Customer Service Medical

Laura Davis

**** ** ********* ** ***** Valley, MO. 64029 C: 816-***-****

******@*****.***

UAT TESTER

UTA Tester with experience in designing, writing defects and test

cases/scripts and testing claims to execute all activities. Proficient in

an assortment of technologies, including Facets, Macess, HIP, Xcelys and

Windows. Skills include:

HealthCare Claim processing Medicare/Medicaid

Pricing/Fee Schedules Provider Contracts

Audits Medical Terminology

ICD9, CPT, HCPCS QA Analyst

Experience

Blue Cross Blue Shield of KC

September 2012 to Present

(Apex Systems-Contract)

Configuration Specialists using Facets to operate groups renewing benefits

contracts.

. Built, verified and tested benefits, fee schedules, price rules and

rate tables

. Entered and/or reviewed benefits using GBS

. Built queries to extract data

. Compiled research to identify payment rules and provider billing

trends to establish proper contract configuration

. Reviewed provider contract agreements to ensure benefits/pricing was

built per contract

Kaiser Permanente/Anthem BCBS 2007 to 2012

(Perot/Dell Systems-Contract-Travel and Remote)

. Write defects and testing professional/institutional claims

. Test providers for fee schedules, pricing, contracts and credentials

. Performed adjudication and audits to ensure appropriate benefits

applied correctly and other automated processes

. Test defects using various scenarios for multiple products

. Develop numerous test plans to client to ensure claims processed

according to health plans

. Created design solutions utilizing HIP (comparable to HP QTP), and

other technologies

. Utilized SQL and Excel posting test case, defect and steps to analyze

results

. Trained client staff how test cases were performed, how claims were

executed and explained results on how test cases performed

Part Time Instructor 2009

Concorde Career College

Instructing various courses including medical terminology, basic computer

skills, word, excel, letters, tables, charts, HIPPA, coding, billing, and

medical records.

Medical Claims Manager 2006

TIC International

Oversee departments which include claims, customer service, and eligibility

for TPA. Performed stop loss and predeterminations. Developed goals for

all departments. Handled overpayments, adjustments and all errors that

occurred. Coordinated and merged systems to clients needs. Training

employees with new updates to system, policies and procedures. Interview

and train new employees.

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