status of each enrollment
• Tested initial enrollments by using SSN in Edifecs/IEG to make sure that EDI 834 & 999 got generated and reached Gateway successfully.
• Pulled out transmission file name & ID in Edifecs/IEG to send it to MHS
• Used ROAM to test a various kind of testing using Broker/Agents flows.
• Tested HIPAA EDI HIX Transactions and Code Sets Standards such as 834/999 transactions through Edifecs
• Prepared HIPAA-Compliant Benefit enrollment and maintenance transactions EDI 834 files and tested if members are getting enrolled successfully via Edifecs
• Extensively worked with Edifecs to create test files, analyzed all EDI test files with 5010 implementation guide and gap analysis of EDI transactions
• Used PowerMHS7.1.0 for UAT testing to make sure membership enrolled correctly with selected plan & effective date by reviewing member information details.
• Used Power MHS to make sure members passed all required policies successfully according to member’s age & coverage.
• Ran SQL queries to pull up USI numbers for initial enrollments for specific SSN to run a different kind of Patch testing.
• Executed a different kind of Patch testing like Inbound Renewal & Policy for the new enrollments to ensure the data & test cases are ready to be executed
• Executed a unique kind of patch testing “Closing renewals” to test the passive members who didn’t take any actions in their current plans.
• Contacted AEDW team to make sure the members reached Data Warehouse & data went through full cycle successfully.
• Followed up with the data when they run Inbound Policy (IBP) jobs/Batch to make sure that data have PCR, which allows member to make changes in current plan for Passive & Active Renewal testing.
• Followed up with the data when they run IBR Jobs to make sure that data have Renewal Tab, which allows member to make changes after effective date for Active Renewal testing
• Executed test case for members that have Renewal Tab for Renewal (Passive/Active) testing which made sure it went through the second cycle (IEG/MHS/AEDW)& reached Connecture (CNX) front end.
• Executed Regression & UAT test cases in OEP/SEP flows for every Production release
• Executed Regression & UAT tests cases in OEP/SEP flows within different flows to ensure that the rates are displayed correctly before every Production release.
• Worked on data mining different kind of test data for Individuals, Small Group (2-99), Large Groups (100-299), (300+), Traditional & UCD to calculate the commission of the broker for PA & NJ.
• Data mined a Different kind of scenarios to calculate commission by pulling out the data from A20, A40 and A50 Files.
• Ran weekly patches on ICM to export & to validate the data received on specific week.
• Ran monthly patches on ICM to export & validate the data received on specific whole month.
• Validating Result on Callidus (IMC) front-end to ensure that test cases are executed successfully by validating Process period & commission amount
• Executed parallel testing where the user reconciles the outputs of the new system to the output of the current system to verify the new system performs the operation correctly & ensures that results are matching on both applications.
• Validated level of Primary Agency using Triple A (AAA) application by using Group number.
• Ensure payments from BACS for all invoices numbers in a specific month compared to the payments generated from the ICM tool for all that specific month’s invoice numbers.
• Validated Enrollment Fie A40 got generated from AEDW with the all hierarchies for identified payees for all business segments are correct.
• Validated Enrollment File A40 loaded into ICM tool after verifying that all hierarchies for identified payees are loaded correctly
• Tracked Transaction File A50 that got generated from AEDW that appropriate invoices and payment are routed to both BACS & IMC
• Validated Transaction File A50 that got loaded into IMC successfully with all invoices and payments
• Validated the commission calculations are correct for payouts at the writing agent if applicable & primary agent/FMO are within 5% between systems.
• Tracking weekly/monthly AP file got generated after payment process for E2E testing.
• Calculated the Pro-rate, True-up’s & initial amounts for new enrollments & renewals for PA & NJ plan.
• Mined data for cancelation codes, PBP, FMOs, Reason Codes, Cycles& Retracted Amounts
• Performed Functional testing for the price comparison application ensured that customers could compare up to three products or more and the prices are correctly listed correctly before going Live.
• Performed Functional testing to check AHNJ 2014 & 2015 plans rates according to effective date & coverage however if its HMO, PPO or EPO.
• Performed End to End testing for Active & Passive renewal starting from creating initial enrollment till the result reach Connecture (CNX) frontend.
• Generated test data in MS Excel and shared it in SharePoint to be on the same line with offshore team.
• Followed up with different departments off site to make sure data reached successfully to their departments.
• Developed and executed test cases, test scenarios and followed-up defects using ALM.
• Worked on uploading all the Test cases and Scenarios to the ALM for the current and prior releases
• Involved in weekly defect review meetings to review the status of defect fixes and upcoming build releases.
• Upload the new defects in Basecamp to track production defects with Developers & CNX team after uploading them in ALM.

Environment: HP ALM, SQL, Windows, Internet Explorer, Google Chrome, Firefox, Base camp, Edifecs, PowerMHS & ROAM, AAA, IMC, BACS, Advanced Query Tool (AQT)

Confidential, Los Angeles, CA

QA Tester

Responsibilities:

• Attended various meetings coordinated with business clients, developers, and management team to discuss the implementation of the new features.
• Responsible for translating the new business requirements into technical specifications for developers.
• Created and documented the test plan, test scenario and test case from business requirement document (BRD).
• Full knowledge of the Diagnosis and Procedural Code changes for Healthcare Entities like Payers, Employer Groups, and Providers.
• Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes.
• Tested ICD 9 / ICD 10 Clinical Modification Codes & Procedure classification system in each new release
• Designed and executed test cases for different mobile operating systems and browsers.
• Tested HIPAA EDI Transactions and Code Sets Standards such as 837/835 and 834 transactions.
• Worked with business leaders to translate business requirements and processes into test cases according to claim processing (QNXT) requirements and subsequent effective configuration
• Worked on testing the X12 claims using QNXT to check if the claim is on hold.
• Responsible for testing the 837 Professional edits testing for 4010 and 5010 .
• Involved in End-to-End process for testing the 5010 837 and 4010 837 using QNXT claim processioning management tool
• Compared between ICD 9 & ICD 10 diagnose code’s description in ICD Manager
• Involved in preparing the test data/Claims for 837 Institutional & 837 Professional
• Worked on different EDI transactions like 837 for submitting claims, 835 for payments, 834 for benefit enrollment.
• Worked on uploading all the Test cases and Scenarios to the Quality Center for the current and prior releases
• Performed Functional testing for the price comparison application ensured that customers can compare up to four items and the prices are correctly listed according to new ICD 10 CM/PCS codes.
• Performed Positive and Negative testing for the claim manually to ensure the Claim Processing by using QNXT showing the expected results
• Validated EDI 835 got generated successfully through Inserting Claim ID & submission date in Gateway Access Portal “GAP”
• Performed the Backend testing by writing and executing the SQL Queries.
• Responsible for writing SQL queries to find out if the data is correctly populated in each field for price comparison.
• Involved in weekly defect review meetings to review the status of defect fixes and upcoming build releases
• Identifying Test Cases to be run for Regression Testing and conducting Regression testing as and when new builds were made
• Used Quality Center for version control, tracking defects, enhancement requests, assign work activities, and assess the real status of project throughout the life cycle.

Environment: HP Quality Center, SQL, Windows, Internet Explorer, ICD Manager, Gateway Access Portal “GAP”, EAS, Mojo & QNXT.

Confidential, Oakland, CA

QA Tester

Responsibilities:

• Interacted with Business Analysts and Developers in the requirement analysis, design reviews, testing and documentation for application developed in Waterfall environment.
• Actively participated in all phases of SDLC (Design, Planning, Development and Testing).
• Provided subject-matter expertise during meetings between Business Analysts, Database Administrators and QA team to resolve issues regarding the requirement updates and/or changes in the database fields.
• Tested HIPAA EDI Transactions and Code Sets Standards such as 837/835 and 834 transactions.
• Prepared test plans and test cases documents based on business requirement documents.
• Good knowledge of splitting an EDI 837 X12 file by claim level for testing purpose using Companion guide
• Ability to understand error messages when loading EDI 837 X12 files in test regions.
• Responsible for testing the 837 Professional edits testing for 4010 and 5010 .
• Involved in End to End process for testing the 5010 837 and 4010 837 .
• Involved in preparing the test data/Claims for 837 Institutional & 837 Professional
• Worked on ICD 9 codes and gathered future requirements based on ICD 10 codes. Managed creation of sample mappings for the conversion of EDI X12 transactions code sets version 4010 to 5010 and translation of ICD 9 codes into ICD 10 codes.
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Diamond tool configuration and evaluating the impact of proposed changes in rules and regulations
• Worked on different EDI transactions like 837 for submitting claims and 835 for payments.
• Created Test Files and Test Cases for the 4010 to 5010 migration project including various EDI transactions such as 837 & 835
• Knowledgeable in Claims and Member billing information in Diamond Tool for Provider contracting through ICD 9 & 10 benefits
• Processed claims in Diamond and verified 835X12 ’s are generated and sent to the Provider
• Worked with business leaders to translate business requirements and processes into test cases according to Diamond package requirements and subsequent effective configuration
• Performed Functional testing for the price comparison application ensured that customers can compare up to four items and the prices are correctly listed.
• Performed the Backend testing by writing and executing the SQL Queries.
• Responsible for writing SQL queries to find out if the data is correctly populated in each field for price comparison.
• Created a Requirement Traceability Matrix (RTM) to ensure 100% test coverage to requirements
• Performed Positive and Negative testing for the claim manually to ensure the Claim Processing showing the expected results
• Performed Positive and Negative testing for the claim manually to ensure the Claim Processing by using Diamond Tool displaying the expected results.
• Validated EDI 835 got generated successfully through Inserting Claim ID & submission date in Gateway Access Portal “GAP”
• Validated results published reports and logged defects using HP Quality Center.
• Active participation in decision making and Defect Tracking Meetings with Business Analysts, Developers and other stake holders.

Environment: HP Quality Center, SQL, Windows and Diamond Tool.

Confidential

Jr.QA Tester

Responsibilities:

• Interacted with Business Analysts and Developers in the requirement analysis, design reviews, testing and documentation for application developed in Waterfall environment.
• Actively participated in JAD Sessions to review and develop test scenarios.
• Analyzed the business requirement documents (BRD) in the Requirements Module in HP Quality center to create detailed Test Cases and associated them to the appropriate requirements.
• Created both positive and negative test scenarios according to the functional specification document (FSD) and BRD using HP Quality Center in the test plan module.
• Created Test Strategies by attending walk through meetings like requirement gathering and requirement elicitation meeting
• Created Requirement Traceability Matrix using Entry/Exit Criteria
• Formulated Test Plans, Test Scenarios, Test Cases, Test procedures, expected results, and test data for the System Testing of the application
• Planned and reviewed the Test cases for Functionality, Security, Performance and Database for the web-based application features.
• Used the Defect Tracking System in Quality Center to Report, Update and Analyze Defects during the entire Software Testing Process
• Generated complex SQL queries to conduct Data Integrity and comprehensive backend testing to ensure coherence between the data entered in the frontend UI and the data reflected in the backend database
• Developed and executed SQL queries to verify the proper insertion, deletion and updates into the data Warehouse supporting tables.
• Involved in User Acceptance Testing with users
• Generated valid and invalid test data in MS Excel, to use as input in data driven testing of the feature.

Environment: HP Quality Center, SQL, MS Excel and Internet Explorer