Insurance Test Cases

Pratima Kapoor

Email: ac14ue@r.postjobfree.com

Location: Dover, DE

PH :412-***-****

US CITIZEN

SUMMARY

Hardworking, Dedicated, Reliable & Driven Individual with overall working experience of 17 + years with 2 years in IT industry.

Well versed with phases of Software Development Life Cycle (SDLC) and Test life cycle.

Good knowledge of different methodologies like Waterfall, Agile/Scrum, V-model.

Knowledge of analyzing Business and Functional Specification Documents and developing Test Cases and Test Scenarios.

Understanding requirements, writing Test Cases and reporting bugs.

Knowledge of different kinds of testing like Functional Testing, Regression Testing, GUI Testing, Database Testing, Cross Browser Testing and Retesting.

Experience in testing applications in multiple browsers such as IE, Firefox, Chrome and Safari.

Ability to understand priorities and quickly adapt to new technologies and testing environments.

Flexibility to work in dynamic and continually changing environment.

Committed to excellence, self-motivator, fast learner, team player, analytical skills with strong problem solving and communication skills

SKILLS

SW Methodologies : Agile, Iterative, Waterfall

Testing Methodologies : Test plan, Test case, Traceability Matrix, Test Report

Testing Tools : HP Quality Center / ALM

Bug Reporting Tools : Quality Center

Databases : Microsoft SQL Server, MS Access

Languages : Knowledge of SQL, VB Script

Methodologies : Agile/Scrum, Waterfall

Operating Systems / platforms : MS-DOS, UNIX/LINUX, Windows XP, MAC

Automation systems : Knowledge of UFT / QTP and Load Runner

Others : Knowledge of Toad, ETL Testing, Agile tools- Rally

EXPERIENCE

Jr QA Consultant (Aetna)

1/2017 – 5/2017

Healthcare project - Application was ‘MMP’ (Managing Member Portal) and was related to creating patient portal and managing every detail of the patient profile.

Understanding and analyzing the requirements.

Developed positive and negative scenarios and writing test cases.

Involved in creating test suites.

Created RTM to ensure that all the requirements have been covered.

Created test data using Boundary value Analysis and Equivalence class partition for functionalities like username, password

Involved in execution of test cases manually.

Performed GUI Testing using various browsers such as Chrome, IE8, and Mozilla to make sure that the user interface is as per the requirements and there is no distortion in the screen.

Performed Functional testing as per the test case document to ensure that all the functionalities are covered.

Executed regression test cases to ensure no new defect is induced after bug fixed

Performed (some basic queries) database validations using SQL Queries in Toad to ensure that the transactions are posted successfully in database.

Tool Used: QC / ALM

Jr scrum Master (McKesson)

1/2016 – 12/2016

Conducted and ran the SCRUM Ceremonies: Daily Stand-ups, Story Pointing, Iteration Planning and Tasking (Capacity Planning sessions), Iteration Retrospective and Iteration Demo

Provided visibility to team to identify impediments/risks and helps eliminate them

Act as a single point of contact for all needs and queries regarding the project

Assist with prioritization and resolution of defects/bugs

Calculated the Iteration Burndown and Iteration velocity

Ensured task completion to specification, on time and within budget.

Worked with PO to prioritize the stories for iteration.

Tool used: ‘Rally’

Residents Accounts Coordinator LGAR Health & Rehabilitation, PA

12/2014 – 12/2015

Medicaid Billing: Month end Billing, New Ma Approvals, Cola changes, Annual Ma Renewals

Private Billing: working on getting the bills ready to the last step of mailing them (Resetting accounts, calculating charges, printing, folding, putting in envelopes and then finally mailing)

Posting Medicaid Electronic payments and Check payments for residents.

Handling of Residents Trust Funds (RTF) / paying bills like Insurance Payments for Re payee accounts.

Working on Mthly Trust Transfer (When we transfer money from resident’s trust fund acct to pay their monthly bill)

Working on daily census and making changes accordingly

Working on Month Closing.

Working on MA & Private Aging as needed

Software used was ‘Net solutions’

Medicaid & Medicare Accounts Specialist Woodhaven Care Center, PA

01/2013 - 09/2014

Monthly Medicaid & Medicare Billing

Ma Renewals

Posting of Lab charges

Working on Aging & other related responsibilities

Medicaid Accounts Specialist Golden Living Nursing Centers, PA

06/2008 - 07/2012

Prepared and submitted Medicaid Billing, turnaround documents, and claim adjustments, including Medicare/Medicaid crossover coinsurance claims.

Communicated closely with pending Medicaid specialist to ascertain statues of pending applications.

Identified and documented payment discrepancies and took appropriate action to resolve balance.

Maintained ticker system to ensure timely follow up on unpaid claims.

Prepared Accounts Receivable adjustments and corrections as needed.

Identified, researched, and resolved credit balances according to state requirements.

Reported statues of claims of AR balances to supervisor according to procedures and schedules.

Performed all duties related to timely and efficient billing and collection of Medicaid receivables for a group of facilities.

Collaborated with multiple departments to resolve concerns. Effectively utilized time and resources to achieve key objectives for the success of the company.

Consistently achieved zero plan of correction and errors for UMR’s /state audit (reviews). Consistently exceeds goals with a relentless drive for success

Medical Billing Specialist Med Health Services, PA

01/2008 - 06/2008

Worked directly with the insurance representatives to inquire about rejections or aging claims that were processed incorrectly.

Rebilled adjusted claims electronically or on paper with proof of timely filing.

Followed up on submitted claims, monitored unpaid claims, and resubmit claims as necessary.

Worked on untimely filling rejections, requested appeals, etc.

Worked on posted of UPMC payments and follow up with accounts to make sure that patients and insurance companies were continuing to submit payments until their account was brought to a zero balance.

Experience with posting of Unison payments and their related rejections.

Experience with referrals and some knowledge of pre authorizations.

Performed all insurance/clerical duties, including pulling necessary EOB’s requisitions, putting deposit checks, and statements together, etc.

Crossed trained in other areas of billing to provide backup and assist with routine issues or daily problems.

Experience with auditing the Lab Corp billing statements/accounts to make sure if the charges were posted correctly and with the right CPT codes. Verified them according to the insurances that were accepted/not accepted, and then made sure if the charges should have been posted or not.

Registration Specialist Med Health Services, PA

10/2007 - 12/2007

Obtained the requisitions and separate them by various nursing homes, insurances (Blue Shield, Medicare, Aetna, Cigna, United Healthcare, UPMC, Health America products, Unison, Gateway, and other Commercial Insurances, etc.).

Made sure if the demographics of the patients accounts were correct (patients’ name, DOB, Address, SSN, phone number, guarantor information, etc.).

Verified insurance given was valid and correct in Health Pak (billing software) and Orchard (Lab Software), and was the correct Financial Class.

Updated incorrect information, made changes, and analyzed patterns with Doctor’s offices. When updating insurance, made sure to check if the claims were outstanding, and if so, then completed the zero payment adjustment to take off the wrong insurance from the claim list, and re billed the claims to the correct insurance.

Each requisition scanned after verification, corrections, and updates were made to be saved for future use.

Medical Billing Auditor Med Health Services, PA

06/2007 - 09/2007

Audited the three main Billing systems (Health Pak, PCN, and Orchard) to ensure accurate Laboratory coding.

Compared Orchard with Health Pak to make sure both were running smoothly, information on both were same and both were updating each other.

Verified if every test was posted with the correct CPT codes and right description of Health Pak.

Worked together with all three systems to make sure if the patient/their Insurance Company were billed correctly.

Verified if charges were posted correctly, checked the missing payments, and made sure to get them posted at the earliest thereby generating revenue for the company.

Verified if the information entered relating to the new patient’s account is correct and making changes / adding new and correct information.

Worked on Quality Control Laboratory Report to solve the differences between HPK and Orchard.

Worked on Patient Demographics for any differences related to names, addresses, SSN, DOB, phone number, guarantor information, etc.

Verified patient eligibility for different Insurance carriers, such as Medicare, Blue Cross and Blue Shield, Aetna, Health America, Advantra, UPMC, etc.

Communicated with Patients/Doctors Offices regarding insurance or demographic information.

Distinguished between correct and incorrect insurance information, using various billing tools, websites, interactive voice response systems, and resubmission of claims to the proper insurance carriers

FIFTH THIRD BANK, OHIO

8/1997 - 11/2004

Accounting Specialist III

Performed accounting duties – account reconciliation.

Worked with various departments to identify and clear outstanding items.

Balanced and processed daily work items via OFCS, RAFT and Mobius Software systems.

Securities

Researched and balanced Certificates of Deposits.

Made sure interest payments were paid correctly on a timely basis.

Performed Order Histories and identified missing payments then corrected by balancing account

Mutual Funds

Made dividend and capital gains payments on a timely basis.

Reconciled Out-of-Balance accounts.

Processed checks for monthly payments.

Verified customer statements and information regarding each account.

Worked with funds on various research issues, including registration changes, made sure that the various funds have the right account registration in their system

Depositor Services / Wholesale Lockbox

Balanced COD accounts, worked with banking centers on research issues.

Duties included microfilming, filming, and processing of checks.

Responsible for tracking lockbox activity and assisted other banking centers with research issues.

Worked on Fixed Assets Accounts and their related depreciation schedules.

Researched, posted missing payments, made changes, and verified all transactions to make sure that everything was in balance.

Performed reconciliation of G/L proof accounts: Appraisal fees, Lending fees, Legal fees, and Loan inspection fees.

Trainings

6 Months Training on Manual Testing from H2KInfosys

1 week Training for Agile and Scrum

Academic Profile:

Bachelors from University of New Delhi, India

Few Words about Me

Dear Sir/Madam,

I believe that Life is a learning process and a person learns something new every minute of the day. I love learning new & different things because I feel that broadens a person’s horizon, makes him more disciplined in every aspect of the person's involvement and this approach takes a person towards more perfection.

I belong to a cultural background where Work is considered Worship and so naturally put my 100% in whatever I do. I truly believe in the concept of team where you get to learn & gain new experiences from the other team players & work towards the common goal. I am a person who wants to learn every aspect of the job & concentrates on improving myself every day.

I am an Efficient learner, self-motivated, Hardworking, Disciplined & Dedicated individual, always ready & eager to learn new things & strive for excellence. I really think that I can contribute to the fullest extent, make a difference & can do the best justice with the job.

I hope that you will find my experiences & background intriguing enough to warrant an interview as I am confident that I could provide value to your company, will be a great addition to the team & a great asset to the organization.

I really believe that if I get a chance, I will prove myself. At last, I would say that I would try my best & make every sincere effort to meet everyone's expectations.

Thanks for your time & consideration. I hope to have the opportunity to discuss the opening with you in person.

Sincerely

Pratima Kapoor

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