QA Analyst Resume Profile

Professional Summary

Good Knowledge of creating Medical claims, Billings, Appeals, enrolling subscribers and members in Facets 4.7.1/5.01.
Worked on ICD 9 to ICD 10 conversion project.
Hands on experience working on different modules of Trizetto Facets 4.7.1/5.01 claims processing system.
Over 6 years of IT and Management experience in Software Development Life Cycle SDLC and Project Life Cycle working as Quality Analyst and strong knowledge and experience of Healthcare and insurance sectors.
Managed QA projects through various Life Cycle Models.
Proficient understanding and demonstration knowledge of Medicaid, Medicare, EDI, ICD 10, HIPAA 5010
Possess strong management and functional experience, with a thorough understanding of the business logic and QA approach to software testing.
Expertise working in Healthcare industry with Insurance,Claim Processing, etc. Medicaid and Medicare modules as well as Interface Testing and Data Conversion
Documenting the testing activities including all Test documents, test execution results and defect reports and status reports.
Extensive experience in testing Client/Server and Web-based Applications.
Expertise in Bug reporting tools such as Quality Center / HP ALM.
Experience in Testing in Agile environment and testing enterprise web portal applications.
Applying appropriate validation principles and test case design concepts ensuring applicable regulations, guidelines, and internal procedures related to QA.
Good analysis on User Requirements, Business Requirements, and System Requirements Specification.
Worked on EPIC and HL7.
Excellent understanding of SDLC and analysis with emphasis on black-box testing, functional testing, GUI testing, system testing, regression testing, security testing, load and performance testing of web, and client/server based applications.
Worked on various Line of business HMO, Medicare and Medicaid claims
Worked on Claims, Membership, Enrollment, Benefits and Data Validation.
Experience with data mappings including ANSI EDI 835, 837I, P, 276/277, 278, 270, 997, 850, 834 for institutional, professional, and commercial.
Demonstrated proficiency in all aspects of software testing including generation of test scripts, scopes, and detailed defect descriptions, requirements analysis, test planning and execution, and functional, regression and performance testing.
Good understanding of secure enrollment 834 data submission with Secure File Transfer Protocol SFTP .
Worked on Electronic Data Interchange EDI format using v4010A1 / v5010 Implementation Guides and v5010 TR3 Guides, EMR and EHR.
Supported end users by validating the requirements in each release.
Very much skilled in Back-end testing with MS SQL Server and Oracle database.
Good proficiency in SQL, PL/SQL.
Validation Specialists to develop and design the validation plans and testing protocols for computer-automated systems.
Wrote numerous test plans and test cases for manual and automation testing.
Bug Tracking using Bug tracking Tools like Quality Center, Team Track, Rational Clear Quest.
Possess excellent analytical skills with good communication and self-organizing skills, assertive, and a committed team player.
Have extensive experience in testing reports using business objects.

TECHNICAL SKILLS:

Programming Languages:	Visual Basic, .Net, C , SQL
Scripting Languages:	UNIX Shell Scripting, Java Script, VB Script
Operating Systems:	UNIX, MS-WINDOWS
RDBMS	SQL SERVER, ORACLE 8i/9i/10g, 11i, MS- ACCESS.
GUI:	PEGA, Java Graphical User Interface, Visual Basic, Microsoft Office, Forms and Reports, SEIBEL.
Automated Tools:	Quick Test Professional QTP , Load Runner
Test Management Tools:	Test Director, Quality Center 10.0,11, HP ALM
Defect Tracking Tools:	Rational Clear Quest, Quality Center/HP ALM, Team Track
Operating Systems:	UNIX, DOS, Windows .
Reporting Tools	Cognos, Crystal Reports, Business Objects

PROFESSIONAL EXPERIENCE:

Confidential

QA Analyst

Responsibilities:

Analyzing business requirements to develop functional and detail design specifications of the application.
Creating and implementing Test plans, Test Strategy, Role s , Client Situation s , Business Scenario s , Test Cases and scripts based on technical specifications and business requirements.
Developed Test Cases from the requirements and scenarios for functional and regression testing.
Coordinated with the QA team and developers to prioritize defects and rectify them. Participated in the Release meetings to triage the bugs.
Worked on application related to Medicare and Medicaid.
Extensive testing experience with Members enrollment, Member services, Premium billing, Provider management, Claims processing, Provider reimbursement and Claims adjudication.
Performed Gap Analysis, updated report layout and documented the changes.
Created test cases for test claims in ICD 9 and ICD 10.
Participated in Gap analysis and cost analysis of ICD9 to ICD 10 conversions.
Involved in loading ICD-9 and ICD-10 codes into the grouper for DRG determination.
Tested and compared claims related to the scenarios, created standard 837 transactions on an ICD-9 based representation of the scenario as well as an ICD-10.
Tested the Claims, Members, subscriber and Providers in Facets. Used Quality Center HP ALM for preparing the Test Plans and manual Test scripts.
Reported Defects using Quality Center HP ALM .
Monitoring the defect life cycle, generating customized graphs and reports for the client, using Quality Center HP ALM .
Used Quality Center HP ALM to record documenting information useful in debugging process, evaluating test data.
Effectively used various intakes on each Reference IDs to populate/create further data, and to perform regression testing.
Worked on Facet's Provider Application in order to resolve provider related issues.
Experience in HIPAA 5010 EDI transaction codes such as 270/271 inquire/response health care benefits , 276/277 Claim status , 834 Benefit enrolment , 835 Payment, 837 Health care claim .
Performed Backend Testing by writing SQL statements to review the returned data to ensure that the correct data was retrieved.
Worked on Requesting enrollment of subscribers in FACETS by filling membership request form for different Plans and products
Worked on direct submissions to electronically submit enrollment 834 data.
Assisted with planning resources activities and monitor day-to-day progress, making adjustments as needed for the successful completion of tasks.
Developed scripts for automation testing and performed automated testing using QTP Quick Test Professional
Used QTP Quick Test Professional for reporting, Scheduling, Interacting, invoking the Test Scripts.
Worked in enrolling subscribers using Subscriber/ Family sub application of Subscriber/Member in FACETS.
Worked in creating claims electronically using batch jobs
Hands on Experience in creating groups using Groups sub application of Subscriber/member application of facets 5.01.
Performed manual testing of 834 enrollment file in FACETS 5.01.
Worked on Medical plan application for different newly added Products using FACETS.
Made sure testing team is following guidelines, testing standards and procedures as documented.
Responsible to create Trace ability matrices, Test Matrices and Weekly Status Report
Preparation of Test Reports/Defect Reports
Attending Test Status meetings with relevant Stakeholders
Preparation of Test Sign off Report

Confidential

QA Analyst

Responsibilities:

Worked on various releases of this project.
Involved in leading, guiding monitoring the analysis, design, implementation execution of test cases, procedures suites.
Performed testing for Medicare and Medicaid.
Involved in Planning, monitoring and control of testing activities tasks. Attended detailed design sessions with Client on 276/277 Transactions and the 277 family 277 CA, 277U
Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals
Hands on experience developing Test Plan, Test Requirements, Test Cases and detailed test cases in Quality center.
Involved in developing Functional Test Scripts from requirements to test the EDI X12 837, 835, 834, 276/277/277CA/277U Batch and Real Time Transactions.
Developed Scenarios for the Functional testing of processing Batch Transactions and LOB's for Split claim prior to Member Validation.
Performed manual and automation testing.
Experience in developing test cases for 5010 EDI transactions. Identified the scenarios based on business requirement and HIPAA compliance for each transaction such as 837, 835 and 276/277.
Performed the testing Analysis for the transition to EDI X12 5010.
Hands on experience testing 837 Claims for Billing and Payment, 834 Claims for Benefits Enrollment and 835 Claims for Pre-adjudication.
Involved in scheduling the test execution then monitoring, measuring, controlling reporting the test progress, the product quality status test results.
Performed Web testing, Smoke, Functional, Regression, System Integration testing.
Analyzed the member/eligibility information on claim to that in FACETS.
Prepared and created Test cases/ Test data according to different requirements.
Worked extensively with Clear Quest for defect management.
Analyzed the inbound and outbound interfaces and extensions to Trizetto FACETS claims processing system.
Experience in System and UAT testing of the FACETS core application and custom modules as needed.
Claims validation in FACETS application which includes claims pending status, member status and Enrollment.
Analyzed error messages and investigated defects.
Along with the functionality testing of IBU, tested the functionality of Small Group Renewals as different users such as Underwriter, Producer, Managing Agent, Sales Representative, Internal User, Consumer, HPA, DBM as per requirements.
Interacted with Business Analysts and Developers to address quality problems.
Created reviewed Requirement Validation Matrix.
Coordinated with planning team to complete all the projects within the release time.
Participated organized meetings with other testers, developers, leads, managers written meeting minutes.
Performed IVR testing.
Provided full UAT support to ensure that the business receives the support needed to adequately test the functionality correct processing.
Involved in the Review of Requirements Specification with technical specialists of the application.
Involved in understanding the current business process and in defining scope of the project.

Environment: FACETS 4 .71, Rational Clear Quest 7.1.2.0, SQL Advantage, MS Access, SQL DBX, Sybase, HTML, XML Spy, Ultra Edit, WinScp, FTP Pro, Unix through Vitria, Connecture, MS Office.

Confidential

QA Tester

Responsibilities

Involved in developing Test Scenarios and Test Cases.
Involved in preparation of the Test Matrix.
Involved in Integration Testing, Functional Testing, UAT.
Tested the functionality of the Extensions that meets the BRD requirements.
Worked on validation of HIPAA for EDI 837, 834, 835, 270, 271, 276, 277, 997.
Worked on validating in XML Files.
Performed functional testing on different modules of Epic.
Worked on EpicCare and MyChart.
Prepared Various Test Conditions on various system triggered fulfillment.
Developed Test Case based on the new requirements in the Use cases and maintenance Tickets.
Placed Test cases, Test scripts, and Expected results in HP Quality center
Involved in testing HIPAA EDI Transactions.
Developed Test plans, Test cases and Test Scripts using Quality Center/Test Director.
Involved in testing the Member and Benefit Enrollment, Eligibility Enquiry, Eligibility Response, Claim Status Enquiry, Claim Status Response and conversion of Financial Claims.
Tested the Adjudication of Claims and Migration Process.
Performed Backend Testing by writing SQL statements to review the returned data to ensure that the correct data was retrieved.
Involved in Testing along with Programmer Analysts to resolve the Issues.
Prepared and Submitted Daily and weekly Status Report to Project Manager.

Environment: Quality Center, EDI HIPAA Gateway, U-Connect, PVCS, Rational Clearcase, Requisite pro, Java, J2EE, XML, WinNT, UNIX, Mainframes, SQL Server, MS Word and MS Excel.

Confidential

QA Tester

Responsibilities:

Drove the requirement-gathering phase Provider, Claim components and HIPAA .
Developed Base line scripts for testing the future releases of the application
Worked in importing and cleansing of data from various sources like DB2, Oracle, flat files onto SQL Server with high volume data.
Involved in gathering the requirements for creating BRD.
Created test cases to validate data format from source to target.
Involved in extensive validation using SQL queries and back-end testing
Used SQL for Querying the DB2 database.
Used Excel spreadsheet for retrieving expected test data at runtime on the application using QTP Scripts.
Performed automation testing using QTP.
Developed Schemas of EDI ANSI X12 Claims 837 and Eligibility forms in XML.
Involved in mapping data for various partners and clients transmitting EDI 837, 835, 270/271.
Created Test input requirements and prepared the test data for Data Driven testing.
Used Clear Quest to track and report system defects and bug fixes.
Written modification requests for the bugs in the application and helped developers to track and resolve the problems.
Hands on experience working on HL7 for hospital workflows.
Involved in testing the Member Enrollment, Eligibility Enquiry, Eligibility Response, Claim Status Enquiry, Claim Status Response and conversion of Financial Claims
Involved with backend testing of the SQL database and verified the EDI data transactions going fine in the database
Connected to the Oracle database in TOAD and created and executed SQL queries.
Performed quality assurance reviews on all System Development Life Cycle.
Participated in defect review meetings with the team members. Used MS-Word for documentation.
Involved in other test planning meetings and submitted test metrics daily to the management.

Environment: Informatica, B2B workbench, QTP, Java, Oracle, IMS Mainframe, WEB Sphere, PVC Tracker

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