BCBSFL provides healthcare benefit for individual, small and midsized businesses and large employers. Worked on a data conversion application, which loads EDI claims files into the document imaging system. Claims were received in ANSI X 12 837 format and were converted to the internal XML file format. Files were indexed and loaded into document imaging system. Testing procedures verified document images against claims management database.
Responsibilities:
• Provider and Members data, analyze results using statistical techniques and provide ongoing reports
• Extract the data from data base using IBM SQL Studio and SQL navigator tools validate the required information send the data claim process
• Develop and implement data collection systems and other strategies that optimize statistical efficiency and data quality
• Acquire data from primary or secondary data sources and maintain databases/data system
• Reviewing and analyzing the BRD, FRD and Detail design documents, and understanding the SDLC methodology of the organization.
• Coordinated the end to end testing efforts of the HIPAA compliance and EDI transactions.
• Documenting the test plan, test cases, test scripts and expected results using Quality Center (for GUI testing, Functional testing, Data validation, Security testing, Compatibility testing, Performance testing)
• Preparation of test data for the positive and negative test cases.
• Conducting the walk thru of the test plan with the developers and design team
• Verified HIPAA compliant X 12 format for EDI transactions.
• Validated EDI files against ICD-9 compliance and cross walk ICD 9 - 10 and also ICD10 - 9
• Wrote test cases to check the formats of transaction requirement for 834/835,837,276/278.
• Experience in Testing HIPAA Gateway EDI Transactions. Experience in HIPAA transactions EDI 837 (Institutional/Professional), 835 (Payment Remittance Advice), 270 (Eligibility Request) / 271 (Eligibility Response), 276 (Claims Status Inquiry Request) / 277 (Claims Status Inquiry Response), 834 (Benefit Enrollment and Maintenance Transaction), 278 (Prior Authorization), 997 (Transaction Acknowledgement).
• Tested the EDI interfaces and X 12/EDI transactions (270, 271, 835,837 and 997).
• Backend testing by executing the SQL commands for data retrieval/verification, data updating and data insertion into the tables
• Prepared test matrix and test status reports to reflect the status of testing and bug fixes of the HP Quality Center.
• Used Quality Center to track the defects encountered during testing.
• Test cases are designed for the black box testing and perform boundary value analysis, decision table analysis for business rules, and state transition verification.
• Extensively used Quality Center for defect tracking and prioritizing defects and enhancement requests after base lining the requirements.
• Tested the database integrity by writing SQL queries
• Tested XML files using XML Spy.
• Involved in database testing by writing and executing SQL queries to validate that data is being populated in appropriate tables.
• Involved in manual testing of ETL components, SQL, PL/SQL blocks.
• Conducted and Attended review meetings, performed Walkthroughs with the developers and development team to set a hard-freeze date and gather input for creating the Test Plans and Test Specifications.
Environment: J2EE, Quality Center, DB2, Mainframe, SQL, Oracle, Microsoft, XML, HTML, MS-Excel, Web Services, Web Applications