Summary:

• 7 years of experience in creating innovative and cost effective Quality Assurance solutions with expertise in Insurance, Healthcare processes, applications using manual testing procedures automated tools.
• 6 years of Healthcare 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, 270/ 271, 276/277, 277P and 277CA 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, Physical solution documents Data warehousing, evaluating data sources, translating requirements into specifications and application design.
• 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.
• 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.
• Experience working on SQL database, querrying the database for claim entries into gateway and different fallout scenarios.
• Strong experience in capacity planning, load test configuration.
• Expertise in Sanity/Smoke, shakedown, Integration, Regression, Performance/ Load/Stress, System and Functional Testing.
• Excellent team player with strong writting, communication, interpersonal and analytical skills.
• Experience leading teams and working in Onsite-Offshore models.
• Experience working with third party vendors for defect triage and vendor related issue resolution.
• Experience leading team to meet deadlines and goals set by clients.

Confidential

QA Analyst Onsite lead

Responsibilities:

• Worked as an EDI specilist.
• Worked as lead for a team of 8 members 3 onsite and 5 Offshore .
• Experience in assigning tasks to onsite and offshore team on daily basis.
• Expertise in creating weekly reports on test status and defects.
• Tested various EDI transactions like 837I, 837P, 277CA,277P, 270/271, 276/277 837 Outbounds from Rental Network, 820 and 834.
• Studied business requirements document, PSD Physical Solution Document and Logical Solution Document LSD .
• Prepared test plan, test scenarios and test cases based on the above documents.
• Conducted functional, System Integration SIT , Workflow Integration WIT and regression testing.
• Shakedown testing on member benefit linkage, triplet vendor, provider POS linkage and interface readiness.
• Close interaction with the Developers and BAs for defects and defect resolution.
• Daily triage with vendors like McKesson, Optum and Epic for defect resolution and testing related issues.
• Extensive work on McKesson's ClaimsXten application for code editing.
• Worked on multiple business rules 54 which were client customized by McKesson for Code Editing.
• Tested various filtering criterias for different regions the client has for their claims processing implemented.
• Tested Claimslab application of McKesson installed on Kaiser's system.
• Defect management and triage on HP ALM 11
• Logged and tracked defects on Quality Center Version10 and ALM 11
• Extensive knowledge on testing Optum application - Client customized
• Detailed testing on DRG, Multipricer and APC pricing.
• Tested the rate files loaded on the client Rate Manager for various regions that the client implements.
• Extensively used Optum's Webstrat to compare the base pricing on Webstrat vs Clients claims processing system- Tapestry
• Tested Epic's product Tapestry and various other interfaces that communicate with Tapestry.
• Worked on Kofax application - Paper claims, how paper claims come, how paper claims are converted to X12 files and their mapping.
• Knowledge on Accumulations and buckets limits
• Validation on Audit and cost containment extracts and remittance 835 .
• Knowledge on EOBs, Letter integration, common extracts and mapping of various claims codes to EOBs
• Experience working on Rental networks such as Stratose, Mutliplan First Choice.
• Expertise in manually mocking EDI claims to paid claims and validating the EDI claims to be HIPPA compliant.
• Wrote test scenarios test cases and executed test cases on Member eligibility.
• Validated member eligibility after historical load, incremental load and incremental reload process.
• Worked extensively on member attributes, member covered through fields, ESRD dates, transplant dates and dialysis dates.
• Extensively tested the Filing Order logic for COB members with disabled ESRD attributes.
• Suported automation team to automate manual scripts for the above modules mentioned.
• Created tools on excel using macros to generate X12 files using the clients providers, vendors and members.

Environment: MS Office, ClaimsXten McKesson , Optum, Webstrat, SOAPUI, SFTP, EDIfecs, Quality Center 10.0, HP ALM 11, Edge, Transaction Manager, Transaction Restarter, SFTP Reflection, IBM Mainframes, ESB logs

Confidential

QA Analyst

Trading Partner gateway TPG replacement project. Working on the gateway migration project for Cigna from HP to Sterling gateway. Sterling Integrator component is the new TPG that was built and the goal was to mould this gateway to perfection from the testing prespective.

Responsibilities:

• Worked on the gateway migration project in Cigna performing one to one mapping of different output layouts generated.
• Documenting and developing Test Plans, Test Strategy, System Testing, End-to-End Test and User Acceptance Test Plan for the project.
• Desiging the test cycle plan and keeping it updated with bussiness changes.
• Performed end-to-end System Integration testing flowing through the entire business process flow to all the downstream systems and adjudication.
• 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.
• Worked on different transaction types like 837,820,834,277CA and other aknowledgements generated.
• Loaded and maintained test cases and test datasets in Quality Center.
• Defect tracking and defect management on Quality Center for different projects.
• Generating daily defect reports from QC and presenting in daily client meetings.
• Coordinated with the QA Offshore team for testing activities across multiple systems and managed test execution and defect tracking.
• Worked closely with developers and delivery team to fix defects and issues with defect management.
• Performed one to one mapping from layouts generated on Mainframes.
• Used Oracle database to querry for files coming in to the gateway and validating the fallouts and gateway rejects.
• Tested the BAM and reporting events generated at the gateway for different triggers using SQL querries.
• Worked on EMR Electronic MailRoom,Xerox images , Medicaid and PPACA projects.
• 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.
• Worked on claims flow having ICD-10 codesets and their layouts generation.
• Tested claims routing to different claim engines, evaluating claims adjudication needs and creating HIPAA-compliant business rules configuration.
• Involved in assessment of automation tools for one to one comparition of different layouts and provided business and technical process flow recommendations to the automation tool developer.
• Worked on Sterling B2B component to test different transactions flowing in and their XML schema generated.
• Maintained regression test suite for all the defects opened on the new trading partner gateway and guided the team to run them on weekly basis.
• Extensive testing on clean claim edits and other relaxed bussiness edits for 837/820 834 transactions.
• Worked on Production hotfixes and prodution issues for 837 834 transactions. Performed testing in both System and Integration environments for the same.
• Extensive work on EC payload jobs and finding the rootcause for claim fall outs on Enterprise manager.
• Led a team of 7 from oniste and offshore.

Environment: MS Office, EDIfecs, Specbuilder, Quality Center, Oracle Database, Load runner, Edifecs, Edge, Transaction Manager, Transaction Restarter, SFTP Reflection, IBM Mainframes, ESB logs

Confidential

QA Analyst

Responsibilities:

• Worked as senior QA analyst to create regression test suites for 5010 EDI 837 and 270/271 Eligibility request and response.
• Worked on production defects and defect logging and tracking. Worked with developers to fix these issues.
• Extensive work on paper claims 4010 format .
• Created regression suite for different edits of paper claims and their tracking.
• Worked on FileNet images generated for the above eloctronic and paper claims and their bundling.
• Analysed previous issues faced and added the required testcases to the regression suite.
• Worked on Amisys and United Health Care claims.
• Tested End to end scenarios for different flavours of HPHC claims.
• Tested the routing and bunding of claims to different targets.
• Tested member releated, second pass edits and new born edits.
• Created an exclusive regression on NPI related testcases with different trading partners and snip levels.
• Extensive work on Co-ordination of benefits COB claims and their regression files for different targets.
• Have done mapping on IDOC files comparing the input and output results.
• Worked on medicare claims and their relaxations and routing.
• Used FTP, Tibco and Edifecs Transction Manager to drop and track files respectively.
• Also worked on 270/271 Egiligibility request and response regression test suite.
• Tested different member and dependent related request test cases and their rsponses.
• Tested the coverage plans, co-insurance, co-pay and eligibility.
• Used Jmeter to pull and modify 270 files.
• Worked on UAT SIT environments to test the regression suite.
• Worked with the automation team to automate the regression test cases .

Environment: Windows,Transaction Manager, Filezilla FTP client, JMeter, SOAP UI, Edifecs tools, XML, HP Quality Center 10.0,MS Office, Spec builder 7.0, Agile/Scrum project methodologies, IDOC , Amisys

Confidential

QA Analyst

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.
• 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.
• 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
• 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.

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

QA Analyst

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, JCL,ChangeMan, DB2, MS Office,Autoplugs, Aetna Gateway, Edifecs, TXNR, Quality Center, QTP.

Confidential

QA Analyst

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 testing which 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.
• Analyzed HIPAA EDI transactions in XML and X12 responses and of 270 and looked for defects.
• 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 defects in Quality Center and maintained track of the defects throughout the life cycle.

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

Confidential

QA Analyst

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