Preethi K

acd9n1@r.postjobfree.com

251-***-****

Summary

* ***** ** *********** ********** in the field of IT, Business Analysis and Software Testing of which 18

months are specific to Health Care industry

Experience in analysis of system specifications and business requirements .

Experience in Healthcare, Telecom industries.

Experience in manual testing.

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.

Expertise in B2B standards, Implementation of Integrated EDI and XML applications and Enterprise

Application Integration (EAI) for business processes across applications.

Created companion guides for EDI transactions for both 4010 and 5010 versions and also created

crosswalks and also experience in using EDIFECS Specbuilder.

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).

Knowledge of programming languages like C, C++, Java, PL/SQL to debug and executing LoadRunner

scripts.

Used EDIFECS Step up/Step down to analyze and migrate from 4010 version to 5010 version.

Experience in writing Test cases and Test plans based on use cases and involved in manual testing of EDI

applications.

Extensively worked on HP Quality Center for tracking various defects that arise during submission of

claims.

Performed various types of testing like Functional Testing, Unit testing, Integration Testing, System

Testing, Performance Testing, Regression Testing, User Acceptance testing (UAT), End to End Testing,

and Smoke Testing.

Experience in working on Automation testing tools like HP Quality Center, Test Director, Quick Test

Pro, Load Runner and Rational Suite.

Good Knowledge in extraction, transformation, and loading (ETL) process.

Strong leadership, interpersonal, analytical and communication skills

Experience in FACETS claims Adjudication system.

Expertise in SQL scripts used in manual testing both front end and back end.

Expertise in writing Test Plans and Test Cases and requirements.

Expertise in QA methodology and Software Development Life Cycle (SDLC).

Working knowledge of HIPAA X12 standards for electronic data interchange.

Experience in using Quality Center for building test scripts and using Test Lab for execution and defect

tracking.

Comfortable in working solo and in a team environment.

Excellent troubleshooting, tracking bugs and issue resolution skills.

Efficient in delivering tasks, team player with good communication and interpersonal skills.

Techincal skills:

Operating Systems Unix, Win200X/XP/NT/7, Linux

Programming Languages C, C++, Core Java, Visual Basics

Testing Tools Quick Test Professional (QTP), Load Runner

Bug Tracking/Reporting Quality Center, Test Director

SDLC/Methodologies Waterfall, Agile, Scrum

Databases SQL Server 2005/2008

Web Technologies HTML, XML, and JavaScript

Software/System Knowledge Documentum, MS Office products

EDI Mapping Tools GIS 4.2/4.3, Ecmap 4.1.7/5.1.6

EDI X12 Transaction sets 835, 837, 270/271, 276/277, 834, 997, 999,278

(Versions 4010 and 5010 as

applicable)

Web Servers IIS 5.0/4.0, Personal Web Server

Other Tools Toad, Dreamweaver, Eclipse, Photoshop

Adminovate, Philadelphia, PA (Nov' 13 – May' 14)

EDI Business Analyst

Adminovate is a privately held enterprise software and consulting provider for the global life, health and annuity

industries I worked on the claims processing in medsupp. The claims processing

involved Eligibility Request,Eligibility Response, Adjudication, Acknowledgements.Involved in mapping data from

CMS to graphite.

Responsibilities:

• Created UML Use cases out of BRD document prepared by the Business.

• Created Test Plans, Test Cases to depict the flow of Claims Inbound and Outbound files.

• Developed adjudication logic at the backend and validated data under various scenerios

• Executed ETL scripts to populate all the adjudicate Claim information from Backend

systems to the front end SQL Server database.

• Created document on how adjudication process is going on backend.

• Performed JAD sessions with the Business and the IT Teams to gather the Requirements.

• Conducted Meetings with team members to ensure that everybody is on the

same page.

• Collected weekly status reports and updated the Project MPP accordingly to ensure that all

deliverables are met on time and on schedule.

• Involved in writing Test plans, Test cases and responsible for executing the Test Scripts. • Performed

load testing and performance testing. • Performed Smoke,

Integration, Functional, Regression, and System testing.

• Created current state and future state claims prossesing system in Visio

• Experience in validating and driving the requirements for the conversion of the NSF data coming from medicare to

graphite.

• Experience working proffesional Claims, Eligibility Request, Eligibility Response, Authorization.

• Designed a mapping documents to map NSF details coming from medicare to graphite.

• Worked Extensively with Eligibility Inbound and Eligibility Outbound claims processing

systems.

• Worked Extensively with Inbound 837 I and 837 P, 835s (Out bounds) claims processing systems.

• Developed various test cases for testing HIPAA 837I/P/D and 835(5010) .

• Worked as Business Analyst to create Applicant Portals and Provider Portals to view and update the

Demographics of the Member.

• Used graphite tool for mapping to X12 format.

• Involved in executing ETL (ascential – data staging) scripts to load data into SQL DB

• Used Graphite for converting Business rules as into Processing Modules and for FTP purpose.

• Involved in loading the flat files into PilotFish and involved in writing Complex SQL Queries.

• Have written and executed SQL queries to ensure that valid NPI’s without any duplication.

• Developed Load Runner test scripts according to test specifications/ requirements.

Environment : EDI X12N 5010,XML, SQL, PilotFish, Graphite, Microsoft Excel, Microsoft Word

PHCS/Multiplan, NY ( Jan '12 Apr' 12 )

EDI Business/ QA Analyst

Multiplan is the Industry’s most comprehensive provider of healthcare cost management solutions with 900,000

Healthcare providers under contract, an estimated 57 million consumers accessing the network products and 40

Million claims being processed each year. In addition to offering regional PPO networks in Wisconsin and the

southwest Multiplan also provide access to the leading independent national primary PPO.

Responsibilities:

Involved in HIPAA/EDI Medical Claims Analysis, Design, Implementation and Documentation.

•

Developed various test cases for testing HIPAA 837I/P/D and 277(5010) .

•

Validated the reports and files according to HIPAA X12 enforced standards.

•

Mocked claims in the Aetna Testing region for the issues reported in the Aetna Production area.

•

Created Test Plan that defines the test environment, phases of testing, entrance and exit criteria into

•

different phases of testing.

Identified, built and executed Test Cases and Test Sets for Functional, Error Handling, Navigation and

•

Regression in Test Director.

Manually tested the entire application before the tests were automated.

•

Worked closely with the other members of the Development Team and review the designs of systems,

•

implement test plans, and test the quality of software products .

Performed validation testing on the application for various scenarios and reported the errors.

•

Assisted EDI team with the testing of maps for HIPAA transactions 834,835 and 837.

•

Validated Business rule Edits for 5010 HIPAA transactions 837I/837P/837D, 277 and 835

•

Executed the 5010 system test scenarios for 5010 HIPAA transactions 837I/837P/837D, 277 and 835

•

after loading and adjudication.

Worked on claims adjudication by using axiom transcend.

•

Worked with the outbound team to help replicate the issues in production, giving data support to the team

•

and running different types of claims by request.

Involved in testing mapping logics of the claims on Maniframes and translated data.

•

Intensively worked on claims with different Trading Partners.

•

Created test scenarios for claims with different snip levels of errors.

•

Worked on the Trading Partner migration to production by submitting different claims with specific

•

levels of errors.

Performed Regression testing and Smoke testing for the above.

•

Involved in the user acceptance testing (UAT).

•

Manually tested all the interfaces.

•

Tested for eligibility, Gender mismatch, Clean claim edits, Membership Edits, Medicare, New born

•

and Behavioural claims.

Automated testing using win runner, test scripts execution and reporting .

•

Environment: Spec Builder, HIPAA X12, IBM Mainframe, JCL,ChangeMan, DB2, MS Office,Autoplugs, Aetna

Gateway, Edifecs, TXNR, HP Quality Center, QTP.

Tools: EDIFECS Suites: SpecBuilder 6.8.1

Novartis Pharmaceuticals, India (Nov' 10 May '11)

Project: Customer Maintenance System

Role: QA Tester

Responsibilities

Performed manual testing for the entire application.

•

Used Test Director as bug tracking tool to centralize the bugs and also to follow up the bug status.

•

Performed Regression testing, Ad Hoc testing .

•

Involved in developing detailed test plan, test cases and test scripts using Test Director for functional,

•

security and regression testing .

Co ordinate with developers to fix the problems in the application.

•

Responsible for filing bugs and scheduling running of automation scrips in TestDirector.

•

Involved in creating users, testplans and testcases in TestDirector .

•

Interacted with the UAT team to solve issues related to the defects.

•

Created and executed Manual Test scripts to verify complex system requirements and database testing.

•

Transaction Verified through Data Verification of Backend Database using T SQL Queries.

Conducted Reviews for the project across the division.

•

Responsible for analyzing those new features which are coming into weekly customer patches and

•

analyzing the impact.

Tracked the progress of test case planning, implementation and execution results.

•

Presented project status to upper management.

•

Environment: Manual testing, TestDirector7.6, VB, ASP, MS SQL Server 2000, TFS, IIS, VSS, XML, MS Office

2003 and Windows NT/2000.

Education:

Masters in Electrical Engineering, University of South Alabama (Mobile, AL)

(May 2013) (GPA of 3.5 / 4.0)

Bachelors in Electronics & Communication Engineering, Jawaharlal Nehru technological university

(JNTU) (Hyderabad, India) 2011 (GPA of 3.6 / 4.0)

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