Configuration Testing/Quality Analyst Resume

SUMMARY:

TECHNICAL SKILLS:

WORK EXPERIENCE:

Confidential

Configuration Testing/Quality Analyst

Responsibilities:

Performs testing on the accuracy of new provider contract and amendment configuration
Verifies claim system edits and third party tools
Interprets institutional, ancillary and professional contracts and fee schedules
Develops and executes efficient and effective test plans for physician/institutional/ancillary provider contract installation
Performs capacity planning, reporting, business analysis, and all aspects of quality assurance

Confidential

Configuration Analyst

Responsibilities:

Create and maintain Group/Benefit additions, terms and changes
Configure and maintain the claim processing system mapping and all interface modules
Set-up and file maintenance of all diagnosis, CPT and other medical codes
Collaborate with client to develop, implement and improve cross functional work processes which support claims processing and proper provider payment

Confidential

Provider Contract Control Analyst

Responsibilities:

Provider contract/amendment loading and processing using various databases
Responsible for the installation and administration of assigned contracts
Prepare plan materials, administrative documents and provider education materials
Audits contract loads for adherence to quality measurers and reporting standards

Confidential

Credentialing Specialist

Responsibilities:

Credentialing of physicians, allied health and other practitioners
Maintaining compliance with regulatory and accrediting bodies
Updates accurate filing of all data related to physician credentialing and quality assurance
Collecting and maintaining an accurate practitioner database and analyzing verification information

Confidential

Contract Commercial Planload Specialist

Responsibilities:

Loads medical/dental/prescription benefit plan packages
Coordinates and documents the review and impact analysis of contract changes, and analysis of system enhancements
Creates new products, maintains benefit tables, pricing files and provider network records
Updates system options, development documentation, testing and implementation of corporate projects related to benefits.

Confidential

Billing and Enrollment Representative

Responsibilities:

Processes member payments and maintains demographic information.
Reconciles billing discrepancies, analyzes transactional data and submits retroactive payment changes
Audits billing activities, monitors outstanding balances and submits invoices

Confidential, Louisville, KY

Loan Processor/Proof Operator

Responsibilities:

Confidential, Jeffersonville, IN

Statistical Assistant

Responsibilities: