Test Engineer Health Care

Vinod Kumar Peyyala

EDI Software Test Engineer

Ph No: +1-629-***-****

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

PROFESSIONAL SUMMARY

• 7 Years of experience in Manual/Functional and Mainframe Testing (Health Care Domain).

• Having Good Experience in Mainframes Manual Testing on Healthcare Domain.

• Strong knowledge of all phases of SDLC and working experience of Software testing levels

(Integration, system, regression and UAT).

• Experience in working with Waterfall and Agile methodologies Having experience in handling Test Design, Use Cases, Functional Specification, Project Based Environments, Regression Testing, Defects/Bugs Management, Testing Life Cycle Management and Business Analysis.

• Actively involved in various phases of the testing cycle such as Smoke testing, Unit testing, SIT, UAT & Regression testing.

• Hands on experience in creating Test Cases, Test Data preparation, Execution, Defect reporting & tracking.

• Expertise in Requirements Gathering, Analysing and Tracking their coverage in Test cases.

• Experience with Managed Care plans including HMOs, PPOs Plans.

• Have knowledge in Data Preparation Activity for the HIPAA Transactions like 837 Institutional and 837 Professional.

• Having basic knowledge in preparing ANSI X12 files for all types of 834, 835 and 837 (I/P/D) HIPAA transactions, transmitting them to NASCO and validating the functionality in NPS (NASCO Processing System).

• Have good knowledge in key-in the claims in eFDE Application.

• Having Basic knowledge in 270/271 & 276/277 transactions and Pharmacy Claims as well.

• Have knowledge of checking the compliancy errors in 5010 837 transactions.

• Possess knowledge on end-to-end claim behaviour in NASCO Processing System (NPS), Electronic Error Correction (EEC) & ITS Claims Processing.

• Have good command of NASCO Mainframes CICS screens like HIQK, HEHK, HRBK, HRDK, HSFK, TPOL, HURK, HRRK, HRSK, HZMK, HRJK, HRCK, HRGK, HROK.

• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI). 837

– Claims and Encounters.

• Experienced in executing Mainframe JCL jobs.

• Basic Knowledge of COBOL file handling concepts, including sequential, indexed, and relative file organization.

• Basic Knowledge of understanding and implementing COBOL syntax, data structures, and control flow statements.

• Actively involved in daily status meetings, client status calls and plan review meetings.

• Experience in Testing on Web based Applications and partial knowledge in Selenium.

• Excellent communication skills, team playing spirit and strong analytical & problem-solving abilities.

• Have excellent ability to grasp new technologies and implement them to their highest potential. TECHNICAL SKILLS

Languages C, C++, Python, Java & JCL.

Defect Tracking Tools JIRA & ClearQuest (CQ)

Transaction Sets 270, 271, 276, 277, 834, 835, 837I & 837P Domain Health Care (HIPAA) and NASCO (ICD9 to ICD10) EDI Standards ANSI X12 & EDI-Edifecs

Browsers Internet Explorer, Firefox, Chrome & Safari Databases Oracle, SQL Server, DB2

Methodology Agile Testing, Methodologies covering Functional, Regression, UAT, and System Testing

PROFESSIONAL EXPERIENCE

Client: BCBSM (Blue Cross Blue shield of Michigan) Nov 2022 – Dec 2024 Role - Senior Analyst Detroit, Michigan

Project Description: The migration to NASCO supports an overall improvement to the quality of service for our members by reducing the complexity of technology and gained efficiencies that directly support our commitment to provide affordable products to our customers. The objective of Claims workstream is to leverage existing Claims capabilities from MI and NASCO under Michigan Control Plan to enable BCBSM SHS to reduce operational and maintenance costs, increase scalability, and optimize technology investments.

Responsibilities:

• Analyzed business and system requirements of the project.

• Prepare the Test plans, Test Scenarios, and Test Cases, for specific CSR’s.

• Communicate with Clients to clearly understand the project requirements and scope.

• Prepare the Test data for Test cases.

• Execution of the Test cases and validating the end results.

• Defect analysis and Defect tracking.

• Experienced in creating, assigning, and tracking JIRA tickets to monitor project progress, bug resolution, and task completion.

• Facilitated seamless communication between developers, testers, and business stakeholders using JIRA for task prioritization and updates.

• Taking the accountability of all the deliverables and make sure that all the deliverables are done with quality.

• Escalating issues which cannot be resolved by the team.

• Attending the Status calls with Client.

Environment: JCL, IBM DB2, NASCO Processing CICS screens Client: NASCO - BCBS (Anthem, CF, HZ, MA, VT, MI and Premera) Mar 2019 – Aug 2022 Role - Software Tester TCS, Hyderabad, India

Project Description: The overall objective of this project, HIPAA 5010 (Health Insurance Portability and Accountability (Act of 1996) Inbound Claims 837 is defined and documented to provide reasonable assurance that the developed solution meets the defined business requirements, handles the expected transaction volume, response times and produces accurate results for the BMT reports and Unit test reports. NPS Benchmark tool provides the capability of running claims through MODL/PSTG real time and comparing the Baseline and Parallel results.

Responsibilities:

• Understanding the business requirements to refresh the test bed for each Plan every year with 2k claims.

• Based on BEU report analysis pulling the data from production for recent months. Analyzing the production reports and updating the control Plan datasheet with Claim Types, Diagnosis Codes, Revenue Codes, Procedure Codes, Rejected codes, Suspension codes, Providers, Subscribers.

• Creating membership for each Plan in ME and BB applications.

• Pulling the 837 transactions from HIPAA repository and mocking the claims with Subscriber, Provider, Diagnosis codes, Procedure codes and other information.

• Run the 837 files through compliancy check to make sure it is following the HIPAA standards.

• Submitting the 837 claims.

• Ran the status extraction to confirm whether all the claims are First pass claims, if not again resubmit the claim to get the FPR claims. Capture the TRLOG for FPR claims and add in BMT test bed using Benchmark tool.

• Ran the BMT tool on a weekly basis and report to the client if there are any changes that occurred during the week.

• PDM is used to analyze the CSR loaded into MO and PSTG.

• Identified coding defect and reported before the CSR was released in PSTG and saved dollar amounts.

• Provided the ICN deletion list to client on every alternative week to make sure there will not be any history in Model Office and PSTG.

• Communicating with onsite/client for daily updates.

• Involved in creating weekly status reports, metrics, governance deck, closure documents, value added, and lessons learnt ppts.

Environment: JCL, IBM DB2, NASCO Processing CICS screens Client: NASCO – Benefact Jan 2018 – Feb 2019

Role - Junior Software Tester TCS, Hyderabad, India Project Description: The primary purpose of the BeneFACT suite of applications is to create a single source of truth for all benefit information at NASCO. BeneFACT maintains products, which are a combination of reusable benefit string, and the variable used to replace the reusable portion of those strings. This decreases the need for new code and decreases the amount of code that must be managed. Responsibilities:

• Analysis of User stories, test case preparation and system requirements of the project.

• Validating Test data and documenting status to Clients.

• Understanding and executing the test cases in Iterations.

• Analyzing all the tasks and need to come up with the short cut process to complete the work in less time.

• Coach, solve work issues, and participate in the work of the team.

• Defect tracking and providing the Value add on need basis.

• Take accountability of all the deliverables and make sure that all the deliverables are done with quality.

• Reporting to the manager periodically on team and on work accomplishments, issues and progress on current activities of the project.

• Escalating issues which cannot be resolved by the team.

• Actively participated in daily internal calls, weekly status calls with onsite team and Plan meetings Environments: Selenium & NASCO Processing CICS screens Education:

Master’s: Indiana Wesleyan University – 2022 to 2024.

B. Tech: Lakireddy Bali Reddy College of Engineering – 2013 to 2017. Certification & Training:

Successfully completed NPS (NASCO Processing System) Claims training and Certified by NASCO Software Quality Assurance Program.

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