Santosh Acharya

Apex, NC

Summary: Overall **+ years of professional experience in Software Quality Assurance management and working on different platforms including Client/Server based, Data warehouse Testing, Healthcare Domains.

Good experience in End to End testing, support multiple based and backend data validation for health insurance applications like Facets, CMS, Claim, MMIS.

Followed the Agile methodology, analysed and incorporated User Stories in different release plans for the sprints in Scrum process.

Performed Smoke, Adhoc, SIT, Regression and UAT testing .

Understanding of CMS Enrolment process for Medicare Member, Claim Processing and Billing.

Good knowledge of Claim Processing, HIPAA regulation and EDI X12 834/837 transaction.

Developed manual test case and test case scenario using Quality Centre ALM for various user stories based on release and sprint plan. Performed Automation Test validation using Selenium, Java, Maven, TestNG.

Experience in complete E2E on Member Enrolment for MMIS Project and claim processing on RISK Adjustment .

Executing of test cases and doing Ad Hoc Testing, Iteration, Regression Testing, System Testing, Smoke Testing, User Acceptance testing, logging defects and tracking to resolution.

Excellent skills in overall Defect Management and Problem-Solving including tracking, logging, and reporting bugs / defects using QC ALM/Clear Quest /JIRA/PIVOTTRACKER.

Solid backend testing experience in writing and executing SQL queries for data warehouse testing with Oracle and Microsoft database

RAPS/EDS CMS file validation for EDI X12 transaction 837 (I/P/DME), 277CA, MAOO2

Trizetto FACETS system implementation, Member Enrolment and TPL, Inbound/Outbound Interfaces and Extensions, Load and extraction programs and proprietary format files and Report’s development.

Leadership/Management Skills:

Team Size: 5-10 QA team, SME, BA, Developer

Project Experience: MMIS, CMS, HL7, EDS /RAPS, EDI X12

Root cause Analysis, Requirement Tracking

Industry Standards: CMMI Level V

Education

Master of Business Administration, International Business from Salem International University, Salem, WV 2008

Master of Science, Environment Science from Tribhuban University, Kirtipur, Kathmandu Nepal 2003

Bachelor of Science, Environmental Science from Trichandara Multiple College, Kathmandu Nepal 1999

Certification: AZ900, SAFE 5.1

Technical Summary

HL7, CCD, BizTalk Server, AZ900, EDI-834, 837

Crystal Report validation, ETL

Agile Sprint, Bug Defect life cycle

Requirement Traceability Matrix

Oracle SQL/Microsoft SQL Server/TFS/SSIS/MMIS

RQM, X12, SDLC, STLC

JAVA, .NET, TABLEAU 9.2.2, TestNG

Automation Selenium Web driver

Applications: MMIS, FACETS, HIE, PHINMS, Risk Adjustment, Hl7

Areas: Claim EDI 837, Member Enrolment EDI 834, TPL, HL7 Messages, NWCS, CMS, RAPS, EDS

Methodologies: Agile Sprint, Waterfall

Phases: Project Design, Test Planning, Test Scenario, Test Script, Defect Tracking Meeting, UAT

Tools and Standards: RQM, JIRA, CLEARQUEST, Toad, SQL Developers, TFS, PHIE, PHINMS3.0

Processes: Software Development Life Cycle (SDLC). Software Test Life Cycle (STLC)

UST Health Global –Advalent

Test Lead-Medicare Enrolment Plus August 2021 –Current

Worked as Test Lead for Medicare Enrolment using advent payment system. The project implement enrolment CMS Medicare Member to different Election period like Annual Election Period –AEP, Initial Coverage Election Period ICEP, Open Enrolment Period –OEP and Special Enrolment Period SEP. As part of Enrolment process validated MARx File, DTRR-TRC codes, Cavulus file . Generated MARx file, prepared DTRR validated different TRC and Transaction code like TC 61-Enrollment effective date, TC 51/54- Disenrollment, TC 76 Residence address change .

Responsibilities:

Attend daily scrum call

Process Medicare Claim for Billing .

Performed SIT, SMOKE Test, Regression, UAT .

Attend Sprint planning and Retro call.

Prepared Cavulus file to Enrolment process and make sure system process it without any error and generate MARx file .

Validate and analysis MARx and DTRR –CMS response file for different Transaction type .

Review CMS PCUG guide for latest update on CMS Medicare Enrolment.

Prepared DTRR file as per CMS PCUG standard and process and validate.

Prepared Test case, test data and execute and track in JIRA.

Backend Data validation with Microsoft sql for Enrolment and Billing Transaction .

Developed the test strategy for implementing EDI X12 interface.

Communicate and coordinate with cross functional team to make sure all deliverable are delivered in time.

Provide KT to new team member and help them to understand domain knowledge as well and Testing process.

Infosys-Raleigh, NC June 2018 –July 2021

Test lead HIE

Worked as technical test lead on multiple conduent project.

The Project implements EMR /EHR system for Medicaid . A Health information exchange that queries remote data repositories to receive and process clinical and demographic information for a client. Participated in creating, Testing, and validating different HL7 Messages using HL7 V2.X, XML Schema, Inbound and outbound transaction

Validate different EDI transaction for different state client and make sure all transaction completed successfully via different channel.

Responsibilities:

Test and analyse different HL7 messages between Provider and Department of Health

Validate HL7 Message flow and analysing error log of each segment of HL7 messages, ITI transaction, at each stage of transmission and transaction of medical records and report

Analyse requirement documents and prepared test cases

Execute and maintain automation test using selenium Java for regression test cases.

Create the test case and interact with Dev and HIE business team

Maintain and enhance the test case, analyse to ensure the test case meets functionality changes and business needs of new release.

Problem reporting and analysis and prepare test log and exceptions document.

Participate in weekly status meeting.

Prepare test data and validation testing by writing SQL scripts.

Used TFS to track the bug and issue ticket.

Validate the file transfer protocol from ftp server, MOVIT.

Prepared weekly status report and share with Manger

Validate EDI X12 837 I, 837 P, 837 D, 270, 271, 276, 277 CA real or batch time transaction via Web Portal, SOAPUI, switch vendor.

Skills Used: SQL Server 2014, Microsoft Outlook 2010, TFS, PHINMS, HL7, BizTalk Server, Interface Explorer, HIE tools

Episource-Gardena, CA November 2015 – June 2018

Sr Software Test Lead Engineer, RAPS, EDS, CMS

CMS encounter data processing system from RAPS to EDS, for generating 837-Claims files. Involved in end-to-end testing of EDS file generation and submission to CMS.

Responsibilities:

Manages test for in between process before CMS submission.

Lead the project E2E for Risk Adjustment where claim Process to CMS, validated the Response file and Validated the EDPS file.

Working Closely cross function team and validated E2E Testing for Risk Adjustment Application.

Uploads the RAPS/EDS input file into DB, validate, Create Submission for EDI X12 837 with help of Adeptia.

Prepare the test execution plans, test execution summary reports, test plans and project analysis presentations.

Validate the inbound 837 file from client, Generate the outbound 837 file, send to CMS, and validate corresponding response file 277CA/MAO2.

Prepare the weekly status report including defect status report; perform data and validation testing by writing SQL scripts.

Handle preparation and peer review of Test Cases and Test Data to validate functionalities.

Detect bugs and classify them based on the severity.

Validate the Tableau reports, generate the reports design dashboard and publish.

Conduct the Defect Triage calls to evaluate the progress, performance of the applications, and defects resolution in efficient and timely manner.

Obtain the latest code from TFS and update the QA DB and validate.

Debug the SSIS package and set up the SSIS configuration file.

Skills Used: SQL Server 2014, Microsoft Outlook 2010, .JAVA, Microsoft Office packages 2007, EDI X12, Pivotal Tracker, RAPS, CMS, FERAS, RAPS Error, SSIS, TFS, Agile, Tableau

United Health Group, Cypress, CA May 2015 – October 2015

QA Analyst

3R Member Policy Premium Allocation Testing.

As part of the Affordable Care Act (ACA) with Risk Adjustment (RA) and Reinsurance (RI) programs, this 3RDD project

mitigates the impact of adverse selection of plans and provides stability for Issuers by calculating and forecasting the exact impact of Healthcare Reform programs on premium rates.

Responsibilities:

Prepared the test plan and test strategy documents and presented these to the project stake holder and project management teams.

Prepared the test execution plans, test execution summary reports, test plans and project analysis presentations.

Track the requirement, test cases and bug using QC ALM.

Import Test cases from Excel sheet to QC ALM.

Implementing Agile Scrum software development methodology.

Prepared the weekly status report including defect status report

Prepare test data and validation testing by writing SQL scripts.

Handled preparation and peer review of Test Cases and Test data to validate functionalities.

Detect bugs and classify them based on the severity.

Analyzed the test results and graphs by generating different reports in Quality Centre reflecting the stability of the application.

Developed ETL test scripts based on technical Specification and source to Target mapping.

Conducted the Defect Triage calls to evaluate the progress, performance of the applications, and Defect’s resolution in efficient and timely manner.

Skills Used: SQL Developer 2008, Microsoft Outlook 2010, Java Application, SQL Server 2012, Microsoft Office packages 2007, QC-ALM SharePoint, 3RDD

Cognizant, Xerox, El Segundo, CA September 2014 – April 2015

Sr Software Engineer, California MMIS

CA-MMIS was the claims processing and reporting management system of the State's Medicaid program which processed approximately 156 million Medi-Cal claims yearly utilizing 1,500 edits/audits which affect approximately 86,000 Health Providers. CA-MMIS was launching the Systems Replacement Project (SRP). SRP was a major multi-phased project that would replace the existing CA-MMIS legacy system using Design, Development, and Implementation (DDI) approach.

Responsibilities:

Designed the required test strategy in line with the scope and Organization Standards.

Executed test cases and performed Ad Hoc testing, iteration, system testing, smoke testing, logging defects and tracking to resolution.

Estimated the test effort and team in terms of size, skills, and schedule.

Implementing Agile Scrum software development methodology.

Developed SQL queries for querying data against different data base for data verification process.

Worked on all the modules, including Provider, Member, Claims, Plan Management, and all the other sub modules of the project from the initial days.

Liaised with developers and QA team for a defect triage and defect follow up.

Reviewed test cases and scripts along with the test data and conducted peer reviews.

Skills Used: SQL Developer 2008, Agile, Microsoft Outlook 2010, Java Application, Microsoft Office packages 2007, RQM/CQ, SharePoint, Version One, MMIS

CNSI-CSC-State of Maryland July 2012 – August 2014

Sr Software Test Engineer, Maryland MMIS

State of Maryland was replacing their existing MMIS with a new system, Medicaid Enterprise Restructuring Project (MERP) that supported commercial of the shell solution, call centre, Document management and CRM Activities. The new MERP system was geared towards ability to support future Department of Health and Hygiene service orientated architecture that integrated development of waiver, long term care and state-run program eligibility solution to directly address the inefficient eligibility determination process and eliminate stovepipe system and improving care and Recipient management.

Responsibilities:

Worked with other development teams to teach them the correct usage of Agile and created document templates that acted as the baseline for other projects.

Develop SQL Query to validate the ETL process testing cycle.

Executed test cases and performed Ad Hoc testing, iteration, regression testing, system testing, smoke testing, user acceptance testing, logging defects and tracking to resolution.

Analysed and incorporated User Stories in different release plans for the sprints in Scrum process.

Analysed, executed and tracked the defects using HP Quality Centre.

Involved in mock-up data to perform and validate functionality / business rules.

Maintained the Requirement Traceability Matrix; ran the stored procedure/packaged and validated.

Wrote various complex SQL queries, join, and store procedures for backend testing.

Worked directly with the development and functional team areas to resolve defects.

Skills Used: SQL Developer 2008, Microsoft Outlook 2007, Microsoft Office packages 2007, QCALM, SharePoint, Reqtrace Web, MMIS, Agile

BCBS-Boston, MA January 2012 – June 2012

Sr Quality Analyst

Blue Quote Individual (BQI) was a web-based application (hosted by Connecture) that was to replace the then current systems that handled individual market new and renewal business process. Participated and prepared the Integration Test plan and migration check for promotion of the project from Dev to Prod.

Responsibilities:

Assisted developer in debugging efforts by conducting root cause analysis; used Quality Centre to store all test results and track defects.

Worked actively with developer to identify high risk features, database configuration.

Created Requirement Traceability Matrix to map between the requirements and test cases.

Wrote various complex SQL queries, join, and store procedures for backend testing.

Designed test cases and test scenarios for member enrolment process, 834 EDI transactions.

Skills Used: MS Office Tools, UML, MS Visio, Windows XP, Oracle, SQL, MS Project 2003, Siebel, Oracle DB, Toad, HP Quality Center, FACETS, Agile Sprint

CSC, CVS Caremark, Milford Mill, MD May 2011 – December 2011

Quality Analyst

Project: FACETS 4.81 Upgrade (Phoenix) Project.

Worked as a Data/Business expert on various projects under the Medicare Part D Annual Eligibility Period (AEP) initiative for the CVS/Caremark account at CSC as part of the Development team under the Run and Maintain group. The initiative was about providing ongoing production support to CVS/Caremark as far as their needs for Medicare Part D were concerned.

Responsibilities:

Created Functional Specifications Documents from the Business Requirements Documents; updated and/or reworked previous documentation to get them in sync and up to date.

Develop and maintain the test case repositories for functional and regression testing in HP ALM

Participated and provided input in enterprise architecture design and development.

Use HP ALM for bug reporting, tracking and validate the bug.

Created Test Case and Test Scenario based on EDI X12 834 Integration Functional Testing.

Performed Data Analysis and validated the data flow from source to Target for ETL(SSIS)

Performed review of the mandates sent by CMS for Medicare Part D to figure out the updates needed to meet the new mandates released on a quarterly basis.

Made recommendations for the transformation roadmap and provided support during the transition phase.

Participated in creating risk mitigation plan and planning different approaches for minimizing the risk and its consequences.

Performed Backend testing extensively by writing SQL validation queries in Oracle Toad against the database.

Validated records, structure of tables, Indexes, Triggers in tables after migration from Facets 4.31 to Facets 4.81 database.

Involved in manually testing the application from the back end using TOAD writing and executing SQL scripts and from the front-end using FACETS to carry out data validation.

Skills Used: MS Office Tools, UML, MS Visio, Windows XP, Oracle, SQL, TOAD, MS Project 2003, Siebel, HP ALM, TOAD, FACETS 4.81.

MVP Health Care, Schenectady, NY April 2010 – March 2011

Quality Analyst, Revenue Data Management (RDM)

Revenue Data Management (RDM) team handled all the inbound and outbound Meds II files between MVP and NYS, including vendor files. Worked with other development teams to teach them the correct usage of Agile and created document templates that acted as the baseline for other projects.

Responsibilities:

Analysed and incorporated User Stories in different release plans for the sprints in Scrum process.

Participated in functional/technical design meetings; created detailed test plans bases on analysis of requirements and design documents.

Extensive use of HP QC to manage the test case, track the requirement and track the bug.

Executed systems and data quality testing to ensure all development deliverables were production ready; used quality centre to track the defect and manage the test case/test results.

Performed Data Analysis and validated the data flow from source to Target for ETL

Performed System, Regression, Integration and Performance testing.

Wrote and executed SQL scripts to test various reports and ETL load jobs.

Worked with the business owner to identify key data elements that will be monitored on an on-going basis to ensure a high level of data quality within the DW.

Skills Used: MS Office Tools, UML, MS Visio, Windows XP, Oracle, TOAD, MS Project 2003, Siebel, HP Quality Centre, Rational Rose, BD2, FACETS 4.41

Farmers Insurance, Simi Valley, CA October 2008 – September 2009

Quality Analyst

NWCS (National Worker Compensation System) was a web-based application developed in Siebel Oracle. NWCS was a migrated project, the existing system WC (Worker Compensation) WCS Flat file to NWCS Siebel Oracle. Conducted regression testing, GUI testing, positive testing, negative testing, and security testing, smoke testing, and user acceptance testing. Played a key role in the planning, testing, and implementation of system enhancements/version upgrade of NWCS.

Responsibilities:

Reviewed and developed QA Test Plan, test conditions and test cases based on the technical specification documents requirement documents.

Measured the success/failure/demand for new or existing features.

Used HP QC to manage the testing and track the bug.

Designed the Test cases for all the phases of testing followed by the Project Plan followed by V model.

Involved in business requirement analysis through Business Requirement Specifications and business blueprint documents.

Skills Used: Siebel Oracle RAC 10.2.03, Toad, Java, Quality Centre 9.0, Commercial Insurance Application NWCS.

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