OBJECTIVE:

EXPERIENCE:

4/2014 - 12/2015

Industry: Computer/IT Services

Software Quality Assurance Analyst

SIT tester, UAT, go-live and Production support for HealthRules implementations.

-HealthRules 5.2 -Used Zephyr for test case management and reporting-JIRA for issue tracking-Utilized Solace EMC to manually enter electronic claims-FileZilla was used to load manual claims-Accessed legacy system, Managed Care Optimizer (MCO) to validate dual processing

4/2013 - 2/2014

Industry: Computer/IT Services

Functional QA Analyst

SIT tester, UAT, go-live and post go-live support for conversion from legacy system (ClaimFacts) to Facets.

-Facets 5.01 – Manual testing of Enrollment files and extracts, Reports, Letters, EOBs /Remits, HRA Accumulators (Membership & Claims), Web, IVR and Security-SpiraTest 4.0 – Documented and tracked test cases, test set execution and defects-FrontRange 7.1 – Updated ITSM and NPC tickets -Report2Web v4 – Validated Facets reports

6/2008 - 3/2013

Industry: Computer/IT Services

Functional Testing Analyst

SIT/UAT Membership/Enrollment tester for conversion from legacy system to Facets.

-Facets 4.71 – Upgrade and configuration testing of Subscriber/Member (Group Set-up, Enrollment, Letters, &ID Cards) and Privacy applications-HP Quality Center 11.0 – Documented and tracked business requirements, test cases, and defects.-SAP BusinessObjects InfoView – Ran and tested Facets Membership reports-Emdeon Client Access System – Retrieved and validated PDFs of letters generated out of Facets-WinSCP – Used to validate of Member ID Card files

4/2007 - 4/2008

Industry: Computer/IT Services

Business Analyst

Utility player for Kang Zhong China TPA implementation of Facets 4.41

-Documented report requirements and mocked-up Visio report samples-Documented business procedures based on Facets processing and China business standards.-Coordinated Model Office activities including documenting approach, developing scenarios and tracked results.-Participated in peer review process of business requirements, report requirements, procedure documentation and training lessons.

4/2006 - 10/2006

Industry: Insurance

Testing Coordinator

-Developed Integrated Testing Plan for QNXT 3.2 implementation.-Responsible for the coordination of Member Enrollment, Claims and Authorization Integrated Testing.-Created test cases and scenarios.-Coordinated and managed testing of electronically loaded claims and manually entered claims.-Tracked and reported issues to configuration team and management.-Reported testing status to management team.

5/2005 - 3/2006

Industry: Insurance

Business Analyst

-Participated in post 834 Member/Enrollment load audit for conversion to QNXT 2.0 -Established a schedule for team’s Model Office testing phase.-Tested configuration of Traditional base/supplemental (HMA) LOB.-Tested system enhancements (PERs) for base/supplemental LOB.-Maintained team’s testing dashboard.-Organized and participated in go-live audit process.

9/2004 - 12/2004

Industry: Insurance

Testing Analyst

-Validated QNXT 2.0 system functionality, data conversion, interfaces, business process and workflows. -Reported and documented issues and test results.

3/2004 - 7/2004

Industry: Insurance

Business Analyst

-Established a timeline for the Facets project implementation based on key dates set by Medicare for Drug Card implementation.-Developed testing timeline/workplan for internal testing and testing with Medicare.-Wrote business requirements for the development of new reports.-Created flow charts, documenting the Drug Card enrollment process.-Reviewed and revised test plans.-Validated test results.-Developed training material for Facets enrollment.-Conducted training of new Membership and Enrollment processes.

10/2003 - 3/2004

Industry: Insurance

Consultant

-Tested configuration of new and converted products.-Validated new interfaces and extensions.-Assisted with patch testing of Facets version 2.961.-Performed regression testing of interfaces and extensions.

12/2002 - 10/2003

Industry: Management Consulting Services

Consultant

-Responsible for testing the implementation of QNXT software. -Validated system functionality, configuration, data conversion, interfaces, new releases, enhancements, reports, letters, business process and workflows. -Participated in User Acceptance, Regression, Release and Model Office Testing phases. -Reported and documented issues and test results.

9/2002 - 12/2002

Consultant/Tester

-Configured and unit tested benefit packages and authorization requirements.-Tested configuration of pricing contracts.-Tested problem claims and administrative scenarios including other insurance responses, remarks, COB claims and claims adjustments

11/2001 - 8/2002

Consultant/Tester

-Developed configuration test scenarios & scripts based on business contracts and payment policies.-Developed extension and interface test scenarios & scripts based on user requirements.-Manually tested configuration through entry of HCFA 1500 & UB92 claims. -Performed data verification through data model queries.-Provided troubleshooting of errors and recommended solutions.-Documented, logged & tracked configuration and development issues.-Communicated test results to user.-Verified accuracy of accumulators converted from legacy systems.-Tested functionality of eFacets web implementation.Analyzed eFacets visibility for HIPPA privacy requirements.

6/2000 - 4/2001

Industry: Management Consulting Services

Sr. Consultant

-Developed user requirements for AMISYS (release 10) custom reports for Metropolitan Jewish Health Systems.-Provided data mapping for transferring Provider data from PowerMHS (CSC) to AMISYS (release 9.52) for Value Options Health Plan.-Uploaded and maintained documents on clients’ web pages.-Performed project management tasks.

10/1997 - 4/2000

Implementation Consultant

-Provided Benefit configuration support to Partners Health Plan of NC.-Provided Pricing & Provider configuration support to Presbyterian Health Plan.-Configured Benefit Plan for Partners in Health of NY.-Provided customer support for system conversion for Premera BCBS.-Tested configuration of Benefits, Pricing, Claims and Medical Management for Kirk-Von Orsdel, Inc (KVI).-Participated in Benefits business assessment for MedPartners of CA.-Configured Benefits for BCBS of Arkansas.-Team Lead, Benefits configuration, Reference & Controls monitor, provided user training & Go-live support for CIGNA of NJ.-Audited Liability Recovery configuration for Innovation Health Plan.-Provided go-live support for AvMed Health Plan.-Benefits and complex authorization & referral configuration for Ucare of MN.-Provided benefit configuration support for BCBS of NH.-Tested pre-released software.

7/1997 - 9/1997

Product Tester

-Manually tested accuracy of automated claims review and payment application that was under development.-Documented test results and communicated errors & issues to developers.

2/1996 - 7/1997

Claims Supv & Benefits Plan Builder

-Supervised staff of eight senior claims analysts, handling medical, life and disability claims.-Processed overpayments, refunds, adjustments, appeals, and post-payment quality review.-Reviewed new contracts & configured system to meet payment requirements. -Tested configuration to ensure accuracy.-Developed claims processing policies and procedures.-Participated in the hiring process of new employees.-Trained staff and performed employee evaluations.

6/1995 - 1/1996

Computer Operator

-Responsible for the operations of a Unisys mainframe computer system.-Handled multiple laser print jobs, including medical and pension checks.-Performed system back-ups.

8/1988 - 6/1995

Computer Operator

-Solely responsible for the overnight maintenance of a Unisys 2200 mainframe computer system.-Ran batch jobs, file updates & file reconstruction.-Monitored computer system and re-booted when necessary.-Ran nightly and weekly system back-ups.

12/1981 - 8/1988

Health Insurance Claims Supervisor

-Supervised staff of 10 employees in Claims and Membership Services Departments.-Responsible for keeping employees informed of new payment procedures & guidelines.-Answered oral & written inquiries from members, attorneys, physicians, and union trustees.-Interviewed, hired, trained & evaluated employees.-Conducted pre- and post-payment review of claims.-Processed adjustments, overpayments, refunds and appeals.

9/1977 - 12/1981

Senior Claims Examiner

-Analyzed and coded medical and surgical claims for Medicare Part B-Processed DME claims, including equipment rentals & purchase installments.

EDUCATION:

6/1997

Associate Degree

Comuper Information Systems

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