SUMMARY:

Over 7 of IT Experience in Healthcare industry. Experienced in Test Plans and Test Cases for different types of software testing. Expertise in QuickTest Professional QTP and ALM/Quality Center/ Test Director. Claims adjudication, billing, provider, eligibility and prior authorization for Medicare, Medicaid and Blue Programs. Good knowledge of 21 CFR Part 11, ICD-9/ICD-10 and HIPAA 4010/5010 Transaction requirements. Experienced in various types of testing including Smoke Testing, Functionality Testing, Performance Testing, Volume Testing, Unit Testing, Integrated Testing, System Testing, Positive and Negative Testing, Security Testing and Regression Testing of, Web Based and Client-Server applications. Solid experience in Web Service testing using SOAP UI. Performed Back End Testing by executing SQL queries. Excellent Working Knowledge of HIPPA, Claims Processing, FACETS. Experience working on HIPPA ANSI X12 EDI 4010/5010 conversion, User Acceptance Testing UAT manually.

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

Confidential

Sr. QA Analyst

Responsibilities

• Responsible for Preparing the Test Conditions as per the Business Requirement Document.
• Involved in Test Plan and Test Cases Preparation using RQM Rational Quality Manager .
• Followed Agile Methodology to emphasize on real time communication over written documentation.
• Worked on CA-MMIS Mainframe legacy system for claim processing.
• Broad knowledge of CA-MMIS California- Medicaid Management Information System .
• Performed End-To-End Testing to validate Daily and Weekly Batch processing for the ICD-10 Implementation, Crosswalk of ICD-10 to ICD-9 Diagnosis and Surgical procedure Codes.
• Worked extensively for EDI transaction for Claims status and Payment/Advise 837I, 837P .
• Worked on Financial Analysis of DRG shifts from ICD 9 to ICD 10 to avoid any over or under payments to the providers
• Worked on building ICD 9 to ICD 10 crosswalk map by grouping thousands of codes and ranges in Clinical, Benefits, Financial, Medical policy waves
• Conducted working sessions to gather and document high level business requirements and detailed level business requirements for different business units impacted by ICD 10 such as EDI Claims Intake, Claims Adjudication, Medical Management- Utilization Management, Case management and Provider Reimbursement- Provider Payment
• Coordinated with the project team on MS SharePoint to reduce redundancy across two systems.
• Submitted Medical Claim through different entry point such as EDI, Real Time, POS and Paper.
• Worked with ICD 10 diagnosis codes, CPT and HCPCS codes embedded in different systems and applications
• Performed different types of testing such as System, Functional, Integration, Positive and Negative.
• Worked on parameterizations, calling/copying, Check points heavily.
• Defect reporting and bug tracking using Rational Clear Quest Tool.
• Responsible for documentation of all the test case along with the screenshots from mainframe

Environment: Windows 7, Mainframe, Rational Quality Manager, Rational Clear Quest, Agile, HIPPA, EDI, CMMIS, SharePoint, Edifecs SpecBuilder, SlickEdit, and Test Scenario Application TSA

Confidential

Sr. QA Analyst

Responsibilities

• Responsible for testing the Navigation Flow, Functionality Testing, System Testing and User Acceptance Testing.
• Have good exposure to modern agile methodologies such as SCRUM and TDD.
• Prepared Test Data and executed Test Cases from Quality Center.
• Prepared test data and helped load test data into the test database environment.
• Testing of EDI X12 837P, 837I ,837D and 835 Transaction sets for claims processing
• Created and tested different reports like Cross Tab, Parameterized Reports, Tabular, Freeform Reports and Ad-Hoc Reports using Business Objects Reporting tool for Claims, Members, and Providers and Billing modules
• Tested the HIPAA EDI, 834, 837/835 transactions according to test scenarios and verify the data feed incoming/outgoing from Amisys system to various other vendor and supporting applications.
• Principles in an agile or test driven methodology environment.
• Created and maintained SQL Scripts to perform back-end testing on the oracle database.
• Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
• Perform static, functional, technical integration, end-to-end and User Acceptance Testing
• Worked on Health Plan Services especially Medicaid and Medicare programs in contract with the state of Kansas and New Jersey
• Took part in associating ICD 10 code sets to CPT, HCPCS code sets and modifiers.
• Prepared test cases against the use cases and data flow diagrams to analyze the impact of ICD 10 diagnosis codes, CPT and HCPCS codes embedded in different systems and applications
• Involved in reviewing complex SQL queries, views, functions and stored procedures and spotting issues before/during code migration.
• Created several Test Cases and Test Conditions for testing various Claims, Membership, Billing and Provider reports
• Tested various versions of handheld devices to perform cross platform and browser compatibility testing.
• Performed backend testing for data validation using SQL Queries.
• Performed rigorous manual testing such Functional Testing, Smoke testing, Integration testing, UAT Testing, Backend Testing, Regression Testing, End to End Testing and System Testing
• Used Quality Center to run test scripts and log defects.
• Analyze and make specific recommendations on improvements that can be integrated into business processes
• Participate in reviews throughout the development life cycle
• Reviewed extensive SQL Queries with complex multi-table joins and nested queries.
• Assisted in developing test plans for testing the functionality, GUI, and security.
• Performed manual testing, considering the base line of developed test plan and Test Cases considering both positive and negative scenarios
• Test scenario identification and alignment to service oriented architecture implemented within organization
• Created different pricing rules and verified whether the adjudication system is using the rules while adjudicating the Claims

Environments: MS Project, MS Office, Visio, ALM HP Quality Center 11, SQL, Java, Clear Quest, ALM, Oracle, FACETS, Agile, Scrum, HIPAA

Confidential

QA Analyst

Responsibilities:

• Analyzed the objectives and scope of each stage of testing process from the Test plan.
• Interacted with business analysts to gather the requirements for business and performance testing.
• Participated in the Manual Vs Automated testing decision-making process.
• Responsible for testing the Navigation Flow, Functionality Testing, System Testing and User Acceptance Testing.
• Interacted with users and vendors for full life cycle of project.
• Written Medicare COB functional Requirements, Test steps and Test cases in Quality Center
• Analyzed all types of the workers compensation, Disability insurance and provider Claims.
• Prepared Test Data and executed Test Cases from Quality Center.
• Worked with Web services and created XML files for EDI X12.
• Involved in 4010 TO 5010: 837 and 835 files and ICD 10 and Procedure codes scenarios.
• Life cycle test for various products contracts.
• Responsible for Performing Integration Testing, UAT testing. Conducted Back-End Testing Using SQL Commands
• Extensively used SQL statements to query the Oracle and DB2 Database for Data Validation and Data Integrity.
• I have validated the XML Request passed to web server and the XML responses
• Conducted Functionality testing during various phases of the application.
• Analyzed the SOAP UI responses of test results and compared them with database tables for its validity using SQL Queries.
• Automated test scenarios for GUI, Functionality and performed data driven testing on the application inserting different data in excel sheet
• Worked on parameterizations, calling/copying, Check points heavily.
• Performed extensive manual testing.
• Extensively performed manual testing using Quality Center.
• Defect reporting and bug tracking using Quality Center.
• Created test cases and automated them for the purpose of regression testing and functional testing with check points using Quick Test Professional.
• Analyzed the functional requirement documents, system requirement documents and business requirement documents.
• Assisted in developing test plans for testing the functionality, GUI, and security.
• Performed manual testing, considering the base line of developed test plan and test cases considering both positive and negative scenarios.
• Performed Integration, Functional, GUI and UAT testing
• Interacted with developers to resolve defects.
• Developed automated scripts using QTP to perform functional and regression testing
• I was responsible to create test data for functional testing and UAT.
• Performed functional testing for new release enhancements.
• Participated actively in the team meetings with the developers for bug reviews.

Environment: Quality Center, QTP, SOAP, Web Services, ClearCase, Html, XML, Web Sphere, Oracle, SQL, UNIX, Mainframe, Windows XP

Confidential

QA Tester

Responsibilities:

• Created SQL statements to validate the data tables
• Developed several hundred of test cases to cover the data movement between sources to target
• Developed test scripts in SQL to check the data integrity from the databases
• Imported preexisting Microsoft Word and Excel-based requirements and tests for analysis in MQC.
• Understand and develop Web Services test strategy for different services as part of SOA
• Developed Test Plans, Test Cases to test the Screens and workflows for Quality Assurance.
• Performed Positive and Negative Testing Manually. Actively participated in walkthroughs and enhancement meetings
• Implemented technical solutions for complex state-mandated prospective claims pricing methodologies
• Performed negative and positive testing manually, along with functionality testing
• Actively participated agile and scrum meetings, review and developed test scenarios.
• Prepared test data and helped load test data into the test database environment.
• Analyzed all types of the workers compensation, Disability insurance and provider Claims.
• Stimulate financial calculations for a given formula for a given period.
• Maintained Test Matrix and Requirement Traceability Matrix
• Performed Gap Analysis. Validate the date from EDI transaction
• Analyzed and worked with HIPAA specific EDI transactions for claims, membership enrollment, billing transactions.
• Used Ramp up and Ramp Down options in Load Runner to simulate real time scenarios.
• Document request/response XML's, test procedures and functional/technical findings from the test run
• Develop, design implement department plan to operationalize new FACETS integrated processing system, to include but not limited to, workflow, management oversight and performance analysis.
• Authored test case scenarios in Excel spread sheet and export them into Mercury Quality Center.
• Extensively used SQL statements to query the Oracle Database for Data Validation and Data Integrity.
• Executed test cases found errors reported defects, determined repair priorities, did regression testing and closed by using Quality Center.

Environment: Quality Center, ClearCase, Html, SQL, UNIX, Mainframe, Windows XP, Oracle, MS Project, MS Office

Confidential

QA Analyst

• Responsible for review of requirements from Business Functional Specifications and conducted code as well as application design walkthroughs with Business, dev. team and test team members respectively to create Application Design Document.
• Executing System Test scripts developed in Test Director manually.
• Performed Gap analysis and assessed risks of the project
• Managed Project description and defining the design steps in Test Director.
• Followed Agile Methodology to emphasize on real time communication over written documentation.
• Automated test scenarios for GUI, Functionality and performed data driven testing on the application inserting different data in excel sheet using QTP
• Participated in building automation test scripts based on BPT module of Test Director.
• Prepared Test Plans and Test Cases based on the functional requirements and HIPAA regulations like 834, 837, etc.
• Worked with different modules of Test Director such as Requirements, Test Plan, Test Lab, Defects and Dashboard module.
• Performed Manual Testing to check the usability of the application.
• Executed Configuration Testing to check if the application was compatible in different environment for each module of the application.
• Had thorough knowledge of agile methodology. Attended daily scrums, sprint planning and Sprint Kick off
• Tested HIPAA regulations in FACETS HIPAA privacy module.
• Conducted Back-End Testing manually for the purpose of Database Integrity.
• Developed test scripts in SQL to check the data integrity from the databases
• Bug Reporting and Tracking using Test Director
• Performed User Acceptance Testing UAT
• Generated defect reports using Test Director and presented using MS Office tools

Environment: Windows XP/2000/NT, FACETS, Quality Center, QTP, Load Runner, DB2, Java, UNIX, SQL, HTML, ASP.NET