SUMMARY

• Progressive working experience in the field of Information Technology spanning various areas of the industry with emphasis on Quality Assurance Possess excellent skills in Automation Testing using Rational Tools along with Manual Testing.
• Experience in HIPAA EDI Transactions and code sets: 835, 270/271, and 276/277.
• Expertise in Project Planning, Project Design, gathering requirements, creating Functional specifications, and data flow diagrams
• Experience with Facets Application Groups: Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management.
• Proficient in Functional Testing and GUI Testing of web and mobile applications (API) to meet the business requirements.
• Experience working on Facets Healthcare system, business intelligence tools, employee benefits, health insurance, defined - benefit pensions, Healthcare payer operations and Reporting applications
• Experienced in various Healthcare areas like Enrollment, Benefits, Claims, Medicare, and implementation of HIPAA key EDI (ANSI X12) transactions.
• Good Knowledge of Medicare, Medicaid, claim process and Pharmacy Benefit Management (PBM)
• Experience in testing of Data Warehouse/ETL Applications developed in Informatica, Data stage using SQL Server, Oracle, DB2, and UNIX.
• Expert in Healthcare Payer systems - Claims, Billing with backend data mapping, data integration.
• Experience on Web services to combine component-based development and Internet standards and protocols that include HTTP, XML and Web services Description language.
• 837 Claim Routing, 835 Remittance, payment, and 834 Membership.
• Understanding of translating user requirements into Technical specifications and mapping the process design, work flows for SDLC with documenting, managing business requirements.
• Experience in Designing Test plans, Test Cases, and Test Scripts.
• Experience working with HealthCare Applications Facets.
• Substantial experience in Sanity and Smoke Testing of applications before testing effort of UAT and Regression Testing of applications.
• Used Agile-testing methodology for achieving deadlines in UAT.
• Experience with health care Systems: FACETS, Medicare Part A, B and Medicaid
• Experience testing variety of applications such as Client/Server, Windows, and Web based applications, SOAP, Rest services.
• Experience with WSDL, SOAP, Web services, XML Schemas
• Worked on Claims Transactions (Institutional/Professional)
• Experience of Web and Mobile applications using Android and IOS devices in agile process
• Strong skills in performing Acceptance, Regression, Performance, Functionality, Front End and Back End Testing, Participation in requirement reviews.
• Performed acceptance testing on membership and claims module.
• Possesses excellent skills in Bug Reporting using Test Director
• Extensive experience in Client/Server by performing Smoke Testing, System Testing, Functionality Testing, Integration Testing, Regression Testing and GUI Testing.

TECHNICAL SKILLS

Test Reporting Tools: Quick Test Professional (QTP), Quality Center/ALM

Languages: Visual Basic, XML, HTML, DHTML

Operating System: Windows 95/98/NT/2000/XP, UNIX

Databases: SQL Server, MS - Access, Oracle, and DB2

Others: UML, SDLC Agile Methodology, Rational Unified Process (RUP), Waterfall model

Other tools: MS Office, MS Vision, Rational Requisite Pro, MS Visio, Rational Rose, Microsoft Project, Job Manager, SQL Server Management Studio, XML

PROFESSIONAL EXPERIENCE

Confidential, Albany, NY

Facets QA Tester

Responsibilities:

• Create test data for Off-Exchange members and validate that data has been captured.
• Involved in validating that Off-Exchange Reports for members and providers populate in FACETS 5.3 as per requirement by using WebFocus and InfoView application.
• Involved in developing Test Plans, Test Cases/Test Scripts.
• Analyze, track and documents defect in ALM.
• Ordered TCS letters in FACETS by using template IDs.
• Drafted detailed Test Cases in ALM and link requirements.
• Create TCS letter templates in FACETS 5.3 QAE01
• Compared and validated changes in letter between Production Template versus Requirement Template.
• Compared and validated changes and letter content between Nightly Batch PDF letter versus Requirement Template attached in ALM Requirement.
• Manually performed end-to-end testing.
• Responsible for providing regular test reports update to team lead.
• Reported defects to developers through HP ALM.
• Tested FACETS 5.3 Claim Processing, Customer and Prospective UM application for TCS letters creation

Confidential, Boston, MA

Facets QA Tester

Responsibilities:

• Worked with the Agile methodology reviewing the Business requirement, Functional Design Documents and Technical Specification documents.
• Created Test Cases and Test data after analyzing the BRD.
• Monitored ETL batch jobs on batch servers and reviewing Log, Error and Output files
• Tested and managed the XML files of the Claims.
• Performed Functional and GUI testing on Facets Billing, Customer service and Subscriber application under Facets.
• Involved in FACETS Implementation, involved end to end testing of FACETS Billing, Enrollment Claim Processing and Subscriber/Member module.
• Tested web services by generating XML SOAP requests and validated the corresponding XML SOAP responses.
• Tested the claims (837s) processing application (Facets) for any defects.
• Tested HIPAA Transactions and Code Sets Standards such as 820,834, 837/835, 270/271, 276/277 transactions using Facets.
• Involved in the testing of web portal of New MMIS system.
• Logged of defects in Quality Center to maintain Test requirements and to communicate the bugs with the Developers.
• Tested the Medicare and Medicaid preferred Eligibility and EOB claims extract files for CDHP plans.
• Worked on uploading all the Test cases to the Quality Center for the current and prior releases.
• Responsible for performing System and integration testing for configuration release.
• Worked with MMIS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication).
• Prepared test sets executed and validated functional test cases in ALM.
• Developed test strategies and test scenarios for all 837, 835, 834, 270/271, 276/277 transaction related reports
• Wrote Test Cases for Manual Testing and created Traceability Matrix.
• Validate the preparation of test scripts and the execution of UAT of all MMIS contract components and documents risks and variations based on earlier defined requirements.
• Responsible for checking member eligibility, provider enrollment, member enrollment for Medicaid and Medicare claims. Identified gaps between standard FACETS functions and client specific requirements to write requirements for FACETS extensions
• Worked on Claims Customer services, Members, Enrolment interfaces and extensions for FACETS as a part of FACETS implementation team.
• Validated the following: 837 (Health Care Claims or Encounters), 835 (Health Care Claims payment/ Remittance), 270/271 (Eligibility request/Response), 834 (Enrollment/Dis-enrollment to a health plan).
• Written multiple Test Cases (System, Integration) for multiple transactions include 837I, 837P, 835, (both inbound and outbound) transactions
• Verified testing based on system analysis.
• Responsible for testing of claims adjudication process for the New MMIS system
• Identified the requirements for accommodating HIPAA standards for 837P transactions and captured these requirements to develop new GUI for the internet-based application.
• 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.
• Created input test files as per the business requirements in Ultra edit and processing them in batch server to load data to respective tables in database and to generate the output

Confidential, Basking Ridge, NJ

QA Tester

Responsibilities:

• Created Detailed Test Plan, Test Approach, Test Matrix, Test Strategy documents based on the information gathered through business requirements and design/application walkthroughs.
• Actively participated in all phases of testing lifecycle (Design, Planning, Development and Results).
• Involved with other team members to set up testing tools, implementation and testing environments.
• Tested HIPAA EDI Transactions and Code Sets Standards such as 837, 835, 834, 276/277 transactions.
• Worked with Claims, enrollment, eligibility verification for members and providers, benefits setup, fee schedules and backend payment cycle in claim processing system.
• Performed manual testing and conducted positive and negative testing.
• Performed Sanity and Smoke Testing of the application manually after each build.
• Tested the HIPPA EDI, 834, 837/835 transactions according to test scenarios and verify the data with FACETS Son different modules.
• Created different pricing rules and verified whether the adjudication system is using the rules while adjudicating the Claims.
• Created traceability matrix between requirements and test case for each round of testing using HP ALM/Quality Center.
• Used Jira, confluence to store test cases and upload the results back to Confluence.
• Involved in creation and maintenance of Test Matrix and Traceability Matrix.
• Validated the date from EDI transaction in the front end as well as back end.
• Ran the SQL queries for checking the data stored in the database.
• Performed Backend testing by extensively using complex SQL queries to verify the integrity of the database.
• Validated the integration of applications with Facets, which manages the customer service, claims, membership, care facilitation and appeals.
• Created and maintained test strategies, test plans, test cases, and product release reports for small projects or components of larger projects in Confluence, and Jira
• Work with Agile team of software development engineers to improve quality throughout the software development lifecycle on Web App & Mobile (iOS & Android) applications
• Responsible for mobile testing of client websites on the following platforms (Android, iOS and Windows OS).
• Tested the UI of the end product on Mobile, PC, Tablets, Android and iOS platforms to ensure that language translation and currency conversions were displaying as required

Confidential, Eagan, MN

QA Analyst

Responsibilities:

• Worked on following applications to cut down the duplication.
• Solid expertise with MS Word, Excel, PowerPoint, and Project.
• Also worked on FACETS member’s implementation.
• Coordinated with the developers and IT architects to design the interface of the new system according to the X12 (270, 276, 278, 834, 837 (I, P, D) and 820) standards.
• As a part of operational production support team, received work request tickets for resolving on daily basis.
• Troubleshoot any problems found within FACETS and when testing the SQL data database while validating the business rule.
• Provided weekly project status report to project manager and project presentation to the high-level management on monthly basis.
• Involved in testing EDIs according to code set X12 835 Claim Payment & Remittance Advice.
• Performed manual testing using HP ALM/ Quality Center and automation testing using Selenium JavaScript
• Created and ran automation test scripts using Selenium JavaScript.
• Used Firebug to do web-based application testing with selenium for the commands and locator application.
• Executed automated test suites on multiple platforms using Selenium Grid and Maven scripts.
• Interacted with the technical team for the 837 claims transactions design.
• Claims processing and 837 Claim transactions.
• Tested 837/ 835, 820, 270/271, 276/277 transactions with File Aid.
• Worked on developing the business requirement and use cases for FACETS batch process, automating the billing entities and commission process.
• Assisted project manager for planning and organizing the project activities, and in communicating with other business center managers and stakeholders of the project.
• Analyzed and documented the limitations of the billing system.
• Managed project scope and deadlines.
• Developed automation scripts in QTP to automate smoke and regression testing.
• Participated in various meetings and discussed enhancement and modification request issues.
• Performed Gap Analysis.
• Facilitated Joint Application Development (JAD) Sessions for communicating and managing expectations.