Summary:

• Over 7 years of experience in creating innovative and cost effective Quality Assurance solutions with expertise in Insurance, Healthcare processes, applications using manual testing procedures & test automated tools
• 5+ Years of Health care experience.
• Extensive experience in all phases of SDLC processes.
• Experience working with HIPAA EDI 837 transactions which include Medical (Institutional), Professional and Dental claims for both 4010A1 and 5010 versions.
• Work experience on 820, 834, 835 and 277CA transactions for both versions (4010A1 and 5010)
• Thorough knowledge on 270/ 271, 276/ 277, 278 transactions.
• Strong Knowledge and working experience on ICD-9 and ICD-10 codesets and the conversion.
• Experienced in different types of testing like Black box testing, white box testing, functional, GUI testing, Systems testing, regression,integration, UAT and performance testing
• Expertise in reviewing requirements, Business requirements gathering, Data warehousing, evaluating data sources, translating requirements into specifications and application design.
• Worked on the Business Process Testing(BPT) of the Quality Center using the input and output parameters, creating different components on the BPT tab.
• Experienced in documenting Test Plan, Test Objectives, Test Strategies, Test Scripts, Test Scenarios and Test Cases.
• Extensive experience with Dentacom, Webster,Proclaim, Facets and QCare Claim Engines.
• Verified application functionality against business requirements, manually and by using Win Runner.
• Experience with structured QA Methodology and QA Process to ensure the Quality Assurance Control.
• Used Quality Center to prepare Test cases, Requirements Traceability Matrix and managing the Defects as per the Business requirements.
• Strong experience in capacity planning, load test configuration.
• Expertise in Black Box, Sanity/Smoke, Integration, Regression, Performance/ Load/Stress, System and Functional Testing.
• Strong experience in Quality Assurance of multi-tier systems, Client/server systems and Web Applications/Sites including testing large enterprise software applications.
• Excellent team player with strong written, communication, interpersonal and analytical skills.

Technical Skills:

QualityCenter10.0,QTP9.4 , Rational Clear Quest, SQA Manager, EDISIM. Clear Quest, Mainframes, Trasaction Management, Edifecs

Operating Systems:

Windows XP, Unix (Solaris).

Database:

SQL Server & Microsoft Access

GUI Tools :

Visual Basic 5.0/6.0, Developer 2000, Crystal reports

EDI Standards:

ANSI X12, HIPAA, Spec Builder 6.2/7.0 , Edifecs , Edge tool , HTM

PREFESSIONAL EXPERIENCE:

Confidential,Windsor, CT
Confidential,QA Analyst Jan’ 2012 - Till Date

Project Description:

Confidential,needs no introduction. It is one of the biggest and most reliable company providing health care benefits to a few millions around the globe.
In the process of transition from HIPAA 4010AI version to 5010 version, Cigna has made the necessary changes to comply with the modifications to HIPAA Electronic Transaction Standards. Version 4010 standards were replaced with Version 5010 standards on January 1, 2012. Beginning June 30, 2012, Cigna will no longer accept HIPAA 4010 files. Upgrading to 5010 transaction standards means implementing new software that can accommodate the upgrade and making sure trading partners are equally prepared to avoid operational disruptions.

Responsibilities:

• Worked extensively in the System Integration testing (SIT) region of Cigna also handling the issues that arise in production areas.
• Analysing the BRD for HIPAA 4010A1 to 5010 transition and prepared the Test plan and Test cases for 5010 HIPAA transactions 837I/837P/837D, 277, 835 & 999.
• Extensively worked on data preparation for the defects that came up during the transition to 5010 on all the Medical, Professional, Dental claims including Medicare claims.
• Worked on different claim types like CBH(Behavioural) claims, COB( Benefit) claims, Qcare claims, Medicare claims, I2P claims, IPC claims and so on.
• Dealt with special category claims like New born, Medicare secondary,IPC hold and Multiple match claims that go to the transaction restarter on hold, where they have to be manually sent to claim engines.
• Used the reflection SFTP to submit the above claims.
• Worked on preparation of test scenarios, test cases and data preparation for the ICD-10 transition.
• Through knowledge on ICD-10-CM for diagnosis coding & ICD-10-PCS for inpatient procedure coding.
• Extensive experience working with Dentacom, Webster,Proclaim, Facets and QCare claim engines.
• Analysed the records of 277CA of the claims submitted to the gateway on mainframe, where they populate the status codes of the claims in different formats like ACCR, CCSR, XCCR and ECR.
• Familiarity with the accept and reject codes designed by the bussiness for the claim that are submitted to the main gateway.
• Preparation of test cases for Functional, Regression, Integration and System testing.
• Identified the bugs and interacted with the team lead and developers to resolve them.
• Worked on multiple business areas.
• Coordinated with offshore team of 7, giving directions on the defets to work on and explaining the change request forms.
• Worked on the output acknowledgements like 277CA, 999 & TA1.
• Testing and reporting the bugs in product releases and performed the root cause analysis for the defects raised.
• Coordinated test execution efforts such as test data and support team provision, defect tracking and management, ensuring resolution of testing issues.
• Extensively worked on reviewing requirement, functional and design specifications, developing Test strategies, Test plans and Test cases.
• Involved in testing of the loading 5010 HIPAA Inbound Transactions (837I/P/D) in Mainframe database.
• Involved in testing of the extracting 5010 HIPAA Outbound Transactions (835, 277) from Mainframe database.
• End to end testing and Trading Partner Testing.
• Validated Business rule Edits for 5010 HIPAA transactions 837I/837P/837D, 276/277 and 835
• Executed the 5010 system test scenarios for 5010 HIPAA transactions 837I/837P/837D, 276/277 and 835 after loading and adjudication.
• Involved in claims processing of different scenarios and tested the end to end scenarios from 837 to 835.
• Involved in execution of Test Cases and reporting the defects and tracking them to Closure.
• Loaded the defects on to HP Quality Center and maintained a track record of the updates on the defects from the development team.
• Created regression beds of the defects that we worked to use them for regression testing.
• Run the scheduling jobs to load Pharmacy claims data from legacy (Mainframe) system to staging tables.
• Preparing and analyzing weekly and monthly status reports, analyzing root cause investigation for the broken links.

Environment: Windows & UNIX, FTP client, Transaction Manager, Edge tool, Edifecs tools, CED inquiry, HP Quality Center 10.0, Transaction Restarter (TXNR), Sterling, Clear Quest , MS Office, Text pad, Spec builder 7.0, QTP, Agile/Scrum project methodologies, Sybase, MainFrames and File-Aid records.

Confidential,Hartford, CT
QA Analyst Sept’ 2010 - Dec’ 2011

Project Description:

Confidential, is one of the nation\'s leading diversified health care benefits companies, serving approximately 33.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans.

Aetna started its testing plans in November 2009 for the transition of 4010A1 version to 5010 version. The release was planned for December release for both Prduction and Testing. Scripting was done for scenarios to capture the pre-release as well as post-release results. In September 2010, Aetna began testing of the ASC X12 5010 transaction version named in the January 2009 HHS regulations.

Responsibilities:

• Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.
• Developed various test cases for testing HIPAA 837I/P/D and 277(5010).
• Validated the reports and files according to HIPAA X12 enforced standards.
• Mocked claims in the Aetna Testing region for the issues reported in the Aetna Production area.
• Created Test Plan, that defines the test environment, phases of testing, entrance and exit criteria into different phases of testing.
• Identified, built and executed Test Cases and Test Sets for Functional, Error Handling, Navigation and Regression in Test Director.
• Manually tested the entire application before the tests were automated.
• Worked closely with the other members of the Development Team and review the designs of systems, implement test plans, and test the quality of software products.
• Performed validation testing on the application for various scenarios and reported the errors.
• Assisted EDI team with the testing of maps for HIPAA transactions 834,835 and 837.
• Validated Business rule Edits for 5010 HIPAA transactions 837I/837P/837D, 277 and 835
• Executed the 5010 system test scenarios for 5010 HIPAA transactions 837I/837P/837D, 277 and 835 after loading and adjudication.
• Worked with the outbound team to help replicate the issues in production, giving data support to the team and running different types of claims by request.
• Involved in testing mapping logics of the claims on Maniframes and translated data..
• Intensively worked on claims with different Trading Partners.
• Created test scenarios for claims with different snip levels of errors.
• Worked on the Trading Partner migration to production by submitting different claims with specific levels of errors.
• Performed Regression testing and Smoke testing for the above.
• Involved in the user acceptance testing (UAT).
• Manually tested all the interfaces.
• Tested for eligibility, Gender mismatch, Clean claim edits, Membership Edits, Medicare, New born and Behavioural claims.
• Automated testing using win runner, test scripts, execution and reporting.

Environment: Spec Builder, HIPAA X12, IBM Mainframe, DB2, MS Office,Autoplugs, Aetna Gateway, Edifecs, TXNR, Quality Center, QTP.

Confidential,TN
QA Analyst Jan‘2009 - July ‘2010

I worked in theEnrollmentdepartment coordinating with business and other Insurance companies IT team to implement file intake processes for incoming groups. Generated reports and audits for business and management to make sure that implementation has been a success or not. I also worked in Claims area as Quality Analyst to develop applications which accept different claims like Medical claims, Dental claims, and vision claims from different vendors and route the claims into Batch Adjudication System and Online Adjudication.

Responsibilities:

• Being the QA Analyst my responsibilities included documenting and developing Test Plans for the Product using several SDLC methodologies.
• Assisted in writing efficient and effective Master Test Plan, Test Strategy, System Testing, End-to-End Test and User Acceptance Test Plan.
• Performed end-to-end System Integration testingwhich covered the entire business process flow to all the downstream systems and XML output files, including apps interfaces.
• Participated in the planning, development, coordination and presentation of specific testing needs as appropriate to the quality assurance needs of the end user.
• Assisted business users in defining test plans and UAT test cases.
• Established and maintained test cases and test data in Quality Center.
• Coordinated with the QA Offshore team for testing activities across multiple systems and managed test execution.
• Used MS Visio for flow-charting, process model and architectural design of the application.
• Strong experience in conducting Gap Analysis (GAP), Functional testing, User Acceptance Testing (UAT), and System Integration testing (SIT).
• Involved in implementation of HIPAA EDI Transactions ( 835,837,820,276)
• Facilitated Electronic Data Interchange.
• Performed GAP Analysis for HIPAA 4010.
• Used EDI tools to verify mapping to X12 format.
• Participated in changes for system design, methods, procedures, policies and workflows affecting Medicare/Medicaid claims processing in compliance with government compliant processes like HIPAA/ EDI formats and accredited standards ANSI.
• Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and looked for defects.
• Tested the enhanced FACETS, evaluating claims adjudication needs and creating HIPAA-compliant business rules configuration.
• Involved in assessment of tools for use in future HIPAA 4010/5010 migration and compliance by performing GAP Analysis. Provided business and technical process flow recommendations.
• Performed comparative analysis and gap analysis to identify variation in the process as per HIPAA X12 4010 and 5010 guidelines to incorporate updates as per 5010 guidelines
• Mapped EDI 4010 835/837 from clearinghouse sources to ASC X12 formats.
• Extensive testing of EDI Eligibility/Inquiry/Response (270/271) transactions via reports generated by the Gateway.
• Logged the defects in Quality Center and maintained track of the defects throughout the life cycle.
• Participated in QA Team meetings and bug tracking meetings.

Environment:MS-Visio, MS Office, MS Project, Quality Center, HIPAA/ EDI X12, FACETS, Load runner, Edifecs, Edge, Transaction Manager, Transaction Restarter, FTP.

Confidential,Rochester, NY
Sr. QA Analyst Oct’ 2007 – Dec’2008

Project Description:

Confidential,will provide a higher standard of health care coverage and improves the quality of care
for every member. It sets the standard for outstanding quality health care, service and value. It is the leader
in access, affordability and quality in the competitive health insurance market.

Responsibilities:

• Reviewed the Requirements documents for 4010 ANSI X12 Transactions and created the Test plan and test cases for 837I/P/D,835,276/277,270/271,834,820 HIPAA EDI Transactions for Iteration Testing, Integration Testing and System Testing.
• Reviewed the Requirements document for 4010 and prepared the test plan and test cases.
• Involved in Manual Testing of the application.
• Conducted functional, system, data and regression testing.
• Interacted with the Developers and BA for defects and problem resolution.
• Wrote SQL statements to extract data from Tables
• Worked with transactions and validated the data by using SQL.
• Generated Bug Reports and Test case coverage reports for status meeting and also involved in resource planning for test cases coverage
• Involved in Bug Review meetings and participated in weekly meetings with management team.
• Provided testing results and weekly status reports to the QA Manager
• Using FTP we upload and download files for testing data
• Using Text pad to validate the data
• Tested the web services for Provider and Recipient Portal.
• Involved in testing HIPAA EDI Transactions (837I/P/D, 270/271, 276/277, 835,834, 820) for 4010
• Involved In loading the flat files into Oracle Database and involved in writing Complex SQL Queries.
• Involved in writing Complex SQL Queries using TOAD to validate the loads.
• Validated the data on web screens against the data points and database.
• Created QTP scripts for provider portal, Member Portal
• Validated the data on screens against the database
• Wrote the SQL queries on EDW tables and Data Mart Staging Tables to validate the data results.
• Record Count VerificationDWH backend/Reportingqueries against source and target as an initial check and incremental loading check.
• Assists in the confirmation of problems reported from outside sources, and assists system development staff in understanding problems and desired resolution.
• Backend testing of the DB by writingSQLqueries to test the integrity of the application and Oracle databases usingTOAD.
• Responsible for writing version release notes as well as maintenance of the defect tracking system
• Maintained Metrics participated in weekly status updates showing the progress of the testing effort and open issues to be resolved.

Environment: TOAD, Oracle 11g, Ms Office, Text pad, UNIX, FTP client, Clear case, Clear Quest, Spec builder 6.2/7.0, Quality Center , QTP, Cognos, Informatica.

Confidential,Hyderabad, AP
QA Analyst May’ 2005 –Aug’2007

Project Description:

Member of a team that analyzed, and tested credit card banking application, which enables customer service reps to process credit line requests, fraud claims. Extensively involved in testing the desktop applications, designed for customer representatives to offer various services such as removal of account, user lockouts etc. This project also involves the testing of Main Frame.

Responsibilities:

• Involved in defining, and analyzing the testing requirements based on the application functionality.
• Gathered test data requirements for data conditioning from Business units to test total application functionality.
• Created test scenarios for System testing and Regression testing.
• Prepared test plans, test cases for both positive and negative scenarios and mapped the same to requirements.
• Executed test scripts, and analyzed the test results.
• Used test director as a central repository for all the test activity.
• Attended meetings with developers in the discussion on resolving the issues, priority of bugs and updating the status of bugs once they are fixed.
• Responsible for writing the SQL queries to verify GUI front-end results and to extract and to manipulate the data to satisfy test cases/ requirements.
• Tested web page presentation manually for different browser compatibility.
• Tested broken links and inter application links in development, test, and production environments.
• Executed test cases before and after bug fixes for each build for user acceptance testing.
• Performed Back-end testing using TOAD.
• Tested the application for third party vendor confirmation and client reports as per use cases.
• Environment: Test Director 8.0, Win Runner, J2EE, Tomcat, HTML, UNIX Oracle and Toad

EDUCATION

Bachelors of Technology