Experience Summary:

Over 6 years of experience in the field of Information Technology, Specialized in Software Quality Assurance and Implementation of QA Methodologies on both Client/Server and Web based applications. Working towards client and company satisfaction, completing tasks by fulfilling the requirements scheduled within the deadlines, with dedicated effort, motivation and team spirit.

• Experienced in all aspects of testing processes includes Planning, Preparation, Execution and Completion.
• Specialized in system study and testing Health Care, Financial, Insurance and Banking applications developed on various technologies such as Facets, QNXT, J2EE, JSP, Java, SharePoint, VB.Net, Oracle and SQL Server on Windows NT/2000/XP and UNIX environments.
• Extensively involved in Verification and Validation for both Web based on Client server applications.
• Having very good Experience in Unit Testing, Integration Testing, Regression Testing, System testing, UAT.
• Having experience in design and execution of Test Plans, Test Scenarios and Test Cases based on the requirements for the applications.
• Proficient in bug tracking/test management tools like Team Track, Quality Center and Clear Quest.
• Extensively involved in testing Trizetto’s Facets and mainly involved in Enrollment and Eligibility modules.
• Involved in testing QNXT Member, Provider, Claims Processing (with proper ICD – 9 and ICD – 10 and HCPCS/CPT codes), and Utilization Management, Contracts, and Benefits modules.
• Expert in HIPAA Transactions testing and in-depth knowledge of HIPAA framework (Health Insurance Portability Accountability Act) rules for ANSI X12 messages 837P, 835, 276/277, 270/271, TA1 and 997 in 4010A1 Standards.
• Excellent in understanding Business Requirements, Functional Specifications and Technical Specifications.
• Knowledge of Rational Unified Process (RUP) methodology, UML, QA Validations to ensure the Quality standards, Quality Assurance Life Cycle (QALC) and QA Methodologies.
• Expertise in testing Enrollment, Billing and claims processing in FACETS
• Expertise in Implementing Configuration and Change management and Versioning tools like VSS, CVS, Clear Case and Pro Track, PVCS Tracker and Version Manager.
• Having very good understanding of Software Development lifecycle, QA methodologies and strategies.
• Interacted with developers in fixing the defects by verifying the logs and databases in a lot of occasions.
• Very good team player and also have ability to work independently in time sensitive environment.

Work Experience:

Confidential,NY (Aug’11 to present)
Facets QA Analyst (Claims)

CHP (Child Health Plan)

CHP is a health insurance plan for kids provided by NY State. Dependent on family income determines if they will quality for Children\'s Medicaid or CHP. And it is applicable for both Univera (WNY) and Excellus (BLUE). Children must be younger than 19 (coverage ends on 1st day of month following 19th birthday) and no co payments are allowed as per CHP benefits.

SNF (Safety Net Testing)

SNF is also a Medicaid health insurance plan for both adults and children and it is provided by NY State for both Univera and Excellus. And it contains Family Health and Medicaid Plans and categorizes these plans as per age limit.

Responsibilities:

• Responsible for creation of test cases for business requirements and Design Documents.
• Involved in Design, Execution and updating of Test Cases for Functionality testing.
• Working on following functional Threads like Eligibility, Group, provider.
• Involving in preparing Test plans based on user requirement documents.
• Processing claims and adjudicating them as per Networx Agreement.
• Working on provider, subscriber, NetworX, Medical Fee Schedule modules.
• Processing claims to adjudicate successfully to validate whether there is any price mismatch with proper ICD – 9 and ICD – 10 and HCPCS/CPT codes as per Networx.
• Working on members Benefit details.
• Conducted Regression Test for the fixes of the application.
• Validating claims based on legacy claim information by using allowed amounts based on agreements.
• Also used to process claims manually based on service category like Lab, Ref Lab, ER, ASC, PT, Certified Home Care, Urgent Care etc.
• Also working on APRDRG Inpatient claims.
• Working on Medical Networx Configuration under Networx module in Facets to gather agreement information while processing claims like allowed amount and contract terms and Pricing details to process claims and for successful adjudication.
• Also verifying members class plan details, group details and benefit details.
• Responsible for modification and executing of the Test Scripts.
• Working on RQM to upload the test cases.
• Working on Clear Quest to log defects raised while testing.
• Participated and provided input in team status meetings for classification issues.
• Provided status report on weekly Basis to Management prior to weekly meeting.
• Also involving in daily status meetings with Team Lead to discuss the work status and issues.

Confidential,ME (Feb’11 to July’11)
Claims Analyst - (QNXT claims) Research Team

Bridge payment
The purpose of this project is to pay the amount to providers for denied claims based on their bridge request for the services they provide to the members through analysis like justifications, research, classifications.
Responsibilities:

• Worked on classification issues like check for members whether they have their classifications or not based on different NPIs.
• Worked on denied claims for justifications like why the claims got denied and paid zero to the providers to find out the issues.
• Involved in research team meeting s for provider’s bridge payments.
• Involved in converting members from PCCM, buy in, void, OCFS to primary Mainecare.
• Involved in research work, why claims got denied and paid zero.
• Involved in analysis work on claims issues like deleting all the claims they got paid, removing any dupe claims that are paid for another claims.
• Worked on justifications for different providers based on provider’s bridge payment request.
• Also involved in provider credentialing like checking their status which are in active.
• Involved in uploading and processing of EDI 278, 276 claims in Portal.
• Prepared sample EDI test sets for files like 276/77, 278,837 and followed HIPAA implementation guide in preparing them
• Worked on providers bridge payments based on their NPI’s for denial claims.
• Involved in classifying the enrollment issues for those members who are not enrolled under mainecare as primary.
• Participated and provided input in team status meetings for classification issues.
• Also updating provider licenses under work flow.

Confidential,State of Maine, ME (Dec’09 – Jan’11)
QA Analyst (QNXT Claims)

Description: The Dept of Health and Human services is responsible for health policy and management of the state’s publicly funded health systems. These programs include Medicaid health coverage for those with limited income, mental health service etc. MIHMS (Maine Integrated Health Management solution)/ MeCMS are a replacement of legacy MIHMS System to web based MIHMS.

Responsibilities:

• Developed Test Cases bases on Requirement Specifications and Design Documents.
• Responsible for modification and executing of the Test Scripts.
• Involved in testing QNXT Member, Provider, Claims Processing, Utilization Management, Accumulators, Contracts and Benefits with proper ICD – 9 and ICD – 10 and HCPCS/CPT codes.
• Involved in manual claims Adjudication process.
• Creating, Approving and Modifying PA in both Portal and QNXT.
• Involved in Adding Contracts to the Provider in QNXT and associating Providers in Portal while creating claims.
• Involved in Functional, Integration, and Regression testing of the application.
• Processed Medical claims and applied edits to the claims for testing purposes
• Involved in Processing QNXT 837 Healthcare Claims (Institutional and Professional) in PORTAL with valid TPI.
• Worked in utilization management module for to create and test PA.
• Involved in uploading and processing of EDI 278, 276 claims in Portal.
• Prepared sample EDI test sets for files like 276/77, 278,837 and followed HIPAA implementation guide in preparing them.
• Also used BizTalk server as middle ware server to see responses for X 12 files like 835.
• Coordinated with offshore people and updated the tasks to manager.
• Worked with stakeholders in UAT environment to ensure Business requirements are tested properly.
• Logged defects in Clear quest and worked with the developers to resolve any issues.
• Conducted Regression Test for the fixes of the application
• Used RMT for running the tasks like uploading, modifying, executing and taking logs accordingly.
• Updated status report on weekly Basis and submitted to the team prior to weekly meeting.
• Participated actively in conference calls, project meetings and delivered input.

Environment: ASP.NET, VB.NET, QNXT, DB2, Oracle, SQL, QNXT, UNIX, Windows95/98/NT/2000/XP, Clear Quest, RMT.

Confidential,CT (Aug’08 – Dec ‘09)
Facets QA Tester

Quote to Bill: The quote to bill engagement replaces and improves upon two current quoting systems – Broker Express and PC Rate Quote. The new system will be a unifying application with a centralized, enterprise architecture-based scalable system providing end-to-end workflow supporting quotes, proposals, new business, renewals, benefit changes (on- or off-cycle) and migration and account installation. The new system will support appropriate integration with FACETS, supporting all authorized users through a Web browser.

Responsibilities:

• Understood the business process that included Sales processes, Rating methodology, different Products, Group Renewals and Enrollment process in Facets.
• Performed Smoke Testing, End-to-End Functionality Testing, Adhoc Testing, Regression Testing, Integration Testing and User Acceptance Testing (UAT),
• Designed and Documented Test Procedures, Test Requirements, Test Scenarios and Test Cases for End-to-End functionality testing.
• Extensively involved in testing Facets Member/Subscriber, Billing modules.
• Involved in testing Facets for Group Information, Enrolling Subscribers, adding members, Related Entities, Class/Plan definition, Premium Rate Tables and all.
• Reviewed and Analyzed, Business, System and Technical requirements of the application.
• Developed and Executed Test Plan, Test Scripts and Test Cases for the application based on the requirements.
• Involved in Test Planning, Test Schedule Management, Reporting, and Test Data gathering.
• Involved in Design, Execution and updating of Test Cases for Functionality testing.
• Conducted Regression test for fixes and enhancements of the application.
• Used Quality Center as test management tool for defect tracking and test case execution.
• Used Quality Center 9.0 for defect tracking and maintained the trailing history of the bugs.
• Prepared Traceability matrix, bug matrices, weekly and daily status reports and sent to management.
• Interacted with Development Team to fix the defects raised during the testing period.

Environment: PEGA PRPC, Facets, Quality Center, Web services, SQL server, crystal reports, Reporting services, MS office Suite, MS Project.

Confidential, (Jan’07 – Aug’08)
QA Tester

Core Systems Replacement

HMSA has planned huge migration of current LRSP system to Trizetto’s QNXT system which is a user friendly tool. Core Systems Replacement Project is part of migration. Subscriber’s enrollment and Eligibility and claims processing are migrating to QNXT which involved in upgrading applications from Mainframes to QNXT. This is focused on future, with concentration towards quality to provide the best Health insurance and benefits to its customers.

Responsibilities:

• Responsible for creation of test cases for business requirements in Quality center.
• Involved in Design, Execution and updating of Test Cases for Functionality testing.
• Worked on following functional Threads like Eligibility, Group.
• Involved in preparing Test plans based on user requirement documents.
• Managed tests using Quality Center.
• Performed Smoke Testing at every new release.
• Involved in overall system testing which including Functional testing, Integration testing.
• Conducted Regression Test for the fixes and enhancement of the application.
• Worked closely with the developers to resolve Bug Issues.

Environment: J2EE, EJB, Servlets, Quality Center, QTP, JSP, Struts, JMS, XML, Windows 2000/NT, Ms Access, Ingenix, Clear quest, SQL server, crystal reports, Reporting services, .Net, MS office Suite, MS Project, MS Visio, Web Logic, QNXT.

Education:

• Master’s Degree in Computers