Summary:

Confidential is an accomplished Healthcare Analyst with a track record in all phases of system lifecycle like Quality Assurance, Business Analysis, and User Acceptance Hands on experience in Healthcare Insurance and Clinical workflows Proactive at facilitating discussions and negotiating with stake holders Established Test Plans for Verification and Validation of new builds, features and functions of EDI transactions Communicate timelines, deliverables, risks, delays and impacts to test team and management Supported Pharmaceutical and Healthcare systems i.e. Claims Adjudication systems that involve EDI X12 transactions from Medicaid/Medicare systems using legacy IBM mainframes and Web Service Technologies.

SUMMARY

• Proficient in working with application developed on IBM Mainframes using COBOL II, CICS, VSAM, JCL, DB2/SQL, IMS, SAS, Easytrieve, MQ-Series, PL/1 and REXX.
• Good understanding and hands on experience of HIPAA 5010 and ICD -10 initiatives.
• Expertise in Analysis of Test scenarios and documenting Test cases and developing SIT, UAT Plans, maintaining the Traceability Matrix and Integration Test activities.
• Experience working in various development Methodologies and various environments like JAVA, .NET, SOA, UNIX, and legacy systems i.e. mainframes.
• Extensive exposure to Functional, Regression and User Acceptance Testing Mainframes, Web, SOA and Client/Server applications. Extensive Claims Testing experience.
• 9.5 years of extensive experience in the field of Quality Assurance and 6 years of Business Systems Analysis to implement business requirements into the software application in IT/Healthcare Industry.
• Experience in Medicaid Management Information System MMIS and Medicaid HIPAA Administrative Simplification for mechanized claims processing and information retrieval systems.
• Strong knowledge of Health Care Insurance, EDI transaction types and ANSI X12 data 837 I/P .
• Involved in history conversion from 4010 to 5010 with working knowledge of ICD10 conversions.
• Formulated Test Plans and recorded Test Cases in Quality Center MS Excel templates.
• Extensive experience in End to End testing for the applications. Supported the post-implementation/production for various projects.
• Validated the database integrity by writing SQL Queries using TOAD-Oracle and QMF/ SPUFI.
• Expert in all phases of Defect management and in the process of defect identification and resolution using tools like Silk and Quality Center.
• Possess excellent verbal and written communication, team spirit, conflict resolution and motivational skills.
• Ability to work with ease under tight deadlines and fast-paced environments.

TECHNICAL SKILLS:

HIPAA EDI X12 4010/5010, CMMI, Six Sigma, SDLC, RUP, Waterfall, Agile Methodology, CPT and ICD-9 Coding, ANSI X12, Rational Rose, Requisite Pro, Microsoft Visio, Mumps, C,C , COBOL, JAVA, J2EE, JSP, Web sphere, Web Methods, MQ Series, VB.NET, Microsoft Project, Microsoft Office, MS SQL Server-2000/2005, UNIX, Mainframes OS/390, MS Windows XP, MS Windows Server 2000.

PROFESSIONAL EXPERIENCE:

Confidential

Quality Assurance

Confidential is undergoing a transition from their current Confidential developed Provider Data Management Systems for their provider related data. This is the core initiative of the Network Data Management NDM program which comprises the Data Conversion , Application Configuration , Technology Integration , Electronic Data Warehousing and Operational Readiness tracks to achieve their goal of an entirely new Provider Data Management Systems and Amisys Independence.

Responsibilities:

• Formulate and coordinate the UAT strategy and plan for the entire NDM Program. Implement, lead and manage the UAT Strategy and Plan.
• Participate in the creation of Test Scenarios Test Cases with the UAT Team and the Business Analysts.
• Work with business analysts and the business experts to understand the business flow and business rules
• Interact with cross-functional team members, stakeholders, business users for all the areas of the program
• Manage the UAT process for all the tracks within the NDM program. Coordinate between the Business Users and Project Team. Serve as a point of contact for any issues/concerns raised for UAT for all the tracks in the program.
• Analyze and estimate the timelines and schedules for a specific UAT activity. Convey all the required information to the business in an organized manner.
• Arrange training / workshop sessions for the new applications and processes in place to train the business users.
• Be a medium of communication between the Project Team and the Business Team.
• Provide the Business Users with all the required details/tools , user manuals guides, related information to conduct their UAT
• Escalate any obstacles/issues about the applications, tools, environments etc. to the Project Team. Work with the concerned parties to resolve the issues.
• Document all the findings/results/defects in UAT in ALM Application Lifecycle Management . Work towards the quick resolution and resumption of testing.
• Reach out to the QA team for any specifics about the application.
• Upon completion of UAT with no outstanding issues, convey the message of successful UAT session to the Project Team and the Senior Managements for obtaining Approvals and Sign-off.

Confidential

Test Lead

Confidential is gearing up to be compliant with the Affordable Care Act to incorporate Confidential and Confidential on premiums that are applicable to individuals, small and large Confidential . This is one of the key IT initiatives taken by Confidential Care Reform program, to accurately allot and calculate the 7 different types of taxes as they apply, to the different segments of their business.

Responsibilities:

• Actively participated from the beginning in the different phases of the Software Development Life Cycle and planned for the different phases of the Testing Life Cycle from the requirements gathered. Prepare Agenda, organize meetings and conduct status calls with the testing team.
• Developed High Level and Detailed Test Plans and Test Scenarios from the Business and Functional Requirements documents and implemented them. Kept track of the requirements for enhancements/modifications. Communicated the test strategy to the Project Manager and the Development team.
• Coordinated with SME's and developers to better understand the technical details from the Technical Design Documents. Escalated the issues to the senior management.
• Assigned tasks to all the team members in the testing team. Assisted in the Planning and scripting of test cases and executed them for different cycles. Performed System Integration Testing and facilitated User Acceptance Testing. Collected and reported out the Testing Status to the client.
• Effectively logged defects using Clear Quest in Rational, assigned them to the concerned developers and conducted the triage meetings. Closed the defects upon fixing and re-testing them.
• Communicate all the timelines and changes to the schedules to the team and ensure that the work is complete on time. Represent the Project and the Project Manager in his absence.
• Carefully analyzed the changes and defect fixes in the new builds and assisted the testing team in Regression Testing to ensure that the existing functionality was not disturbed and that the defects were fixed and closed. Report the same to the Project Team
• Performed end to end testing in various business processes and also provided production support after implementation. Was an integral part of the User Acceptance Testing.
• Interacted and assisted with the end business users to make use of the tools online Online Estimator for T F calculation that could calculate the different taxes and fees as applicable to them.

Hardware/Software: Mainframes and its tools: File Aid for DB2, SPUFI for SQL queries, COBOL, TSOE/TSOB, IMS, CICS SQL Extensive Microsoft Excel, MS Visio Rational: Clear Case, Clear Quest Web Methods MQ Series XML.

Confidential

EDI Test Lead /Business Analyst

Responsibilities:

• Acted as a liaison between the Development and the Testing Team. Prepare the Test Strategy and ensure that it is achieved.
• Conduct Status calls and publish the testing results No of test cases executed, passed/failed to the senior management. Prepare the Agenda and report out the meeting minutes.
• Responsible for collecting and documenting the test cases, creating a repository and uploading on the Share-point for the Clients to view.
• Report out any issues with the project to the Project Manager.
• Mentor the testing team on a One to One basis and also as a group to motivate and achieve the desired results.
• Arrange for workshops/training sessions to the team when they are exposed to a new software or when they have any difficulty in understanding the functionality of a software.
• Analyze the forthcoming work and the need for Resources, Hardware and Software needed for the successful execution of the assigned project.
• Keep a track of all the deliverables. Provide the Project Manager with the Testing Status and success rate.
• Escalate application issues to the Client. Played an integral role in the System Integration, Regression and User Acceptance Testing.
• Working on Provider Services, Recipient Services, Security Management and DSS-data warehouse sub systems within MMIS.
• Modifying JCL's accordingly to run the required tests by submitting the batch jobs.
• Responsible for validating EDI workflows ASC X12N 837I and ASC X12N 837P.
• Working with CMS1500 claims from various types of Providers P/I .
• Involving in analysis of EDI X12 transactions, versions 4010/5010, including 837 Claim, 835 Remittance, 276/277 Claim Status Inquiry / Response 999 acknowledgements.
• Performing 4010/5010 testing on the 27X transactions with respect to HIPAA validations
• Support Provider portal enhancements and cross referencing data from mainframes.
• Developing and executing several SQL queries in Mainframes DB2 as part of backend testing and involved in data validation to verify data-integrity and check data between different Systems.
• Create and modified test data using File-AID for EOBs providing information about claim payment information and patient responsibility amounts.
• Developing Test Scripts and coordinated with developers to quickly resolve associated defects.
• Identify, analyze and log defects, questionable behavior, errors, and inconsistencies in the Application functionality, outputs, and content using Silk.

Business Analyst Responsibilities:

• Created Impact Analysis documents recording systems impacted field by field for 835 and 837 I/P.
• Utilized business process models context and data flow , Entity Relationship diagrams ER-Diagrams as precursors to workflow development, re-engineering, functionality enhancements, migration to new technology, Risk Analysis GAP Analysis.
• Interviewing Subject Matter Experts SMEs and asking detailed functionality aspects of business process and carefully updating information to the requirements in an easily understandable format.
• Analyzing and verifying requirements for completeness, consistency, comprehensibility, feasibility, and conformity to standards.
• Analyzed regulatory requirements to define impact on customers and systems in order to define the system requirements. Conducting Gap Analysis on AS-IS and TO-BE business processes and technology and identified potential pitfalls, risks, and issues.
• Worked with Test teams to maintain the Traceability Matrix to uniquely trace new business requirements to general design to testing for coverage reporting.

Hardware/Software: IBM Mainframes, UNIX, Mumps Cache, IDX, MS Visio, Clear Case, EDI X12 4010/5010, ICD, Silk, SQL, DB2, Oracle, Java, J2EE, JSP, Web sphere, Web Methods, MQ Series, Perl.

Mainframe/EDI QA Lead

Responsibilities:

• Bring meaningful information on to the table for the testing team which is easier to interpret and implement.
• Participated in Requirement Analysis, Business Analysis, Use-Case Analysis and Gap Analysis.
• Oversee all the testing activities of the team and ensure that all the testing standards are met.
• Involved in creation and execution of Test Scenarios by reviewing all Functional Specifications. Keep a track of all the Requirements.
• Conduct daily if needed and weekly meetings with the Testing Team and the Project Manager. Report out the Testing Status on a daily basis.
• Developed Detailed Test Plans, Test Scenarios, Test Cases, and Test Data for Black box test phases. Escalated the issues in the project/software to the Project Manager and follow up for quick resolution.
• Communicate the changes in the timelines and schedules to the testing team and conduct the activities accordingly.
• Conducted Functional, Integration, Regression, Database Integrity and User-Acceptance UAT .
• Developed complex SQL queries using joins, sub queries to test data against the source and target and to validate data and verifying referential integrity.
• Involved in testing the Claims adjudication and HIPAA EDI transactions. Also tested the integration between Claims engine and other systems like Providers, Eligibility and Member Services data.
• Reported defects in Quality Center and interacted with the developers to resolve technical issues. Ensure that the defect is fixed and the functionality is re-tested.
• Involved in testing the Member data and Claims that are processed in Mainframes.
• Extensively worked with EDI ANSI X12 270/271, 276/277, 837 835 transactions.
• Worked with JCL extensively to schedule and execute the jobs.
• Wrote the SQL queries on data staging tables and data warehouse tables to validate the data results.
• Tested the Adjudication of Claims, claims pre-pricing, and claims logging.

Hardware/Software: Quality Center, HIPAA Validator, EDI, SQL, PL/SQL, Oracle 10g, Mainframes COBOL, DB2, QMF, TSO/ ISPF, JCL, CICS , Putty, UNIX.

Test Lead

Responsibilities:

• Performing System Integration testing SIT to validate the Integrity of the data between the Siebel.
• Assisting in test planning, documenting requirements Traceability Matrix and mapping test cases.
• Executing test suites for data integrity of Siebel data through Ad-Hoc reports from SAP-BO.
• Responsible for updating Test Completion Matrix reports to monitor testing progress.
• Identified services and developed test cases for Web Services functional testing of the Web portals.
• Validating the TRx, NRx and Copay amounts extracted by the ETL workflows from various data sources and reported in Business Objects WebI reports.
• Executing Informatica workflows from UC4 scheduler and directly from the Workflow Manager to execute the Test scenarios of data integration from source to target tables.
• Writing SQL Queries on local Sybase database to retrieve data and match Siebel data.
• Developing complex SQL queries using joins, sub queries to test data tables against the source and target and to validate data and verifying referential integrity.
• Verifying the Informatica Log Files and Error Exception handling in UNIX environment.
• Responsible for logging and updating Defect Status in Quality Center for SharePoint and Siebel.

Hardware/Software: Agile, UNIX, Windows, Quality Center, SQL, J2EE, AJAX, XML, Oracle 10g, SoapUI, Mainframes Cobol, DB2, QMF, TSO/ ISPF, JCL, CICS ,TOAD,XML, Informatica, Siebel.

Test Lead/Business Analysis Support

Responsibilities:

• Participated in requirements gathering phase and documented proposed processes to the existing system.
• Served as a point of communication between the Business Stakeholders and the Testing Team.
• Ensure that all the protocols are followed and the testing standards are met.
• Worked with JCL extensively to schedule and execute the jobs.
• Claim Transactions and Billing Transactions Created flows for adequate matching of Claims. Matched Billing File and EDI Claim File records upon receipt.
• Verified applications associated with Claim Numbers so that duplicate Claim Numbers could be eliminated in the system. Updated the Electronic Claims, Patient Screen.
• Claims Processing Files and HIPAA Guidelines adherence.
• Organized daily and weekly meetings. Prepared the agenda and published the meeting minutes.
• Work with the Project Manager for Project Milestones and Timelines and ensure that they are met.
• Duplicate Claim Number Project Enhanced three different applications EDI Feeds and Patient Screen App to remove duplicate claim numbers.
• User Acceptance Testing UAT Performed UAT tests using the MORAE Usability Testing Tool using the Observer and the Manager Mode along with the testing team.
• Testing - Developed Test Scripts and coordinated with developers to quickly resolve the defects.
• Wrote SQL queries on data staging tables and data warehouse tables to validate the data results.

Hardware/Software: Visio, Word, Excel, PowerPoint, CMMI, Rational Rose, Requisite Pro, Clear Case, Clear Quest, SQL, Oracle, J2EE technology, Java, Perl.

Test Analyst

Responsibilities:

• Met with report users and stakeholders to understand problem domain, gathered customer requirements through surveys, interviews group and one-on-one along with JAD sessions.
• Managed and tracked the status of requirements throughout the project lifecycle enforce and redefine as necessary and leveraging these processes.
• Generated Test Metrics showing the number of test cases executed, number passed, number failed and number left to execute in weekly meetings.
• Executed System Integration SIT and Regression testing for all critical EDI 837 transactions.
• Tested all HIPAA transactions for version 4010 and validating the database to file elements.
• Developed complex SQL queries using joins, and sub queries for data validation.
• Analyzed Test results. Identified discrepancies, logged and communicated defects.

Hardware/Software: AS/400 mainframe, Windows XP, MS Office Tools, UML, Ms Visio, Diamond.

System Business Analyst

Responsibilities:

• Understanding business requirements for Medicare Part C and D file required for CMS.
• Identified Use cases for Group, Claims and Enrollment process.
• Extracted within Facets for Group and Eligibility, Provider and Claims related information.
• Captured and re-tested Claims 837 and Claim Status Request/Response 276/277 .
• Analyzed with business to define integrated test case scenarios.
• Wrote SQL joins Store Procedures to retrieve data to test the validity of reports generated.

Hardware/Software: FACETS, AMISYS, Citrix, UNIX, Oracle 10g.