EXPERIENCE SUMMARY

• More than 8 years of IT industry experience with a proven skill in the field of Software Testing/ Quality Analysis and Business Analysis.
• Strong knowledge of Software Development Life Cycle (SDLC) as well as Testing Methodologies and the Role of QA/ EDI Specialist.
• Experience and Familiarity working with Waterfall, AgileandScrum methodologies.
• Experienced in developing scenario based test cases based on Use Cases, User Requirement Documents (URD) and developing acceptance test cases from the Business Requirements Documents (BRD) and System Requirement Specifications (SRS).
• Strong experience in all levels of Testing such asPositive testing, Negative testing, Integration Testing, Functional Testing, System Testing, Regression TestingandUser Acceptance Testing.
• Experience in SOA based Testing, worked extensively on TIBCO, a SOA tool for Data Integration.
• Expertise in BizTalk06/10 schemas, mapping and administration console
• Expertise in gap analysis of 4010/5010 of all transactions such as 837, 835, 999.
• Expertise in EDI transactions used in healthcare industry and good knowledge of HIPAA X12.
• Experience as an EDI analyst performing verification and validation of the EDI transactions.
• Possess strong knowledge of healthcare terminology and extensive experience working on healthcare projects. Specialized experience in healthcare insurance domain. Profound understanding of insurance policies like HMO and PPO and proven experience with HIPPA 4010/5010 EDI transaction codes such as 270/271(inquiry/response health care benefits), 276/277(Claim status), 999(Functional Acknowledgment)
• Thorough understanding on ICD9/10 codes
• Attended meetings on cross walking between ICD9 and ICD10.
• Gathered, analyzed and documented business requirements for ICD10.
• Expertise in working with direct submitters, clearing houses and providers in regards to all the issues with EDI setup, claim submissions, eligibility transactions and ERA’s.
• Expertise in writing SQL scripts used in manual testing both front-end and back-end.
• 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.
• Extensive knowledge on the Inbound and Outbound HIPAA transaction sets with both 4010A and 5010A HIPAA versions.
• Expertise in TOAD, and SQL Server Management Studio.
• Experience testing Back End and Front End databases like Oracle 9i, 10g and AS 400, HP 9000 systems.
• Excellent troubleshooting, tracking bugs and issue resolution skills.
• Experience managing and working with On-Site and Off-Shore teams.

• Operating System: UNIX, Windows 9x/NT/2000, MS-DOS
• Language/Tools: SQL, PL/SQL, COBOL
• Database MS SQL Server, MS Access, Oracle 8i/9i, DB2, LDAP, AS 400, HP9000
• Testing Tools: Manual Testing, Mercury tools
• Networking Tools: Unix, Telnet, FTP, ETL - Data Staging, LDAP Server (SSE enabled), Filezilla.
• GUI Tools/Internet Programming Tools: Visual Basic, Developer 2000, Power Builder and Crystal Reports, HTML, XML.

Bachelors of Engineering (Computer Science & Information Technology)

PROFESSIONAL EXPERIENCE

Confidential, Gaithersburg, MD Mar 2011 - Present
EDI/QA Specialist

As EDI/QA specialist, worked mainly on the transition of all EDI transactions to 5010 from 4010. Involved in the gap analysis, testing all transactions. Transmitted all of our trading partners from 4010 to 5010 by testing new maps.

Responsibilities:

• Created trading partner agreements and trading partner’s party set up for both 4010 and 5010 in BizTalk06 and BizTalk10.
• Did the 4010/5010 gap analysis for all EDI transactions such as 837, 835, and 999.
• Extensively worked with Edifecs Specbuilder to create test files, analyzed all EDI test files with 5010 implementation guides and gap analysis of EDI transactions.
• Worked on troubleshooting of the entire claim processing issues with all the providers and hospitals.
• Hands on experience with daily claim processing and uploading 837 files into database.
• Conducted user interviews, gathered requirements, and analyzed the requirements for the new health insurance product.
• Worked with Monument people on 5010 to 4010 conversion and loading of 5010 837 files into database.
• Data management and metadata reporting done using Monument Express ETL tool
• Evaluate and planned to collect and report clinical performance using CRS tool
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating the database to file elements.
• Transactions focused on were 270,271, 834, 835, and 837
• Attended meetings on cross walking between ICD9 and ICD10.
• Gathered, analyzed and documented business requirements for ICD10.
• Met with users to discuss and gather ICD10 requirements.
• Prepared mapping documents for ICD10 and 5010 transactions.
• Closely worked with development team to enhance and standardize the ETL Process to load underlying system that supports Network Health.
• Setting up new trading partners in sFTP, BizTalk and database.
• Researched the existing client processes and guided the Vendors in aligning the HIPAA compliance output with the client systems.
• Participated in risk sessions to address the risks and addressed of entry to finalizing, claim review, identifying claims processing problems, their source and providing alternative solutions project impacts to bring to light the possible workaround.
• Conducted workflow analysis to bring out the identified gaps and documented it.
• Worked with different functional groups to arrive at the common business and technical specifications.

Environment: EDI X12N 5010, EDI X12N 4010, BizTalk 06/10, Edifecs Specbuilder, DB2, sFTP, Visual Basic, ASP, XML, SQL, MS Access, UNIX, SQL Server 2005/2008, Windows95/98/NT/2000/XP and Internet Explorer

Confidential, Hartford, CT Oct 2008 - Feb 2011
QA Specialist - II

HP works with the State of CT and provides healthcare services to individuals all over the New England area. It provides quality health, dental, vision, pharmacy and behavioral health coverage for employees and their families.
Worked on several projects that include - Member Portal, CSI - via EDI and Web.

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, 835, and 837.
• Worked Extensively with Inbound 837 I and 837 P, 835s(Out bounds) claims processing systems
• Prepared and Created Test Cases /Test Data according to 5010 Business requirements.
• Tested all HIPAA transactions for multi version support (4010 and 5010) and validating the database to file elements.
• Modifying JCL\'s accordingly to run the required tests submitting the batch jobs
• Use of QMF and SPUFI in extracting the queries.
• Using with XPEDITOR debug the COBOL programs, and see the runtime values for the COBOL variables.
• Used File Manager to edit the datasets.
• Hands on experience in manual testing of the application on mainframes for claims processing.
• Created Requirements v/s Test Case Matrix in Excel Spread Sheet template.
• Developed the Reports for Manager Using Crystal Reports.
• 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.
• Researched the existing client processes and guided the Vendors in aligning the HIPAA compliance output with the client systems.
• Worked with different functional groups to arrive at the common business and technical specifications.
• Designed and delivered HIPAA training material regarding information security and best practices
• Worked to build extensions for FACETS Members, Claims, Billing and enrollment applications.
• Supervised the work of junior technical writers and worked in collaboration with them
• Used SharePoint to store document and version control.
• Well versed with Claim processing from point to point.
• Traced Requirements using Requirement Traceability Matrix.
• Used SQL statements for Back-end testing

Environment: EDI X12N 5010, EDI X12N 4010, Altova Mapforce, ClarEDI validation, DB2, LDAP, TSO/ISPF, JCL, Visual Basic, ASP, XML, SQL, MS Access, UNIX, SQL Server 2005/2008, Windows95/98/NT/2000/XP and Internet Explorer

Confidential, Boston, MA Aug 2006 - Sep 2008
Sr. EDI Analyst

As a EDI Analyst /QA performed functional, regression, performance and UAT testing of various functionalities like member enrollment, benefit administration, billing, reimbursement, claims productivity, claims adjudication to ensure consistency and also to make the system user-friendly and error-free for its customers. Interacted with the End users and participated in JAD sessions to ensure that their requirements are compliant with the code tested.

Responsibilities:

• Identified and involved all key stakeholders, contributors, business, operations and technical resources that must participate in a project and ensured that contributors are motivated to complete assigned tasks within the parameters of the project plan
• Involved extensively in testing of the application both manually as well as using the required tools
• Involved in creating the business case and project plan
• Created product documentation, including online help, printed user manual, and training materials
• Participated in the design of the 276/277 Claims Status transaction, create EDI map(s), and added some project leadership thru-out the project by working closely with the Business Analysts and Project Manager.
• Analyzing and Testing the 837 (Institutional/Professional - Inbound/Outbound), 834 Inbound, 835 Outbound, 997 Acknowledgement Inbound and Outbound EDI Transactions.
• Created mapping documents and technical analysis on Paper Claims, Medicaid Claims like UB04, UB92, and HCFA.
• Created Rate sheets for Trizetto Claims Adjudication Process, by creating Mock Up’s for Business Users, these Web screens were built on the ALUI-Java platform.
• Created Test Plan that defines the test environment, phases of testing, entrance and exit criteria into different phases of testing and resources required.
• Created Rate sheets for each of the Claims Diagnosis and Proc Codes based on Business needs.
• Ensured that ETL process steps involved in Claim Codes loads data to Oracle Db’s as anticipated.
• I was involved as a Team Lead of aggregation of outbound X12 to UHG .I have made decision of aggregation on billing provider (2000 A) Subscriber (2000B) and CLM (2300) per ST -SE instead of a single claim per ST-Subordinated with the Quality & Technical Leads on Test Coverage and Test Planning.
• Identified, built and executed Test Cases and Test Sets for Functional, Error Handling, Navigation and Regression in Test Director.
• Manually tested the entire application along with the junior testers before the tests were automated.
• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Validated the reports and files according to HIPAA X12 enforced standards.
• Created test cases for Accounts, Activities, Opportunities, Contacts, and Plans.
• Performed validation testing on the application navigation for various scenarios and reported the errors.
• Assisted EDI team with the testing of maps for HIPAA transactions 835 and 837.
• Involved in testing maps and translated data.
• Verified the relationship between accounts, contacts, opportunities, and activities.
• Performed thin client testing for the remote users.
• Performed custom tables testing to check if they are resolving the foreign key.
• Involved in the user acceptance testing (UAT).
• Supervised Automated testing using WinRunner, test scripts, execution and reporting
• Created projects, groups and multiple sets of logins depending on the privileges to be given in Test Director Administrator module.
• Manually tested all the interfaces.
• Wrote SQL queries to perform backend testing.
• Executed SQL queries to identify and manage to eliminate Duplicate and Improper data that would load into the RDBMS via ETL.

Environment: IBM Mainframe, DB2, Test Director 8.0, HIPAA X12, MVS/JCL, Aldon CMS, TIBCO.

BMI offers various insurance policies to customers. MAI is designed for quote, new business and customer care models. The main purpose of Multi Access Integration (MAI) is to get the quote for auto insurance through online.

Responsibilities:

• Automated and customized the scripts for the entire application using Quick Test Professional.
• Reviewed the Business Requirement specification Document and the technical specification of the application
• Reviewing System Requirements to define testing scope for various levels of testing (Functional, System, Regression, and UAT).
• Experience testing Transaction processing system for End Users during UAT and ensuring that payments made and received were calculated based on all the Business rules.
• Developed Test Objectives and Test Plans.
• Created manual and automated Test Cases and Test Scripts.
• Created Standard, Image, Table, Page, Text/Text Area Checkpoints.
• Parameterized the test(s) and modified steps affected by parameterization.
• Worked with developers to communicate regarding issues in the application.
• Coordinated the testing effort towards End-to-End testing to verify the proper functioning.
• Created several compiled modules.
• Performed Regression Testing.
• Wrote SQL queries to test the application for data integrity.
• Tested User Interface inconsistency and application functionality.

Environment:Windows 2000, HTML, Java, MS SQL Server, Test Director 7.0

Confidential, Hyderabad, India Jul 2004 - Jan 2005
Data Analyst

Responsibilities:

• Studied and assessed the clients systems and business processes. Developed project plans and managed scope.
• Established a business Analysis methodology around the Rational Unified Process.
• Assisted in building a business analysis process model using Rational Rose and Visio.
• Conducted JAD sessions for communicating with Stakeholders and Project directors.
• Linked business processes to organizational objectives, perform critical path analysis, and identify opportunities for business process improvement
• Communicated extensively with the clients and with different levels of management to identify requirements, use cases and to develop functional specifications.
• Created Use-Cases and Business Use-Case Model after accessing the status and scope of the project and understanding the business processes
• Integrated RequisitePro with ClearQuest and Rose to provide all teams visibility and maintain tractability among requirements, use cases and change requests
• Managed all the requirements in RequisitePro, making requirements available to all team members.
• Used SQL Plus and Toad to create, query and verify test data for backend testing.
• Assured that all Artifacts are in compliance with corporate SDLC Policies and guidelines.
• Coordinated and prioritized outstanding defects and enhancement/system requests based on business requirements.
• Addressed all aspects of the claim processing lifecycle, starting from identifying a claim right up to closure.
• Researched the various steps in the lifecycle and then constructed the system in such a way that the riskier claims could be easily identified and monitored.
• Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML
• Experience using SQL queries to test the Backend applications and database
• Used Date warehousing for the arrangement of customer data.
• Implemented Traceability Matrix and User Requirement Specification Document (URS) verified the functionality coverage.

Environment: SQL, Rational Requisite Pro, Rational Rose, UML, SQL, MS-Office, MS Project, MS Visio, Test Director.