QNXT Configuration Consultant Resume

PROFESSIONAL EXPERIENCE:

Confidential

QNXT Configuration Consultant

Responsibilities:

Consultant supporting the research and remediation of configuration issues, Consultant supporting the research and remediation of configuration issues.
Identifying provider edits with queries and reports. Correcting provider edit discrepancies within the operating system.
Identifying provider edits with queries and reports. Correcting provider edit discrepancies within the operating system.

Confidential

QNXT Consultant - Contract/Benefit Configuration Specialist

Responsibilities:

implementation on the Medicare line of business for Confidential, by obtaining business requirements, performing test case scenarios to ensure accuracy of Contract and Benefit
configuration.
Created Provider Contracts, Benefits, load Fee Schedules, assisted with provider contract mapping and aided in claims unit testing for QNXT 4.7 implementation.
Detailed SQL and Access queries to verify changes made to system configuration.
Detailed claims/application testing to ensure proper benefit, contract, provider and claim functionality.
Develop, execute and support UAT test scripts to ensure the system’s behavior is consistant with the business requirements. UAT testing consists of Analyzing Business Requirements, Identifying UAT Scenarios, Define the UAT Test Plan, Create UAT Test Cases, Run the Tests, Record the Results and Confirm Business Objectives are met.
Integration testing.

Confidential

System Configuration

Responsibilities:

Prioritized issues, creating claims testing scenarios to validate and ensure that system implementations, conversions, contract and benefit builds/updates, fee schedules updates, etc., were functioning properly within QNXT system.
Responsible for performing system analysis and testing to develop system updates for contractual upgrades as well as general system maintenance.
Creating and maintaining new fee schedules for DME, Home Health, Lab & Pathology, Physicians.
Assisted with performing service pack updates and critical path testing, utilizing my knowledge of QNXT applications to maintain the system. I Participated in QNXT implementations and conversions of Medicaid-Medicare Health Plans. Executed updates on fee schedules & Reimbursement methodologies and other source files for applicable health plans. Exhibited behaviors outlined in Application Support Analyst Competencies.
System Configuration on the following modules: Carrier, Sponsor, Policy Administrator, Contracts, Benefits, Fee Schedules, Claim Finance Codes, Providers, Member, Configuration, Medical Codes, Claims, and Claims Workflow

Configuration Analyst

Confidential, AZ

Responsibilities:

As a Contract Analyst I reviewed, interpreted and loaded provider contracts into the Diamond claims payment platform.
Maintain accuracy and timeliness, provide technical support to the department in order to secure, interpret, document, catalog, and update documents for potential internal and external customers.
Strong knowledge of Crystal for reporting purposes.

Confidential

Quality Assurance

Responsibilities:

Deliver solutions to clients in response to varied business requirements, utilizing products and technology skills.
Logging of possible system irregularities.
Perform and direct software coding, testing, debugging, documentation, and installation tasks.
Conversion from an existing system automatically or manually. Ensure that safeguards are employed to protect the accuracy and integrity of the data conversion process.
Compatibility with functioning on a broad range of open systems architecture hardware platforms and multiple operating environments (DOS, DBC UNIX, VMS and Windows).
Strong knowledge of maintaining a full complement of support services intended to help customers achieve maximum value from their system investments. Services include consulting, training, data conversion, customer specific enhancements and ongoing user support.