SUMMARY:

• 6+ years of experience working in the Healthcare Industry primarily and an EDI / Business Analyst as well as Quality Assurance Tester.
• Results - driven, versatile consultant with over 6 years’ experience as a Business Analyst/EDI Analyst in HealthCare.
• Strong understanding of requirements for the project and UI testing related to the creation of software supporting handheld mobile devices.
• Expertise in RTM (Requirement Traceability Matrix) and Gap Analysis.
• Extensive experience in Manual testing using QC and ALM and create a repots (standard, tabular and test summary).
• Expertise in Bug tracking and reporting using Quality Center, Test Director and Rational Clear Quest. And experience of Bug life cycle system.
• Expertise in different types of testing such as black box, sanity, smoke, details, positive, negative, integration, configuration, and regression testing as well as involved in UAT (User Acceptance Testing).
• Experience in testing Client-Server and Web-Based Application. Front end and backend 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.
• Strong understanding of SDLC methodologies like Agile, Scrum, and Rational Unified Process (RUP).
• Strong understanding on identifying what is in-scope and out of scope for the project.
• Good understanding of Health Insurance portability and accountability act (HIPAA).
• Worked on healthcare standards such as HIPAA 4010, 5010 and ICD-9 & ICD 10.
• Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
• Strong experience and understanding of health care industry, claims management process, knowledge of Medicaid and Medicare Services.
• Experience in participating in Joint Application Development (JAD) sessions.
• Experienced in creating Test Plans.
• Thorough hands on experience with designing test cases covering all test conditions and eliminating redundancy and duplications.
• Strong work ethics, able to take ownership of all duties and responsibilities and efficient time management skills.
• Group and individual based problem solving and decision-making skills.
• Excellent knowledge of MS Office especially MS Excel, Power Point, Word, and Project etc.

TECHNICAL SKILLS:

Healthcare Industry: 6+ years

EDI Analyst: 5+ years

Business Analyst: 5+ years

Affordable Care Act (ACA) - 2+ Years

FFM/FFE: 3+ years

Federal contacts experience: 2+ Years

1095A Form: understanding on it Never worked on

Design, development and implementation: of an Enrollment Resolution and Reconciliation process for health insurance exchanges: 2 years

Analysis of discrepancies: in the eligibility reconciliation process for multiple stakeholders: 4+ years

834 transactions: 4+ years

820 transactions: 1+ years

X12 transactions: 4 years

Premium Payment transactions: 1+ years

Eligibility reconciliation: 2 years

Reconciliation of Enrollment transactions: 2 years

Training support: 1 year

Any QA/Testing experience: 3+ Years

PROFESSIONAL EXPERIENCE:

Confidential, Raleigh, NC

BA/ EDI Analyst

Responsibilities:

• Identified the requirements for accommodating HIPAA 5010 standards for 837P transactions and captured these requirements to develop new GUI for the internet-based application.
• Participated in setting up testing environment.
• Involved in preparing Test Cases based on business requirements.
• Tested HIPAA Transactions and Code Sets Standards such as 837/835, 270/271, 276/277 transactions.
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Involved in forward mapping from ICD-9 to ICD-10 and backward mapping from ICD-10 to ICD-9 using cross work tables.
• Tested 837/ 835, 270/271, 276/277 transactions with File Aid.
• Authored and executed Test cases for Claims and Customer Service Workflow by manually.
• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical Specification and documented in Mercury Quality Center.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, 270/271, and others.
• Responsible for Back-End Testing Using SQL Commands using TOAD.
• Perform functional, exception and scenario testing.
• UAT testing for HIPAA 4010 and 5010 projects including legacy testing and HIPAA requirements and compliance mandates.
• Logged the errors, reported defects, determined repair priorities and tracked the defects until resolution using Mercury Quality Center.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Responsible for performing System and integration testing for release.
• Identified, analyzed and documented defects, error and inconsistencies in the application using Quality Center.
• Created and maintained Test Matrix and Requirement Traceability Matrix and performed GAP Analysis.
• Performed User Acceptance Testing (UAT).
• Generated defect reports using Quality Center for the developers.

Environment: s: Quality Center, UAT, UNIX, TOAD, AGILE, SCRUM, HIPPA, EDI 5010, QTP, Windows, SQL Server, SQL.

Confidential, Quincy, MA

BA/QA /EDI Analyst

Responsibilities:

• Developed Test Plans, Test Cases for the Facets Modules
• 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 and ICD-9-CM to ICD-10
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Tested the interface between database and the application
• Participated in requirement walkthroughs and creation of test plan
• Worked on Unix Platform and experienced in back end testing by executing SQL Queries.
• Checked the data flow through the frontend to backend and used SQL Queries to extract the data from the database.
• Configuration and evaluating the impact of proposed changes in rules and regulations.
• Maintained various versions of Test Scripts
• Validated records, structure of tables, Indexes, Triggers in tables after migration from Facets 4.31 to Facets 4.81 database.
• 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
• Performed Usability Testing
• Supporting and Handling the UAT co-ordination with the Business and preparing the valid business scenarios for testing thru out application versions
• Tested conversion of ICD-9 to ICD-10.
• Working very closely with Production Support team in testing all the Emergency Change Requests/Tickets opened by the developers to validate the code change which was tested and verified in UAT environment before pushing the code in Production..
• Tracked and reported defects using Quality Center.
• Generated defect reports using Quality Center for the developers.

Environment: Quality Center, HIPAA, EDI 5010, QTP, Windows 2000, SQL Server, SQL, PL/SQL, Oracle 9i.

Confidential, VA Beach, VA

EDI / Business Analyst

• Organized and conducted meetings, briefings, demonstrations, conducted JAD sessions, and wrote minutes of project meetings.
• Gathered Business Requirements, interacted with the Users, Designers and Developers, Project Manager and QA Team to get a better understanding of the Business Processes.
• Interacted with the “End-Users” by interviewing them, by preparing appropriate questionnaire to better understand end-user needs and the business process.
• Followed a structured approach to organize requirements into logical groupings such as requirements for Customer, Client, Group, Member, and Reporting that critical requirements are not missed.
• Involved in creating Business Process Documentation.
• Identified Use Cases from the requirements. Created UML Diagrams including Use Case Diagrams, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams using MS-Visio.
• For Project management purpose worked on Microsoft Project, used Microsoft Share Point for maintaining the updated Documentation.
• Microsoft Office (Outlook, Word, Excel, Visio, Access) at various phases of development for documenting the requirements.
• Analyzed and optimized the process, Prepared Business Requirement Document and managed requirements using Rational Requisite pro.
• Facilitated JAD sessions with business and technical units to fine tune prioritize and detail requirements and use cases.
• Experience with developing HIPAA Companion Guides for 834 Enrollments, 270/271 Eligibility Inquiry/Response & 820- Health Plan premium payments for MMIS.
• Worked on Different Modules like Billings, Membership, Claim and Provider in MMIS application.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Involved in System testing, Regression Testing and User Acceptance Testing (UAT) manually and Automation tool.
• Experience working in ANSI x12 837-835 EDI Transaction.
• Managed the testing and verification of HIPAA standard transactions, and EDI messages (837),
• Validate the date from EDI transaction.
• Prepared GAP documents involved with 834, 820 transactions in collaboration with other team members
• Resolved issues with member attributes, enabling multiple rules associated with member lookup process in Facets.
• Managed defect tracking process, which include prioritize bugs, assign bugs and verifying bugs using QC.
• Involved in end-to-end testing of FACETS Enrollment Claim Processing and Subscriber/Member module.
• Involved in writing extensive SQL Queries for back end testing oracle database.
• Retrieved files using SQL statements and UNIX commands.
• Maintained Traceability matrix and Test Matrix
• Created and maintained SQL Queries for back-end testing
• Performed manual back-end testing using PL/SQL to connect to an Oracle 9i database on a UNIX server
• Reviewing and testing reported defects in the concerned applications in both UAT and Production testing environments
• Verified and Reported of all issues/defects from small to big raised by UAT team
• Coordinated with concerned developer/developer teams for design reviews per the business requirements for both UAT and Production testing
• Responsible for Performing Integration Testing, UAT testing.
• Customized Quality Center to suit the requirements of testing effort
• Worked on SOAP UI for Testing Request and Response using XML document.
• Performed Back End Testing-using SQL queries, generating reports to ensure data integrity and validate the inserted and updated data
• Extensively involved in testing. Worked with the project manager for planning and organizing the project activities, and in communicating with other business center mangers and stakeholders of the project.

Environment: SQL Oracle, HIPPA, EDI 5010, XML, QTP, Mercury Quality Center, EDI 834, 820.

Confidential, Los Angeles, CA

BA/QA Analyst

Responsibilities:

• Worked with Business Analyst and reviewing and analyzing the business requirements Documents and functional requirements. Imported preexisting Microsoft Word and Excel-based requirements and tests for analysis in Quality Center.
• Prepared Test Cases based on business requirements and business rules for HIPPA EDI Transaction 834, 276/277, 270/271, 837/835. Tested all HIPAA transactions for multi version support (4010 and 5010) and validating the database to file elements.
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Configuration and evaluating the impact of proposed changes in rules and regulations.
• Set claim processing data for different Facets Module.
• Performed Positive and Negative Testing Manually
• Actively participated in walkthroughs and enhancement meetings
• Maintained Test Matrix and Requirement Traceability Matrix
• Performed Gap Analysis. Performed Security Testing on the application
• Experiences working in ANSI x12 837-835 EDI Transaction.
• Validate the date from EDI transaction. Tested the HIPPA EDI 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 Quality Center.
• 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 Quality Center. Responsible for Performing Integration Testing, 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 Quality Center

Environment: Oracle, HIPPA, EDI 5010, XML, QTP, Agile, Mercury Quality Center Window XP, SQL, UNIX, UAT.