SUMMARY

• QA Analyst with over 7 years of experience working in the Healthcare domain. My objective is to work in a fast paced, dynamic environment in the field of Healthcare industry that would enable me to utilize my technical/analytical skills, greater inter - personal skills and strong ethics to achieve a company’s goal.
• Implemented and experienced in various QA methodologies.
• Experienced in every phase of Quality Assurance Life Cycle (QALC) and Software Development Life Cycle (SDLC)
• Performed planning and development of Test Plans, Test Strategies, Test Cases and Test Scenario to meet product’s business requirements.
• Experience with mapping and validating various EDI files such as 834, 820, 835, 837, etc.
• Excellent knowledge of Affordable Care Act (ACA).
• Proficient in Defect Reporting and Tracking throughout the entire defect life cycle.
• Possess strong problem solving skills with the ability to adapt to a new environment and meet deadlines.
• Experienced in manual as well as automation testing of both web based and client based applications on Windows and UNIX environments.
• Expert in all phases of Requirement Management, including gathering, analyzing, tracking requirements and quality assurance.
• Good Knowledge of Web Service Testing using Soap UI
• Experience in maintaining test matrix and RTM.
• Strong Knowledge of Used Case, UML and Activity Diagrams.
• Experience in requirements gathering, system specification analysis and Test Plan formulation.
• Strong data warehouse background with knowledge of data analysis, ETL and data mining
• Expertise in Testing of Client/Server and Web based applications.
• Strong knowledge of software development methodologies including the Agile methodology, Waterfall, and V-Model and SOA Methodology.
• Skilled in bug reporting and tracking using Test Director, HP ALM.
• Strong in IT research, software analysis and design skills.
• Performed backend database testing by writing SQL and PL/SQL scripts to verify data integrity.
• Extensive experience in Backend Testing on distributed databases using SQL queries.
• Experience in Functional Testing, System Integration Testing, Back End Testing, GUI Testing, configuration Testing, User Acceptance Testing.
• Solid understanding of Membership, Claims Processing, Billing, Benefit/Eligibility, Authorization/Referrals, COB, and have experience in HIPAA standards and corresponding EDI transactions.
• Knowledge of Medicaid and Medicare Services.
• Followed Workgroup for Electronic Data Interchange standards for testing that need to comply with the HIPAA guidelines.
• Tested the HIPAA EDI transactions 834, 837/835, 276/277, 270/271 according to the requirement test scenarios.
• Optimum use of documentation to avoid any form of miscommunication or misinterpretation during the entire software development process
• Excellent communication and organizational skills with the ability to adapt to a new environment.
• Experience in facilitating meetings with clients to discuss and sign-off on the document.
• Conducted User Acceptance Testing (UAT)
• Motivated self-starter with exceptional team building, leadership, and interpersonal skills. Good team player with the ability to work in time sensitive environments.
• Proficient in working with FACETS, claim processing systems

TECHNICAL SKILLS

Methodologies: SDLC, RUP, Agile, Waterfall, Agile

Platforms: Windows, Linux

Testing tools: SOAPUI, ALM, JIRA, Facets, PowerMHS, Test Director

HealthCare Tools: PowerMHS, ITS, Facets

Change Management Tools: Rational ClearQuest, TestDirector, HP Mercury Quality

Office Tools: MS Project, MS Office, MS Visio, Adobe Acrobat, Excel, MS Word

Database: MS SQL Server, Oracle SQL pro, Toad, MS Access, IBM DB2

Programming: Java, C++, JavaScript, HTML, XML, Visual Basic, SQL

Operating Systems: Windows 98/2000/XP/Vista/7, Linux

PROFESSIONAL EXPERIENCE

Confidential, Nashville, TN

QA Analyst

Responsibilities:

• Validate the different interfaces and inbound/outbound eligibility, enrolment transactions between TEDS system and MMIS.
• Verified the eligibility according to the test scenarios for different healthcare programs.
• Validated MAGI, Non-MAGI programs; eligibility determination and Enrolment, MCO Assignments, Life Events, Retroactive Medicaid, Renewals, Income verification.
• Validate the different reports, files, letters like daily inbound eligibility files, demographic-eligibility-TPL runout extracts, balancing reports, Enrolment roster error report, eligibility error report, Linking balancing report, Linking error report, Eligibility/Enrolment/Linking error files, and letters that were generated out of daily eligibility/enrolment job run.
• P erformed Back end Testing using SQL queries to validate the same set of reports/files.
• Utilized an appropriate testing methodology, analysed testing requirements as the basis for developing testing scenarios for a test level to be executed on a project.
• Designed testing scenarios and test cases that demonstrated conformance to all functional and non-functional requirements, relative to the test level, as defined in business requirements documents or technical specifications.
• Executed tasks related to the production of the Test Plan, test cases, test scripts, and test data for Eligibility determination and the enrolment for Tennessee’s Medicaid program.
• Prepared and conducted Acceptance Testing of new or modified applications/systems.
• Reviewed and analyzed Business Requirement Design documents for every Work Request or System Change Request (SCR).
• Analyzed and worked with HIPAA specific EDI transactions for Claims, member enrollment, billing transactions. Worked specifically with 837, 835, 834, 270/271
• Involved in Executing, Analyzing, Verifying Test Results and work with developers to resolve issues.
• Developed design specification writing Test Reports & documenting Test Results and submitted to the client for the review/sign off.
• Setup data in different interfaces inbound files e.g. TEDS inbound file, 1610 file, accent file, TN Anytime online site, MMIS online, by using SQL queries extensively on Oracle 11g database to test the scenarios based on requirement and execute the test cases to see if we get result as expected and fixing data setup if any for next cycle run.
• Reported bugs using ALM and MS Excel. Involved in Daily Status on Testing Activities.
• Wrote Test Plan/Test Strategy/Test Scenarios/Test Cases/Test Matrix/Traceability Matrix as per the business requirements in HP ALM and Submitted to Client for the sign off.
• Logged, updated, tracked and closed defects using ALM in the process of validating applications.
• Logged defects in ALM which was identified during test case validation and assigned to appropriate developer, tracked all defects of test cases and Analyzed, and reported test results.
• Generated all reports- Test Execution reports, Defect Report, Issue logs through ALM.
• Resolved issues related to data setup to avoid negative impacts on testing.
• Performed Back end Testing using SQL queries, generating reports to ensure data integrity and validate the inserted and updated data using database management tools (SQL developer, TOAD).
• Involved in web services like SOAP and RESTful API testing using SoapUI and developed and executed test cases using Soap UI tool
• Actively participated in end to end testing of business rules of web-based applications
• Analysed the User Story acceptance criteria, and created the test cases based on this.
• Involved in Agile methodologies; including Sprint Planning, product backlog Grooming, Sprint demonstrations, daily Scrums stand up, retrospectives, and stakeholder meetings.
• Analyzed the user stories and have converted them to test cases.
• Performed various types of testing including Integration, system, regression and UAT.
• Used HP Application Lifecycle Management tool (ALM) for testing purposes; Writing test plan, test case, execute test case in test lab, tracking defects, logging issues, Traceability Matrix, documenting all test results, generating test result document, and issue log for clients review and approval.

Environment: Windows XP, MS Office 2007, DB 2, MS Project, HP ALM, SQL Plus, Edifices, Putty-Linux, MMIS, TN Anytime, UltraEdit, Project Workbook, TOAD, SQL Developer, FileZilla, SharePoint, Citrix, MMIS, Snagit.

Confidential, Nashville, TN

EDI Analyst

Responsibilities:

• Interpreted various federal policies, regulations, and a system in response to consumer inquiries about Marketplace enrollments issues.
• Analyzed discrepancies in the eligibility reconciliation process for multiple stakeholders.
• Informed clients (CMS) of enrollment issue resolution by conducting research, workflow investigation, business procedures and making recommendations.
• Reviewed regulations and other policy documents from Centers for Medicare & Medicaid services (CMS) to assess impact to business operations, including processes and communications.
• Identified processing deficiencies and initiate corrective actions.
• Responded to client and consumer about complex questions relating to program eligibility, plan enrollment, and other policy related issues.
• Worked as part of a team supporting all phases of the design, development and implementation of an Enrollment Resolution and Reconciliation process for Health Insurance Exchange.
• Conducted various analyses of EDI transactions and formats; handling format mapping and other EDI documentation as well as various EDI reporting.
• Was responsible for troubleshooting and resolving errors on EDI 834 ad EDI 820 transactions and performing root cause analysis to resolve discrepancy on form 1095A.
• Was responsible for analysis of discrepancies in the eligibility reconciliation process for multiple stakeholders and continues process improvement of the reconciliation process.
• Responded to regular EDI inquiries and troubleshooting issues from international organizations, trading partners and vendors regarding healthcare transactions (claim, enrollment, payments, encounter, etc.) and clearinghouse activities.
• Created Test Plans and Test cases for Eligibility determination and the enrollment of the Health Insurance Marketplace.
• Created and executed Detailed Test Cases for full requirement coverage and mapping test cases into RTM.
• Performed Back end Testing-using SQL queries, generating reports to ensure data integrity and validate the inserted and updated data.
• Attended Defect Review meetings with Developers, Tech Lead, Team Lead and Project Manager to discuss issues regarding the open defects, resolved defects and all other defects associated to the Source system.
• Performed various types of testing including Integration, system, regression and UAT testing as needed.
• Reviewed training material for accuracy and assisted in end user training and support.
• Attended daily/weekly status meeting, review meetings, conducting research, workflow, and making recommendations.

Environment: CERRS(In-house Tool), Toad, SQL, DB2, MS Word, MS Project, MS Excel, SharePoint, Quality Center.

Confidential

QA Analyst

Responsibilities:

• Created Test Plans and Test cases for Eligibility determination and the enrollment of the Health Insurance Exchange (HIX) of Connecticut.
• Worked closely on Eligibility determination process, 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 271, 834 EDI transactions
• Documented Test result document for Eligibility (270/271)Enrollment (834), Customer Service Interface, and Capitation Payment (820) and adjustment
• Involved in business analysis and project management, coordinating between the team members according to the business requirements.
• Performed Back end Testing-using SQL queries, generating reports to ensure data integrity and validate the inserted and updated data
• Created and maintained procedures and documentation.
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Worked on Different Modules like Billings, Membership, Claim and Provider in Facets application.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 835 transactions.
• Involved in Defect reporting and tracking through QC
• Involved in external data testing
• Involved in system Integration, regression and UAT testing.

Environment: MS Access, MS Visio, MS Office, MS Project, HP ALM, SQL, EDI 271.834, 820, Windows XP, MS Office 2007, DB 2, Oracle E-Business (Oracle Federal Financial), SQL, Oracle, Claims Look Up Environment (CLUE).

Confidential, Quincy, MA

EDI System Analyst/ QA Analyst

Responsibilities:

• Created Plans and Strategies for Confidential to streamline their Systems including EDI Transactions so they are able to pass through the EDI Gateway, to name a few 837, 835, 834 & 820.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions
• Used Process log browser to view different types of log history files to figure out issues with 834 transactions
• Worked on Batch processing, member, subscriber enrollment module of 834, ID card generation processes and Created business process flow to capture the required data in future, define business rules to determine Medicare (Part C and Part D) Member Coordination of Benefit letters as required by CMS, Medicare Secondary Payer for members with Workers Compensation.
• Documented Functional Specifications for Enrollment (834), Customer Service Interface, Claim (837) including Encounter Claim and Capitation Payment (820) and Authorized Representative for Medicaid Members.
• Gathered requirements, developed Process Model and detailed Business Policies.
• Actively participated in Agile Sprint Planning, Backlog Grooming, Sprint Demonstrations and Retrospectives
• Analyzed the user stories and have converted them to test cases.
• Involved in business analysis and project management, coordinating between the team members according to the business requirements.
• Performed Back end Testing-using SQL queries, generating reports to ensure data integrity and validate the inserted and updated data
• Good Understanding of the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Worked on Different Modules like Billings, Membership, Claim and Provider in Facets application.
• Worked on HIPAA Transactions and Code Sets Standards according to the test scenarios such as 270/271, 276/277,837/835 transactions.
• Worked with development / technical team members to ensure that the enhancements would meet the defined business requirements.
• Involved in end to end testing of Oracle E-Business Billing and Payment Processing.
• Validated the translated HIPAA files with the proprietary CCR (Common Claim Record) implementations.
• Organized and conducted meetings, briefings, demonstrations, conducted JAD sessions, and wrote minutes of project meetings.
• Prepared the Business Workflow using MS-Visio with input, output, Pre and Post conditions
• Developed recommendations and designed solutions for process improvements.

Environment: Configuration and Testing Management (In house Tool), Toad, Interactive SQL, DB2, MS Word, MS Project, MS Excel, Quality Center, QTP, SQL, Facets