SUMMARY:

• 8 years of experience in Quality Assurance and software testing in 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 a repots (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).
• 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 Frame work 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 managements, member/subscriber and others.
• Excellent comment skill along with verbal and written.

WORK EXPERIENCE:

Confidential, Minneapolis, MN

Sr. QA Tester/HIPPA EDI Analyst/ETL Tester

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.
• 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.
• Determined the requisite ICD10 training for both internal staff and Medicaid provider groups and assisted in the development of training materials. Used QTP to perform Regression Testing.
• Reviewing the Use Case Requirement, Functional Design Documents and Technical Specification documents.
• 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.
• Prepared test matrices based through defect status in Quality Center/ALM.
• Involve in testing of FACETS Implementation, involve in end-to-end testing of FACETS Claims. Processing module, Membership 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.
• Recommend 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 the 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.
• Worked on Unix Platform and experienced in back end testing by executing SQL Queries.
• Involved in ETL process testing using Informatica ETL tool
• Supported the extraction, transformation and load process (ETL) for a Data Warehouse from their legacy systems using Informatica.
• Created Test Plans, SQL scripts for verifying the ETL process as part of the Enterprise Data Warehouse (EDW).
• Involved in testing Web services and XML using SOAP UI. Verified the response received by updating the request XML.
• Created and uploaded Requirements and Test Cases on HP ALM.
• Developed test strategies for large scale data and report projects in EDW by involved in testing ETL and BI systems with multiple data sources and target.

Confidential, Eden Prairie, MN

Sr. Validation Analyst/ETL Tester

Responsibilities:

• Directly involved in download data from production environment to different test environment, defined in Oracle Database.
• Participated in solving Billing issues from the FACETS Problem Log for Trizetto and Billing Entities. Set claim processing data for different Facets Module.
• Performed Data Analysis to make sure its correctness and completeness in test environment.
• Participated in weekly meetings to keep up to date with issues and business changing elements.
• Conducted regular meetings with the people directly responsible for the business in each State.
• Performed the role of QA Analyst as a core role and also took a lead in resolving problem logs.
• Closely worked with SME's Business Analyst, System Analyst on every stage of application.
• Used QTP for automated testing, modified VB Scripts to meet requirement.
• Wrote test cases based on user stories in Team Foundation Server (TFS) using Microsoft Test Manager(MTM)
• Maintained Visual SourceSafe for all environments and aided conversion from Visual SourceSafe to Team Foundation Server (TFS)
• Used Claims Test Pro for processing claims.
• Analysis of inbound and outbound interfaces and extensions to Trizetto FACETS Claims Processing system.
• Prepared Test Strategy, test plans and Test Cases, Scenarios as per requirements and executed as and when needed.
• Validated Medical, Hospital and Dental claims in FACETS, verified Codes with description and requirements, verified adjudication process of Claims of FACETS.
• Responsible for Back-End Testing Using SQL Commands using TOAD.
• Developed SQL queries, functions, stored procedures and triggers to perform the backend testing of the data
• Used Unix commands and utilities to monitor ETL Informatica activities and tail the log execution.
• Performed ETL Testing (on Informatica and Teradata) on Data Warehouse.
• Tested the ETL process that loaded the data into target database after performing all the transformations according to the business requirements in Informatica as ETL Tool.
• Worked with relational databases, and developed PL/SQL queries to interact with Databases.
• Performed legacy DB2 Testing to cross check new database entity relations
• Tested the SSRS reports to verify the data is accurate.
• Validated 835, 837, 276, 277, Institutional and Professional HIPAA Transaction and X12 format messages.
• Performed Database testing using DB2 Connect and Extra tools for verification of data tables in database.
• Performed Table, GUI, Database, and XML Check Points in Quick Test Professional scripts to check the validity of the data.
• Involved in claims submission and payment (remittance) retrievals by using ASCX12N 820 for the In- bound premium payments; ASC x12N 834 for the Inbound Enrollment and Maintenance; ASCX12 276/277 for the claims status enquiry and response; and ASC X12 835 for the Health care Claim Payments.
• Tested all HIPAA transactions for HIPAA 5010 and validate the database. Created members through express claim test pro for testing purposes
• Involved in testing HIPAA EDI X12 transactions & Code Sets Standards like (820-Premium Payment for enrolled health plan members, 834-Enrollment /Dis-enrollment to a health plan, 837- Health Care Claims and 278 Authorizations.)
• Analyzing User and Functional requirements to point out gaps between used SQL queries to extract the data from the database.
• Worked on billing and payments in the provider module in Claim Test Pro of Facets. Test Case design and Test execution using HP ALM.
• Executed Functional and Regression testing using application QTP/UFT
• Conducted Functional, Positive/Negative Testing, Integration Testing and System Testing using JIRA for different modules of application.
• Extensively involved in Back-End Testing, database table manipulations of relational database systems by writing complex SQL queries manually.
• Involved in Functional, Black Box, Usability and Regression Testing for UAT (User Acceptance Testing) using QTP.
• Developed and executed automated scripts using QTP/UFT for Functional and Regression testing.
• Created user-defined functions and output values for the content builder and appliance by using QTP/UFT
• Performed checkpoints, parameterization in QTP scripts to check the validity of the data.
• Provided daily status report about problem to project Manager, Business and Systems Analyst.
• Responsible for updating the QA manager on weekly updates regarding the progress of testing efforts and open issues to be resolved. Used HP ALM (defects management tool) for defects/bugs tracking.

Confidential, Mounds View, MN

ETL QA Tester/SQL Tester

Responsibilities:

• Manually tested each module of the application and verify 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 EDI4010 to 5010 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 validate the related tables from database using SQL query.
• Hands on experience in working on designing and reviewing the EDI system applications.
• 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.
• Performed Root Cause Analysis.
• Tested the HIPPA EDI 834, 835, 837 transactions according to test scenarios and verify the data on different modules.
• Extensively used Claims processing, Provider, Subscriber/Member, Utilization Management and NetworX 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 defect, 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.

Confidential, Rochester, MN

Manual Tester/Validation Tester

Responsibilities:

• Created Test Documentation and Test Plans. Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Entered numerous claims for testing purposes to ensure accurate and quality adjudication and implementation of business and operational requirements.
• Worked on Data Mapping to map Facets data to outbound eligibility extracts. Wrote SQL queries to extract and validate the data from the Facets database.
• Designed Activity, Sequence and Process Flow Diagrams using MS Visio to simplify and elaborate certain selection criteria and filter conditions.
• Extensively worked with Member/Subscriber and HIPAA Privacy Facets application groups.
• Used Quality Center to create to create Test Plan, Test cases and test scripts as well as steps for manual and automated implementation of test cases in Quality Center.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Prepared Test Cases based on business requirements and business rules for HIPAA EDI Transaction 270/271, 834,837/835.
• Tested the HIPAA EDI transactions 820, 834, 837/835, 276/277, 270/271 according to the requirement test scenarios.
• Projects include claims and enrollment testing as well as NPI and medical coding and ICD-9 EDI testing.
• Created test data for 837I, 837D, 837P to have Segments/loops information with different combination of Submitter, Receiver, Billing Provider, Pay-To-Provider, Subscriber, Payer, Patient, Claim Information, Physicians, Referring Provider, Service Line Info, Adjudication Information
• Developed and maintained complex SQL queries for MS SQL Server and MS Visual SourceSafe for extensive back end testing purposes.
• For testing purposes, manipulated Members information in the QA environment through Facets front-end application.
• Web testing utilizing HP Quick Test Professional (QTP), Client/Server application manual testing utilizing Windows XP, Oracle 9i, TOAD, and SQL Server. Clear Quest for defect tracking and test cases repository and maintaining RUP documentation.
• Monitoring the performance of the system on a day-to-day basis.
• Regression testing on weekly builds. Performed weakly Walkthroughs and Inspection meetings.
• Performed Black Box Testing. Performed Positive and Negative testing for the system.
• Conducted Back End Testing to test the connection between Store's system and the database in order to verify data integrity.
• Documented the dimensional models of ETL system. Used SQL to test various reports and ETL load jobs in development, QA and production environment
• Monitor and analyzed activity report. Created reports for Server monitoring and Transaction time
• Bug reporting using Quality Center.