Healthcare FACETS QA Lead with EDI experience

Sudheer Babu Bachina

Contact: 317-***-****

Email: ***********@*****.***

SUMMARY:

• Over 9 Years of experience as a QA Analyst in analysis design and automated testing of Client/Server, Data

Ware Housing and Web-Based Applications. Actively participated in all the stages of the Software Development Life

Cycle and Testing Life Cycle. Experience in Information Technology with focus on Business Analysis, Business

Modeling, Requirement Gathering, Technical Documentation, Total Quality management (TQM) with Mercury

Quality Center and ALM.

• Certified ISTQB (International Software Testing Qualification Board ) Foundation level - QA

• More than 5 years of successful, progressive QA Test lead experience in HealthCare Testing using FACETS

product

• Experienced in all QA methodologies and Software Development Life Cycle ( SDLC) from Requirement

analysis to User acceptance Testing.

• Expert in all software testing techniques and methodologies which includes White Box, Black Box, GUI

Testing, Functional Testing, and System Integration Testing, Regression Testing and End to End Testing and strong

expertise in UNIX & Client Server application testing and Multi-platform testing.

• Solid expertise in Automated testing tools ALM, Test Director, Quality Center,

QuickTestPro,RationalTestManager,ClearQuest,ClearCase,RequisitePro, Rational Functional Tester.

• Extensively worked on multiple platforms i.e. Mainframe, Web-based and Client-Server application on

different environments.

• Have developed excellent professional skills by working independently and as a team member in designing,

developing, and implementing innovative business process and system solutions for HealthCare applications.

• Expert in Health Care testing, FACETS product, EDI transactions.

PROFESSIONAL EXPERTISE:

• Excellent knowledge of Software Development Life Cycle (SDLC), iterative Software Development Life Cycle

Process as per Rational Unified Process (RUP) & Agile for Business Analysis, Data Analysis & Requirement

Analysis.

• Expertise in analyzing Business and Development Specifications, Data Modeling, Use Cases and detail design to

develop requirement gathering, conducting Feasibility studies, document generation and conducting JAD sessions.

• Comprehensive knowledge of working as QA Test lead & QA on customized test plans, test cases & templates and

testing lifecycle within client server & Mainframe environment.

• Has a very good knowledge of FACETS tool and Healthcare domain, Worked on the various modules like

Subscriber/Member, Groups, Enrollment, Claims, Billing, Accounting, Provider, MTM and Utilization Management.

• Good experience on FACETS CTP (Claims Test Pro) and FACETS Testing.

• Good experience in manipulating EDI X 12 837(Health care claim), 835(Payment/remittance advice),

834(Benefit enrollment),, 270/ 271(inquire/response health care benefits), 276/277(Claim status) transaction files

as per HIPAA guidelines

• Mapping the EDI 12 files as per the HIPAA guidelines for various EDI Transactions.

• Good experience in Interface testing, Reports validation, Letters validation, GUI validations.

• Worked with clients like United Health Care, Excellus BCBS, WellPoint, and Wal-Mart and has core Healthcare &

Retail domain skills.

• Good experience in Legacy to FACETS migration and FACETS upgrade testing.

• Good knowledge on ICD 9 and ICD 10 codes and involved in migration from ICD 9 to ICD10.

• Use Case development and UML modeling using modeling tools like Rational Rose/MS Visio by preparing graphical

depictions through state diagrams, activity diagrams, sequence diagrams, component-based diagrams and

collateral diagrams.

• Hands on experience of Data manipulation, Data masking.

• Formulating Test Plan, Test Scripts and Test Cases for Functional, System, Integration, UAT, and Regression

Testing based on the Design Document and User Requirement Document for the Functional, Security, and

Performance Testing.

• Good experience in handling Deep dive meetings, Risk assessment and Mitigation planning.

• Good experience in applying business and functional knowledge to meet the team's overall test objectives and coach

and advise members of the testing team as required.

• Expert in writing queries, bridge scripts in SQL and PL/SQL using SQL Developer during testing of different

databases such as SQL Server, ORACLE and DB2.

• Expertise in creating Bug Reports using tools like Quality Center/ALM and Clear Quest.

• Worked on various Healthcare government program projects like Medicare/Medicaid/CHIP and also commercial

business projects.

• Have good experience in Onsite/Offshore model.

• Desire to learn new tools and technologies.

TECHNICAL SKILLS:

Operating

UNIX, IBM Mainframes, Windows 98/NT/2000/XP/Vista

Systems:

Languages: C, Java, J2EE, C++, SQL, PL/SQL, HTML, DHTML, Cobol, Perl.

Databases &

SQL Server, Oracle, DB2, MS-Access, Crystal Reports

Reports:

GUI Visual Basic 5.0 and, Developer 2000

Automation

Requisite Pro, Rational Rose, Clear Case & Quest

Tools:

Utility: MS Office, MS Project, MS Visio, Exchange, Informatica.

HP Quality CenterALM11.0,Test Director), QTP11.0, Win Runner, Load Runner, Rational

Test Automation

Robot, Rational Clear Quest, Clear case, Soap UI

PROFESSIONAL EXPERIENCE:

Client: United HealthCare IT, SC Feb’13-Till Date

QA Test Lead

United Healthcare Community and State (formerly AmeriChoice) currently supports the claims payment systems of

Cosmos, Diamond and 3 versions of Facets. Due to the multiple claims platforms, United Healthcare Community and State has

selected Trizetto’s Facets claim platform as the claims management system for all of Community and State. FACETS

application is one part of the Community and State Strategic Platform (CSP) and is the Community and State Franchise model.

Handled various state migration projects for NY, NJ, OH and KS Medicaid, CHIP and Dual eligible members. These projects

involve providing independent testing services to test the Membership processing through EDI 834, Providers, and Claims

processing via EDI 837, Billing, Reports and Letters, Various Inbound and Outbound interfaces for Provider, Membership,

Billing and Claims functionalities.

Responsibilities:

• Currently performing the QA lead role for various state migration projects and handling multiple projects in parallel as

a Test Lead.

• Responsible for On Time, On Quality, On Budget, On Benefit & On Scope delivery

• Involved in the review of requirements with Business, IT and Technical specialists.

• Responsible for attending all PROGRAM meetings like Requirements review, Solution and Design review and Technical

specification walkthrough’s and gathers all the required information for End to End testing.

• Responsible to identify the Requirement and Design gaps.

• Involved in preparing the detailed High level Test Plan to cover both System & SIT activities.

• Responsible for preparing a detailed work break down structure for all the detailed SIT activities to be done and

incorporating that into Project Plan.

• Responsible for preparing the Test Plan.

• Responsible for Risk assessment and preparing Mitigation plan.

• Responsible for assigning the tasks to team members and tracking the progress regularly and showing consistent progress.

• Responsible for writing and reviewing the Test Cases and Test Scenarios based on the Business requirement document

and Solution Requirement Document.

• Responsible for scheduling review meetings with all key stakeholders and getting approvals for all Test artifacts and

Test Results

• Responsible to ensure 100% requirements coverage and preparing RTM.

• Responsible for aligning Test environment and required Test Data for all the deliverables.

• Responsible for Integration testing with downstream vendors.

• Responsible for coordination with UAT team and helping on Test data needs.

• Manipulated EDI X 12 837, 834, 270, 271, 276,277 files as per HIPAA guidelines

• Processing claims through EDI 837 files to FACETS system and also worked on scenarios for complete claims lifecycle

by running Adjudication(CLMU),and Payment (CKMM),Adjustments for Overpayment, Under Payment, Resolving the

errors associated with claims.

• Worked on Billing and Accounting deliverables like Invoice generation, Processing payments and Receipts through

Lock box file and worked on Interfaces for Finance reconciliation with downstream vendor application RAM and

FSDB, EFT/ERA and generating EOB’s.

• Have good knowledge and Testing experience on Billing and Accounting deliverables

• Have good hands-on experience in writing complex queries using Sybase/Oracle databases

• Extensively used SQL queries to retrieve data from Oracle database using PL/SQL developer and Sybase. Tested and

modified PL/SQL Packages, Stored procedures and functions.

• Responsible for multiple testing cycles involve multiple extracts of the providers.

• Responsible to ensure members are getting loaded correctly to CSP Facets through 834 files

• Responsible to ensure Invoices, ID cards, Member Packets, Letters and various other functionalities are working as

expected.

• Responsible to ensure that edits are correctly applied and claims are processed successfully through 837 files and are

getting adjudicated and paid correctly.

• Responsible to ensure that all the functionalities related to Billing, Providers, Authorizations, Pricing are working as

expected.

• Performed Database integrity testing by executing SQL statements.

• Responsible for defect management and follow-up on defects till closure and also responsible for testing and sign off

for various interfaces and sending the files to vendor.

• Responsible to provided Metrics in the form of Weekly and Daily Status Reports.

• Responsible to host status calls with project stake holders.

• Responsible for successful Go Live implementation and providing required warranty support.

Environment: Windows XP, Unix, Oracle, Sybase, Sql Server, FACETS 4.7.1, Informatica 8x/7x, HP Quality Center

ALM11.0, JavaScript, HTML, Outlook.

Client: Excellus BCBS, Rochester NY Apr’11 – Jan’13

QA Lead

Excellus BlueCross BlueShield, Headquartered in Rochester, NY,is part of a family of companies that finances and delivers

healthcare services across upstate New York and long term care insurance nationwide. Collectively, the enterprise provides

health insurance to New Yorkers. Previously, The Company’s BlueCross BlueShield operations were known as: BlueCross

BlueShield of Central New York (CNY), BlueCross BlueShield of the Rochester Area and BlueCross BlueShield of Utica-

Watertown.

Project Description:

The Facets system is upgraded to Facets 4.71. This Transformation process will ultimately to replace LRSP, TOPPS, ICPS,

CAPS, U-Win and the Univera Facets, which are currently EHP’s Legacy Systems.

This Safety Net project was executed to test the transformation of legacy systems to FACETS implementation. The aim of this

project is to engineer a new Health Plan that will be successful, high performing and competitor in every community EHP

serves. The result of this will be a unified organization with standard business processes built around a single core system. This

includes the base implementation of Facets (with all applicable interfaces), the Blue Card modules and the new core business

processes in operation. SafetyNet project is for the Medicaid business and is scheduled for three releases R1, R2 and R3.R1 is for

FHP/MMC program and is of for the people who are below 65 ages and below the poverty line and R2 is for Child Health

Insurance program, R3 is for the Healthy New York Commercial Business.

This project involves providing independent testing services to test the Interfaces, Extensions, Reports and Letters. Various

requests are raised for changes/enhancements for the systems interacting with the Facets application; Excellus requires assistance

in addressing these requests.

Responsibilities:

• Worked as a Test Lead for SafetyNet Program and Product testing.

• Involved in writing Test plans, cases and Test Scripts on various modules like Membership enrollment, Billing,

Provider and Letters and ID cards and Product testing on FACETS 4.71 version.

• Worked actively in planning and coordinating the testing of the product where I had responsibility for specifically

coordinating the test plans with Client.

• As a Test Lead, I am Responsible for preparing a detailed work break down structure for all the detailed SIT activities

to be done and incorporating that into Project Plan

• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical

Specification and documented in Test Manager.

• Responsible for validating the various Interfaces, Cognos Reports and Letters.

• Worked on critical components like enrollment of SafetyNet members by processing the Roster files from state and

Sending contract and benefit details to members, Billing/Invoices/Reminder bills on monthly basis.

• Worked on Outbound Membership interfaces i.e., sending Membership files to Vendors like MedImpact

• Responsible to perform gap analysis with client and partners.

• Responsible for testing and sign off for various interfaces and sending the files to vendor

• Worked on Defect management and follow-up on defects till closure.

• Responsible to provided Metrics in the form of Weekly and Daily Status Reports.

• Worked on other projects like Key Large Accounts and Medicare

• Manipulated EDI X 12 834 files as per HIPAA guidelines

• Processing claims through EDI 837 files to FACETS system and also worked on scenarios for complete claims lifecycle

by running Adjudication(CLMU),and Payment (CKMM),Adjustments for Overpayment, Under Payment, Resolving the

errors associated with claims.

• Worked on Billing and Accounting deliverables like Invoice generation, Processing payments and Receipts through

Lock box file and worked on Interfaces for Finance reconciliation with downstream vendor application RAM and

FSDB, EFT/ERA and generating EOB’s.

• Responsible for writing the Test Cases and Test Scenarios based on the Functional Specification and technical

Specification and documented in Test Manager.

• Involved in project planning, coordination and implemented QA methodology.

• Involved in the review of requirements with functional manager and technical specialists

• Created an end-to-end integrated test script that meets business functionality.

• Verified and validated Ad-hoc reports, Reports from multiple data sources with Parameters cross tabs and drill down

capabilities using Business Objects.

• Extensively used SQL queries to retrieve data from Oracle database using Sybase and Oracle PL/SQL. Tested and

modified PL/SQL Packages, Stored procedures and functions.

• Involved in the meeting with SME (subject matter experts) and Technical Lead and Project Director.

• Participated in the test environment setup and in ensuring that the facilities, test tools and scripts are in place to

successful perform the required testing effort

• Performed extensive Regression Testing for subsequent versions of the application

Environment: Windows XP, Unix, Mainframe, Oracle, Sybase, Informatica 8x/7xWeb logic, Facets 4.7.1, Cognos

reports, HP Quality Center, JavaScript, HTML and Lotus Notes.

Client: WellPoint - Indianapolis IN Aug 2010 – Apr 2011

QA Lead &Test Coordinator

CLIENT DESCRIPTION:

WellPoint, Inc. is the largest health benefits company in terms of commercial membership in the United States. WellPoint offers

a spectrum of network-based managed care plans to large and small employer, individual, Medicaid and senior markets and to

Self-funded customers. It also provides an array of specialty and other products and services such as life and disability insurance

benefits, pharmacy benefit management, specialty pharmacy, dental, vision, behavioral health benefit services, radiology benefit

management, analytics-driven personal health care guidance, long-term care insurance and flexible spending accounts. Through

its nationwide networks, the company delivers a number of leading health benefit solutions through a broad portfolio of

integrated health care plans and related services, along with a wide range of specialty products such as life and disability

insurance benefits, pharmacy benefit management, dental, vision, behavioral health benefit services, as well as long term care

insurance and flexible spending accounts.

PROJECTS DESCRIPTION:

ESI Medicare Migration project, as part of this project implementation – MA, MAPD, and PDP business will be migrating from

NextRx to ESI. MA and MAPD business will be added to the Core Facets file and a separate file will be created for PDP

business to be pulled from Med D Facets..

As part of ‘Healthy Indiana program’ project, Worked on HIPAA 820 files that EDI Gateway is picking up from the State of

Indiana’s Healthy Indiana secure server and putting on the Facets Unix servers, and reformatting the files into Excel (comma

delimited format) so that the Healthy Indiana dedicated business unit can reconcile the money the State paid versus what was

expected. The 820 files will contain detail information pertaining to specific electronic fund transfer (EFT) transactions made

by the State to Anthem. The business will identify any discrepancies, and notify the State so that the State will send corrections

on the next month’s corresponding 820 file.

As part of Medisys Vendor projects, we have an out of sync situation between Facets 4.71, Medisys and EMPI where in

members are not matching with HCID or EID or Group ID. For this situation we need to correct these members through defined

preprocessors and while correcting them we also need to make sure interfaces for other vendors is not picking up these bad

members and sending out to our vendors.

ROLES AND RESPONSIBILITIES:

• Played the role of Overall SIT Test Lead for ESI Medicare Migration project leading a team of 2 Onshore and 5 offshore

team members for this project.

• Involved in meetings with Business and understanding all the impacts on Facets 4.71 Group Membership and Billing

(GMB) work items.

• Responsible for attending all PROGRAM meetings like Requirements review, Solution and Design review and Technical

specification walkthrough’s and gathers all the required information for End to End testing.

• Involved in preparing the details Master Test Plan for ESI Medicare Migration testing.

• Responsible for preparing a detailed work break down structure for all the detailed SIT activities to be done and

incorporating that into Project Plan.

• Responsible for the full cycle of the testing (understanding the requirement, estimation for the testing, Test case preparation,

Test execution and Review test result validation).

• Responsible for maintaining the quality related activities (Like Tracking the Tasks, Tracking the Defects identified in each

project, Collecting Metrics at the end of each Project etc

• Responsible for assigning the tasks to offshore team members and tracking the progress regularly and showing consistent

progress.

• Responsible to analyze Functional Specifications for Group Membership and Billing (GMB) work items.

• Responsible for reviewing the test cases, test data created by the offshore team along with onshore peers for quality check.

• Responsible to coordinate testing activated effectively with onsite peers and offshore team on a daily basis through emails

and teleconferencing to keep them updated with the project progress.

• Responsible to prepare requirement Traceability Metrics template to make sure all the requirements are covered and tested.

• Extensively used SQL queries to retrieve data from Oracle database using Sybase and Oracle PL/SQL.

• Worked on Defect management and follow-up on defects till closure.

• Responsible to providing Metrics in the form of Weekly and Daily Status Report. .

• Participated in various meetings and discussed Enhancement and Modification Request issues.

Environment: Windows XP, UNIX, Mainframe, Oracle, Sybase, Informatica 7x, Facets 4.7.1, Cognos Reports, Quality

Center 10x, JavaScript, HTML, Outlook

Client: WellPoint - Indianapolis IN July 2009 – July 2010

Location: Hyderabad, India

QA Analyst

PROJECT DESCRIPTION:

WellPoint, Inc. is the largest health benefits company in terms of commercial membership in the United States. Through its

nationwide networks, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated

health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits,

pharmacy benefit management, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible

spending accounts.

Facets is a product which handles enrollment, claims processing and other allied services pertaining to the Managed Care

business for both HMO and PPO book of business for different clients like WellPoint, which runs FACETS 4.71 in the Mid-West

(OH, KY and IN). In order to support the ongoing business requirements, numerous processes are built in and around Facets in

the form of extensions, interfaces, and reports/letters.

The project involves providing independent testing services to test the Interfaces, Extensions, Reports and Letters. Various

requests are raised by the Small System Requests (SSR) for changes/enhancements for the systems interacting with the Facets

application; WellPoint requires assistance in addressing these requests.

This project involves providing enhancement, maintenance to address the SSCRs for the Facets application in addition to

providing independent testing services to test SSCRs.

ROLES AND RESPONSIBILITIES:

• Worked as the offshore team lead as part of SSCR releases.

• Responsible for assigning the tasks to team members and tracking the progress regularly and showing consistent

progress.

• Responsible to provide Metrics in the form of Weekly and Daily Status Reports.

• Responsible to analyze Functional Specifications for SSCR work items.

• Involved in writing and reviewing of test cases for SSCR work items.

• Worked on Interfaces, Extensions, Reports, Letters and delivered quality deliverables to onsite.

• Involved in Functional Testing, Test data preparation, Execution of test cases and reporting defects. He worked on

Defect management and follow-up on defects till closure. He was involved in Regression Testing for all the SSCR work

items

• Worked on Billing deliverables like generating Invoices, Processing payments and also generating EOB’s.

• Worked on Claims processing deliverables and have good knowledge and Hands-on experience on Claims life cycle

and processing claims in FACETS.

•

Environment: Windows XP, UNIX, Mainframe, Oracle, Sybase, Informatica 7x, Facets 4.7.1, Cognos Reports, Quality

Center 10x, JavaScript, HTML, Outlook

Client: Walmart June 2006 – June 2009

Location: Chennai, India

QA Analyst

PROJECT DESCRIPTION:

Wal-Mart has four code bases and seventeen different flavors of Warehouse Management Systems (WMS) running in various

DCs of Wal-Mart across the globe. Supporting, maintaining and enhancing these many different systems are becoming

increasingly difficult and cost-prohibitive as Wal-Mart’s business continues to grow.

The purpose of the project is to develop a unified Warehouse management system (WMS) named as Global Logistics System

(GLS) which would serve all Wal-Mart DC’s. The scope of the GLS phase 2 was restricted to unify the main frame based

DCS2000, a WMS running in grocery DC’s in US and MGDS (Manual Global Distribution System), a WMS running in grocery

DC’s across the globe. Earlier in Phase 1, few core modules of WMS in DCS2000 were built as a part of new development in

VB and a unified data model accommodating all the applications was developed.

The scope of the project includes: Requirement gathering for Order Processing (OP) and Quality Assurance modules (QA) of

WMS based on the existing DCS2000 and MGDS applications and building it as a part of new development, Decoupling the

existing WMS components from the mainframe based DCS2000, migrating the existing core WMS from VB to .NET,

Integrating all these components with unified data model with residual DCS2000 and migrating the data from the existing VB

application to the newly integrated system.

The scope of testing involves functional testing of individual modules of Warehouse Management System (WMS),

functional system testing, regression testing, parallel testing, System integration testing with inbound and outbound interfaces

and Test automation.

ROLES AND RESPONSIBILITIES IN THE PROJECT:

• As a Test Analyst, I was involved in Test estimation, Test design & Approach and Test Management activities.

• Involved in analyzing the use cases and system design and also in identifying gaps between requirements and system

design in the early stage of system design.

• Involved in preparation of Test scenarios, test case and test data for System tests and System Integration testing phases.

• Worked as an offshore lead for a team of 6 members. As a team lead I was responsible for reviewing the test scenarios

and test cases prepared by my team.

• Coordinated the off shore test team’s day to day activities, such as task allocation, conducting reverse knowledge

transition sessions, review meetings with Business Analysts & Designers, supervision of allocated tasks, review of

client deliverables and report generation.

• Responsible for planning and coordination of the System testing and System Integration tests phases.

• Involved in analyzing test environment set up requirements.

• During system test execution phase, I was involved in testing UI screens and business logic by data base querying and

data manipulation activities like data engineering and data mining from the existing systems.

• During SIT phase, I was involved in testing interfaces across different platforms. I was also involved in defect

management and tracking along with root cause analysis of defects.

• Extensively used SQL queries to retrieve data from Oracle database using Sybase and Oracle PL/SQL.

• Worked on Defect management and follow-up on defects till closure.

• Responsible to providing Metrics in the form of Weekly and Daily Status Report. .

• Participated in various meetings and discussed Enhancement and Modification Request issues.

Environment: Windows XP, UNIX, Mainframe, Oracle, Sybase, Cognos Reports, Quality Center 9.0, Clear Quest,

Outlook

Contact this candidate