SUMMARY:

• Dedicated IT professional with overall 14 years of Information Systems experience along with 11 years of proven ability in leading multiple Healthcare programs.
• Project Lead with demonstrated experience, leading a team of 20 plus IT professionals.
• Expertise in Healthcare Information Systems, project management, business analysis, business administration/operations, Electronic Data Interchange (EDI), Electronic Medical Record (EMR), Physician Practice Management (PM), Health Information Exchange (HIE),Pharmacy Benefits Management, ClaimsXten, Provider Finder, testing, training, support and consulting; Experience working directly with providers, payers, software manufacturers, electronic data interchange organizations, billing services, clearinghouses and government agencies; Excellent skills for communication, technical research and problem - solving.
• Efficient and effective leadership for cost effective solutions.
• 14 years of IT experience in SDLC; Project Management, Process/Workflow Engineering
• HIPAA Healthcare Transaction creation, implementation, testing, trading and compliance; HIPAA under ACA; 5010A1 and ICD-10 implementation
• Electronic Data Interchange (EDI), Value Added Networks (VAN), Billing Services, Clearinghouses, Payers and other proprietary EDI systems
• Test Data Manager for 26 integrated systems within Anthem Network
• Working as Scrum master for 3 scrum teams with Test Data Management area.
• End to end testing and quality assurance for independent verification and validation of specifications from development to deployment.
• Data warehouse, Data information access and Metadata configuration with SQL query language programming, editing and report building. Extract, Transform and Load (ETL) processes.
• Health Information Exchange, Federated data models with secure single sign-on and Nationwide Health Information Exchange development.
• Health Identity Management, e-Authentication and Role-Based Access Control. - Healthcare Policy and Advocacy for Health Information Technology.
• Expert in evaluating new business capabilities and developing a Project strategy which defines the execution approach for the release.
• Manage large programs while providing thought leadership to accomplish overall operational & process maturity.
• Helping clients build & manage centers of excellence.
• Helped various clients assess, build, streamline & manage centers of excellence, improving overall SDLC processes which would eventually reduce their overall IT spend.
• Built and managed large delivery teams providing services to clients.
• Some of the key strategies & processes defined and implemented include
• SDLC with entry exit criteria, Sign offs, deliverables, roles & responsibilities Release, pipeline & workload management.
• Metrics framework for capturing the data & reporting. Data Management Strategy & Environment management strategy.
• Artifacts utilized across all SDLC stages etc
• Expert in Evaluating and testing new or modified software products and validating documentation prior to release.
• Expert in Preparing, designing, and executing test plans and cases (of moderate to high complexity) based on customer and software requirements and technical understanding of product architecture to attain quality software both economically and efficiently, including both new and existing feature regression tests.
• Expert in ensuring traceability of test cases to requirements. Verifying accuracy of test results and document results.
• Involved in External and Internal business review meetings and having good knowledge to analyze the business requirements, FDD, Data flow diagrams, Flow charts, Workflows, System design documents, X-Walks and Mapping documents for different interfaces and "Ancillary systems".
• Excellent knowledge in identifying gaps in the business requirements.
• Expert in Identifying and documenting plans for identifying the project’s testing activities and approach.
• Having friendly co-ordination with Business people, Developers, Managers, Team Leads and colleagues.
• Expert in Manual and Automation testing for Client/Server, Object Oriented and web based multi-tier architecture applications.
• Expert in both Black box testing and White box testing.
• Mainframe Testing using JCL and Batch jobs
• Expert in setting up Test environments which includes Configuration, data, builds and batch job installation & execution
• Expert in Designing, Implementing & Developing of Test Plans, Test Scenarios & Test Cases and Execution of Test cases as well.
• Experience in authoring Use-Cases, Test schedule, Test summary Reports and Traceability Matrix.
• Excellent domain skills include Financial services, Insurance, Information Media Entertainment and Healthcare Testing
• Expert in System Testing, Regression Testing, Reliability Testing, GUI Testing, WS Testing, Smoke Testing, Functional Testing, End to End Testing, Compatibility Testing, Backend Testing and Security Testing.
• Experience in Backend testing using DB2, Oracle and SQL server databases.
• Experience in Local, ITS Host and Home testing for Prof, Dental and Inst claims.
• Experience on preparation and validation of 4010, 5010 EDI X12 files
• Experience with EDIFECS and IAS Trace Tools for WEDI SNIP Level Edits Testing.
• Experience in EDI standards: 837,835,270,271,276,277,278 and HL7 messages validation with various ancillary systems.
• Excellent experience in and ICD 9 to10.
• Experience in XML files validation against XSD.
• Experience in ETL Data warehousing, Data base testing using Informatica for workflow process.
• Bug Reporting or Defect tracking using Quality Center/Test Director and Clear quest.
• Highly Commendable in core concepts of Manual Testing, Automation Testing, SOA and Web Services Testing.
• Worked on different testing methodologies like agile/scrum, water fall and V- model
• Expert in using JIRA and Confluence
• Medicaid, Medicare claims Verification
• Experienced in Managing the QA/test team and conducting status calls, Daily stand ups.
• Participating in PMO and Due Diligence meetings with Business & IT team.
• Participating in Production deployment.
• Having good knowledge in Automated Testing Tools like Win Runner, QTP, Rational Robot, Rational Quality Manager and Test Director.
• Persistently energetic in Leading and motivating the team to complete the tasks with eminent problem solving skills in all aspects that are needed for accomplishing goals and deliverables.
• Experience on QA estimates using Estimation Techniques like Test Case Point, Functional Point and Use Case Point.
• Worked on Metrics preparation of the project.
• Worked as a Defect Prevention Coordinator.

TECHNICAL SKILLS:

Testing Tools: Rational Service Tester, Rational Quality Manager, SOAP UI Quality center, Clear Quest, Test Manager, Test Director, Quick Test Pro

Bug Reporting Tools: Quality Center, Clear Quest and JIRA

MS: DOS, Windows 95/98/2000/NT/XP and UNIX

Scripting Languages: TSL, VB Script, AJAX, JavaScript, CSS, Shell Script, HTML, XML. XSLT

Languages: TSL, SQA Basic, C, C++, SQL, PL/SQL, Visual Basic, Java

RDBMS: Oracle, SQL Server, MS Access, DB2, Sybase

Technologies: Java, J2EE, EJB, JSP,.Net Servlets,ASP, .Net, C#

Servers: Web Logic, Web Sphere, Tomcat, Apache server, MS IIS.

Protocols: TCP/IP, FTP, Telnet, SSL, HTTP, HTTPS,SMTP,UDP/IP

EDI Standards: 837,835,270,271,276,277,278,997 and HL7 messages.

Mainframe: JCL, CICS, QMF, ISPF, TSO, VSAM, FILEAID, IBM S/390 and IBM 3090.

PROFESSIONAL EXPERIENCE:

Confidential, Richmond, VA

Associate. Manager

Responsibilities:

• Staffed and managed a testing team of 20 resources in onshore/offshore model
• Working as Scrum Master for 3 scrum teams in Test Data Management for 20 integrated systems
• Managed SIT and UAT teams to deliver defect free application from design to Deployment
• Expert in Resource Management, Work allocation and on time delivery
• Prepared Estimates and accruals for all projects
• Worked on Time Management and Project Management in Agile/Scrum Methodologies
• Managed Automation Team and set up Framework integrated with Dev ops.
• Gather and analyze requirements for different systems like Broke/Shopper, Employer and Provider
• Prepare High Level activity diagrams representing different scenarios on Health Exchange Implementation
• Prepare Health Care Reform Education deck to be used as a training material for project teams
• Prepare Process Model for Health Exchange Implementation
• Develop Use cases based on BTRD gathered during working sessions
• Develop overall Project Test strategy defining potential test approach for different areas like Provider, Broker, Shopper and Employer etc
• Participate in Business discussions on New Health Care Reform products and Benefit Configuration
• Analyze IT development on Exchange build using Agile/Scrum
• Build and Lead a Multi Site team of Analysts, Developers and Test Engineers at Onsite and Offshore. Working on this project to Build, Execute and Maintain End to End testing framework for a enterprise applications of a Healthcare Payer organization covering the following Business Areas for HIX Implementation:
• Group & membership,
• Account Manager, Rating Quoting and Underwriting,
• Claims, Billing and Enrollment,
• Authorizations & Clinical Applications,
• Provider Systems

Environment: Diamond 950, SharePoint, Facets, Quality Center, QTP, MBSP Web app, NASCO, Mojo, Web Page JSF 1.1 . AJAX, Web&App-Websphere 6.1, Stored Procedures, MQ Series, AIX-Unix, WSAD, Rational s/w Architect, Requisite Pro Web, FTP2 Gateway tool, EAS, DB2, Mainframes, JSF, EJB, Spring, Hibernate, Web services, SOAPUI, J2EE, J-Unit Quest, Availity, GAP tool, EDIFEC’s, ETL,SAS, SQL Navigator, Oracle, DB2, Teradata and Unix.

Confidential, Richmond, VA

Associate Manager

Responsibilities:

• Worked closely with Business analysts in understanding the business requirements, X-Walks, Mapping documents, FDD’s and SDD’s.
• Evaluated new business capabilities and develop a comprehensive test strategy which defines the testing approach for function or release.
• Evaluated and tested new or modified software products and validating documentation prior to release.
• Verification of Local, Home and Host Transactions
• Validation of External Trading Partners.
• Validation for Blue Exchange Transactions.
• Preparing, designing, and executing test plans and cases (of moderate to high complexity) based on customer and software requirements and technical understanding of product architecture to attain quality software both economically and efficiently, including both new and existing feature regression tests.
• Ensured traceability of test cases to requirements. Verify accuracy of test results and documents results.
• Created High level Test Plan, Scenarios, test cases from Use case documents, which improved efficiency and traceability.
• Created test data for test execution from production tables.
• Tracked transaction logs using EAS Viewer.
• Developed and verified XML data files against XSD’s, Mapping documents and crosswalks.
• Involved in updating membership based on Member Change file, Processed TRR file, Non-Processed TRR file, BEQ Failure file, Transaction response file, BEQ Legacy file, EAF Fallout file, EAF Missing fields file, LIS Discrepancy file and MMR exception files.
• Involved in validation of Members and Span files to PDM, Provider files, Pharmacy files, Prof and Inst claims.
• Involved in Auto-assign PCP/Assign PCP and Fulfillment.
• Performed Integration testing, System testing, Regression testing, End to End components testing and UAT testing.
• Involved in Enrollment and Claims Processing in Facets and Diamond Involved in testing the Web services security and Net work security of the Share IT applications and verified the broken links.
• Involved in validation of exceptional errors and Provider correctable errors.
• Performed Prof and Inst ITS Host, Local claims, ITS Home claims and Dental claims.
• Validation of 270, 271, 276, 277 and 278 files.
• Involved in 4010 and 5010: 27X files and ICD 10 digits validation.
• Created UAT Test Plan.
• Tested Data Warehousing application by using Informatica.
• Involved in Data migration and data validation Testing.
• Extensive experience on McKesson Enterprise tools like ClaimsXten rules engine in claims processing.
• JCL Job submission for claims testing
• Tested SOAP Web Services.
• Worked with Web services and XML.
• Involved in defects reporting and tracking with Quality Center.
• Identify the Regression Test Scripts and automate them using QTP.
• Automated the functionality in QTP and established Data Driven Framework for Automation.
• Participate in periodical defect meetings and team meeting.
• Prepare defect matrix and status reports.
• Co-ordinate with the developer and analyst to track defects closure.
• Participated in Code Deployment.

Environment: Diamond 950, SharePoint, Facets, Quality Center, QTP, MBSP Web app, NASCO, Mojo, Web Page JSF 1.1 . AJAX, Web&App-Websphere 6.1, Stored Procedures, MQ Series, Rhfutil tool, AIX-Unix, WSAD, Rational s/w Architect, Requisite Pro Web, FTP2 Gateway tool, EAS, DB2, Mainframes, JSF, EJB, Spring, Hibernate, Web services, SOAPUI, J2EE, J-Unit Quest, Availity, GAP tool, EDIFEC’s, ETL,SAS, SQL Navigator, Oracle, DB2, Teradata and Unix.

Confidential, Boston, MA

EDI Manager

Responsibilities:

• Project Management for development of 820 & 834 and report progress to Director of Solutions (Architect). Monitor development resources on X12 transactions, release control staff, X12 translation/validation staff, QA testing staff and respond to development management on priorities.
• Analysis in the creation of detail design documents from original high level design documents prepared for RFP and compliance with HIPAA requirements.
• Hold customer requirement sessions to define detail requirements. Created documents for client feedback and buy-in.
• Apply the specific rules for HIPAA X12, Medicaid managed care requirements and industry best practices for transaction handling.
• Prepare companion guide definitions for the transactions. System architecture definition to move detail design into architectural design for development.
• Work with Director of Solutions and development staff to define flows, monitor development and form/perform testing of developed solutions.
• Subject Matter Expert (SME) training local and off-shore development staff on X12 transactions for healthcare, HIPAA transaction requirements and appropriate coding. Primary SME for 834 and 820, but also helping as needed on 835, 837, 270/271 and 277.
• Interacted with Business users to analyze the Business requirements and Mapping documents.
• Involved in authoring Test Plan, Test Scenarios and Test cases.
• Involved in Integration testing, System Testing, Regression testing and UAT testing.
• Involved in Backend testing
• Involved in XML validation for Eligibility Benefits, Claims Inquiry against XSD.
• Conducted Batch jobs and Cron Jobs on Mainframe to verify results on CICS.
• Involved in validation of 270, 271, 276, 277 and 278 files.
• Involved in 835 validations in different levels for Denial changes, Credits and Correspondence.
• Implemented a service-oriented architecture (SOA) to enable reuse of BCBSMA core business processes.
• Enhanced capabilities to conduct EDI transaction testing both internally and with trading partners.
• Validated Claims processing through NASCO and ITS
• Validated X12 transaction in MQ series using JVM
• Provided improved visibility and activity monitoring of transactions for research and resolution of production issues (e.g. HLM replacement).
• Simplified operational and transactional flows where possible.
• Improved consistency of experience through use of shared services sourced from a common operational data store.
• Conducted Scrum calls in agile environmnet
• Performed backend testing and verified data integrity.
• Involved in HL7 messages validation for various Interfaces.
• Logged the defects using HP Quality center.
• Responsible for Test schedule, Traceability matrix and weekly status report.
• Executing WSDL test cases and Verification of Data, schedules etc.
• Validating SOA and Webservices using SOAP
• Created Project in Rational Service Tester for the functional validation of web services.
• Medicaid claims validation for BCBSMA
• Automated the Test Scripts of WSDL functions using Rational Service Tester
• EDI 5010 transaction validation using Edifecs and RST
• Created Database Connectivity for RST to refresh the production database.
• Parameterized the Data driven Approach for Data validation

Environment: Oracle 9.1, PL/SQL, Toad, HP Quality Center 9.2, RST,SOAP UI, Mainframe DB2,CICS,FileAid,QMF,JCL,Cobol,TSO,VSAM Java, Java script and UNIX.

Confidential, St.Louis, MO

Sr. EDI Lead

Responsibilities:

• Project management technical lead for the development of software, infrastructure, system testing, for HL7 clinical data and X12 EDI claims submission from employers and providers to Managed Care Organizations (MCO) and the State Bureau of Workers' Compensation (BWC). Key partners State Department of Health, Anthem BC/BS, Cerner/Health Network Ventures
• Coordinated with Business users in analyzing the Business requirements.
• Reviewed Work flow charts with the functional requirements and participated in developing the Work flows with the Application Coordinators.
• Involved in writing Test Plan, Test scenarios, Test Cases, and Static reports for System and WIT Testing in accordance to the Business requirements, Use Case, Technical Design Specifications.
• Performed System Testing, Regression Testing and Cut Over Testing Dry Run
• Logged defects in Quality Center and actively involved in Defect Tracking meetings.
• Actively involved in Daily report status meeting.
• Involved in validating messages in ancillary systems
• Performed backend testing.
• Actively involved in testing Professional and Institutional billing in Resolute Module.
• Actively involved in various activities in Pharmacy Benefits Management for Tpharm Project.
• Actively involved in placing Orders to various patients.
• Participated in testing various Anesthesia navigators.
• Actively involved in testing Ambulatory activities.
• Actively involved in testing Cadence module.
• Actively involved in testing ADT modules.
• Actively involved in testing HIM module.
• Actively involved in testing resolute billing HB and PB.
• Actively involved in Workers Compensation validation.
• Actively involved in After Go-Live support.
• Involved in members enrollment in CM system and validating the downstream systems.

Environment: Quality Center, Mainframes DB2, COBOL, MVS, JCL, CICS, VSAM, JavaScript, ASP, ASP.NET, TeraData, ETL, Sql Plus, Oracle 9i, Toad, Java, Ancillary systems.

Confidential, St.Louis, MO

Sr. EDI Lead

Responsibilities:

• Involved in Internal and External Business requirements review meetings.
• Responsible for preparation of Test Plan and Use-Cases.
• Involved in writing the Test Cases and Test Scenarios against business requirements for System, Integration, Regression and UAT testing. Mapped the requirements to Test cases in Quality center and executed the Test cases in Test Lab.
• Experienced in Whit Box Testing, Black Box Testing.
• Performed Backend data Testing.
• Validated the Pharmacy Benefits in Tricare and NASCO application.
• Validated claims processed and deductibles and coinsurance amounts met in Tricare and NASCO.
• Validated the subscriber information is being updated in Tricare and NASCO.
• Experienced in 270, 271, 276 and 277 files validation.
• Involved in System Testing, Integration Testing, Regression Testing and UAT for Professional and Institutional IP and OP claims for Non ITS Host, FEP and ITS Host claims.
• Verified T-Providers, J codes, Hold codes, Reason codes, Allowed amount based on NDC Fee schedule discount, NDC Code, NDC Quantity and NDC Unit Price for all LOB’S.
• Involved in Validate Enrollments, Claims, Reverse and Rekey claims, Potential Duplicate claims, Quick entry claims, Internal entry claims, EDI Claims, Availity Claims, Batch Claims and Exact duplicate claims.
• Verified BMA in Diamond for Prof claims and Institutional claims.
• After Payment cycle, Involved in Verifying the EOB’s and RA’s.
• Verified ERN flat file Records positions.
• Involved in verifying the 835 files. As per X-Walks verified Segments, Service line balancing, Claim balancing and Transaction balancing.
• Experienced in EDIFEC’s Tool to validate 835 AND 837 files.
• Involved in Professional and Institutional IP and OP claims to verify the MER’s on member, PEC logic, MEC logic, CC Logic, Member eligibility for IBO LOB.
• Verified Claim attachments-HL7 messages, LO INC codes, 277 and 275 transactions for PAIS application.
• Reported the defects to the developers using Defects Tab in the Quality Center.
• Extensively involved in Database testing by writing SQL queries.
• Involved in Data migration and data validation Testing.
• Performed Load and Stress testing
• Performed integration testing for RPE Recognize Physician Excellence
• Verified Audit records in EAS.
• Used USERIMS/ISPF to validate SF/DF data for NDC project.
• Responsible for Production service center tickets.
• Performed Migration Certification and Smoke Test for each Build.
• Verified Entry exceptions in EAS and Quest.
• Extensively Involved in EOB’s, RA’s, ERN file, 837,835, GAP tool, EAS, EDIFEC’s, Quest and Availity.
• Tested SOAP Web Services.
• Worked with Web services and XML.
• Responsible for preparation of weekly and Daily status report

Environment: QualityCenter9.2,RequisitePro,FTP2Gatewaytool,EAS,WebSphere,Mainframes DB2,TSO,CICS,JCL,VSAM,QMF,Cobol, J2EE, J-Unit, Quest, Availity, GAP tool, EDIFEC’s, NASCO, FEP, PPO, HMO, IBO, SAO, GBO, ETL, SQL Navigator, Oracle 9i, Teradata and Unix.

Confidential, St.Louis, MO

EDI Analyst

Responsibilities:

• Interact with Business users to analyze the Business requirements.
• Reviewed work flow diagrams and functional requirements.
• Involved in writing Test Plan, Test scenarios, Test Cases, Test scripts and Static reports for System and WIT Testing in accordance to the Business requirements, Use Case, Technical Design Specifications.
• Performed System, Work flow integration testing and Regression Testing.
• Responsibilities include regular interaction with the development team and requirements team.
• Creating defects, providing defect descriptions by using Mercury Quality Center.
• Responsibilities included support in production.
• Involved in testing the identification of Membership and benefits data for California which come from Foundation systems SCAL to PIMS using ADOBE interface.
• Involved in testing Pricing calculations for Branded and Generic drugs.
• Involved in testing the adjudication and accumulation for dispense covered drugs and non-covered drugs for different benefits and different plans for a member individual and family with below, crossing and met annual deductible and OOP Max.
• Verified claims response messages, accumulator values and % of member liability billing sent from PBM to PIMS. PIMS has a real-time bi-directional interface to an external vendor - HealthTrans (PBM). SCAL PIMS communicates with HealthTrans using industry Confidential NCPDP 5.1 formats. This project involves end-to-end system testing of various interfaces - PIMS & Health Trans.
• Resolved software defects by interacting with developers and Reviewed to Code to ensure quality software.
• Conducted Regression Testing on various builds of the application and reported the defects using Mercury Quality Center.
• Validate Test Cases and Test Scenarios against business requirements for System, Integration and UAT testing.
• Involved in System testing for verifying Pulling Records into PIMS, View Summary Record, View Detail Record, Demographics, Add/Edit Patient details, Patient Lookup Lines, Inquiry screen, Benefit Summary, Rx Dispensing & Claim Submission, Refills, Trial Claim, Claim status, Claim Submission/Refunds, Mail Order Rx Dispensing, Claim status, Claim Submission/Refunds, Review, View the order, Print Label and Reversals.
• Involved in Regression Testing using QTP tool.
• Generated PL/SQL queries to validate various reports, loads and extract processes.
• Performed backend data testing for POPS and PIMS..

Environment: Quality Center, QTP, HL7, Mainframes DB2, TSO, VSAM, COBOL, MVS, JCL, CICS, SPUFI, WinRunner, JavaScript, Java, TeraData, Oracle 9i, ETL, Diamond, POPS and PIMS.

Confidential, Los Angeles, CA

Business Analyst

Responsibilities:

• Requirement Analysis
• Preparing / Updating Requirements Traceability Matrix
• Coordinating between offshore and Client
• WSDL Verification of URL’s response
• Web Services testing using SOAP UI tool
• Preparing Test Suites in SOAP UI Tool
• Load testing in SOAP UI Tool.
• Preparation, Review and Execution of Test Cases
• Preparation of test plan
• Defect Reporting and Tracking on Quality center
• Involved in production testing

Environment: Java, XML, Manual Testing, PL/SQL, UNIX, ASP and Oracle 8i.

Confidential, Chicago, IL

BSA

Responsibilities:

• Involved in creating Test Plan as per System Requirement.
• Involved in various meetings with Business Analysts and Updated Business requirement.
• Performed Functional, Black Box and System testing.
• Prepared Test data to enable the software to be quality checked.
• Involved in authoring Test cases using Test Director.
• Involved in automation for regression testing using WinRunner.
• Reported software defects in Test director and interacted with the developers to resolve technical issues.
• Generated PL/SQL queries to validate various reports, loads and extract processes.

Environment: Visual Basic, CAPS, ASP, Java Script, VB Script, XML, Oracle 11i, Oracle Financials, SQL, MS Access, UNIX, Oracle Run Time, IAS Web server, Web logic, BEA Tuxedo, Windows95/98/NT/2000/XP, Internet Explorer, WinRunner, Test Director

Confidential, Newark, NY

BSA

Responsibilities:

• Involved in writing test cases in accordance with business requirement and functional specification documents.
• Prepared test scripts by referring to ETL and Reporting functional specifications.
• Performed Requirement Analysis and identified system impact and changes.
• Performed GUI, Functionality and Regression testing.
• Created test scenarios for Functional Testing of the application.
• Performed Backend testing by extensively using SQL queries to verify the integrity of the database.
• Fixing defects, maintained Defect Tracking through Quality Center.
• Developed reports and graphs to present the test results to the management.
• Executing ETL test cases (which involves executing Informatica mappings and checking the output in the database tables)
• Performed all phases of testing of front-end and back-end components.

Environment: Informatica, Oracle 8i, Quality Center, Windows 98, ASP, Java Script, VB Script