PROFESSIONAL SUMMARY

Experienced Healthcare Consultant with over 8 years of diverse information technology experience with emphases on Quality Assurance, Business Analysis, System Integration, EDI,ETL, Data Analysis, Reporting and implementation support activities.

PROFILE

• Experience in gathering, analyzing, and documenting functional/business requirements and writing use cases, based on information gathering sessions with clients/stakeholders and technical team members.
• Experienced in creating Test Plans, thorough hands on experience with designing test cases covering all test conditions and eliminating redundancy and duplications.
• System specification analysis, testing methodology and test plan formulation from Business requirements.
• Strong Knowledge of SDLC Software Development Life Cycle .
• Strong knowledge of Six Sigma methodologies.
• Expertise in planning and managing projects based on Rational Unified Process RUP covering the full range of the software development life cycle SDLC .
• Vast knowledge and experience in Health Care industry, experienced in testing different healthcare ERP solutions such as FACETS, MedPlus, EPIC and other claim processing solutions.
• Experience in testing Electronic Data Interchange EDI according to HIPPA Compliance.
• Good understanding of ICD-9 and ICD-10 Codes.
• Experienced in Black Box testing, Database and Backend testing.
• Good experience in creating, modifying and enhancing both manual Test Scripts and Test Scripts created by Test Automation tools- Load Runner, Quick Test Pro, Rational Robot.
• Vast Working Experienced in Web-based environment.
• Expertise in using data modeling tools like SQL Diagrams, Erwin.
• Experienced in ETL testing using Data Stage, Informatica and BW.
• Experience in BI Tools Reporting Services, Integration Services and Analysis services .
• Experienced in SQL, PL/SQL, data ware housing,Oracle and MS SQL Server.
• Ability to understand analyze business processes workflows with the objective of providing recommendations for the best use of technology to improve the process.
• Extensively involved in Performance Testing, Load Testing, Stress Testing.
• Experienced in Data Driven Testing, Batch Testing, Functionality Testing GUI Testing, Regression Testing.
• Exclusively used Security Testing, Usability Testing, Positive Testing, System Testing.
• Experience in Backend Testing using SQL queries and Unix Shell Scripts. Experienced in using Test Central, Test Director, ClearQuest and other bug reporting tools.
• Experienced in Upgrade and Configuration Testing.
• Excellent Communication and Documentation Skills.
• Experience in interacting with business analysts, developers, and technical support and help them base line the requirement specifications.
• Proven ability to work cooperatively effectively with business, team, systems partners.
• Strong communication skills, both verbal written, with particular emphasis on the production of clear detailed written Test Plans, Business Requirements, Functional Specifications..

WORK EXPERIENCE

Confidential

Role: Sr. QA Analyst

Responsibilities:

• Worked on Professional, Institutional and Dental Claims. Involved in data preparation of both 4010 and 5010 837 transactions. Worked with both Errata and Non Errata 5010 transactions.
• Tested HIPAA transaction sets for both 4010 and 5010 A1/A2 versions and specifically tested the crosswalks which highlight the additional elements added in 5010.
• Worked with different Trading Partner Setup.
• Analyzed and validated different X12 files such as 270/271,276/277, 277 CA, 835. 837 and 999 using Edifecs Spec Builder.
• Wrote complex SQL queries to perform backend testing.
• Worked with test plans and created test cases for ETL loads from X12 files to target Databases and then from Databases to output X12 files.
• Extensively involved in validation of one to one mapping and Complex routines based on Cross walk data mapping.
• Validated data loads from X12 files to Main Frame.
• Created data mapping spreadsheet for the user stories as per the Implementation Guide to capture the business process.
• Wrote defects in Quality Center, created reports and graphs using Quality Center.

Confidential

EDIConsultant

One of the largest health care providers in the Confidential market, Cigna also operates internationally in 29 countries, and has approximately 66 million customer relationships worldwide. CIGNA has upgraded its X12 formats from 4010 to 5010 version with the help of its prime vendor HP that also hosts its most of claim processing system.

Environment:Mainframe,UNIX, Edifecs Spec Builder, Java, XML, Oracle, Quality Center

Responsibilities:

• Performed Report testing build in Cognos, and validated the data quality by running the SQL Queries using TOAD for pre and post baseline.
• Responsible to verify all data was successfully processed and trouble-shoot any failures during translation and address the issues to the team.
• Worked extensively in validating 837 Dental, Institutional and Professional loop 2300 which consists the claim information for both 4010 and 5010 and also created various test data for validation purposes.
• Extensively involved in Electronic Data Interchange EDI designing and Implementations. Analyzed different HIPPA transactions such as 837 inbound/outbound, 835, 997, 999, 270,271, 276,277 etc. Involved in implantation of both HIPPA X12 4010 and HIPPA X12 5010.
• Performed System Testing and System Integration Testing, Retested Cigna priority defects assigned to HP.
• Validated different X12 transactions based on X12 Cross Walk data mapping, used both companion and Implementation guide for analysis.
• Extensively used Edifecs Spec Builder to validate HIPPA X12 Compliances, performed HIPPA WEDI Snip Validation using Edifecs Spec Builder.
• Updated X12 837 transactions using Edifecs from 4010 to 5010 compliance validated 4010 to 5010 upgrade.
• Extensively involved in testing of ICD9/ICD10 conversion.
• Tested ETL processes built in Data Stage.
• Performed End to End testing of ETL processes from Source X12 files to databases and from databases to Outbound X12 files.
• Tested Direct Mapping and Complex Routines bases on ETL Cross Walk Mappings.
• Conducted the drop load and incremental testing of source and destination databasesPerformed Regression testing.
• Wrote defects using Mercury Quality Center, Analyzed test results using reports and graphs generated in Quality Center.

Confidential

Sr. Software System Analyst/EDI Analyst

Confidential and Heathens HEOS and as a part of overall ALC/HEOS implementation, ALC/HEOS Claim Receive and Deliver project which is focused on business process of receiving, validation, loading, packaging and delivering American Life Care ALC and HealthEOS HEOS .

Environment: Trizetto NetworX , UNIX, Java, XML, Oracle, Sybase, Quality Center

Responsibilities:

• Analyzed system requirements.
• Validated ICD-9 Codes in Trizetto Networks pricing engine.
• Wrote Stored procedures, Functions, Triggers and Complex SQL queries in Oracle 10g
• Performed data mapping of EDI flat files to oracle Data bases.
• Performed the Backend integration testing to ensure data consistency on front-end by writing and executing SQL statements on the Database.
• Performed Sanity and Smoke, User Acceptance, Load, Functional, EDI and Data Driven testing.
• Performed ETL testing and validation of End User Reports.
• Worked to resolve customer issues with proactive support, developed point solutions and prototypes components, created factory with best practices and reusable components
• Performed Verification and Validation and wrote defects using Mercury Quality Center
• UHG is an innovative leader in Health Care Industry, serving more than 55 million members across United States. AmeriChoice is a business unit of UnitedHealth Group, serves more than two million beneficiaries of government health care programs in 21 states and the District of Columbia.

Confidential

Facets System Analyst

Confidential is awarded as qualified Contractor to provide comprehensive health insurance coverage for Mississippi children determined to be eligible for the Children's Health Insurance Program CHIP by state of Mississippi. For this new Mississippi market Americhoice using Facets as core system integrated with UHG sub-applications.

Environment: Quality Center, Facets 4.41,Informatica,Cognos,UNIX, Oracle, Sybase

Responsibilities:

• Worked with Business team, Development team and externals Vendors to review BRD's in order to define test strategies and test plan.
• Lead FACETS QA team in MS CHIP, defined test scope, setup up test environment and test data.
• PerformedSystem and System Integration testingfrom core Facets to different UHG and external vendor's subsystems.
• Prepared test plans on various Facets modules such as Membership, Claims, Providers, Finance, Customer Serviceandaccording to MS CHIP plan requirement.
• Performed extensive testing in Facets Subscriber/Member, tested Groups, Eligibility, and Enrollment and validated outbound 834 Extracts to different Vendors.
• Coordinated with different external vendors to accommodate MS CHIP plan integration, wrote detail test plans to test core Facets with extended UHG and External Vendors sub applications such asSMART, ppoONE, CareOne, Thomson Reuters etc.
• Prepared state review documents to get approval on respective tasks from states.
• Perform Extensive EDI testing on X12/4010 837,835, 270 etc, worked with state vendor ACS to validate inbound /outboundEDItransactionsto Facets.
• Created detail test plans for Pharmacy, Dental and Vision claims which were processed by External Vendors RxSolution, Dental Benefit Provider DBP , and Vision Service Provider VSP .
• Extensively involved in data validation between 834 Membership file to Facets backend tables and from Facets Backend tables to different external EDI extracts based on MS CHIP plan requirement.
• Tested ETL process for the load of 834 Files to Facets Database.
• Tested various Membership reports built in Cognos.
• ProvidedFacets related systems expertise training to system users, business partners, and other internal/external customers including trouble shooting issues, as well as, identifying and correcting inefficiencies.
• Responsible for verifying data integrity from several distributed systems to Facets system.
• Designed Regression Test Bed for regression testing in order to check core Facets system after changes made due to MS CHIP plan implementation.
• Extensively performed System and System Integration testing.
• Facilitated User Acceptance Testing by creating UAT test scripts in order to test end-user functionality and to ensure that business requirements were met.
• Extensively performed Partner Testing to make sure all the external components are receiving data from FACETS according to new MS CHIP plan configuration.
• Used Mercury Quality center for defect tracking and prioritizing defects and for enhancements after base lining the requirements.

Confidential

BA/QA Analyst

Confidential is currently Upgrading Facets 4.31 to 4.61 release. Upgrade includes Facets 4.61 , custom interfaces, custom extensions, conversion components, mini apps, EDI, new business functionality, regression testing. This will include reviewing what custom development is modified and evaluation of business process. This will also support the business functionality needs of the CP-SS product roadmap. As more Regence business moves to Facets we will create a repeatable process where the business and IT can regularly evaluate the new functionality released by TriZetto.

Environment: Rational Manual Tester, Rational Clear Quest, Facets 4.31,Facets 4.61, UNIX, Java, XML, Oracle, SQL Server, Sybase, Mainframe, Data Stage

Responsibilities:

• Identifies the motivation for and ideas behind the test areas to be covered.
• Outlined testing approach, test scope, Entry Criteria and Prerequisites, Exit Criteria and Deliverables and testing environment.
• Identifies the required resources other than personnel resources i.e. Hardware, Software, Access, Data, Security, and Application Training. that will used as SME's, Test Analysts, Data Analysts or Application support.
• Identified the all the core facets and Regence sub-application that are targeted for testing.
• From Facets 4.61 release notes identified changes between 4.61 and 4.31, and specifically tested impact of these changes on Regence core and sub-applications.
• Cordiant testing efforts between Integration, User Acceptance and End to End testing.
• Perform core facets testing on Batch Jobs and Interfaces, Membership Enrolment Application, Online Group/Subgroup , Online Subscriber/Member Loads ,Online Billing, Online Commission, Online UM, Online Claims Medical, Hospital, Dental , Online Accounting, Online Customer Service and Pricing and workflow.
• Extensively performed parallel testing in Facets 4.31 and 4.61 to check effects of 4.31 in Regence sub-applications or extensions.
• Perform volume testing of claims in both Facets 4.31 and 4.61 to check end to end status of claims under identical situation.
• Involved in high level Integration and User Acceptance Testing that includes testing of all new features from 4.31 through 4.61
• Worked as a ETL tester to test ETL transformation in Data Stage.
• Extensively involved in testing of transformation rules from Source databases to Integration Database servers and then from Database Servers to Target databases.
• Tested Analytical reports built in Cognos.
• Tested all the Trizetto hosted andnon-hosted batch jobs as a part of Sanity and smoke testing to make sure all the components or sub-applications are mapped with Facets 4.61.

Confidential

Sr. Test/Claim Analyst

Confidential is the leading publicly-traded company dedicated exclusively to caring for the financially vulnerable, seniors and people with disabilities through publicly-funded programs. Confidential group is currently serving around 1.7 Million members across 10 different states and District of Columbia.

Project Description:

• The project goal is to improve the Sigma Level to greater than 3.2. Reduce the number of pended claims due to authorizations to less than 4 . Reduce the COPQ by 50 .
• Environment: QualityCenter, QTP, UNIX, C, C , Pearl, PL/SQL, Oracle, SQL Server, FACETS, AMISYS, Manual Testing.
• Responsibilities:
• Served as a lead for the Facets testing effort on WS7, involved in the Reviewing of Requirements Specification with functional manger and technical specialists.
• Develop testing strategy and test plan, outlined various capabilities of the testing process. Describe the tasks of each testing capability, outlined roles and responsibilities related to the testing process.
• Coordinate working sessions for testing communicate risks/issues to WS7 project leads.
• Review the test environments that will support the various testing capabilities, highlighted testing schedule across all testing capabilities.
• Analyzed current Claim Authorization Process across all the FACETS Markets. Identified possible constrains that pends claims related to Claim Authorization Mismatch.
• Configured best suitable Facets CLUM Settings in order to auto-adjudicate maximum number of pended claims.
• After the successful configuration of CLUM settings, performed Volume, Parallel and Post Validation Claim testing to validate new CLUM settings and to ensure nothing else in claim processing is effected due to new CLUM settings.
• Recommended improvements to standardize authorization and claim process in order to increase auto-adjudication of pended claims related to Authorization Mismatch.
• Analyzed test results using reports and graphs generated in QualityCenter.
• Wrote test cases and test scripts, execute test scripts and analyzed outcomes.
• Created and maintained SQL Scripts to perform back-end testing on the oracle database.
• Prepared summary reports of configuration changes, test results and recommendations.

Confidential

Cognizant Technologies

QA Lead

• Confidential provides revenue cycle management and clinical communication solutions that enable payers, providers and patients to improve healthcare business processes. Emdeon offers a full suite of products and services to automate key business functions for healthcare payers, providers, and vendors.
• One of the leading solutions of Confidential is Clearing House that process claims for different health care payers, providers and vendors. In past few years Emdeon acquire number of claim processing companies, however the product offered by these individual companies was based and processed in different platforms switches . In order to cut maintenance and process cast for all these individual switches, Emdeon recently start Batch Switch Consolidation BSC project that will consolidate all the individual switches application into one switch.

Environment: Mercury ITG, UNIX, C, C , Pearl, Main Frame, SQL, Rational Clear Case, Oracle, MS Project, SQL Server, Manual Testing.

Responsibilities:

• Actively participated in different stages of project such as Design, Planning, Development and Debugging.
• Lead the efforts in designing test strategies, creating test scopes and test standards for different phases of BSC project.
• Design System, Integration, Parallel, Performance and Post Validation testing efforts for BSC project.
• Designed Assumptions, Pass fail Strategy, Entry Exit Criteria for end to end testing efforts.
• Write test plan and test cases, prepare input data for test scenarios, execute test scripts manually or using In-House tool.
• Participated in various meetings and discussed Enhancement and Modification Request issues.
• Involved in the Review of Requirements Specification with functional manager and technical specialists of the application
• Review Unit Test cases developed by Development team perform System and System Integration testing.
• Design and Execute Regression Test Bed at the end of every phase.
• Validate different Electronic Data Interchange EDI formats such as X-12, EMCDS, PCDS and 1500 formats.
• Validate different EDI formats and transactions under HIPPA compliance.
• Performed back-end testing by extensively using SQL commands to verify the database integrity.
• Created and maintained SQL Scripts and UNIX Shell scripts to perform back-end testing on the oracle database.
• Lead a team of 4 onsite and 5 Offshore QA Analysts.

Confidential

Sr. QA/Implementation Analyst

Confidential is implementing a set of projects under a common program called CP-SS Common Process Single System . CP-SS will bring individual four states legacy system affiliated with Regence group into a common Platform to deliver valuable experiences to its members.

Environment: Rational Manual Tester V6.1, Rational Clear Quest, Facets 4.31, UNIX, Java, XML, Oracle, SQL Server, Sybase, Mainframe, Data Stage, Cognos

Responsibilities:

• Actively participated in all phases of testing lifecycle Design, Planning, Development and Results .
• Design Test Plan and test strategies based on high level business and technical documents.
• Implemented Standardized and Unified process through out the software Development Life Cycle SDLC .
• Involved with other team members to set up testing tools, implementation and testing environments.
• Involved in Designing and Analyzing of Test Scope strategies with other Test Analyst.
• Write Unit, Integration and System Test cases using Rational Test Manger from Functional, Technical and other high level documents.
• Extensively involved in writing Test scripts using Rational Manual Tester to perform Manual and Automation testing on the AUT under the different Programming Environment.
• Performed Sanity and Smoke Testing of the application manually after each build.
• Write test cases using Rational Test Manger and Rational Manual Tester for Functional testing.
• Tested 834 ETL process bases on Cross Walk mapping.
• Validate EDI Claim Process according to HIPPA compliance.
• Conduct Business, Functional, User Acceptance and Usability testing.
• Involved in creation and maintenance of Test Matrix and Traceability Matrix.
• Write UNIX Shell Scripts to perform Backend testing.
• Perform Backend testing by extensively using complex SQL queries to verify the integrity of the database.

Confidential

Database/Upgrade QA Engineer

Currently working in a Motorola in a web based application called Kamet this real-time application is developed for various wireless providers globally such as Cingular Wireless USA , Telefonica Spain etc. This server based application enables customer to access RSS feeds News, Weather, Sports etc on their Motorola wireless phone.

Environment: Test Central, Rational ClearDDTS, Windows XP, Toad, DB Commander, UNIX, Java, Java Script, XML, Oracle, QTP, Test Director, Manual Testing.

Responsibilities:

• Involved in the Review of Requirements Specification with functional manager and technical specialists of the application.
• Participated in setting up testing environment.
• Participated in Test Planning.
• Performed Security, User Acceptance, Regression and Usability testing.
• Manually test each and every module of the application and verify against expected results.
• Performed Back-End Testing of the application for Oracle databases.
• Checked the schema of Oracle database manually or using Toad after every upgrade.
• Compare Database Schema between different builds and Track the defects generated due to schema changes.
• Extensively involved in DataWare House Testing.
• Perform Back-end testing for reusability by writing UNIX ShellScripts.
• Created and maintained PL/SQL Scripts and UNIX Shell scripts to perform back-end testing on the oracle database.
• Extensively involved in Batch Testing.
• Used TestCentral for Project management, Test Case writing and planning.

Confidential

Business Analyst

Confidential's largest Medical Assistance Medicaid managed care health plan serving more than more than 250,000 Medical Assistance recipients in Southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Key Stone is implementing Facets to manage their healthcare needs.

Environment: FACETS, Quick Test Pro, Test Director, Facets, Windows XP, C , PL/SQL, Oracle, UNIX, Manual Testing.

Responsibilities:

• Captured all the requirements for new feature implementation, up gradation and had a complete walkthrough on the existing application and documentation
• Clearly defined systems work scope and objectives based on business requirements
• Worked to resolve customer issues with proactive support, developed point solutions and prototypes components, created factory with best practices and reusable components
• Coordinated and facilitated key upgrade activities like Facets conversion, upgrade and patch implementation
• Wrote test cases for Extracting, Transformation and Loading ETL data using from the legacy systems to Oracle.
• Validated data mapping between Source and Target databases using SQL queries.
• Analyzed bi-directional EDI interface eligibility export and claims import with Rx vendors and prepared interface specification document
• Coordinated with the design team for EDI transaction code set X12 835, 837, 270 development and ensured compliance with standards for HIPAA
• Performed User Acceptance Testing, system and data testing of enhancements including regression testing

Confidential

QA Engineer

Confidential is a mortgage provider on the east coast. Wachovia was updating their website to include online application for home loans and wanted to retain the data thus collected from the applicants. They also wanted to maintain a database of the applicants who were rejected, including the basis of rejection so as to focus on those criteria on re-application by same applicants

Environment: Win Runner, Load Runner, Test Director, UNIX, SQL, Windows 2000, DB2, Oracle, SQL Server 2000,JSP, UNIX, C , TestDirector, Manual Testing.

Responsibilities

• Prepare test plan, test cases and test procedures in accordance with the Business Requirements.
• Performed Regression, functionality, System, Performance, Interface, front end, back end, negative, positive and User Acceptance Testing using Mercury WinRunner/LoadRunner.
• Conducted load testing, front end testing and security testing.
• Documented Test cases for Functionality, Back End Testing.
• Performed the Backend integration testing to ensure data consistency on front-end by writing and executing SQL statements on the Database.
• Analyzed the results from online monitors and generated reports using Load runner.
• Performed Backend testing using PL/SQL Queries.
• Performed auto correlation testing for checking difference in two versions in LoadRunner.
• Conducted manual data integrity testing using SQL
• Data Driven Testing to test the application with different sets of data.
• Prepared Load test Strategies for the application and set guidelines for best practices.
• Tested Reports functionality and result applying Business rules with estimated Results.