Raj Kasireddy

Sr. Quality Analyst

Ph:512-***-****

E: adctoo@r.postjobfree.com

PROFESSIONAL SUMMARY:

15+ years of experience as Sr QA Analyst/ EDI Analyst in industry with knowledge in Software testing and Business process flows.

Excellent knowledge of Software Development Life Cycle (SDLC) models like Waterfall, Agile Scrum, Waterfall- Agile Scrum Hybrid and Rational Unified Process (RUP).

Good background in handling EDI transactions 837,835, 834, 270, 271, 276, 277, 278

Good knowledge on industrial standards Six Sigma, CMM, RUP, Waterfall, Scrum, Kanban

Working knowledge of project management tools like Version One, JIRA, HP ALM/QC, MS Project, and Financial Force Project Management.

Proven ability to work under pressure, prioritize and working with deadlines.

Strong experience in Health Insurance Portability and Accountability Act (HIPAA) standards with background in HL7 transactions and transition strategies from HIPAA4010 to HIPAA 5010 versions

Experience in handling International Classification of Disease (ICD-9 CM and ICD-10 CM) coding and claims processing.

Knowledge in projects involving Medicare (Part A,B,C (Medicare Advantage),D (Pharmacy Benefit Management)), Medicaid, Claim process, Procedural, Diagnostic codes with experience in determining membership eligibility in different plans

First hand experience in preparing Test plan, Test cases, Script Status report and Defect status report

Extensive knowledge in writing complex SQL queries during project development

Hands-on experience in conducting Requirement Traceability Matrix (RTM), GAP analysis, SWOT analysis and User acceptance testing (UAT)

Sound proficiency in using MS Word, MS excel, MS Power point and MS Project

Experience performing system, integration, UAT(user acceptance), white, black, grey, load, stress testing using tools QTP and ALM

Proficiency in using Rational tools Rational Requisite Pro, Rational Clear Quest and Rational Rose

Skill and understanding of Rational Unified Process (RUP), Waterfall, Spiral, Scrum and Agile, Rapid Application Development (RAD) application development methods

Excellent communication both verbal and written skills and presentation skills Proficient in Business

Excellent interpersonal and negotiation skills with Developers, Application Architects, Subject Matter Experts, business users as well as senior executives.

TECHNICAL SKILLS:

Business Skills

Business Process Analysis & Design, Requirement Gathering, Use Case Modelling, JAD/JRP Sessions, Gap Analysis and Impact Analysis.

Methodology

RUP, Agile, Scrum, SDLC, OOAD and Waterfall.

Standard and Codes

HIPAA, EDI, ICD-10, ICD-9, ANSI X12, HL7, CMM, ISO, CPT and CMS form.

Management Tools:

Rational Rose, Requisite Pro, Clear Quest, Clear Case, Serena Team Track, MS Visio and MS Project.

Testing Tools

Test Director, Win Runner, Load Runner and TOAD.

Database

Oracle 8i/9i/10g, DB2, Teradata, MS SQL Server.

Languages

SQL, T-SQL, PL/SQL, CSS, VB, HTML, XML, MHTML, Java, VB.NET, C++, C, C#

Operating Systems

UNIX, Windows 95/2000/NT/XP.

Office tools

MS Office (Word, Excel, PowerPoint, Outlook), MS Visio, MS Project

EDUCATION:

Master’s degree in Science from INDIA

PG Diploma in Computer Applications

PROFESSIONAL EXPERIENCE:

Client: VA FSC Austin, TX Jun 2018 to Present

Sr QA Analyst

Project: CCNNC : Community Care Non Network Claims.

VA FSC adapted new claim adjudication system eCAMS ( Electronic Claims Adjudication Management System ) to process CCNN Claims.

Also VA FSC developed new web provide portal system to verify claim payments and status.

Responsibilities:

Followed Agile Scrum Methodology.

As a Sr QA supporting to write a Test plans.

Responsible to create EDI test data 837 for UAT and Claim modernization project users.

Responsible to create HL7 /JSON test data for FHIR project team.

Gather and validate member and provide data to testers.

Collected different Member data from VA external Member Portals/DB

Responsible to generate pre-authorizations for members and add it in 837 claim transactions.

Created test cases and test data for assigned requirements.

Execute test scenarios in eCAMS application.

Involved in Test Design, Test Execution and Defect Tracking

Responsible to test Provider portal to validate payments.

Coordinated with the technical team for any functionality related questions.

Responsible to End to END testing.

Involved various kinds of testing including UAT.

Tested Claims Pricing rules according to CMS guidelines.

Tested and validated all different types of claims (Professional, Institutional, Dental, Skilled Nursing Home, Home Health, Clinical Rural Health, Hospice, ASC etc.

Worked with Quality control teams to develop Test Plans and Test Cases in RATIONAL Software.

Client: Health and Human Services, Austin, TX March 2014 – Jun 2018

Senior Quality Analyst

Project: Worked on the CMBHS application. This application has a user interface developed to support health care functionality like client eligibility, assessment, service descriptions, admission to facilities and claims. Request and response web service interfacing implementation between external users and CMBHS application. Daily batch implementation (parsing and creation of documents) for multiple clinical documents. Implementation Waiver service functionality in Phase I and II (Enrolment, Eligibility, EOC, Plan of Care, Claims to Medicaid (MMIS), Medicare and Third party insurance.

Responsibilities:

Attended requirements gathering meetings with various teams.

Attended JAD sessions JAR sessions to understand the requirements.

Worked on mapping documents with industry standards (HIPAA standard transactions, EDI), business process mapping, and reengineering. • 270 Eligibility, Coverage or Benefit Inquiry - Request • 271 Eligibility, Coverage or Benefit Information - Response • 276 Health Care Claim Status - Request • 277 Health Care Claim Status – Response • 278 Health Care Services Review Information – Request • 278 Health Care Services Review Information - Response • 835 Health Care Claim Payment/Advice • 837 Health Care Claim(s) - Professional

Created detailed Test Cases for assigned requirements.

Coordinated with the technical team for any functionality related questions.

Planned and defined Use Cases, created Use Case diagrams, Scenarios and Use Case narratives.

Followed Agile scrum Methodology and gathered the requirement and interviewed stakeholders and end users.

Written and executed complex T-SQL queries using SQL Server Management Studio for back end data.

Tracked change requests and monitored workload and schedule.

Worked with Quality control teams to develop Test Plans and Test Cases.

Designed and developed workflow templates and lifecycles for process involving creating content to publishing product information on Web.

Involved in Test Design, Test Execution and Defect Tracking.

Involved various kinds of testing including UAT.

The Application uses the standard XML file that is generated by various systems and merges the data into the PDF documents, which must be given to the customer.

Managed successful Migration of critical production and contingency servers with no impact to business

Worked with Front end and Backend systems.

Worked on exporting reports in multiple formats including MS Word, Excel, CSV and PDF.

Successfully used Scrum Analysis Model (Agile) for gathering requirements by facilitating Use Case Workshops and sessions.

Organizing weekly Project Status and Task Review meetings.

Creating PowerPoint presentations and project updates using MS Project for management review.

Client: BCBSNC, Durham, NC Jan, 2013 – Feb, 2014

Senior QA /EDI Analyst

Project: This project involved updating existing business system to comply with HIPAA 5010. Mainly focused on providing a single plan to be enough for the subscriber and their dependents. Based on subscriber’s requirement, instead of separate maternity plan for spouse or paediatrics plan for children, new system was designed to bring all such individual plans for dependents into single plan. Thus diminishing the need to enrol in separate multiple plans for health benefits to subscriber’s dependents.

Responsibilities:

Worked on different Facets modules Subscriber/Member, Provider, Customer Service/Claims Workflow, Claims, Medical Plan, Utilization Management, Billing, Accounting, ITS, Medical Plan and Capitation as part of the Topaz Project.

Prepared Test Scenarios, Test Cases in accordance with Business Requirements and Detailed Design documents.

Executed test cases and logged defects using HP ALM.

Performed a walkthrough of the test cases during the test case review meeting with Client.

Manually created claims for Claims testing and created test data for Claims processing.

Created Providers, Subscribers, Groups, Sub groups and Class Plan for Claims testing.

Verified the Claims are processing as per the benefit grid.

Good understanding on Product, Plan and Agreement setup.

Validated Workflow routing rules and verified the claims are routing to correct queues and rules

Worked on custom development of Data migration, Sales Force and Provider Overpayment. Requested the batch jobs and verified the log files to ensure the data is loaded to tables properly.

Processed Medical and Hospital claims and validated their pricing as per the Benefit grid.

Validated Provider contracts for In network and Out of network by processing Claims.

Identified the test estimates for various functional areas and change requests.

Participated in Daily defect meetings, weekly and bi weekly team meetings.

Coordinated with Offshore and resolved their questions and clarifications and provided training.

Tested EDI 834 transaction for both ON Exchange and OFF Exchange.

Prepared EDI 834 files as per the CMS specifications and validated the batch results and data load in Facets.

Involved various kinds of testing including UAT.

Validated ITS specific changes made to Custom Interfaces. Processed ITS Home claims.

Client: Harvard Pilgrim Health Care, MA July, 2011 – May, 2012

QA Analyst

Project: The project involved enhancing the existing system for credit card business. It mainly focused on development of system for management of application portfolio and project portfolio along with detailed analysis of the performance of the credit card business. The process flow of the system involved ETL processing of the credit card transactions, identification of valid transactions, performing evaluations followed by data warehouse integration. A web based user interface for easy access to the data required is also provided.

Responsibilities:

Analyzed the Stories (Agile Methodology Requirement Documents) and Identified the Test Scenarios and Test Cases.

Attended daily Agile Scrum meetings, Sprint Retrospectives, Sprint Reviews.

Responsible for finding the common claim files from the Jms logs and uploading them to the Quality Center.

Responsible for completing the Cigna select Claims tracking grid and trading partners tracking grid and Daily Claim tracking grid.

Uploading the Jms logs and X12 files to the share point.

Responsible for doing System Testing, Functional Testing, UAT.

Researching for the claim reject reasons in the BPM and filling them in the tracking grid.

Downloading the log files from the web and uploading the daily Jms logs, Proxy logs, Business rules logs to the Share point.

Responsible for Testing Business Objects Reports.

Responsible in Test case, Test Plan designing.

Involved various kinds of testing including UAT.

Participated in Business Analysis, Requirement review and Technical Specs Inspection.

Developed Test scenarios, Test Scripts and Test cases based on Requirements.

Involved in Testing along with Developers and Coordinated with Developers to resolve the issues.

Responsible in providing regular test reports and Daily Status to the management.

Client: Blue Cross Blue Shield, FL Sep, 2004 – Jun, 2011

Sr Quality Analyst

Project: Participated in different implementation and maintenance projects in BCBSFL.

Federal Employee Program (FEP), Thomas Settlement, Blue card ITS host and Home, MBSP ( Enrollment, Fulfillment), Claims Finance, HIPAA 5010, Blue2, And Several Change requests and enhancements.

Responsibilities:

Involved in Business functionality review meetings and Use-Case Analysis for all Precipitated Projects.

Analyzed the System Requirement Documents and Business Requirement Documents.

Developed test cases and created Test plans for few Projects.

Experienced in ITS HOST, FEP, Local and Medicare Claim processing

Tested Various Edits on the claim by editing data on the claim and routing it to FEPOC.

Tested the Web applications and Web Portals

Test Lead for MBSP Implementation.

Responsible for Running and maintain Control M jobs. (Unix and Mainframe jobs)

Prepared the 837 I and 837 P XML files

Worked exclusively on 820 transaction

Experienced with Edifices tool

Developed Test Plans, Test Cases and Test Scripts for FEP Local Plan.

Tested the deferral task which are routed from FEP Direct

Prepared Test data for Performance team.

Performed Migration certifications for each enhancements in Diamond and Middleware Applications

Analyzed enhancements of DIAMOND use cases of Create FCR and FCR response status.

Responsible for preparation of test strategy and test plan documents.

Prepared test cases as per use cases.

Using MQ client software for Blue2 Internal testing.

Created data pools using Rational Test Manager and used the data in data pool to verify the system functionality with different set of data.

Inserted verification points wherever necessary.

Performed smoke test on each build.

Involved various kinds of testing including UAT.

Performed the Diamond application test manually as well as using automation to verify that the results appeared correctly and in the appropriate fields.

Performed XML data mapping during end-to-end testing.

Mapping the requirements to test cases (Tractability metrics)

Responsible for system testing and user acceptance testing.

Participated in all LOB Claims Adjustments.

Involved in the creation of the strategy document that defines the test environment, phases of testing, timelines of different phases of testing, entrance and exit criteria into different phases of testing and resources required to conduct the effort.

Extensively communicated with Business Analysts to come up with efficient test plans and test cases.

Enhanced the automated Regression Scripts and conducted Data Driven Testing.

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