Test Cases Project Manager
Resume:
SAURABH NALAVADE ***.********@*****.***
EXPERIENCE SUMMARY
Highly motivated, focused, and detail-oriented Business Systems Analyst with professional experience in Healthcare domain. Experience in testing HIPAA compliance conditions and strong knowledge of EDI X 12 transaction code set version 4010 to 5010. Well versed with ICD9, ICD-10, CPT, HIPAA, claim adjustments, claim pricing, claim adjudication. In-depth knowledge of Testing concepts, Software Development Life Cycle (SDLC). Thorough knowledge of various phases of SDLC like Requirement Gathering, Analysis/Design, Development and Testing, Deployment and Maintenance of software applications. Proficient in writing Test Plans, Test Strategies, Test Scenarios and Test Cases. Ability to succeed and excel in diverse environment and projects with strong determination and dedication. Highly self-motivated individual capable of functioning in a team environment with excellent analytical, presentational, inter-personal and verbal/written communication skills.
SYSTEMS ANALYST EXPERTISE
Extensive experience in all phases of SDLC and STLC processes
Strong knowledge of Software Development Life Cycle(SDLC) Methodologies such as RUP, Waterfall and Agile Scrum
Experience in Healthcare/Claims adjudication working with various modules which include claim processing using EDI transactions which fall under the HIPAA compliance
Experience in verifying EDI raw data of 834 transactions as per HIPAA 4010 and 5010 formats
Excellent skills in identifying test data including the input data, pre-conditions and expected results for both positive and negative test scenarios
Ability to review and analyze Business Requirement Document (BRD), Functional Requirement Document (FRD/FRS) and develop appropriate Test Cases
Proficiency in creating Test Plans, Test Strategies, Test Scenarios and Test Cases
Involved in Test Planning, Test Cases, Issue Resolution, and Report Generation
Performed manual testing of the applications to verify the requirements and business functionality
Proficient in writing SQL queries to retrieve data from databases for Back-End Testing to check and analyze data integrity and validation
Strong experience of working and interacting with clients to transform their business problems into technology solutions and ensuring that business goals are met throughout the product lifecycle
Experience in Joint Application Development (JAD) sessions with cross-functional project teams
Good Management, Execution and Documentation skills
TECHNICAL SKILLS
SDLC Methodologies:
Waterfall, Agile Scrum, RUP
Operating Systems:
Windows 9x/XP/NT/2000, Unix, Mac, Linux
Markup Languages:
HTML, XML
Databases:
SQL SERVER, MS Access
Defect Tracking Tools:
JIRA, Quality Center, MS Excel
Modeling Tools:
MS Office, MS Visio
PROFESSIONAL EXPERIENCE
Sharp Healthcare - San Diego, CA
Data Quality Specialist / Tester - EDI Management
October 2016 - Present
Project Overview -
Sharp is not for profit, but for people, which means all their resources are dedicated to delivering the highest quality patient-centered care, the latest medical technology and superior service. At Sharp HealthCare, mission is to improve the health of everyone. Moreover, as San Diego's leading health care provider, Sharp is proud to touch the lives of more individuals in community than any other health care system.
The scope of the project is to migrate to a new system (HealthEdge). HealthEdge will provide better enrollment and claims processing efficiency, and is a more flexible system that will enable to implement enrollment and eligibility changes quickly and easily. The project also focuses on accommodating feeds and services such as: claims processing, paper vs automated enrollment, Coordination of Benefits (COB), Account Receivable (AR), ID Cards, and Provider/Customer/Member services.
Responsibilities:
Enrolling members in IDX system from different employer groups
Analyzing and reviewing the Sharp Health Insurance plans, PCPs for employer groups
Assigning health plan contracts, PCPs, and terminating contracts in IDX system as per inbound EDI 834 files
Working on the discrepancy reports with employer groups on inbound EDI 834 enrollment files
Analyzing the IDX system with all EDI 834 transactions
Managing member data in IDX system from CureIS
Testing the EDI 834 specifications to meet HIPAA requirements set forth by the Federal government
Modifying the inbound EDI 834 file, and checking if the eligibility enrollment is properly loaded in IDX system
Working with other Analysts regarding EDI 834 transactions as per guidelines of 5010 implementation guide
Coordinating with the QA team to manage and perform project planning, system requirements, auditing and certification of documentation to ensure compliance according to QA
Involving in review and walkthrough meetings with Testing and Development team
Demonstrating health plan operations, health plan software configuration, enrollment, and data processing environments
Prioritizing and reporting defects by using the generated documents and reports for further analysis
Collaborating with the Project Manager and Business Users to gather, analyze and document the functional requirements for the project
Performing mapping of the requirements to ANSI X12 for 834 Benefits Enrollment Process
Performing parallel testing for enrollment of members in IDX and HealthEdge system
Developing test cases for HIPAA EDI 834 from CSRs (Change System Requests)
Working on EDI 834 (Benefit Enrolment and Maintenance) claim transaction in IDX system
Working on HIPAA EDI 834 use cases and collaboration templates according to business requirements in Claims Process
Involved in validation of EDI 834 for claims used for dental billings by writing test cases, test plans
Executing test cases manually to check GUI and Functional features, compared and analyzed actual results with expected results and reported all deviations
Performing manual testing for enrollment of members in HealthEdge system
Environment: EDI 834, IDX System, HealthEdge System, SQL Server, Microsoft Office Suite, Windows
INTERNSHIP EXPERIENCE
Parker Hannifin - Madison, MS
Engineering Intern (EI)
Co-op Engineer
January 2014 – June 2014
Responsibilities:
Created layout, part detail and assembly drawings to design specifications
Performed engineering calculations for use in design work
Created model index charts, and reported performance, event records of Assembly Cell Units
Setting up and monitoring laboratory tests on different assembly parts
Assisted with product failure analysis
Assisted in shipping out the final product from the plant
RELATED SKILLS
CAD:
SolidWorks, Autodesk Inventor
Computational:
Mathcad, Mathematica
Programming:
Visual Basic Programming
HONORS & ACTIVITIES
Honored with Commercial Pilot License, Aviatour Flight School, Philippines (July 2009)
Basic survival awareness program for the Pilots
Outstanding Achievement award by The Green Glory Club for advertising and campaigning of events
Awarded the Entering Freshman Access Grant Scholarship by Mississippi State University (2010)
Dean’s Scholar: Spring 2011
President: Mississippi State University Cricket Club, Starkville, MS
EDUCATION
Bachelors of Science in Mathematics Mississippi State University, USA
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