SUMMARY:

• More than 8 years of QA experience in Agile environment including requirements gathering, risk analysis, project planning, scheduling, testing, defect tracking, management, and reporting.
• Adept at using manual testing tools to troubleshoot systems, integration, user acceptance, positive and negative, functionality, object, black box white box and regression testing.
• Develop use cases, user interface specifications, and user requirement specification documents.
• Liaise with developers, business analysts, and user representatives in application design and document reviews.

TECHNICAL SKILLS:

Windows

Microsoft Office

Rumba (IBM MF)

HIPAA Validator

Beyond Compare

Mercury ITG

Data Center Management System

Basic SQL queries

Unix

Siebel

Rhapsody

MHC

Intuit QuickBase

Oracle

PROFESSIONAL EXPERIENCE:

Confidential, Nashville, TN

QA Contractor

Responsibilities:

• Test new clinical web set up and functionality in an Agile Scrum Environment.

Confidential, LaVergne, TN

EDI Systems Integration Analyst

Responsibilities:

• Assist new or current customers with EDI setup which includes the implementation process through company specifications
• Test new customer files for accuracy; test current customer files for changes made.
• Set up new customers on company file transfer protocol.
• Research any customer order issues during processing.
• Maintain QuickBase application for Key Performance Matrix meetings.

Confidential, Nashville, TN

BA/QA Analyst III

Responsibilities:

• Tested system migration for Veteran's Affairs data. Testing included user web application, claim flow data, reports and print claim forms.
• Responsible for 270/271 (HealthCare Eligibility Benefit Inquiry and Response) system updates, client concerns.
• Worked in detail to resolve issues; production, claims, researched claim format mapping documents and specifications for changes requested by the VA.
• Created test claim files and test plans for system changes, bug fixes (UAT, internal, regression and end to end testing)
• Maintained up to date knowledge of the all claim formats as well as system requirements for X.12 837 professional and institutional.

Confidential, Nashville, TN

EDI Analyst/ QA Analyst

Responsibilities:

• Tested new application of X12 837, X12 835.
• Research claim files for rejection issues.
• Provide information for new providers setting up the EDI process (e.g.; FTP).
• Test new provider claim files for compliancy and system requirements.
• Create daily and monthly claim reports for management.
• Create map flow for new applications.

Confidential, Nashville, TN

Quality Assurance III

Responsibilities:

• Lead QA for 2 different batch medical and hospital claims processors (Commercial Batch and enhanced edits)
• Created test claim files and plans to test changes, bug fixes (UAT + internal, validation,regression and end to end testing.
• Tested new web application for major client for user friendliness and system requirements.
• Maintained an up to date knowledge of the claim format as well as system requirements.
• Successfully tested 8 major development projects
• Develop detailed test plans and data based upon business and system requirements.
• Create User Acceptance data and test plans for Payers and Providers to review.
• Documented issues and concerns during the QA process.
• Ensured that system changes do not impact other payers and providers and test results comply with the requests.
• Perform end to end testing to ensure data integrity and compliance.
• Work closely with development and Business Analysts
• Provide weekly written status reports to IT management
• Participate in technical logic and design discussions
• Create, maintain, and present technical documentation
• Monitor and update the change request tracking system.
• Review other QA staff test plans, data, and results to ensure production readiness.
• Assist other areas of the company in establishing the request through customer interaction.
• Train new employees on systems, department guidelines, understanding of the overall testing methodology and strategy
• Run Volume testing and compare development and production results.
• In charge of training offshore employees of applications, requirements, documentation, testing procedures and processes for a smooth transition.

Confidential

Lead Implementation Analyst

Responsibilities:

• Assist clients with implementing and converting to X12/4010 formats.
• Tested client claim files for compliancy and system requirements.
• Extensive knowledge of Proprietary Claim formats, EDI, National Standard Formats and ANSI X12 formats with an emphasis on the 837 Transaction Set.
• Educate payers on the WebMD Envoy Companion Guides and HIPAA Implementation Guides to aid in their set up and testing.
• Coordinated and created extensive end to end test plans and data in current payer format and 4010 and documented differences.
• Utilize Claim Analyzer Tools and Foresight (HIPAA Validator), in the analysis and testing process.
• Participated in conference calls with payers to set up testing process and discuss issues.
• Researched and documented all issues. Created requests for payer specific edits.
• Communicate to the WebMD Help Desk and Handholding group all pertinent information about the client to assure excellent customer service after they go “Live.”
• Meet established turnaround times on clients testing.
• Maintain a working knowledge of WebMD switches, communication protocols, translators, and desktop products as they relate to the clients HIPAA conversion
• Supervise other Implementation Analysts and monitor their work assignments.
• Train new team members on all processes.
• Maintained the payer testing queue and payer database
• Ensures accuracy and timely set up of client on the system. Responsible for meeting deadlines of the department.
• Interfaces with production control to assist in establishing resolution in production related issues for new live payers.

Confidential

Lead Provider Relations

Responsibilities:

• Provide assistance to representatives to ensure accurate responses to providers.
• Monitor daily call center service level.
• Review and evaluate representatives work performance.
• Maintain various monthly reports.
• Train staff and perform one on one orientation with other personnel.
• Answer telephone and written inquiries regarding policies and procedures.
• Completed provider correspondence in a timely manner.
• Instructed providers on CPT and ICD9 codes/fees, contract limitations and benefits.

Office Manager

Confidential

Responsibilities:

• Process all insurance and private billing
• Maintained patient financial records by positing charges and payments.
• Maintained and followed up on outstanding account receivables.
• Complete monthly aging reports.
• Bank reconciliation of business and savings accounts.
• Coordinate employee schedules; verify payroll, order supplies, equipment and outside maintenance of office.
• Assist in hiring new personnel.
• Supervise front office activities, scheduled appointments and other telephone inquiries. .

Confidential

Senior Account Manager

Responsibilities:

• Complete patient charts with correct CPT and ICD9 codes
• Post private and insurance payments.
• Complete aging reports and submit follow up.
• Answer telephone and written inquiries.
• Balance monthly ledger reports for multiple clients.

Confidential

Senior Claims Processor

Responsibilities:

• Reviewed medical and institutional claims for processing.
• Processed claims per policy specifications.
• Reviewed denied claims for further consideration in payment.
• Trained new employees and assisted current employees.