EDI QA Analyst

• 7+ years of IT industry experience with a proven skill in the field Software Testing and Business Analysis.
• Possess strong knowledge of healthcare terminology and extensive experience working on healthcare projects. Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 4010/5010 EDI transaction codes such as 270/271,276/277, 834, 835,837,277 CA,999 .
• Extensive experience in writing and executing complex SQL queries using TOAD 9.0.1 to validate data within SQL Server 2007 database
• Experienced working with x12 version 5010 transactions and ICD -10-CM and ICD-10-PCS Code set changes analysis, design and migration strategy.
• Participated extensively in Diamond, HIPAA and Health Claims under Health Care domains
• Have excellent knowledge of HIPPA 4010 /5010 versions.
• Experience working and testing mapping for X-12 transactions using Integration tools like TIBCO, EDIFECS and Sterling GIS suites.
• Experienced in writing test queries/scripts for data analysis and QA report testing.
• Extensively involved in Full life Cycle Testing.
• Extensive experience in writing and executing complex SQL queries using TOAD 9.0.1 to validate data within SQL Server 2007 database.
• Experienced in Object Oriented Analysis, Data Analysis, Requirement Analysis, Business Modeling and Use Case development using UML methodology
• Expertise in developing QA Test Plan, Test Conditions, and Test Cases; ensuring adequate testing of software both before and after completion; conducting and documenting UAT.

Technical Skills

Operating System

UNIX, Windows 9x/NT/2000, MS-DOS

Language/Tools

SQL, PL/SQL,HTML Scripting

Database

Oracle SQL Server, MS Access, Oracle9i/10g, DB2, LDAP, OLAP,Toad,C,JAVA

Testing Tools

Manual Testing, Mercury tools.

Networking Tools

Unix, Telnet, FTP,ETL - Data Staging

GUI Tools/Internet Programming Tools

Tibco, Edifecs, Visual Basic,TRIZETTO (QNXT) , Crystal Reports, Cognos Reports, HTML, XML.

Professional Experiences:

Confidential, August 2012 - Present
Watertown, MA
EDI Analsyt
Project Description:
Implementation of TMP encounter project .This project involved in sending 837 I and 837 P to CMS and getting back 277 CA for send 837 files .Once the 277 CA files came from CMS Rejected claims would be loaded into work baskets of Internal Web users.Once the claims are corrected they would be send to back CMS .In this project I also worked on MAO flat files send back from CMS .This are similar to 277 CA files ,except they are not in EDI format.These also would be loaded to workbaskets.

Responsibilities:

• Experience working with CMS ,Trading partners and direct submitters and setting them up in EDIFECS .
• Validated all HIPAA Transactions including 837I ,837 P and 277 CA HIPAA 5010 versions.
• Involved in designing, developing test plans use cases and executing test scripts.
• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Transactions focused on were 837I ,837 P and 277 CA 5010 versions of HIPAA standards.
• Major work was involved with Inbound 837 I and 837 P, 835s(Out bounds) claims processing systems.
• Data validation and Database integrity testing done by executing SQL statements.
• Created Base Files for 5010 Transactions and mocked up data to create Test files based on test scenarios and conditions.
• Prepared and Created Test Cases /Test Data according to 5010 Business requirements.
• In depth experience in manual testing of the application on mainframes for claims processing.
• Extensively Used BIZTALK for validating HIPAA 5010 test files.
• Wrote test cases and executed results for 834 which have different Bussiness rules for different Trading Partners.
• Involved in Daily meetings for 5010 conversion almost all the year until the end of the project.
• Hands on experience in manual testing of the application on mainframes for claims processing.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Used SQL statements for Back-end testing.
• Worked with Businnes Analysts in problem serving and resolving the issues with Trading Partner setup in 5010 conversion.

Environment: EDI X12N 5010, MS Outlook, UNIX, Windows95/98/NT/2000/XP/7 and Internet Explorer, Sharepoint.

Tools: EDIFECS , Xengine, TM 6.8, FileZilla, Quality Center 9.2,Toad, Oracle 10g, Reflection, IBM Mainframe, Microsoft Outlook for Bug Tracking.

Confidential, April 2012 - July 2012
Watertown, MA
EDI Tester - II

Project Description:
Implementation of TMP SCO Project .This project involved in recieving medicare claims from CMS .Once the claims come from CMS they are loaded into DIAMOND data base .
These claims are then loaded in Internal Web based screens and worked upon .

Responsibilities:

• Experience working with CMS ,Trading partners and direct submitters and setting them up in EDIFECS .
• Validated all HIPAA Transactions including 837I ,837 P and 277 CA HIPAA 5010 versions.
• Involved in designing, developing test plans use cases and executing test scripts.
• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Transactions focused on were 837I ,837 P and 277 CA 5010 versions of HIPAA standards.
• Major work was involved with Inbound 837 I and 837 P, 835s(Out bounds) claims processing systems.
• Created Base Files for 5010 Transactions and mocked up data to create Test files based on test scenarios and conditions.
• Prepared and Created Test Cases /Test Data according to 5010 Business requirements.
• In depth experience in manual testing of the application on mainframes for claims processing.
• Involved in loading the flat files into Oracle Database and involved in writing Complex SQL Queries.
• Extensively Used BIZTALK for validating HIPAA 5010 test files.
• Wrote test cases and executed results for 834 which have different Bussiness rules for different Trading Partners.
• Involved in Daily meetings for 5010 conversion almost all the year until the end of the project.
• Hands on experience in manual testing of the application on mainframes for claims processing.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Used SQL statements for Back-end testing.
• Worked with Businnes Analysts in problem serving and resolving the issues with Trading Partner setup in 5010 conversion.

Environment: EDI X12N 5010, MS Outlook, UNIX, Windows95/98/NT/2000/XP/7 and Internet Explorer, Sharepoint.

Tools: EDIFECS , Xengine, TM 6.8, FileZilla, Quality Center 9.2, Toad,Oracle 10g, Reflection, IBM Mainframe, Microsoft Outlook for Bug Tracking.

Confidential, TX May-2010 - Jan 2012
QA Analyst
Project Description:
Implementation of this Project involves a list of fields that must be added to Diamond in support of the 834 inbound file to EOHHS. The purpose of this project is to identify the new fields and files required for processing the Senior Care Option (SCO) product.
And changes to the processing of Daily TRR files in Diamond for SCO LOB.
Responsibilities:

• Involved in Preparing Test Plan.
• Developed Test Cases bases on Requirement Specifications and Design Documents.
• Responsible for executing the Test Scripts.
• Involved in Preparing Test Data for various scenarios.
• Performed Smoke, Integration, functional and system testing.
• Solo Tester for the entire module and used to report directly to manager.
• Followed the Mapping documents and HIPAA implementation guides for HIPAA Transaction Mapping
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Involved in testing the efficiency of healthcare delivery by using HIPAA
• Involved in creating initial eligibility file and change files.
• Involved in writing SQL queries in SQL Developer to validate whether the member has coverage.
• Involved in creating separate extract files for different LOB's.
• Involved in testing HIPAA EDI Transactions mainly focused on 837 and 834.
• Involved in Processing claims and verifying whether it's delivered to DIAMOND System or not.
• Involved in processing claims in Diamond and validating the full cycle process to make sure the checks are generated and 834's are generated.

Environment:EDIX12N4010,DIAMOND,Oracle,SQL Developer,Windows95/98/NT/2000/XP and Internet Explorer, Quality Center

Tools: Quality Center 9.2, Oracle 10g, Reflection for unix and Digital, IBM Mainframe, Microsoft Outlook for Bug Tracking.

Confidential, LA Oct 2008 - May 2010
EDI Analyst

Project Description:
Implementation of Web Project for Providers using ETL procedures, this portal was developed for Providers to perform Claim Status Inquiry transactions, Member Eligibility transactions and Preregistration submission. This Project was implemented as a part of the Health Care reform process

Responsibilities:

• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Involved in testing HIPAA EDI Transactions and mainly focused on PA and Eligibility Transactions.
• Transactions focused on were 270,271, 834, 278, and 837 in 4010 and 5010 versions of HIPAA standards.
• Involved in loading the files into Oracle Database and involved in writing Complex SQL Queries.
• Worked Extensively with Inbound 837 I and 837 P, 835s(Out bounds) claims processing systems
• Created and executed test cases for testing HIPAA compliancy using SpecBuilder 6.8.1.
• Set up Trading Partners within the TPM Management tool.
• Experience validating XData created by Xengine for data mapping of X-12 to XML format and in turn to TRLog format.
• Validated X-12 files sent by external vendors to ensure that they are passing EDI Gateway level using SpecBuilder.
• Worked collaboratively with BI and ETL resources to design and develop effective solution.
• Involved in creating test cases for data mapping procedures.
• Worked on Informatica Work Flow designer and Work Flow Monitor to execute transformations and schedules, and to validate the log files.
• Experienced with high-volume load processing into Data warehouse database.
• Prepared and Created Test Cases /Test Data according to 5010 Business requirements.
• Tested all HIPAA transactions for multi version support 4010 and validating the database to file elements.
• Involved in the development of web platform for online transactions through E-commerce.
• Implemented Data ware house strategies to build the enterprise architecture.
• Worked with other data analysts in creating and maintaining Data functional design documents.
• Hands on experience in manual testing of the application on mainframes for claims processing.
• Participated in user acceptance testing for the UDD application.
• Worked on 837, 835, 276 and 277 Institutional and Professional, EDI Gateway.
• Analyzed existing processes, Extracted XML/COBOL files, for successful FACETS implementation and integration with other proprietary tools/application.
• Used SQL statements for Back-end testing

Environment: EDI X12N 4010, EDI X12N 5010, ICD 10, MS Outlook, UNIX, Windows95/98/NT/2000/XP and Internet Explorer.

Tools: EDIFECS Suites: SpecBuilder 6.8.1, Xengine, TM 6.8, Informatica 8.6, COGNOS, FileZilla, Lotus Notes for Bug Tracking, Quality Center 9.2, Oracle 10g, Reflection, IBM Mainframe.

Confidential, CO Nov 2006 - Aug 2008
QA Analyst

Worked on several Projects related to ETL, Web and Claims Adjudication process.

Responsibilities:

• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Responsible for designing, developing test plans use cases and executing test scripts.
• Performed Smoke, Integration, functional, Regression, and system testing.
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Verify and validated enrollment and adjudication
• Verified X12 to TR log mappings for claims processing
• Involved in testing ETL projects and mainly focused on file creating for data extraction and loading process.
• Worked on writing Transformation rules on CDW ETL which transfers the data from ODS to CDW.
• Involved in Data Analysis for the data warehouse and data mart system for the process of report generation.
• Participated in writing data mapping documents and performing gap analysis on the systems.
• Queried the IMS/ DB2 database in Mainframe for the Proper validation of the claims into the Database
• Prepared High Level Logical / Physical Data Models and BRD supporting documents containing the essential business elements, detailed definitions, and descriptions of the relationships between the actors to analyze and document business data requirements.
• Used Claridy tool to verify mapping to X12 format.
• Base-line and Regression tests were scheduled and performed on every Release and build.
• Extensively involved in real time testing.
• Involved in writing and testing complex SQL queries.
• Extensively involved in Reference Interface (In bound and out bound) testing.
• Used Quality Center for preparing the test plans and manual test scripts.
• Worked extensively with Quality Center for requirements, Preparing Test cases, Executing, Defect openings and closings.
• Involved In loading the flat files into Oracle Database and involved in writing Complex SQL Queries.
• Involved in generating Reports using Oracle Report Builder and testing the reports using Oracle Run Time.
• Involved in writing Complex SQL Queries using TOAD to validate the loads for Caremark and DEA.
• Involved in writing UNIX shell scripts.

Environment: EDI X12N 4010, NASCO, Sybase Paper Free HIPAA Toolkit, DB2, LDAP, TSO/ISPF, JCL, Visual Basic, ASP, XML, SQL, MS Access, UNIX, Oracle Run Time, Windows95/98/NT/2000/XP and Internet Explorer, I-Frame Portlets, Siteminder.

Tools: SQA Manager, Toad, SpecBuilder, Tibco BC, Lotus Notes for Bug Tracking.

VISA Status : Green card

Education:
Bachelor of Engineering (Computer Science).