PROFESSIONAL SUMMARY:

I have over twenty years of experience in Customer Service, Claims Processing, Healthcare Insurance, Medical Terminology, Research and Development, Medicare/Medicaid and Data Analysis.

SKILLS SUMMARY:

• Written and Verbal Communication
• Claims Processing
• Claims/Customer Service
• Data Analysis
• Healthcare Administration
• Computer Literacy
• Medical Benefits
• Research and Development

TECHNICAL SKILLS:

Management Tools: Epic Tapestry AP, QC Application Lifecycle Management Tool

Project Management: MS Project 98

Office Tools: MS Office XP Professional Word, Excel, PowerPoint, Outlook, Lotus Notes, Office 365, and Sharepoint

Software: Diamond, KmateWeb, Macess Claims Systems

Data Modeling Tools: Visio Professional, Adobe Pro

Operating System: Windows 98/NT/XP/7.0/Windows 10

Databases: MS Access, Oracle, Business Objects

EMPLOYMENT HISTORY:

Administrative Support

Confidential

Responsibilities:

• Organize the store management office
• Execute operational administrative functions
• Oversee departmental scheduling maintenance
• Performed end of the night balance sheet maintenance
• Distribute reports from the My Confidential ’s portal to the management team
• Facilitate the onboarding process for new hires and other Human Resource functions as needed
• Performed other administrative duties as assigned

Testing Analyst/User Acceptance Tester

Confidential

Responsibilities:

• Assess results for documented feedback on processes and capabilities
• Perform comprehensive configuration testing processes for provider contracts of benefits
• Serve as technical resource for business concerns
• Communicate outcomes of user testing results to business partners for sign off and approval
• Create testing scenarios according to product plans for benefit configuration validation and proper claims adjudication
• Perform parallel validation testing with stakeholders ensuring accurate benefit builds according to stakeholder requirements
• Execute claims quality review testing to validate member benefits before claims are correctly adjudicated
• Perform ICD 9 and ICD 10 testing for various claims projects
• Create and present weekly status reports for stakeholder
• Assist in the on boarding process for new hires

Business Process Consultant

Confidential

Responsibilities:

• Conducted User Acceptance Testing (UAT) with testing and validation team
• Maintained integrity of the business model testing environment
• Coordinated testing schedules with project team
• Triaged all incoming service request from project team
• Created an internal audit process for quality control
• Created a structured workflow process
• Performed testing and validation configuration design process
• Tested BETS system
• Conducted testing for code freeze changes and updates from project team

Customer Relation Billing Rep

Confidential

Responsibilities:

• Handled customer inquiries/complaints in a call center regarding a myriad of lines of business
• Created a matrix design to handle customer inquiries that was utilized throughout the call center
• Received escalated calls from customers with complex inquiries

Subject Matter Expert/Business Analyst

Confidential, Maryland

Responsibilities:

• Supported team leads with modifying, creating and writing of test scripts for claims processing and management system
• Supported project team with data and systems analysis support
• Assisted in developing testing and systems deployment activities
• Created documentation for project team to use for customer requirement documents
• Researched and analyzed claims adjudication issues from provider network and reported findings back to Project Managers
• Was a project team member for various federal mandated projects including HIPAA and ICD 10 migration