To analyze business needs and lead projects in the healthcare market and as well as Work on Technical Projects inclusive of SAP, EDI, HIPAA, Healthcare, Insurance Market, Software and Systems/Unit validation. SKILLS: *Experience in creating and maintaining the Requirements definition documents that included Business requirements and Functional requirements. *Skills in developing Use Case diagrams, Sequence diagrams, State Chart diagrams, and Class diagrams. *Performed Automated Testing using QTP, Winrunner, Load runner and Rational Test Suite *Expertise in Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets. *Medical Claims experience in Process Documentation, Analysis and Implementation in 835/837/834/270/271/277/997(X12 Standards) processes of Medical Claims Industry from the Provider/Payer side *Knowledge of health information and health care services regulatory environment including HIPAA, Medicaid/Medicare, CCHIT, EDI and XML *Strong HIPAA EDI 4010 and 5010 with ICD-9 and ICD-10, analysis & compliance experience from, payers, providers and exchanges perspective, with primary focus on Coordination of benefits *Involved in Facets Output generation, Interface development and Facets Migration Projects. *Provided analytical solution to the customers for Facets Production Issues *Prepared unit test cases and performed unit testing *Good Management, Execution and Documentation skills *Inserted several checkpoints *Thorough hand on experience with all levels of testing viz., Integration, Performance Regression, Sanity, Functional and System testing *Involved in writing and executing test cases using MQC based on the requirements *Performed Back-End testing *Good experience in analyzing changes and identifying areas of the application to be regression tested *Experienced in reporting bugs using Test Director , Quality Center and bugzilla. *Conducted IP spoofing in Loadrunner *Strong working knowledge of PowerMHS modules *Involved and tracking the defects using Quality Center *Strong working experience with HIPPA Transactions
*Good working knowledge of major Operating Systems and tested applications developed in wide variety of environments viz., Windows 98/NT/2000, UNIX
*Tested aplications belonging to Health Care domain *Experienced in creating Test Plans. Thorough hands on experience with designing test cases covering all test conditions and eliminating redundancy and duplications *Good experience in creating, modifying and enhancing both manual Test Scripts and Test Scripts created by Test Automation tools - WinRunner, Quick Test Pro, Rational *Experience in interacting with business analysts, developers, technical support and help them base line the requirement specifications *Used MS Excel spread sheet, PowerPoint, MS Visio, MS Projects *Performed Sanity, Smoke and Usability Testing *Good knowledge of SQL and experience at conducting backend testing *Ability to thoroughly analyze system`s functional requirements and break them down into test requirements/test objectives and test conditions using techniques like state transition diagrams, decision tables, functional analyses etc. *Experience in creating Requirements Traceability Matrix to ensure comprehensive test coverage of requirements *Extensively used Black Box testing techniques *Familiarity with programming and scripting languages *Ability to handle multiple tasks and work independently as well as in a team *Good team player with excellent written and verbal communication and interpersonal skills
TECHNICAL SKILLS: Operating systems: Windows 2003 Server, Windows XP/2000, UNIX Testing tools: Win Runner, Load Runner, Quick Test Professional, Bug tracking tools: Quality Center, Rational Clear Quest, Test Director Front-end tools: MS Office, MS Project, sharepoint Languages: SQL, TSL, PL/SQL Web technologies: HTML, XML, .NET Databases: Oracle, MS SQL Server
PROFESSIONAL EXPERIENCE: Coventry Health Care, Downers Grove, IL June 2011- May 2012 Quality Tester Working with Coventry Health Care, which is upgrading an existing EDI system, to use for dual purposes: First, this system is used as a National HIPAA 5010 EDI testing tool and for
5010 test-data generating, typically for Medicare, Medicaid or Commercial Payer HIPAA 5010 Projects or HIPAA Training. The second use is for an affordable 5010 desktop solution for Providers.
Responsibilities: *As a QA Analyst worked with other QA in Unit Testing tasks, Trading Partners for connectivity issues; liaison between customers and corporate staff or between IT and Business Units as well as performing system matrix testing *Also performed impact analysis. Work with trading partners, clients, management, technical and non-technical personnel to create use cases and system validation artifacts and testing documentation and also performed medical coding testing *Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 4010; 837, 835, 270/271, and others. Provided healthcare provider problem resolution. Work as a medical coding SME, including ICD-9, HCPCS; Procedures and diagnosis testing *Created technical documentation, Reviews, analyzes, and evaluated business systems for end user needs, including Companion Guides, business process reengineering, including GAP analysis and documenting requirements, documenting processes, workflows *Created test plans and test procedure templates and guidelines to be used by the QA team *Also worked on 837 and 835 projects, including syntax and business rules for X12 HIPAA 4010 and 5010 validation for loops, segments, elements, qualifiers and code sets. Create export and XML processes for Lotus Notes *Created EDI Export and Import processes and work with EDI Trading Partners, Payers or Vendors. Perform a range of telecommunications processes, including FTP, Dial-up, TCP/IP, Web transfers *Performed Load, stress and Performance Testing. *Involved in writing test cases using MQC based on the requirements *Designed Test cases, test plan creation and Companion Guide development from stage to production, including both internal and external requirements *UAT testing for HIPAA 4010 and 5010 projects including legacy testing and HIPAA requirements and compliance mandates *Quality Center administrator and used Quality Center for defect tracking and reporting *Unit testing documentation developed using Excel. Artifacts were created and listed for UAT validation. Writing/validating Use Case Documents *Conducted Back-End Testing and Regression Testing using various phases of the application *Managed Financial Processing that served as primary lead for corporate financial systems, including accounting processes for accounts receivable and accounts payable systems. Manage financial spreadsheets and vendor accounts. Spearhead collection processes and manage accounts receivable personnel
Completed several HIPAA 4010 and 5010 Projects, included Medicaid and Commercial entities. Projects include claims and enrollment testing as well as NPI and medical coding and ICD-9 EDI testing *Involved in writing and executing test cases using MQC based on the requirements *Performed Back-End testing *Trading Partner / Vendor Management and managing the requirements and selection for Trading Partners and Vendors *Used Quality Center Checker Diagnostic, a tool to test many of the QC components. *Schedule conferences, JAD sessions, participate in negotiations, set/create/resolve EDI TP issues and create legal draft points for corporate attorneys *Followed Unified Modeling Language (UML) methodology using Reqisite Pro and Rational Rose to create/maintain: Use Cases, Activity Diagrams, Sequence Diagrams, and Collaboration Diagrams *Tested and delivered Inbound/Outbound Facets interfaces *Use Claredi web-based tool to validate HIPAA EDI files. Document errors and artifacts showing success
Environment: Facets, UML, Quality Center, MS Visio, MS Outlook, DB2 Mainframe, UNIX
Humana Health Care, Dayton, Ohio July 2008- May 2010 QA Tester Humana Inc., headquartered in Louisville, KY., is one of the nation's largest publicly traded health benefits companies, with approximately 9 million medical members. The project included the HIPAA Business Analysis and Quality Assurance testing activities and involves in HIPAA compliance, claims and Insurance and provides the different plans - to employer groups, government-sponsored plans, and individuals. Responsibilities: *Involved in claims submission and payment (remittance) retrievals by using ASCX12N 820 for the In- bound premium payments; ASC x12N 834 for the Inbound Enrollment and Maintenance; ASCX12 276/277 for the claims status enquiry and response; and ASC X12 835 for the Health care Claim Payments *Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers. The Claims were processed, co-pay is calculated, and the pricing is calculated using the IBM systems for both Retail and Direct Claims processing flow *Was Responsible in finding the eligibility of the members and filing claims for the States Disability Insurance benefits for both short term disability who are not eligible for the Social security benefits and for the Long term disability customers who are qualified under Social security plan for the payment of benefits as a result or injury *Performed Functional, regression, System Integration and User Acceptance Testing for the various applications. *Managed multiple priorities, project plans, time frames and trade-offs while ensuring the clinical and administrative staff understood the final results of the projects, sharing detailed vision of cost-benefit analysis *Executing System Test , Regression Test, User Acceptance Test (UAT) *Created reports to satisfy user requests, data sampling, project analysis, or testing verification *Wrote Automated Test scripts using QTP *Tested user interface and navigation controls of the application using Quick Test Pro. *Involved in writing and executing test cases using MQC based on the requirements *Performed Back-End testing *Used the Rational Unified process methodology for the application development and created Use cases, activity diagrams and drafted UML diagrams using the Rational Rose *Responsible for customer interface, requirements definition, general and detailed design, testing, maintenance and training programs and managed requirements using Rational Requisite Pro *Developed associated project documentation, schedule, design specifications, test plan, test scenarios/scripts, performed gap analysis, and test tracking reporting/monitoring for all phases of testing including B2B user acceptance testing
Environment: Microsoft Visio, Windows XP, IBM systems, Rational Requisite, Rational Rose, Win Runner, Load Runner, QTP, Sybase, .NET, Oracle. Affinity Health Care, Bronx, NY May2007-June 2008 QA Tester
I have worked on the project for Health Claims Scanning and Data Extraction (OCR) for HCFA 1500 and UB92 claims. I developed and managed needs analysis, requirements gathering, gap analysis, creation of vendor disaster recovery plan, design, layout, business rule development and associated software interface development and test documents, development, and EDI implementation insuring HIPAA compliance. The project had a budget of $800K and the system was anticipated to have an annual volume 1.5M claims Responsibilities *Used SDLC basis of planning approach Microsoft Project used for Planning, Control, Resource Planning and Status reporting *Involved in daily communications and face to face discussions with individual team members, the sponsor and key stakeholders. Presented project proposals and status to executive management *Developed Business Cases as needed *Writing Test Plans/Test Scenarios/Test Cases/Test Matrix. *Tested user interface and navigation controls of the application using Quick Test Pro. *Developed Project Plans incorporating resources, schedule and scope using the Work Breakdown Structure *Project Manager for the development of Medicaid reports for the state of NY
*Application Imaging Project Manager. Project to image enrollment applications. Budget $750K, Teamof10 *Developed automation test scripts for performing regression testing on the application using Quick Test Pro *Financial System Replacement and Warehouse Project Manager that identified the new process and software through requirements gathering and gap analysis, implemented Solomon and created a Financial Warehouse with data feeds from the core system for Claims, Service Accounting, and data required for regulatory reporting along with feeds from external sources. Budget $750K, Team of 25 (matrix organization) *Change Management Process, Managed requirements analysis, process development and implementation of Serena Software Change Management Process *Responsible for reporting Core System Upgrade for the Finance and Claims Module
Environment: Windows XP, SQL server, Rational Requisite Pro, MS Visio, Load Runner and Quality Center.
EDUCATION: Bachelor`s in Business Administration - international finance