Quality Assurance Sql Server

Rahul Mehta

g42dz7@r.postjobfree.com

A highly motivated professional with 8 years of experience spanning over the fields of Business Analysis and Business Process Design. with a strong understanding of Business Requirements Gathering, Process Analysis, Business Process Flow, Business Process Modeling and Technical Writing concepts.

Professional Summary

• Considerable experience and understanding of Software Development Life Cycle.

• Knowledge of Health Information and Health Care Services Regulatory Environment including EDI, HIPAA,HL7, Medicare & Medicaid.

• Worked in Agile and Waterfall Software Development Environments.

• Expertise in Functional Testing of Client / Server and Web Applications.

• Strong experience with NPS (Nasco Processing System ).

• Experience with National Provider Identifier (NPI), MMIS, MITS, Medicare, Medicaid and Commercial Insurances in HIPAA ANSI X12 formats including 270 / 271, 276 / 277, 834, 835, 837 and NSF formats.

• Performed Validation of the EDI 837 Claim Billing ( Professional and Institutional ) and

835 (Remittance advice or payment) claims adjudications.

• Validating 270 and 271 messages (Coverage Verification ).

• Strong knowledge of EDI formats and HIPAA 4010 to HIPAA 5010 changes to these formats.

• Created Test Plans and Test Cases for HIPAA 5010 standards.

• Knowledge in HIPAA Implementation. Involved in various HIPAA related projects.

• Performed GUI testing, Functional testing, Regression testing, End to End testing, User Acceptance testing and Database testing.

• Performed Backend testing of the SQL Database and verified the EDI data transactions.

• Strong experience in data validation and manipulation in SQL server databases using SQL queries.

• EDI Testing with good understanding of Quality Assurance Tools and Methodologies.

• Writing Test Plans, Test Cases / Scenarios, Test Strategy and Analyzing test results.

• Knowledge and experience in EDI Data Mapping and Migration.

• Familiar with FDA Regulations like 21 CFR Part 11 and ICD Diagnosis Codes.

• Good understanding of web technologies like CSS, XML, HTML, .NET and Java Script.

• Experience and Strong knowledge with Medicare, Medicaid, insurance and claims processing for the EDI Transactions sets, HIPAA ANSI X12 4010, 5010X222, 5010X222A1, 5010X223A1, 5010X223A2 formats including 835, 837I, 837P, ICD 9, ICD 10, DRG, CPT, NCPDP codes for interfaces, enveloping of transactions and NPI requirements for 5010.

• Strong experience in Healthcare Systems (HIPAA 5010 Compliance NASCO, FACETS, ENTERPRICE, EDIFECS, SPECBUILDER, RAMP MANAGEMENT FOR 5010 MIGRATION), Health insurance plans – Indemnity plans, Claims processing, Managed Care plans (HMO, PPO & POS) and C Codes for the business of claims processing.

• Strong knowledge of Unified Modeling Language (UML), Software Development Life Cycle (SDLC), Waterfall, Rational Unified Process (RUP) and Agile Methodologies.

• Extensive experience in handling Requirements Management, Business Requirements Document (BRD), Functional Requirements Specification(FRS), System Requirement Specifications (SRS), Use Case Specifications and Requirements Traceability Matrix.

• Extensive experience in eliciting, structuring, documenting and validating (ESDV approach) requirements based on Joint Application Development (JAD), Joint Requirement Planning (JRP) and Rapid Application Development (RAD) sessions with stakeholders, end- users and technical teams.

• Involved in Business Process Reengineering and GAP analysis.

• Proficient in creating Use Case Diagrams, Activity Diagrams, Sequence Diagrams and Process Flows using Rational Rose, MS Visio and Enterprise Architect.

• Experience in creating Test Plans, Test Cases and Quality Assurance Testing

• Excellent written and verbal communication, decision making and leadership skills.

• Strong questioning, observational, facilitation and Coordination skills.

TECHNOLOGY SKILLS

Testing tools Quality center 9.2, QuickTestPro 9.2/9.5, LoadRunner 9.1, Rational Robot, Test Manager

Defect Tracking Tools Rational ClearQuest, Quality Center

Database Oracle 9i, 10g and MS Access

Programming Language Java c, C++, Visual Basic, SQL, PL/SQL

Web Technologies Java Servlets, XML, JavaScript, HTML

Other Products and Tools MS Office, Rational Rose 2000, Visio, RequisitePro, TOAD, Cognos

IDE Tools Eclipse 3.0, Net Beans

Operating System Windows 9x/XP/NT/2000, Unix, Linux

PROFESSIONAL EXPERIENCE

NASCO, Atlanta, GA

Senior Business Systems Analyst

Jan’2011-Present

Worked on different projects for NASCO including NASCO financial Voucher processing, compilation and testing, where the Vouchers were sent to providers and a detailed outline of charges and reimbursements for services.

As a Senior Business Analyst handled the HIPAA 5010 and ICD 10 implementations.

Responsibilities:

• Received financial vouchers from providers and filed them in database ledgers after they were tested and validated.

• Practiced the financial transactions on the NPS System with accounting principles.

• Created COB comment files for COB testing.

• Validated creation of EOB’s and mapping of dollars and Messages on the Ledger.

• Validating Different kinds of financial reports like 100 SERIES REPORST, 200 SERIES REPORTS generated by financial system in NPS.

• Validated creation of subscriber and provider checks.

• Validated creation of ANSI 835 and performed transaction, claim and line level balancing.

• Responsible for testing coding changes made on NASCO system.

• Completed knowledge of claims processing on NASCO system.

• Prepared Test Scenarios and Test grids in NASCO.

• Used SQL and Ad-Hoc querying to pull and also validate claims data from database.

• Responsible for Vouchers inside of the NASCO system.

• TSO application to view copy and edit 834/837 datasets.

• NASCO’s HIQK was used to view claims.

• Helping the team in Day-to-Day activities, problem resolving.

• Supported teams in Implementation and Post Implementation activities.

• Part of many successful projects from analysis through implementation phase.

• Performed SIT (System Integration testing) to check compatibility of new changes with current system.

• Regression Testing was performed to check the adverse impacts of new technical changes that were made.

• As part of UAT(User Acceptance Testing), integrated with users(Providers) to validate the tested results with requirements.

• Impact Assessment for ICD 10 Implementation – Field Expansion for Codes, ICD Indicator, 25 Occurences, Code Mapping from ICD -9 to ICD -10 and vice versa.

• Identified and reported all testing issues including data and process.

• Performed end to end testing by sending claims on 837.

• Complete knowledge of loops and elements present in 837,835 and 834.

• Complete knowledge of validating 837 and 835’s based on HIPPA compliance.

• In-depth knowledge of downloading 837 files from PROD and editing as per requirements specified.

• EEC (HEHK) was used to adjudicate claims.

• Used HSSK application to downloaded claims into Model Office for Testing.

• Worked on all applications in NASCO like HIQK, HURK, HRSK, HZMK etc.

• In- depth knowledge of analyzing claim process in the NPS system.

• Performed writing CSR’s in PDM.

• Viewed and modified GENO tables using TPOL application.

• Extensive knowledge of GENO tables usage in claim processing.

• Worked on NASCO membership, eligibility and benefit sub system.

• Extensive knowledge of using eFDE application to create claims.

• In-depth knowledge of NASCO system from end to end.

ENVIORNMENT:HIPAA, Windows 200/2003/XP, MS Office, NASCO, TSO, EDI, SQL, Ad- Hoc, Sybase.

PREMERA BCBS (a Health Benefits Company), Mountlake Terrace, WA

Senior Business Analyst

Jan’2010-Dec’2010

Worked on Facets migration project, 5010 changes.

Responsibilities:

• Interacted with business managers and other stakeholders to determine project scope thus defining key challenges, risks and project deliverables.

• Involved in PMO activities to make sure proper documentation and standards are being followed.

• Creating project plan and communicating to the team with ongoing project activities.

• Performed GAP Analysis for HIPAA 4010 to 5010 Migration

• Created process flow diagrams for all “As Is” and “To Be” scenarios using MS Visio

• Generated requirements through JAD sessions, discussions and one-on-one interviews with stakeholders.

• Exposed to extensive use of MS Visio and UML for generating class object, component, deploying, use-case, sequence, collaboration, state and activity diagrams.

• Worked on EDI X 12 transaction set 837 I/P/D, 834,276/277 feeds to allow for change in the claim number.

• Understood and analyzed project requirements and specifications and provided estimates on effort and duration of test assignments.

• Reviewed and Validated Requirements and technical specification and developed and executed test strategies.

• Used standard test plan templates, wrote components of the Test Plan document.

• Independently wrote and executed test cases utilizing standard test methods and tools.

• Executed testing, recorded and tracked test case execution and benchmarks.

• Recorded, tracked defects using standard test tools.

• Analyzed the FACETS(claim engine) data and discussed with the Business team regarding the requirement.

• Working knowledge of the data mode, data fields of the FACETS system and worked on FACETS tables such as Provider, Contract, Benefit, Claim details and Member.

• Worked on Claims attributes, Provider attributes, enabling EOB & Remit rules associated with Provider configuration process in FACETS.

• Provided basic metrics reporting on test execution and defects.

• Communicated status, issues and risks on a timely basis.

• Consulted with development engineers to resolve project related technical questions and issues.

• Identified and reported project issues and risk.

• Provided test execution results and analyzed test results to ensure existing functionality.

• Conducted User Acceptance Testing (UAT) and after interacting with the end users and collecting their feedback: documented the changes/enhancements required.

• Worked on generating the companion guide for the various trading partners depending on the SNIP WEDI edits from level 1 through 7 and generating Business edits for the 5010 837P and 837I Transactions sets for the HCFA and UB ( Inbound and Outbound).

• Performed the gap analysis for the various loop, segments, elements like ICD 9, ICD 10 diagnostic codes, mapping of NPIs under the NM108 segment and removal of REF*IG segment were performed under the latest addenda versions of 5010X223A2 and 5010X222A1 and documenting the BRD for the same.

ENVIORNMENT: HIPAA, UNIX, PL/SQL, Quality center, QTP, Oracle, SQL Server, SQL Query Analyzer, SQL Enterprise manager, SQL server Compare, PVCS, FACETS 4.71.

ANTHEM BLUE CROSS BLUE SHIELD, Richmond, VA

Business Systems Analyst

Aug’2008- Dec’2009

WGS (WellPoint group of system): WGS is the Claims Processing System that receives the claims as input from various sources like the EDI Gateway systems, electronic applications and few other manual entries. The claims are further processed by interacting with the appropriate system in the WGS family like membership, Provider, Contacts, Plans, Products, etc.

Responsibilities:

• Involved in gathering user requirements and preparing following documents: Functional Requirement Specification (FRS), System requirement Specification (SRS), Business Requirement document (BRD) nad Product Configuration Specifications.

• Involve in documenting the development and implementation of Business Data Catalog.

• Identified the scenarios based on business requirement and HIPPA compliance for each transaction such as 837(Claim) and 276/277 (Claim status).

• Worked on 837 files and validated the claims in NASCO processing system.

• Created Use Cases for NASCO claims processing system.

• Working knowledge of benefits and claims processing on NASCO processing system.

• Used MS Visio and UML for generating class diagrams and activity diagrams. Used standard Business Analysis methodology centered on RUP (Rational Unified Process).

• Followed Scrum development process using agile methodology.

• Used Sprint backlog and User stories in the process.

• Performed Integration testing between WGS system and NASCO application.

• Worked on provider, subscriber information and claim enquiry through HIQK platform.

• Entered professional and institutional claims in eFDE and mapping of claims.

• Participated in multiple team JAD sessions.

• Involved in reviewing the Test cases and Test Plans and identifying the gaps to make them more effective and relevant according the requirements.

• Good documentations skills.

• Provided support during the integration and UAT.

• Worked on the HIPAA 5010 Transaction and NPI Implementation Phase.

• Directly dealt with the SMEs for the Medicare Claims for Crosswalk, Provider Audit Reports for Claims, DRG pricing, NPI Maintenance using Taxonomy and Zip+4 and documented the BRD and FRD and impact screens.

• Analyzed the existing 4010 transactions, performed Gap Analysis and documented the BRD and FRD for 5010 ANSI X12 835 and 837 set of transactions.

• Developed test cases and completed the entire System Testing of the Provider Enrollment Screen for NPI Implementation, prioritized the defects and raised to the Mainframe developer. Defect tracking was done using MS Excel.

ENVIORNMENT: HIPAA, NPS, MS Office, Windows, TSO/ISPF, Clear Quest, RTM, Visio, XPEDITER, HTML, XML, SQL Server.

GEISINGER, Danville, PA

QA Analyst

Apr’2006- Jul’ 2008

• Responsible to ensure that EDI Process is HIPPA (Health Insurance Portability and Accountability) complaint and worked on ANSI X12 standards.

• Analyzed URS & Functional Requirements Specifications to understand business rules of application.

• Identified the scenarios based on business requirement and HIPPA compliance for each transaction such as 837 (Claims) and 276/277 (Claim Status).

• Developed all operational and technical flows using MS Visio and involved in the creation of business Architecture Document to provide an overview of different aspects of the application.

• Actively participated in creating requirements traceability matrices, test scenarios, test scripts and test cases.

• Documented test cases corresponding to business requirements and other operating conditions.

• Used RUP methodology.

• Wrote Test cases and Test scripts for functional testing.

• Responsible for back end testing/database testing, which was done using SQL queries.

• Maintained and executed test cases and test scripts using Rational Clear Quest.

• Reported the bugs, Email notifications to the developers using the Rational Clear quest.

• Provided Support services for centers for Medicare and Medicaid services (CMS).

• Performed Data mapping, logical data modeling.

• Used SQL queries to filter data within the database tablets.

• Involved in Data selection for testing the EDI Load Process: backend process for loading and processing the data received through EDI and manual process as per Business Rules.

• Preparation of Traceability matrix.

• Participated in testing using SQL queries on SQL Server tables and generating reports to ensure data integrity.

• Performed UAT testing with client an supported all phases of testing with QA team and managers.

• Facilitating and co-coordinated all User Acceptance Testing activities.

• Worked on the HIPAA 5010 Transaction and NPI Implementation Phase.

• Directly dealt with the SMEs for the Medicare Claims for Crosswalk, Provider Audit Reports for Claims, DRG pricing, NPI Maintenance using Taxonomy and Zip+4 and documented the BRD and FRD and impact screens.

• Analyzed the existing 4010 transactions, performed Gap Analysis and documented the BRD and FRD for 5010 ANSI X12 835 and 837 set of transactions.

• Conducted GAP Analysis to determine the AS IN and TO BE case flow scenarios.

ENVIORNMENT: SQL, Quality Center, rational Clear Quest, Windows, Excel, Outlook, PowerPoint and word, MS Office, MS Visio, Rational Unified Process, UML, Use Case Diagrams.

CITIGROUP, New York City, NY

UAT Tester

Feb ‘2005- Mar’2006

VTMS(Vulnerability Threat management System): CTMS is the process standard that Citigroup Technology Infrastructure (CTI) must follow in order to meet the requirements contained with the Citigroup Information Security Standards. The purpose is to provide business background and understanding the base process that is being implemented as an automated and interactive Web- based software tool, via “Projext X” and VTMS is one of the major module of it.

• Studied Business Requirement Documents and Functional Requirement Documents to get a better understanding of the system on both technical and business perspectives.

• Responsible fpor creating and managing a UAT plan, involved in maintaining schedules, dealing with resource constraints, providing guidance, setting environment and with identifying and recommending changes to establish a perfect UAT Plan.

• Actively involved with client meeting and managing requirements and worked on the developing entire test plan.

• Worked with the PM to decide upon the best approach for UAT.

• Wrote detailed UAT script for Java client as well as web interfaces.

• Executed UAT scripts and reported the errors.

• Did data cleansing before migration the data in to the new application.

• Tested Data Migration and actual UAT based on the script created for the new application.

• Involved in various interactions, meetings with users, vendors, Business Analysts and discussed Enhancement and Modification Request issues.

• Worked with the Production Support/ Functional staff to evaluate the need for changes to the application based on existing system.

• Performed Validation testing on the application and navigation for various scenarios

• Reported errors.

• Reported UAT Test results to the management and business team with recommendations.

• Tested the functionality, User Interfaces and Security of the web application.

• Managing of Defining, creating, documenting, verifying and executing test cases and work with development team to resolve UAT issues.

• Maintained and troubleshoot test issues, recorded test results, tracked and prioritized defects, actively participated in release decisions and established measures of test efficiency, effectiveness and product readiness.

• Documented the entire testing process, test metrics, assessment report and test results.

• Identified the defects in applications and reported the issues using Rational Clear Quest.

ENVIORNMENT: Oracle, SQL Server, XML, Perl script, UNIX, JavaScript, Windows XP, rational Clear Quest.

EDUCATION

Masters in Business Administration

Pacific Coast University,

Des Moines, Iowa

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