Customer Quality Assurance

Kelly D. Young

**** **** ***** ****: 210-***-****

Spring Branch, Texas 78070

E-mail: *****.*******@*****.***

SUMMARY

Information technology professional with successes in systems and project management,

software development, programming, and training. Solution provider who focuses on value and

quality. Experienced in dealing with senior decision makers and diverse internal and external

customer groups. Strong leader and team player adept at prioritizing and managing costs,

schedules, deliverables, and technical work groups. Detail-oriented contributor whose results

reflect a high level of motivation and strong customer focus. Highly qualified to leverage

sophisticated technology to attain challenging business goals. Strengths include:

•

EDI Processes General Project

Management Management

Programming

Software User Support

Analysis and

Development

Problem Solving Operations and

Software Quality T raining

Information

Assurance

Technology

Database Design

TECHNICAL COMPENTENCIES

•

Gentran Sterling Cold Fusion Visual Basic

I ntegrator

EDI – HIPAA PowerBuilder

Symphonia Compliant ANSI

Fortran

Mapper 834/837/278

Pick Basic –

M VEnterprise SQL Server 2008

PROFESSIONAL EXPERIENCE

Medsolutions, a utilization management provider for commercial, managed medicaid, state

medicaid populations, Franklin, TN 2012-Present

EDI Business Analyst, Data Acquisition Team responsible for gathering and developing

requirements for mapping inbound member and provider data and outbound pre-auth files using

symphonia mapping software and Sterling Integrator mapping tools. ICD10 implementation and

migrations. Monitor file requirements for state and private vendors supplying member and provider

information. Develop requirements for off shore developers, test and QA maps before deployment

to production environment. Resolve production issues using Cherwell Service Management.

UMR, a third party health claims administrator, San Antonio, TX 1999-2011

Applications Development Consultant, Facets Solutions Group, 2009- Present

Senior System Programmer assisting team with creating user requirements and technical

documents to satisfy internal and external auditors. Responsible for final program code reviews,

testing and quality assurance before moving code to production. Responsible for approving and

moving product to the production environment. Lead programmer for 834 & 837 EDI files creation

and modifications.

Senior Systems Programmer, 2006-2009

Lead developer in conversion to new OCR vendor converting paper claims to the ANSI 837 format

to be used to load all inbound medical and dental claims to the claims payment system and for

creating outbound claim files to be sent to external repricer networks.

• Assisted in stabilizing existing claims programs and integration with new OCR vendors X12

ANSI 837 requirements to format loading health and dental claims to production system to

meet year end project deliverables.

Streamlined critical data processing methods, impacting 3.5 million claims annually by

determining improvement areas and modified processes accordingly allowing 16% of all claims to

be processed electronically with no manual intervention.

Responsible for loading customer groups employee eligibility and creating outbound eligibility files

to outside vendors in ANSI 834 and other formats. Advised programming maintenance staff on

development of new programs and troubleshooting existing programs; provided technical reviews

of program code prior to deployment to production systems.

Assigned to stabilize new customer eligibility load program while providing ongoing

enhancements, including processing files in ANSI 834 format; loaded data on life, short term

disability, and long term disability. Completed programming to convert outgoing eligibility files to

ANSI format for disease management projects.

Systems Programmer, 2003-2006

Facilitated loading of electronic files for transferring provider members and fee schedules from

external vendor files to internal claims payment system.

• Created and maintained menu driven program used to control the EDI transfer of insurance

related provider data from external vendors to internal systems; supervised other EDI

processes including financial reporting and banking interfaces. Designed a program to directly

load national customer networks into database; reduced claim processing time by 23% and

eliminated existing backlog, saving $298,000 annually.

Maintained database of Personal Identification Numbers for employees to use to access external

web site. Designed programs to create internal files used in the creation of Personal Identification

Numbers for employees and to generate customer satisfaction survey cards; new programs

allowed secure access to confidential employee information and customer feedback through the

Internet.

Programmer Analyst, 1999-2003

• Revamped an inefficient process; reviewed the existing manual process of bank checking

account reconciliation; created a new automated system that saved employees up to two

weeks of manual checkbook reconciliation time per bank account.

• Reorganized load programs for provider network updates into a menu driven system

affecting 94% of all claims; evaluated monthly updates for 54 vendors that included

2700 fee schedules loaded electronically; provided a standardized method for all

updates so that data could be processed identically across all business areas.

VSLI TECHNOLOGY, a microchip component manufacturer, San Antonio, TX 1995-1999

Computer Aided Manufacturing (CAM) Engineer,1997-1999

Co-op Programmer,1995-1997

FULL TIME STUDENT, San Antonio College & Saint Mary's University

1992-1997

KELLY YOUNG CONSTRUCTION, INC., Midland, TX 1980-

1992

President/Owner Residential & Commercial Builder & Remodeling

Directed all activities of a custom construction and remodeling business. Conducted

complex estimating, bidding, and contract negotiations with contract services on

projects up to 5000 sq. ft. Administered contracts to minimize costs to ongoing

operations and supervised up to 50 employees. Monitored all efforts to ensure quality

production and developed new business by existing customer referrals.

EDUCATION

1.

• BS, Software Engineering and Computer Applications, St. Mary’s University, San Antonio, TX

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