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Sr Risk Control Analyst Resume

Wilmington, DE

PROFILE:

Senior QA/Test Engineer with full system development lifecycle experience, including designing, developing, and implementing test plans, test cases, and test processes. Offer significant achievements driving cost savings, process efficiency, and fault - free audits. Skilled in Agile methodologies with strong leadership and strategic thinking skills.

SKILLS:

Windows, Unix, Linux, Mac OSX, VMWare

TECHNICAL SKILLS:

Platforms: UNIX, Linux, Windows (NT, 2000, XP, Modeling and simulation 2003, Vista), Macintosh, MS-DOS. Writing use cases

Programming languages: Perl, SQL, JavaScript, Analytical problem solving Java, UNIX/Linux shell, VB, PL/SQL, HTML. Cross-functional teamwork

Database systems: Oracle, Microsoft SQL Microsoft Visio Server,Teradata SolidWorks

Web Server: IBM Web sphere, Data power (IBM), SQL database Weblogic Sharepoint

Networking: SS7 signaling & protocols, TCP/IP Phoenix

Defect-tracking software: JIRA, Mercury Quality Centre(ALM)

Source-control software: CVS, Visual SourceSafe, Accurev.

Tools and Utilities: Teradata, SQL Developer, SOAP UI, JIRA, Confluence, Microsoft Exchange, Accurev, Toad, Macro, visio

PROFESSIONAL EXPERIENCE:

Sr Risk Control Analyst

Confidential, Wilmington, DE

Responsibilities:

  • Perform control walkthroughs to understand the business risk and control design
  • Develops and executes robust control test scripts for functional, common foundation controls designed determine root causes, and recommend solutions.
  • Comprehend the Business Guidance and Procedures (BG &P) to determine type of Controls, Frequency, evidence and Rationale
  • Evaluating the design of Controls to support Risk mitigation.
  • Determine if Controls are operating effectively.
  • Measure if theService Level Agreement (SLA) is met
  • Translate the lines of Business (LOBs) functions into test execution scripts.
  • Analyze samples and evidence to determine if the LOBs are following procedures to support Control effectiveness.
  • Functions of Phoenix and reporting.
  • Monitors and test control and business exception reports.
  • Conducts proactive audits to target specific and high risk processes or functions Verifies accuracy and ensures compliance with plans, policies and procedures prescribed by management Develops and administers ongoing exception - based quarries to test critical and sensitive transactions to ensure procedures and identify emerging trends and issues.
  • Documents test plans and test results.
  • Verifies accuracy and ensures compliance with Confidential Procedures related to Confidential structure and Risk and control definitions and element
  • Make recommendation to enhance the Confidential Framework Work closely with control officer and issue Management teams as needed to explain test result and remediate finding.
  • Executes quality and test advocacy, resource planning and management, reporting and test metrics tracking.
  • Delivers review findings to Control team and /or business counterparts.
  • May participate in developing procedures, training materials and/or job aids.

Senior Risk Acquisition UAT (Back End Testing)

Confidential, Wilmington, DE

Responsibilities:

  • AS A User Acceptance Testing (UAT) responsible for conducting software quality assurance testing following systems in support of different Card Services LOBs Participate in the UAT testing phase of each project, particularly the following established written procedures guidelines and techniques, develop, enhance, test, maintain and debugs software application that support Risk Technology business.
  • Analyze and review the high-level requirements as defined in the Business Requirements Document (BRD), Functional Specifications Document (FSD) and Use Cases.
  • Validated Credit Decision Navigator (CDN) according to Visio/design documents.
  • Analyzed and testedManaged Test and Evaluation Master Plans (TEMPs), ensuring proper format and content.
  • Credit Card Strategy rules and Dodd frank federal compliance rules in the credit card application processing engine.
  • Used QT90 Macros to drop test data into test region and confirmed the test results in Confidential Screen Capture/Spool file aid manually.
  • Used ACS (Application Capture Service) macro to drop Consumer and Business CRCLI Apps.
  • Communicated with Project Management to establish LOE of each phase of SDLC and prioritized QA task.
  • Design and review test scenarios and test scripts.
  • Prepare UAT and Production test environments through smoke testing and test data and test strategies needs
  • Execute the Functional and Regression test scripts
  • Record the actual testing results via HP ALM
  • Conditions test data in support for other testing groups Identify, track and monitor defects' progress until closure
  • Help assess readiness and deviation of system modifications based upon test results and product specifications Contribute to team's common knowledge
  • Performed Defect Root Cause Analysis, interacted with related Team, and tracked defects in a Test Director.
  • Performed impact analysis and executed test scenario with Regression Testing. Interacted with Business Analysts and Software
  • Developers for bug reviews and participated in UAT meetings.
  • Involved in change control at each new changes by discussing impact of current functionality, release notes, preparation for production launch.
  • Adhered to established standards and methodologies.
  • Utilized tools and methodologies to improve individual effectiveness and to increase efficiencies in the UAT process.
  • Developed and sustained appropriate relationship with peers and other project team members.

Confidential, MD

Office Manager

Responsibilities:

  • Coding and Billing specialist with outpatient, rehab, home health and medical inpatient
  • Provide excellent customer service and serve as the first point of contact for all patients
  • To Analyst in Revenue cycle process based on OIG guideline and reimbursement based on procedure and CPT code.
  • Abstract Confidential -9 code from patient chart as per medical record.
  • Resolve issue with patient insurance or any medical denial or query for medical claim.
  • Maintain credential and recredentialing with Confidential data update along with maintain and develop good client relationship with insurance.
  • Handle basic daily accounting function with account payable and receivable.
  • Communicate for weekly Confidential for Confidential Company.
  • Attend seminars and webinar for current coding updates and other software update.
  • Order all office supplies and equipment.

Confidential

Medical Software and Billing Specialist

Responsibilities:

  • Software implementation including testing EDI (835, 837, 834) transactions.
  • Accomplish more than 4 facility/Healthcare center EDI enrollment and claim transaction and EDI.
  • Excellent testing experience
  • Also successfully delivered training in all aspects of Health Information Specialist Programs including HIPPA, Insurance, Medicare, Medical Billing Software)
  • Medical Coding ( Confidential -9-CM, Confidential -10, CPT, HCPCS)
  • To abstract Confidential -9 code for more than 8 doctor from electronic medical record.
  • Network participation and enrolment for new facility and surgical center with all insurance including Medicare, Medicaid, and third party insurance
  • Providing complete billing training to existing and new staff including Confidential -9 coding and introduction of Confidential -10
  • Resolving most complex denial for all insurance and third party claim and train existing staff for the same
  • Maintains strict confidentiality, adheres to all HIPPAA guidelines regulation.
  • Maintaining and updating internal credentialing and recredentiailng policies and procedure for 10 and more doctors, Surgery Center, wound care center and Urgent Care Center.
  • To perform and train Medical Coding and Medical Billing to Billing staff.

Confidential

Billing Associate

Responsibilities:

  • Contacting Insurance company for claim status and Denied Cases
  • Prepares and submits clean claim to various insurance companies and verifying if Confidential -9 code and CPT codes are correct as per coding Guideline.
  • Answers questions from patients, clerical staff and insurance companies.
  • Follow up on unpaid Insurance claim Including appeals and denials with Confidential -9 code correction.
  • Conforming prior authorization from insurance company for different procedure
  • EOB posting and resubmission of claims
  • Conforming activation of insurance through Confidential .
  • Assisting in account for various insurance company

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