Quality Analyst Resume New Jersey, NJ - Hire IT People

SUMMARY OF QUALIFICATIONS

MS Word
Excel
PowerPoint
Internet research
Outlook
ESI
IDX
Medisoft
Agile
Bugzilla

PROFESSIONAL EXPERIENCE

Tested web application in Agile development processor
Proficient in software development life cycle including test strategy preparation, test plan development, test case creation, test execution and bug tracking
Understanding of Quality Assurance Life Cycle and Software Development Life Cycle
Developed and maintained automated test scripts
Enjoy learning new tools and technologies

Confidential,02/2008 to 07/2012 Keller, TX

Business Franchise Owner

Confidential, 02/2007 to 02/2008 Fort Worth, TX Claims Rep

Responsible for calling insurance companies for status of medical claims
Completed a minimum of sixty worked claims per day with an error ratio percentage below five (5%) percent.
Documented all account information into hospital s health information system
Maintain a minimum of 3-4 hours daily on the phone. (PMS telephone system logs all calls by telephone extension)
Completed all additional information request

Confidential,04/1999 to 01/2007 Anaheim, CA Claims Examiner / EDI Processor II

Processed HMO claims on a daily basis per established guidelines for: Fee-for-service claims, Emergency claims, and Encounter based/capitated claims
Processed encounter based/capitated ER HMO claims from ER pass-through authorization listing
Determined and forwarded medical review ER claims which did not meet criteria
Followed-up on all claims are in a final status
Produced claim denial letters when appropriate
Alerted directors and supervisors of all claims issues
Downloaded EDI files from FTP site and runs through the scripting program
Produced and audited reports of routine to moderate level of complexity utilizing database/spreadsheet software
Promoted from Enrollment Processor II
Processed and update eligibility information on health plan report
Generated excel worksheet for plans that needed to be built in preparation for the system analyst
Communicated directly with health plan provider to resolve eligibility issues
Assigned primary physicians to memberships based on selected health plans
Communicated professionally with coworker, facility sites, and providers
Resolved duplicate account related issues
Sent enrollment reports and capitation checks on a monthly basis
Sent letters to health plans regarding payment of capitation/member names missing on eligibility reports
Accepted other office related assignment from manager

EDUCATION

Fundamental of CCNA
Associate of Arts in Business Administration
Minor in Computer Information System