SUMMARY:

• Worked with Business Analyst and QA Lead in reviewing and analyzing the business requirements Documents (BRD’s) and functional requirements.
• Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 4010 EDI transaction codes such as 270/271(inquiries/response health care benefits), 276/277(Claim status), 834(Benefits enrollment), 835(Payment/Remittance advice),837(Health Care Claim).
• Strong knowledge of Medicare and Medicaid state benefits plans.
• Excellent understanding of HIPPA 5010 rules as well as ICD 9 and ICD 10.
• Expertise on various Electronic Data Interchange (EDI) transactions.
• Hands on experience with testing of OPL, COB, Healthcare Claim pricing, Healthcare Claim Benefits, End to End Claim Processing.
• Hands on experience with membership maintenance system (MMS).
• Expertise in analyzing system and functional specifications used cases, Business Requirements and business rules to prepare Test Plans and design Test Cases.
• Substantial experience in Sanity and Smoke Testing of applications before testing effort of UAT and Regression Testing of applications.
• Created test scripts for security. Positive, negative and system integration testing (SIT) were perform.
• Skillful in Enhancing and Editing Test Scripts.
• Expert in retrieving database information writing SQL Queries and transforming data to information as needed. Performed extensive Backend Testing of the applications using PL/SQL Queries.
• Hands on experience with Sybase database with platform of Interactive SQL.
• Well known with flow of EDI transaction processing through trading partner to the core database and also know the process for External database for the facets system.
• Experienced with batch processing system for claim electronic transaction.
• Well known with frontend processing for the Claims, Subscriber/Family and with Providers.
• Experienced with External claim editing system on frontend system of Facets 5.01
• Excellent Communication, presentation and interpersonal skills.
• Exceptional inquisitiveness and ability to learn new concepts.
• Able to work independently as well as in a Team Environment.
• Effective Time Management skills and the consistent ability to meet client deadline.

TECHNICAL SKILLS:

Testing Tools: HP ALM, QTP/UTP (Quick Test Pro), Rational Team Test

Bug Reporting: Quality Center (QC), Rational Clear Quest, Test Director.

Operating Systems: Windows, UNIX/LINUX

Programming Language: C, C++, C#, SQL, VB Script, Java Script, TSL (Test Scripting Language)

Database: MS SQL Server, My SQL, Oracle, MS Access, DB2.

Applications: Visual Studio, MS Project, MS Visio, MS Office, Adobe Photoshop.

Web Technologies: HTML, PHP, XML, .NET, UML, ASP.NET, Web Services, TCP/IP, SQL

Process Improvement Methodologies: Process Modeling (MS EXCEL, Web), Total Quality Management (TQM), Root Cause Analysis

PROFESSIONAL EXPERIENCE:

Confidential,Denver,CO

QA Tester/ EDI Analyst

Responsibilities:

• Worked on Agile SDLC approach implementation for the whole testing life cycle.
• Reviewed Functional requirement documents, High level design requirement documents and finalize the testing in scoops and scenarios for Integration testing for each project.
• Worked with Business Analyst and QA Lead in reviewing and analyzing the business requirements Documents (BRD’s) and functional requirements
• Gathered requirement and created, executed and documented Test Cases as per requirements in HP ALM Quality Center.
• Maintained QA lab standards, documentation review assisted in establishing and maintaining best practices for QA.
• I was responsible for 2 Manual Jr. Tester as they need to performed task on Test Cases under my direction.
• ICD 9 - ICD 10 conversion project - worked in the analysis of the ICD 9-10 codes conversion Project Expertise in GEM processed and concepts.
• Wrote test cases and test scripts for the User Acceptance testing (UAT).
• Performed Back End testing using SQL Query.
• Involved in Web Security testing, Backend API testing, Regression testing, Integration testing and User acceptance testing (UAT).
• Created and maintained data mapping documents to support data migration.
• Validated the data mapping process using SQL query.
• Created test scripts for security. Positive, negative and system integration testing (SIT) were perform.
• Worked with team manager in supervising, guiding, and supporting their testing efforts for integration.
• Verified the test cases and tests scripts written by Jr. Testers in QC.
• Tested HIPAA EDI transactions and code sets standards such as 820, 837/835 and 834 transactions.
• Experience with batch processing system for claims electronic and manual transaction.
• Well known with frontend processing for the claims, subscriber/family and with providers.
• Responsible for writing the test cases and test scenarios based on the functional specification and technical specification and documented in HP ALM Quality Center.
• Worked on Quality Center for bug status tracking and maintained and created status reports for the application.
• Involved in the weekly defect review meetings to review the status of defect fixes and upcoming build releases.
• Used QC for version control, tracking defects, enhancement requests, assign work activities and assess the real status of project throughout the life cycle.
• Identifying test cases to be run for regression testing and conducting regression testing as and when new builds were made
• Documented the test execution summary results and reported the status of assigned test tasks and issues to project manager for approvals.

Environment: Windows, MS SharePoint, HP ALM/ Quality Centre, MS Visio, QTP,Agile, Java, SOAP

Confidential,Dayton,OH

QA Tester

Responsibilities:

• Reviewed Business Requirement Documents (BRD’s) and functional requirements.
• Formulating detailed Test Plan using HP ALM Quality Center after analyzing business rationale and software requirement artifacts.
• Conducted Positive, negative and system integration testing (SIT).
• Interacted with the team member to ensure meaningful development of the scripts and simulated real time business scenarios.
• Involved in Functional System Testing, Integration Testing, Regression Testing, and User Acceptance Test (UAT) using the test cases before releasing the application.
• Performed the Back-End integration testing to ensure data consistency on front-end by writing and executing SQL statements on the Database.
• Tested the HIPPA EDI 820, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data on different modules.
• Wrote test cases and test scripts for the User Acceptance testing.
• Automated test scenarios for GUI, Functionality and performed data driven testing on the application inserting different data in excel sheet using QTP.
• Reviewed manual testing methods and developed and executed.
• Involved in Configuration testing.
• Used Quality Center for version control, tracking defects, enhancement requests, assign work activities, and assess the real status of project throughout the life cycle.
• Maintained Requirement Traceability Matrix (RTM) to make sure that test plans were written for all the requirements.
• Identifying Test Cases to be run for Regression Testing and conducting Regression testing as and when new builds were made.
• Documented the test results and reported the status of assigned test tasks and issues to project manager.
• Involved in upgrading HIPAA 4010 transaction to HIPAA 5010 transaction project, processed 837 claims file and verifying 277 report, checking various 835 ERA
• Involved in testing of HIPPA 835 for the payment of claims and transfer of remittance information
• Executed Performance test procedures to check to time span
• Analyzed and testing data on different billing and membership functionality manually and writing queries on database for validating data.

Environment: Windows, MS SharePoint, HP Quality Centre (QC), MS Visio, Facets, QTP, Agile, Java, SOAP.

Confidential,Minneapolis,MN

QA Tester

Responsibilities:

• Worked with Business Analyst and QA Lead in reviewing and analyzing the business requirements Documents (BRD’s) and functional requirements.
• Imported preexisting Microsoft Word and Excel-based requirements and tests for analysis in MQC.
• Maintaining knowledge of Medicare and Medicaid rules and regulations pertaining to the Facets configuration and evaluating the impact of proposed changes in rules and regulations.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Enrollment Claim Processing and Subscriber/Member module.
• Set claim processing data for different Facets Module.
• Performed Positive and Negative Testing Manually
• Actively participated in walkthroughsand enhancement meetings
• Maintained Test Matrix and Requirement Traceability Matrix
• Performed Gap Analysis
• Performed Security Testing on the application
• Tested user interface and navigation controls of the application using QTP.
• Validate the date from ED5010 I transaction.
• Tested the HIPPA EDI 820, 834, 270/271, 276/277, 837/835 transactions according to test scenarios and verify the data on different modules.
• Authored test case scenarios in Excel spread sheet and export them into HP Quality Center (QC).
• Documented the test results and reported the status of assigned test tasks and issues to project QA Lead.
• Conducted Back-End Testing Using SQL Commands.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Executed test cases found errors reported defects, determined repair priorities, did regression testing and closed by using Mercury Quality Center.
• Responsible for Performing System Integration Testing (SIT), UAT testing.
• Customized Quality Center to suit the requirements of testing effort
• Monitored the Defect Tracking Process and generated customized graphs and reports for the client using QC.

Environment: Oracle, HIPPA, EDI 5010, XML, QTP, Facets, Quality Center (QC)

Confidential,Vienna, VA

QA Tester

Responsibilities:

• Involved in business analysis and project management, coordinating between the team members and creating use cases according to the business requirement Document (BRD’s).
• Worked with the project manager for planning and organizing the project activities and in communicating with other business center managers and stakeholders of the project.
• Gathered requirements, developed process model and detailed business policies.
• Worked with the project manager to estimate best/worst-case scenarios, track progress with weekly estimates of remaining work to do and conducting informal meetings ad hoc and as needed.
• Involved in Testing the EDIs according to HIPPAcode set 834 enrolment and disenrollment in a health plan using QTP
• Involved in testing EDIs according to code set X12 835 Claim Payment& Remittance Advice Claims processing and 837 Claim transactions.
• Performed Database testing using SQL queries
• Performed backend testing for data validation using SQL Queries.
• Executed SQL statements to check if the data integrity has been maintained.
• Executed SQL statements to test the integration between application and database
• Performed negative and positive testing using SQL Queries
• Developed Use cases and articulated business rules based on the requirements of the user.
• Created class and state diagrams based on the existing electronic patient record system and other departmental requirements.
• Provided support to development and testing team in different phases of SDLC.
• Participated in JAD sessions and walkthroughs.
• Involved in project planning, coordination and implementation of QA methodology.
• Provided overall management to multiple projects successfully completing them on-schedule and on-budget.
• Utilized technical flow charts and network diagrams to effectively map and manage critical paths and bottlenecks in conjunction with project tracking reports and project data sheets for senior management.
• Enhanced test cases and scripts by adding the required functionality as per the new business requirements.
• Quality Center was used to create the test plan, store test cases and run the test sets.
• Interacted with developers to report and track bugs using Quality Center.
• Detected and reproduced the defects, and logged defects using Quality Center.
• Generated the test execution report in HP Quality Center to be reviewed by the QA Manager and development team.

Environment: QC, SQL, QTP, EDI, HIPPA, MS Word, Windows, MS Access, MS Visio, SQL, Requisite Pro.