SUMMARY

• Accomplished professional with over 16 years of experience contributing to development of several business enterprises through customer support, business analysis, quality assurance and testing
• Experience working on MMIS applications for the states of Alaska, New Hampshire, Mississippi and Georgia
• Experience in the Software Testing Life Cycle including analysis, preparation of test plans, development of test cases, test execution, defect tracking and change management
• Worked on Business Rules testing within a Rational environment for healthcare applications
• Possesses excellent analytical, problem solving and decision making skills with detail oriented approach to testing
• Experience in interfacing with stakeholders and senior management with excellent communication and interpersonal skills
• Experience in User Acceptance Testing, Smoke Testing, Regression Testing and Functional Testing
• Strong skills performing data analysis, writing test cases for User Acceptance Testing. Gathered Functional and Data Requirements, analyzed workflows and created Use Cases, Requirement Specifications
• Experience working with Developers, SMEs, and user representatives in application design.

TECHNICAL SKILLS

Applications: MMIS/Healthcare, Excelicare, EDI, Facets

MMIS Subject Areas: Claims, Member, TPL, Provider, Service Authorization, Reference, Benefit Plan

Facets Subject Areas: Claims

Methodologies: Object Oriented

Tools & Standards: QTP, Rational Robot.

PROFESSIONAL EXPERIENCE

Confidential

Business Analyst

Responsibilities:

• Facilitate requirements gathering and gap analysis processes.
• Creation of requirements and design documents
• Identify business problems and opportunities
• Elicit, analyze, communicate and validate requirement for changes to business processes and systems
• Create and execute test scenarios
• Defect Tracking
• Ensure that system documentation is updated according to client standards.
• Build/ maintain strong working relationships with project stakeholders and development teams.
• Primary point of contact between business stakeholders and programmers
• Travel to client location per project needs and requirements

Skills Used: SharePoint, MS Visio, Word, Excel, Rational Tools, Medicaid Eligibility Determination Portlet

Confidential, Van Buren County Hospital, IA

Senior Consultant

Responsibilities:

• Epic Resolute Hospital Billing and Professional Billing Claims
• Effectively utilized Facets,Epic and CareMedic portal to resolve assigned claims issues
• Reviewed claims for billing errors, prepare adjustment request forms, voided negative transactions in a timely manner
• Adjudicated Medicaid/Medipass medical claims daily.
• Resolved invalid and rejected claims.
• Documented the system with notes on current status received and takes appropriate action.
• Seasonal Remote position

Skills Used: Data Entry, 10 - key, Microsoft Outlook and Customer Service

Confidential, Xerox/ACS, Juneau, AK

QA Tester

Responsibilities:

• Manual Testing Tools (User Acceptance, Regression, Functional/User Interface Testing and Verification/Validation Testing)
• Developed test documents and test cases; created test plans, test cases and test scripts
• Defect Tracking in Ration ClearQuest Web
• Responsible for execution of test cases
• Experience working with Developers, SMEs, and user representatives in application design
• Ability to work independently as well as in a team environment and success with meeting deadlines under pressure
• Shared Knowledge with other members of the team
• Updated the test cases based on the Change Requests/Enhancements
• SQL queries

Skills Used: SQL, MS-Windows XP, Rational Clear Quest, Rational Manual Tools, and MMIS Web portal

Confidential, Cognizant, Jackson, MS

Proposal Writer

Responsibilities:

• Facilitated requirements gathering and business analysis processes
• Creation of requirements and design documents
• Supported all phases of proposal development and supported efforts to meet requirements for Requests for Proposals (RFPs)
• Wrote proposal content, as directed; exceptional written communication skills
• Maintained a consistent company image and brand through the creation and use of templates, presentation materials, graphics and supporting tools
• Created boilerplates

Skills Used: SharePoint, MS Visio, Word, Excel

Confidential, AllyAlign Health

Business Analyst

Responsibilities:

• Facilitated requirements gathering and gap analysis processes
• Creation of requirements and design documents
• Developed Provider P&P Manual/Admin Guide, Comprehensive Assessment P&P, and Care Coordinator P&P Manual/Admin Guide
• Built/ maintained strong working relationships with project stakeholders and development teams
• Primary point of contact between business stakeholders and programmers
• Responsible for testing facets core application and UAT modules by following standard testing procedures
• Handle the tasks of testing and entering data in FACETS4.7 application
• Assigned the tasks of performing regression testing of facets application
• Performed Claims validation of facets application as required
• Responsible for running test scripts for facets applications and modules
• Performed defect analysis for failed test cases and develop solutions for the same by coordinating with developers

Skills Used: SharePoint, MS Visio, Word, Excel, Facets and Excelicare portal

Confidential, Xerox/ACS, Juneau, AK

QA Tester

Responsibilities:

• Manual Testing Tools (User Acceptance, Regression, Functional/User Interface Testing and Verification/Validation Testing)
• Developed test documents and test cases; created test plans, test cases and test scripts
• Defect Tracking in Ration ClearQuest Web
• Responsible for execution of test cases
• Experience working with Developers, SMEs, and user representatives in application design
• Ability to work independently as well as in a team environment and success with meeting deadlines under pressure
• Shared Knowledge with other members of the team.
• Updated the test cases based on the Change Requests/Enhancements
• SQL queries

Skills Used: SQL, MS-Windows XP, Rational ClearQuest, Rational Manual Tools, MMIS Web portal

Confidential, Atlanta, GA

QA Tester/Claims Department Lead

Responsibilities:

• Developed test documents and test cases; responsible for execution of test cases
• Defect Tracking in Ration ClearQuest Web
• Facilitated requirements gathering and gap analysis processes
• Creation of requirements and design documents; experience creating test plans, test cases and test scripts
• Experience working with Developers, SMEs, and user representatives in application design
• Managed workflow of the Claims Resolution Unit
• Created production reports on a daily basis and review Quality Assurance results with Specialists
• Created Claims procedure manual
• Responsible for supervising sixteen employees in the Claims Department
• Coordinated and conducted training for Claims Support staff
• Excellent analytical, problem solving and decision making skills and detail oriented
• Responded to DCH Escalation inquiries within 24 hours of the initial email
• Documented the results of research in Omni-track
• Keyed and processed Medicaid claims into the MMIS System

Skills Used: User Acceptance, Regression, Functional/User Interface Testing and Verification/Validation Testing, Ration ClearQuest Web, Omni-track

Confidential, Atlanta, GA

Human Resource Staffing Specialist

Responsibilities:

• Managed multiple education facilities.
• Interviewed prospective candidates for employment.
• Facilitated salary negotiations and conducted new hire orientation
• Responsible for supervising six employees in claims department.
• Responsible for entering providers’ information into the accounting system and printing checks for providers
• Processed 500 medical claims on a weekly basis based

Skills Used: Data Entry, Created spreadsheets, Customer Service, Accounts Payable/Receivable, Microsoft Access

Confidential, Atlanta, GA

Benefit Analyst

Responsibilities:

• Adjudicated multi TPA Group medical claims
• Administered Group Medical Accounts for 5000 members and was successful in reducing backlog by 50%
• Maintained required logs and reports
• Investigated and resolved disputed claims
• Assisted in training of associates.
• Provided quality customer service care to policyholders and assisted subscribers on coverage issues
• Processed HMOs, Managed Care, claims
• Responded to written and verbal inquiries from providers, members, and payers

Skills Used: Data Entry, Audit, Customer Service