Objective:

• Over 8 years of experience as a Quality and Programmer Analyst with Healthcare Industries.
• Experience with healthcare system with prime focus on Enrollment, Eligibility Enquiry, Claims, and Claim Status for different provider and payers.
• Experience on analyzing and gathering testing requirements for Automated Enrollment applications like AE process, TPM, Error Handling GUI, Business Objects reports, and BAM Dashboard and for Clearing House Applications OPTUM Healthy-E-Network which included all CH transactions 270, 271, 276, 277, 837 and 835 .
• Adequate knowledge in Health Administration Automated Enrollment, Clearing House Process auto adjudication , HIPAA Compliance 4010/5010, TriZetto Facets, EDI, Medicare, Medicaid, and Federal Health Plans.
• Experience on designing and developing the testing solution for Commercial, Medicare, and Medicaid Payers with prime focus on Member enrollment, claims adjudication, provider, eligibility and prior authorization into Trizetto Facets and EDI X12 healthcare transactions.
• Highly experienced in Software Development Life Cycle SDLC and extensively on Agile Scrum Methodology.
• Experience with application for PEGA, TIBCO, EDIFECS, CLAREDI, ACE, and IEDI.
• Experience in troubleshoot file transmission problems with EDI Enrollment transactions 834, 824, Claims transactions 837, 835, 276, 277, 278, Eligibility transactions 270, 271 related inquires and enforce HIPAA guidelines with ANSI X12 Version 4010, 5010.
• Experienced in Smoke Testing, Functional Testing, Regression Testing, Back-end Testing, Ad-Hoc Testing, Sanity Testing, End-End Testing, Unit Testing, Beta Testing, Alpha Testing, White Box Testing, Load testing, Performance testing and User Acceptance testing of the HealthCare applications.
• Experienced in the Bug Reporting, Bug Tracking and Analysis.
• Expert in Database Testing by creating and executing the SQL Queries.
• Experience in managing the whole requirement process using Mercury Interactive Management tool Mercury/HP/HP ALM Quality Center and RALLY.

Projects:

Confidential

QA Tester

As per contract between HP and Ohio Department of job and Family services ODJFC . I am working on Ohio Medicaid information technology system MITS . HP developed this web-based application. It is the HP claims administration platform which provides claims processing for health care providers, Medicaid eligibility verification services, and electronics health records for Medicaid recipients. The system provides data Analysis about health care trends and outcomes enabling assessments of needs and impacts of current programs. The system also identifies Fraud and abuse. I was involved in various subsystems including Managed care. The two primary Managed care assignment programs supported by Ohio MITS system are Covered Families and children CFC and Aged, Blind or Disabled ABD .

Responsibilities:

• Test business requirements user story , performed Quality Analysis for HP business requirements and validate system workflows for HP Claim Administration.
• Troubleshoot EDI file transmission problems and business rules related inquiries which enforced HIPAA guidelines in the X12 Version 4010, 5010 Transactions Implementation guides with FTP/SFTP Servers by STOMP UI, SOAP, API, and HTML applications.
• Validate EDI transactions 837, 270, 271, 276, and 277 related inquires for HP and NON HP payers along with ICD9 and10.
• Involved in Scrum call during pre-planning meeting to help the estimation process for the user stories based on the complexity.
• Worked as a proactive member of Quality engineering team for projects like IEDI, STOMP and ICD10.
• Worked on different kind of Claim, Claim status and Eligibility files format like in X12, Print Image, CMS GUI and XML for quality testing.
• Developed QE test plan, test scenarios and test cases in using Application Life Management and update testing tables for automation testing on regression suite during testing Functional, Regression and UAT on different environments.
• Creation and execution of QE and testing processes on applications like Healthy-E-Network, ACE, CM, CLAREDI and BYPASS.
• Experienced and adequate knowledge of Unit Testing, Beta Testing, Alpha Testing, White Box, Integration, Functional, Regression and User Acceptance Testing UAT .
• Experience with Data selection, testing and handling to write complex SQL queries for testing Databases of Clearing House project.
• Run Automation scripts and review failure analysis, update scripts and data tables for Hybrid Framework in QTP.
• Writing SQL queries to retrieve required testing data from SQL server 11g in TOAD for the purpose of quality testing.

Environment: TOAD, MS Office, Agile Methodology, Scrum and Sprint environment, SOAP, STOMP UI, ACE, HP ALM, QTP, HIPAA X12 4010/5010, Oracle 11g, SQL, HP ALM, QTP, Rally, X12, Print Image, XML, Ortelius.

Confidential

Sr. Quality/ Programmer Analyst

This AEv2 project involved in design and developed the software and solution for TriZetto Facets system which is Health Care ERP system in CareFirst within BCBS. It consisted of different modules like Enrollment, Products, and Billing. This project also involved the maintenance of trade partner management workstation that automatically handles the entire enrollment life cycle.

Responsibilities:

• Test business requirements, performed Gap Analysis for Care First business requirements and generated system workflows in TriZetto Facets.
• Creation and execution of QA and testing processes on Automated Enrollment project for test planning, test case writing, test case execution, Log defects, bug documentation and issues investigation for TriZetto Facets application.
• Worked and tested different web applications like TPM, Error Handling GUI, Startup, Business Object, and BAM Dashboard.
• Experienced in validating more than 500 TIBCO and PEGA business rules for Automated Enrollment EDI834 transaction in Facets for Group and IMD business which related to 15 submitters.
• Troubleshoot file transmission problems in enrollment related inquiries by EDI and enforced HIPAA guidelines in the X12 Version 4010/5010 Implementation guides 834, TA1, 997, 824 .
• Analyzing experience with Data Conversion, testing and handling to write complex SQL queries for testing Databases of TriZetto Facets, TPM, TDB, AE.
• Using FTP and SFT environments to dropping transaction file to test the complete enrollment process of the organization.
• Run Automation scripts and review failure analysis, update scripts and data tables for Hybrid Framework in QTP.
• Experience on testing system upgrades in TriZettoFacets 4.3 to 4.5 and 4.5 to 4.7, TIBCO, PEGA and Automated Enrollment systems.
• Worked on Vendor Extracts, Extensions, Enrollments, Startup, Mass Transfer, CJA, CareFirst Letters, TIBCO, PEGA and AE2 Applications TPM, BAM, Error Handling, Broker Express and eHealth for TriZetto Facets, Mainframe.
• If needed organized meetings to discuss outstanding issues with BA and Developers like Walkthrough and DRB.
• Developed Test Scripts, Test Cases and Test Plans for Functional, Regression and User Acceptance testing for Testing and Production environments.
• Worked on Integration, Functional, Regression and UAT testing along with updating automation tables for regression suite.
• Involved in testing the Business Objects Reports as a part of Integration, Regression Testing.

Environment: Pega PRPC, SFT, FTP, TriZetto Facets 4.3, 4.5, 4.7, HP ALM Quality Centre, SOAP GUI, HP Output Server, RUP Methodology, 4010/5050 X12 Format, COBOL, MS Office 2007/10, Lotus Notes, Mainframe 3270, SQL, SQLDBX, TRMS, HPX, Oracle Developer, EDI, Business Objects 6.5,DB2.

Confidential

QA Tester

This project involved creating the medical claim processing system and Facets for Aetna within MMIS Medicaid Management Information System . It consisted of different modules like Claim Status, Eligibility Enquiry and Claim. This project also involved the maintenance of claims workstation that automatically handles the claims life cycle.

Responsibilities:

• Test facets application based on business requirements for client and validates system workflows for Facets.
• Use TSO/ISPF Mainframe to test data files of claim process, including DB2 and VSAM files.
• Experienced on testing Facets Migration, Customization and Upgrade 4.3, 4.5 applications related to Claim and Eligibility modules
• Tested troubleshoot file transmission process with EDI claim related inquiries and enforced HIPAA guidelines in the X12 Version 4010 Transactions Implementation guides 837, 270, and 276 for submitters Kelly and GBS.
• Validate scheduled batch jobs using COBOL in Mainframe for downloading data into temporary tables to generate the data required for some of the Facets related claim applications.
• Create and execute testing for trading partners and validate HIPAA guidelines mapping for 837, 270, 271, 276, and 277.
• Using FTP and SFT environments to dropping transaction file to test the complete EDI transaction process of the project.
• Developed Test Scripts, Test Cases and Test Plans for Functional, Regression and User Acceptance testing for Testing and Production environments.
• Created X12 transactions files and configured facets application for real time test scenarios for quality work which adherence to design test specifications for testing in TEST and PROD environments.

Environment: Tibco, Pega PRPC, Mercury Quality Centre, TriZetto Facets 4.3,RUP Methodology, COBOL, Lotus Notes, SQL, Oracle Pl/SQL, EDI, BEA Aqua Logic , Business Objects 6.5,DB2, Mainframe 3270.

Confidential

Analyst Data

and affordable access to the health care service of their choice. Project involves integrating Market Prominence and the Claims processing System with the data warehouse to support the reporting requirements .It were included designing the model of ODS to automate and maintain the ETL process.

Responsibilities

• Analyzed Requirements such as BRD along to FRD for ETL process.
• Extensively prepared Test Plan, Test Scenarios, Test Cases as well as test data creation based ON user point of view.
• Preparation of ETL/Back-End Test cases to validate the business requirement outcome.
• Involved in review process and meeting and also involved in the transformations testing.
• Performed the record count validation and data validations
• Performed functional testing, system testing, Re-testing and Regression testing.
• Analyzed trading partner specifications and created EDI mapping HIPAA guidelines
• Documented the Traceability Matrix for tracing the Test Cases and requirements related to them.
• Developed Test Scripts, Test Cases and Test Plans for Functional, Regression and User Acceptance testing for Testing and Production environments.
• Created X12 transactions files and configured ETL process for real time test scenarios for quality work which adherence to design test specifications for testing in TEST and PROD environments.

Environment: Windows XP professional, MS Office suite, UNIX/Oracle Platform, XML, Oracle Application server 10g, SQL, Oracle Pl/SQL, Datastage, QC.