QA Tester
Resume:
OBJECTIVE: To obtain an analytical or system support position in a healthcare organization or a company serving the healthcare industry.
WORK HISTORY:
#1: Kaiser Foundation Hospitals, Aug ’04 - May ’10; Lead Programmer Analyst, Lead QA Tester
1451 Harbor Bay Pkwy; Alameda, CA 94502
Successfully led testing teams charged with verifying and validating customized versions of Epic Systems’ Tapestry UM/CM product in the Mid-Atlantic and Northwest Kaiser Regions, and their Inpatient product for the Northern California Region.
Led the national testing teams that partnered with system developers and user analysts to verify business requirements and the physical and logical designs of the national “Continuous Record and Replay” and “Scanning Solution” Epic interface projects. Monitored the progress of all reported issues from inception through resolution.
Distributed detailed spreadsheets to project management and stakeholders showing the testing progress, all issues and their severity with any projected impacts.
Adhered to Sarbanes – Oxley documentation guidelines as required, archiving all specified testing artifacts in the designated repository.
Created test plans that included risk mitigation strategies
#2: IntraNexus, Inc., Mar ’01 – Sept. ’02; Senior Regulatory Analyst 502 Viking Dr; Virginia Beach, VA 23452
Using the Federal Register and other internet sources, identified regulations, trends and policies affecting their current and proposed HIS products.
Performed impact analyses of proposed and final rulings from CMS and DHHS.
Using the above, completed functional requirements for compliance solutions to HIPAA’s National Provider Identifier and Privacy rulings and the proposed Inpatient, Outpatient, Long Term Care and Inpatient Rehabilitation PPS regulations.
Created test plans to validate solutions to software issues.
#3: Shared Medical Systems (absorbed by Siemens Medical Solutions Health Services); Oct. ’96 – Mar. ’01; Advanced Business Analyst
51 Valley Stream Pkwy; Malvern, PA 19355
Led the system Maintenance and Support Group for the company’s turnkey Hospital Information Management System (Allegra)
Coordinated all programmer activities within their turn-key systems’ (Allegra) maintenance team. Assigned open system issues to maintenance programmers. Monitored department inventory. Verified the accuracy of all resolutions. Within 12 months was able to reduce the inventory of more than 400 reported issues by more than 80%. Aged items over 45 days were either cancelled or completed
Reviewed client-generated system enhancement requests for feasibility and legitimacy. Identified training issues and converted user requirements to programmer specifications
Monitored government and commercial websites and internet discussion groups for trends and policies affecting hospital information systems.
Served as subject matter expert for all HIPAA projects on the Allegra system
Using proposed rulings from DHHS and CMS, drafted business and system requirements for compliance solutions to HIPAA’s 835 and 837 e-claim transactions and the Code Sets, National Provider Identifier and the Ambulatory Patient Classification PPS proposals.
Earned department’s Employee of the Year Award for alerting leadership to potential HIS exposure to HIPAA non-compliance, thus enabling the company to avoid any associated penalties
Coordinated integrated testing and product upgrade installation activities at client sites.
Developed end-user documentation of software releases
#4: StellarNet, Inc; (dissolved in December 2001); Feb. ’94 – Oct. ’96; Business Analyst
Established and maintained a library of government and major commercial healthcare claim billing requirements. This library consisted of Fiscal Intermediary bulletins, Medicare and Medicaid billing manuals, National Standard Format and UB92 e-claim manuals and bulletins from all major national payers.
Coded, tested and maintained EMC edits to facilitate EDI transmission of healthcare claims from billing agencies, hospitals and physicians to claims clearinghouses and federal, state and commercial health insurance payers throughout the nation.
Developed release notes for software releases and error resolution desk procedures.
Created Business Requirements Document and coded HL7 transactions for an Electronic Funds Transfer (EFT) system. This was to send Worker Compensation claim payments to the commercial banks of their healthcare providers.
Developed end-user documentation of the beta transfer system.
#5: Blue Cross of California; Jul. ’78 – Jun. ’93; Senior Business Analyst
21555 Oxnard St.; Woodland Hills, CA 91367
Successfully led the development and implementation project charged with codifying over 5,000 healthcare benefit combinations, coverages and contracts for a healthcare claims adjudication system.
Performed detailed analyses of benefit plans, products and policies, both corporate and legislative, ascertaining compatibility with claims processing software, support systems and corporate goals, This allowed successful functioning as liaison for administrative staff to corporate counsel, medical and claims policy/product development staff, management information groups, underwriting and quality assurers.
Successfully led the effort that populated a database with over one million healthcare data records comprised of all billing form Code Sets. Each individual code was assigned specific identifiers and classifiers that enabled contractual claim pricing, benefit categorization, payment, electronic 3rd party billing and reporting.
Interfaced with business and systems teams to resolve on-going challenges.
Facilitated cross-functional groups focusing on problem resolution, client satisfaction and new business opportunities.
#6 Blue Shield of Calif, Sept. ’70 – Jul. ’78; Utilization Review Analyst, Service Supervisor
50 Beale Street, San Francisco. CA
Trained new claims processing personnel and customer service representatives on Medical Terminology and manual claim adjudication procedures.
Supervised claim adjudication and customer service units.
Documented potential Medicaid fraud and abuse causes for the State of California.
Addendum:
Since being laid off from Kaiser Permanente I’ve been spending additional time with two long-term volunteer projects that work with faith-based organizations to find low cost/no cost health care to the under insured/uninsured.
EDUCATION:
BS Health Education
North Carolina Central University; Durham, North Carolina
Epic Certified in Tapestry UM/CM 2004 with NVT Recertification through 2009
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