SUMMARY:

• QA Lead Tester, Testing Manager, and Business Analyst: Develop and lead the software system testing process executing the principles and responsibilities of software quality assurance. This includes implementing test strategies, test plans, test cases, user stories, analyze, design and develop test procedure, test automation and product specifications for software and hardware integration testing. Have up to 24 years’ expertise in the Healthcare arena utilizing every IT healthcare aspect that would contribute greatly to a potential employer.
• QA Tester, QA Lead, Testing Manager, Business Analyst, Benefit Support Analyst, Testing, Claims processor, Systems Conversion functionalities, Inbound/Outbound 834 testing, Product Implementation, Automation testing, all aspects of a Business Analyst.
• Systems used: MembersEdge (Certified), NPS, Tex Med Connect, Benefit Focus Ebilling, MCS, MHS Power, MHS Power II, MarkII, Filenet, Rims 2.7, Texen, CSC, UPRO, Pace, Image Systems, Macess, Lawson, Mobius, AS400, Test Director, WINSQL, EROOM, home grown claims systems
• Extensive Knowledge of Medical Terminology, Medicare Risk, HIPAA Compliance, ICD - 9, CPT Coding, Capitation, DRG, COB, TPL
• Health Plans: ASC, TPA, HMO, PPO, POS, TRAD, Medicare, Medicaid, and Self-Funded Groups, worked with many Blue Cross/Blues Shields across the United States.

PROFESSIONAL EXPERIENCE:

Confidential

QA Testing Analyst/Benefit Plan Support, Tester Lead, Testing Manager

• Contractual assignment with Jawood-Genpact, working with NASCO, Horizon BCBS, MA BCBS, Anthem BCBS, Florida Blue BCBS. Responsibilities include, QA Testing Lead, Testing Manager, Testing Benefit Analyst, Auditing, and training. Includes project implementation, training, system release work, developing Test Plans, Testing Analysis of benefits for employer groups, ASC’s, ASO’s, PPO, HMO, Split level and Direct Access plans based on system implementations, updates and conversions of existing plans into the NASCO Processing System.

Confidential, Austin, TX

Business Analyst

• Contractual assignment with Accenture, working with the State of Texas (HHSC) and ACS (Affiliated Computer Services) for customer-focused Medicaid and Healthcare services as a Business Analyst in the Business Service Delivery department. Responsibilities include the collecting and analyzing the project’s business requirements, system implementations, system enhancements and interpretation of business rules and requirements for technical systems. Developing Charter/BUR Business Requirements, Functional Designs, Test Approach, Test Plan, and test script documents to meet the client business needs. System Product Test and UAT testing, configuration and client presentations for approval of the system implementation.

Confidential, Bloomfield Hills, MI

Business Analyst/BCBS Michigan

• Contractual assignment with BlueCross Blue Shield of Michigan involving QA testing in the MetaVance/Members Edge system preparing for conversion of Direct Pay individual business. Data build and configuration of Groups/Divisions in production environment for conversion. Creating test scripts for QA testing of membership, billing, invoicing, configuration, and Ebilling. Developed training material and provided training of personnel on the Member’s Edge system for membership/billing purposes.

Confidential, Dallas, Texas

Business Analyst

• Lead Business Analyst liaison function between NASCO and various clients which included CareFirst, BCBS Michigan, and Horizon. I was a technical resource in the development of NPS Membership and Billing system and how it interacts with the Members Edge (MetaVance) membership solution. Provided subject matter expertise and technical support for member enrollment; billing, maintenance, and benefit configuration. The projects included conversion mapping logic of business levels for control plans into the system; upgrades of the Members Edge for clients to ensure proper conversion of their groups, divisions and subscribers. Responsibilities included QA testing analysis, system implementation, enhancements, applying client policies and standards throughout product/project delivery and technical consultation, creating business requirements, test scripts, test Plans.

Confidential, Natuck, Ma

Business Analyst/EDS

• Contractual assignment with EDS as a Lead Business Analyst involving client contact between NASCO and various clients which included CareFirst, Horizon and BCBS of Michigan in the development of membership and billing conversion processes from the NASCO System into the Members Edge. I was a technical resource in the development of NPS Membership and Billing system and how it interacts with the Members Edge (MetaVance) membership solution. Responsibilities included technical consultation with NASCO, implementation of system upgrades which involved writing Business Requirements, creating Test Plans and test cases; QA testing analysis, Group, Benefit and Billing configuration.

Confidential, Phoenix, Arizona

Business Analyst

• Contractual assignment with Centene (Medicaid) using the Amysis System, performing various services which included testing analysis. Executed audit reviews to meet code of Federal Regulations pertaining to National Provider Identification quality assurance management to ensure updated NPI product met expectations which included EDI formatting and audit analysis of incoming 837 reports and Medicaid guidelines.

Confidential, Natuck, MA 

Business Analyst/EDS

• Contractual assignment with EDS as a Lead Business Analyst involving client contact between NASCO and various clients which included CareFirst, Horizon and BCBS of Michigan in the development of membership and billing conversion processes from the NASCO System into the Members Edge (MetaVance). I was a technical resource in the development of NPS Membership and Billing system and how it interacts with the Members Edge (MetaVance). Responsibilities included claim systems payer data analysis, creation of Business Requirements, Scope Documents, Test Plans, Release Notes, and test cases. Performed QA testing analysis; claims, benefit, group and division configuration and work product collaboration reviews with clients to meet their business needs.