Professional Summary

• 8 years of professional experience as QA Analyst/EDI Analyst/Software Tester in various System Integrations and Business Applications for Health Care Industry Retail domains.
• Strong knowledge on HIPAA standards, ICD9/ICD10, EDI transactions 4010/5010 versions, Medicare and Medicaid Services.
• Strong Knowledge on claim processing and EDI transactions i.e. Claims Inquiry and Response 276/277 , Receipt and Verification of claim forms 837 , Claim Payment and advice 835 , Eligibility Inquiry and Response 270/271 , Certification Request and Response 278 , Benefit Enrollment 834 , Order and Payment Remittance 820 , Functional Acknowledgement 997/999 .
• Experience in Mainframe Batch Cycles Online Real-time Processing.
• Experienced in Batch Processing EDI interfaces in healthcare domain.
• Involved in testing the claims conversion from Mainframe to Facets. Also involved in testing the EDI transactions 834, 837, 835. 270/271 276/277 conversion to Facets.
• Experience in testing Web Based and Client Server Facets, Healthcare Payer Application applications on different platforms.
• Experience in Revenue Cycle Management RCM for Insurance claims processing and payment.
• Experienced in Data Driven Testing DDT and creating reusable functions with HP QTP Tool.
• Experienced in project management skills like scheduling, monitoring in gap analysis, risk analysis.
• Expertise in B2B standards, Implementation of Integrated EDI and XML applications and Enterprise Application Integration EAI for business processes across applications.
• Experience in SOA based Testing, worked extensively on TIBCO, a SOA tool for Data Integration.
• Manual Testing skills include White Box Testing, Black Box Testing, User Acceptance Testing, System Testing, Regression Testing, Integration Testing, Load Testing, Security Testing, Joint Alliance testing and Smoke Testing.
• Experience in CLAIMS, MEMBERSHIP, ENROLLMENT, BILLING.
• Experienced work in with X12 version 4010/5010 transactions, GAP analysis, design and migration strategy.
• Checked the HIPAA compliance of the manually created 27X transactions using the Edifecs Analyzer tool.
• Expertise in COBOL, CICS, DB2 LUW, VSAM, JCL, File Manager, QMF, SPUFI and File-Aid.
• Extensive experience with testing Multi-Tier application architecture.
• Competent in Creating Unified Modeling Language UML diagrams such as Use Case Diagrams, Activity Diagrams, Class Diagrams and Sequence Diagrams.
• Familiar with performing Business Analysis and Testing software and web application developed in C, C , Java, JSP, HTML, and XML.
• Have a good knowledge of Rational Unified Process RUP .
• Experience testing Data Marts, Data Warehouse, User Reports using ETL tool IBM Ascential Data Staging.
• Experienced in HL7 electronic health information exchange.
• Efficient in delivering tasks, team player with good communication and interpersonal skills.

TECHINCAL SKILLS

Professional Experience

Confidential

QA Analyst

Responsibilities:

• Automated and customized the scripts for the entire application using Quick Test Professional
• Parameterized the test s and modified steps affected by parameterization.
• Reviewed the Business Requirement specification Document and the technical specification of the application.
• Reviewing System Requirements to define testing scope for various levels of testing Functional, System, Regression, and UAT .
• Worked as a liaison between the Technical and Business partners for getting the EDI systems readily available.
• Experience testing Transaction processing system for End Users during UAT and ensuring that payments made and received were calculated based on all the Business rules.
• Experienced in configuring, backing up and recovering all EDI transactions.
• Worked on Amisys system - Testing of Enrollment and Claims Services for upgrade of AMISYS 4.0 to 6.0.
• Involved in Developing a System Breakdown of the Billing Cycle in order to create quality management testing in Amisys.
• Involved in testing the Transactions in EDIFECS Transaction Manager.
• Uploaded Test EDI files via EDIFECS Specbuilder 5.1 to validate data as per the Requirements.
• Benefit configuration and coordination, data abstraction and data mining via AMISYS.
• Created manual and automated Test Cases and Test Scripts using ALM and QTP.
• Provided technical support, managing change requests, and the development of customizations including workflows, templates and reports for single, enterprise-wide HP Quality Center environment using software development lifecycle SDLC processes.
• Wrote SQL queries to test the application for data integrity.
• Tested User Interface inconsistency and application functionality.

Environment: QCARE MF, PPO MF, Windows 2000, EDI X12N 4010 5010, EDIFECS Transaction Manager, Specbuilder, HTML, Java, MS SQL Server, Test Director 7.0

Confidential

Brentwood, TN

Responsibilities:

• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts.
• Performed Smoke, Integration, Functional, Regression, and System testing.
• Involved in interviewing Subject Matter experts SMEs and carefully recording the requirements in a Business Requirements Document BRD for the eCPR system.
• Created Process Flow Diagrams, Activity Diagrams, Sequence Diagrams and ER Diagrams in MS VISIO and Rational Requirement Composer RRC .
• Created Use Cases and Use Case Diagrams in Rational Requirement Composer RRC .
• Participated in EDI X12 transactions including 834, 820 and 999s. Triage calls with vendors for the EDI X12 834 and 820 reconciliation and 999s issues.
• Analyzed Business Requirements, performed gap analysis and segregated them into high level and low level Use Cases, Activity Diagrams/State Diagrams and Class Diagram.
• Involved in testing all the loops, segments and elements within each hierarchal loops for 837i and 837p.
• Worked with MS Project, MS Access, MS Excel and MS Visio graphs to represent the charts and data
• Closely worked with development team to enhance and standardize the electronic secondary Crossovers ESC .
• Worked with BizTalk Teams who designed and developed BizTalk applications to integrate with partners.
• BizTalk was used to develop the new interfaces to support EDI transactions in the New Data Format, projects which were involved in 837/ 835 transactions.
• Created RTM Requirements traceability matrix mapping Requirements to Design Artifacts to SIT Cases to UAT Cases.
• Worked on User Acceptance Testing in the ESC application.
• Performed data analysis and assisted solution architect to drive the delivery of analytics and business intelligence upon Health Information exchanges HIX
• Executed and validated data mapping for Claims via EDI into RDC through Oracle PL/SQL.
• Created Requirements v/s Test Case Matrix in Excel Spread Sheet template.
• Coordinated and prioritized outstanding defects and system requests based on business requirements.
• Performed System Integration Testing on Medicare Bad Debt project.
• Developed Test logs and opened/closed as and when the issue is fixed and Quality checked with the assumed company data with all the possible Test Scenarios.
• Hands on experience in QTP and other open source automation tools.
• Experience in working on Crystal reports for consolidated balancing reports for Cash posting team.

Environment: EDIX12N 5010, EDIX12N 4010, BizTalk Server 2006, Oracle PL/SQL, Microsoft SQL Server 2008, XML, QTP, Windows 7, HP ALM Quality Center 11.00.

Confidential

QA ANALYST

Responsibilities:

• Worked closely with the project team in planning, coordinating and implementing QA methodology
• Knowledge of Project management principles and practices, defines and creates schedules, statements of work, directs, and coordinates projects by establishing a work plan, arranging staffing, assigning duties, producing reports, and ensuring the progression and completion of the project.
• Designed wireframes in MS Visio for the user interfaces of the eCPR system.
• Participated in Quality Circle meetings with the management and development teams
• Triage calls with vendors for the EDI X12 834 and 820 reconciliation and 999s issues.
• Managed test planning for Functional testing, Integration testing, Systems testing, Acceptance testing, Regression testing for the Health Care application.
• Wrote and distributed reports to describe automation program evaluation problems found, corrections needed, and problem areas.
• Used Rational Requirement Composer RRC for requirement gathering and Rational Team Concert RTC for project planning and implementation
• Tracked overall test coverage for application.
• Worked on Pharmacy benefit management program like claiming issues from the pharmacy, drug stores and resolve those issues. Created, Setup and Implemented end-to-end test environment including QA Methodologies, Policies, Procedures, Standards and Tools for the Health Care application
• Automated test cases using QTP and worked on BPT component of Quality Center to create quality scripts
• Enhanced script by creating standardized, text and XML checkpoints, parameterized scripts for data-driven tests
• Automated and tested software programs, including test case design and execution of alpha, beta, functional, regression, and smoke tests.
• Worked on Medical malpractices and medical claims during the project.

Environment: QC, BPT, Quick Test Pro, SpecBuilder, Oracle, AS 400, QTP

Confidential

QA Tester

Responsibilities:

• SOAP UI Call out to Easy Grouper utilizing the Web services module
• Response data payload from Easy Grouper will be captured in the transactional auditing database
• Response data from Easy Grouper to be sent back to the Soap UI client invoking the request
• Generate OHI canonical output Validation of code involved as system needs to accommodate 2011 Pricer fields into EDI routing existing/new component .
• Testing Using Intuitional Inpatient claims for Both Grouping, Grouping/Pricing
• Two separate Call out requests initiated by OHI for grouping and pricing
• Call out Rule configured in OHI
• Ability to handle requests from different instances of OHI.
• Testing on Reference sheets configured for Rate sheets and Grouper version and type.
• Developed maps using AI Mapper for various transactions.
• Used Data Manager for Routing, Archiving and Translation of data.
• Developed various EDI documents for 834,835, 837, 820, and 270/271.
• Involved in resolving daily Production support issues.
• Developed various maps using HIPPA standards.
• Performed backend testing using SQL queries and sub queries to check backend data and checked data integrity.
• Developed automated regression tests in Win Runner for functional and regression testing
• Assured that all QA Artifacts are in compliance with corporate QA Policies and guidelines.
• Used Test Director to detect defects, communicate to the developers and tracking the defects.

Environment: HP ALM, PL-SQL, SQL, TeraData, Lotus Notes 8.5, Lotus - Same time 8.5, Soap UI, SSH Tectia Terminal, Jmeter, QTP, Edifecs Spec Builder 8.0, Oracle 9i and HIPPA.