Facets QA Tester Resume Buffalo, NY - Hire IT People

SUMMARY:

Accomplished health care professional with over 12 years experience. Thorough health care knowledge with a broad background in testing systems such as Facets. End to end knowledge in testing/processing medical and hospital claims. Extensive expertise of benefits and testing configuration. System conversion experience.

TECHNICAL SKILLS:

SYSTEMS & TECHNICAL KNOWLEDGE: Trizetto FACETS all versions including 4.71/5.01 * Extensive experience on Testing in Trizetto FACETS * Streamline * Ultera * MTM/Quality database * claim assist * excel/word * ICD9 and 10/835/837 * Medicare/Medicaid experience * Adjusting/auditing claims * UAT testing * Adjudicating claims from start to finish * Medical review * Tiger system * Standard testing database * Configuration & testing management system (CTM) * APR/DRG experience * GPOO * Benefits experience * Microsoft Access * HP Quality Center * Workflow * Rapid SQL *

EXPERIENCE:

Confidential, Buffalo, NY

Facets QA Tester

Responsibilities:

Test existing group renewals and new group claims against their benefit matrix
Test products against supplemental tables, limits, deductibles and accumulators
Review Benefit Matrix for specific details of product descriptions
Develop technical solutions for automation processes
Run queries in microsoft ACCESS for each product
Test products and claims via Tiger 3.0 / Validation Testing
Utilizing facets Production 4.71/5.01 and facets Qual 4.71, as well as all versions of FACETS used prior.
Test configuration changes on claims systems, including ICD 9 & 10
Test plan development, execution and management of defects
Utilizing CTM (Configuration Testing and Management System and the standard query claims database to run validation queries; SEPY’S PDBL’S PCAG’S, DEDUCTIBLE’S and LIMITS
Setup Initial & Final Validation spreadsheet in supporting files
Regression testing
Creating test scenarios based on business requirements

Confidential, Indianapolis, IN

Facets Claims Rep / QA Auditor/Tester claims Rep

Responsibilities:

Process incoming hospital and medical claims HCFA and UB92
Determine errors on claims and adjust pended claims as needed per procedures and by resolving error and warning messages, as well as ultra blue messages.
Worked intakes and audited claims done by other processors
Extensive experience with Benefits matrix and different benefits

Claims Auditor/Claims System Tester

Confidential

Responsibilities:

Test configuration changes on claims systems
Test existing group renewals and new group claims against their benefit matrix
Trizetto FACETS testing
Health payee field/INN or OON provider familiarity, ability to choose payee based on in or out of network status.
Experience with Networx pricer - testing and figuring pricing for procedures and claims based on information inputted into networx
Set up of benefit packages per different plans, and contracts
MEDICARE/MEDICAID/COB claims experience
Membership/enrollment and billing-entered information on facets to ensure correct eligibility
Adjust and request refunds on the back end as needed
Ability to send letters on FACETS for provider issues

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Facets Qa Tester Resume

Buffalo, NY

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