Summary:

• Over 7 years of work experience as a SQA Analyst in all phases of the software development life cycle SDLC in terms of testing large scale software's that are built in Multi tier architecture.
• Have around 7 years of experience as a Quality Assurance and Software Test Engineer. Well versed in Quality Assurance of Client/Server and Multitier Web Based applications. Work experience in HIX projects. Proficient in various testing methodologies and has hands on experience in all stages of software development life cycle SDLC .Have a very good knowledge and experience in working with EDI transactions. Good familiarity about HIPAA guidelines and ICD 9-10 codes. Extensive experience in working with Medicaid claiming. Have an extensive documentation experience in writing test plans, defining test cases, designing test strategies, developing and maintaining automated test scripts. Well versed with backend testing by creating SQL scripts to validate and verify data.
• Experienced on testing Internet and Intranet applications.
• Over 4 years of extensive experience in working with ICD 9-10 codes.
• Good Healthcare domain knowledge
• Involved in the projects of Medicaid claiming.
• Proven ability of BA experience and analyzing the business requirements and capable of establishing the best methodologies to break software builds.
• Skills and experience include acquiring the traceability matrices of the business requirements.
• Through understanding of QA methodologies. Expertise and experienced in performing black box testing, white box testing, GUI testing, integration testing, interface testing, end to end testing, backend testing, regression testing, UAT, performance testing, load, stress and Volume testing.
• Excellent Documentation skills to prepare Test documents like Test Plans and Test Strategies and control processes in accordance with SOA compliance. Experienced in working CMM standards.
• Experience in extensive execution of Test Scenarios without dropping quality standards.
• Good Experience in Back-end testing using SQL server Enterprise Manager and Toad
• Knowledge of ETL tool Informatica
• Ability to map data on a large scale and test on exchange layers.
• Experience in Healthcare with mandatory HIPAA compliance checks, EDI transactions 837,835,834, 270/271 and 276
• Good knowledge of Trizetto Facets
• Knowledge of Member/Subscriber and claims module in Facets
• Experience in testing web applications using different browsers. IE6, 7 8, FireFox3, Safari 4, S60
• Experience on Migration, Implementation of the software releases.
• Delivered the tasks which were assigned in agile environment on a daily basis.
• Good communication and co ordination skills to interface with clients or end users.
• Excellent presentation skills for documentation using MS Office in specific Excel and Word.

PROFESSIONAL EXPERIENCE:

Confidential

QA Analyst

Responsibilities:

• Geisinger Health Plan GHS has approximately 300K members and is an integral part of Geisinger Health system, a physician lead health care system of northeastern and central Pennsylvania. HIX project involves facilitating the purchase of insurance on Federal Public and Private exchanges by setting up an online market place and enrolling the members in Facets.
• Health Insurance Exchange HIX
• Analyzed business requirements and developed test cases
• Tested the Web based application built on JAVA
• Worked extensively on EDI 834 files
• Queried Facets database to verify the member details
• Enrolled members manually in Facets
• Created different types of policies and added Coverage's, Limits, Sub Limits, deductibles against the created policies.
• Verified the Installed Group data in FACETS
• Enrolled subscribers manually in FACETS
• Modified and verified the rates in the premium rate table in FACETS
• Used SQL to verify the Facets Group GRGR and Subscriber tables
• Experience testing XML web services built on SOA architecture.
• Involved in testing single sign on portals
• Using TOAD for generating SQL queries for checking the Data Transactions and Database Integrity.
• Worked on middleware tool TIBCO
• Experience working on AGILE methodology
• Documented test suite design and test cases.
• Created and maintained test data.
• Used Quality Center for Logging defects and for defects management lifecycle.
• Executing both Functional Testing and Regression Testing.
• Developed SQL queries to query Facets database setup test data and review test results.
• Created automation scripts using QTP
• Generated QTP Scripts with Standard, Text, Bitmap, Table Checkpoints and also Synchronization Points
• Logging re-testing defects and assigning them to the developers/responsible persons.
• Preparing dashboard reports on a weekly basis using Quality Center
• Filtering E2E, UAT test scenarios for UAT sessions using UAT requirements goals.
• Preparing sample test data for UAT.
• Assisting end users during User Acceptance testing.

Environment: Facets 5.1, C .Net, SQL Server 2008, VPN, Citrix, Windows MS Office

Confidential

QA Analyst

Responsibilities:

• Involved in testing HIPAA EDI Transactions and mainly focused on 837 and 835.
• Involved in testing the efficiency of healthcare delivery by using HIPAA
• Experience in working with health rules testing.
• Involved in testing Medical claims, Hospital claims, and Dental claims.
• Involved in Medicaid claims
• Involved in processing claims and validated the full payment cycle process until it generates 835's
• Interacted with Business users and Technical team in providing clear solutions to requirements.
• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Developed Test Cases bases on Functional Specifications and Design Documents.
• Collection of queries to be posted for clarification of functional behavior of application
• Performing the Onsite-Offshore Coordination for the SIT team and is a single point of contact for offshore testing team to execute the test team activities.
• A convergence project of traditional Treasury Management and healthcare Clearinghouse services which delivers industry leading solution and an integrated comprehensive complete healthcare revenue cycle solution from pre-registration through collection that utilizes decision support tools throughout the cycle is required.
• Involved in Creating Crosswalks for 837 P, D transactions for checking the compliance. Interacted with Mappers while creating Crosswalks.
• Responsible for preparing Test cases and Test data for 276/277,837 P/D/I transactions.
• Adjudicating the claims in Facets
• Queried Facets database to verify the member details and their claims history
• Experience writing SQL queries using SQL developer
• Worked on ICD 9/10 codes
• Checking the Test data for the HIPAA Compliance passing through the compliance tool EDIFECS.
• Involved in testing the EDI transactions 270 271 routing to Blue Exchange for Out of state member inquiries from local providers and responses for local member inquiries from Out of state providers.
• Involved in writing SQL queries in SQL Navigator to validate the payment files.
• Followed the Mapping documents and HIPAA implementation guides for HIPAA Transaction Mapping.
• Used Quality Center for preparing the test case and for tracking defects.

Environment: Facets 4.7, HP Quality Center, SQL, JAVA, Oracle9i, UNIX, Windows NT/2000/XP and MS-Excel.

Confidential

QA Tester

Responsibilities:

• Confidential is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. Involved in the testing of ICD 9/10 Codes, Claims Adjudication, Member Lock In, FACETS Edits, Co payment, PA, EDI, Interfaces, HPAS online Web Portal for the Providers, Claims Payment. Involves in HIPAA compliance, claims and Insurance and provides the different plans - to employer groups, government-sponsored plans, and individuals.
• Part of dedicated QA Test team
• Worked with Use-Cases and wrote test cases.
• Tested the functionality in various subsystems like Claims Adjudication and pricing, PA, PAS, Provider,Member management.
• Involved in simulating the claims for testing purposes using Claims FACETS.
• Tested the edit and audit processing to ensure that claim records are edited and audited in accordance with the claim processing policy.
• Involved in testing the claims pricing methodology for Professional, UB04 UB92 Institutional , Dental and crossover claims.
• Conducted Functional and System Integration testing.
• Involved in ETL testing using Informatica
• Involved in Developing test scenarios and test cases for Data conversion interfaces.
• Involved in Developing test scripts and execution using Rational Manual Tester
• Tested the ETL work flows and batch logs.

• Used Rational Clear Quest for defect tracking
• Involved in defect validation and regression testing

• Tested interfaces and ANSI X12 / EDI Version 4010/5010 transactions for 270, 271, 276, 277, 278, 837P, 837I, 837D, 835, 834, TA1, 997 and 824 BRR
• Involved in working with ICD9 10 codes.
• Tested the HIPPA infrastructure.
• Involved in the testing of the UI Interface and cross browser testing.
• Maintained Test Logs, Test Summary reports and participated in defect review / Status Meetings.
• Proactive interaction with the client for the resolution of issues.

Environment: COTS, Rational Suite 7.0, .NET, ASP, SOAP, Toad, MS-Office, Oracle 10g, Trizetto FACETS, ANSI X12, Message Broker, Edifecs and Quality Center.

Confidential

QA Analyst

Responsibilities:

• CNSI is a vendor who provides web-based systems for Medicaid claims processing, HIPAA transaction support, Provider enrollment and Prior Authorization. WAMMIS project is a State of Washington's new generation web based MMIS Project.
• Business Analysis of the CCFs, NRC's and defined the priorities of the releases.
• Delivered Test documentation Test Plan/Test cases and Test Master
• Designed, Planned, Created and Executed Test cases as part of SIT
• After completion of Final Regression cycles, assisted the end users in UAT.
• Quality Center for closing Status of Defects.
• Tracked the defects, prioritized them according to their severity as a process of Defect management in accordance with Defect life cycle.
• Linked the requirements, test plans and defects while using Quality Center
• Defined and developed tests on the API's
• Worked with ETL process tools. Verified the XML output data.
• Explored and adapted Standard concepts, practices and procedures in healthcare
• Interacted with developers and Re-tested the fixes during Regression Testing. Generated the reports.
• Tested various subsystems like Claims and Adjudication, Providers and PA etc.
• Experience in Claims loading, processing, and resolving, re processing, voiding and adjusting for both single line and multi line claims.
• Experience with derived amounts on the claim both at header level and at line level.
• Worked on ICD 9 codes
• Tested Section 508 compliance, HIPAA infrastructure EDI transactions for Claims 837P, 837I, 837D, 834, 835, 270/271,276/277 and 278
• Executed HIPAA compliance checks throughout the transaction life cycle.
• Used EDI X12 Reader to understand the values of EDI transactions without its codes
• Involved in Test Case Selection Review and Peer Review
• Involved in End to end Testing. Verified the third party data posted in the network on a daily base and analyzed if there are any load time errors and tested the error files.
• Ensured the data from third parties Member, Provider, Hospitals is populated in the Staging tables

Environment: Water fall and Agile Development environment, SCRUM, ,J2EE, RUP, Java, Tomcat, Oracle 9i, SQL Server, C , MySQL ,TOAD, , Trizetto Facets, HP QC, QTP, HIPAA, EDI, ANSI X12.