Project Quality Assurance
Resume:
KAREN GOETZ
**********@*****.***
PROFESSIONAL PROFILE:
Over twenty (20) years of Medicare experience, including management and implementation of Medicare regulations to ensure compliancy
Served on government (CMS) contracts for thirty (30) years
Develop and document processes and procedures for company (SOPs)
Provide analytical support for the development of business systems
Thorough knowledge of reporting and data analysis for financial and procedural tracking
Manage team workloads; train staff; monitor budgets and keep team on target
Interpret business needs by analyzing requirements and providing documentation of validated results
SKILLS:
MS Office products (MS Word, Excel, PowerPoint, MS Project); Outlook; SharePoint, TSO and mainframe programs; multiple CMS programs; CMMI Level 3 compliance
PROFESSIONAL EXPERIENCE:
KForce Contractor at Strategic Health Solutions for CMS August 2014 – February 2015
Senior QA Analyst (Medicare Secondary Payer Integration Contract (MSPIC) contract)
Reviews and analyzes data, processes, and systems for validity and quality
Provides quality assurance (QA) reviews on procedures, processes, systems and data for assigned projects
Assists with QA of quality audits and contributes to continuous quality improvement (CQI) efforts for assigned projects
Interprets and analyzes data, creates written summaries of findings, and provides recommendation for process improvements
Conduct 60 data audits monthly and provide documented audit results to ensure claims were processed accurately
Conduct 20 call audits monthly and provide documented audit results to ensure customers were handled with respect and their questions were addressed properly
Develop trending reports based off of historical data to capture new areas for review
PKW Associates, Inc at Lockheed Martin for CMS October 2012 – June 2014
Program Planner/Scheduler (National DataWarehouse contract)
Use Earned Value Management (EVM) concepts to monitor and track schedules, budgets and monthly reporting
Responsible for maintaining the Project Schedules in MS Project
Reconcile Labor reports and project schedules
Perform Quality assessments on schedules and resolve
Maintain weekly agenda and meeting minutes and post to SharePoint.
Conduct Peer reviews monthly
Apply ETC (estimates to complete) to Project Schedules
Produce Variance Analysis monthly
Produce Power Point presentation for the customer (CMS) on a monthly basis.
Assist with conversion of EVM monitoring tool from MS Project to ARTEMIS, including documented test results for side by side comparison
Write Standard Operating Procedures as needed in SDLC in Agile environment
PPS InfoTech, LLC at QSSI for CMS April 2009 – June 2011
Team Lead - Business Analyst - Quality Assurance Analyst (Common Working File (CWF) STC contract)
Participate in audit of test cases and validity of support; answer inquiries and support findings as applicable.
Develop test cases to effectively test system changes and identify problematic system coding for billing and claims
Perform functional testing and maintain traceability for validation. Document in data warehouse (Quality Center) validation of test results and record and report defects as necessary
Conduct peer reviews for UAT (User Acceptance Testing)
Develop and monitor best practices on a monthly basis for staff training and CMS.
Read, research, and review written documentation, reports, and other materials in order to conduct testing of various systems.
Participate in conference calls/meetings to discuss issues and resolutions of release.
Lead meetings and conference calls (internal and external) while maintaining agendas, minutes, notes and action items as needed.
Document process and procedures (SOPs) for CMMI purposes and training on SDLC contract in Agile environment
Perform data analysis for Process Improvement Plans for ongoing changes as part of any policy changes.
Aide in project management activities including monitoring operations for reporting, scheduling and prioritizing workload for team.
Share concepts and ideas to management team for productivity improvement and time management
Utilize CMS eChimp system on a daily basis in order to be abreast of most current change requests. Update internal database with new change requests including assignment to appropriate area, monitor implementation, and track deadlines.
Lead and implement streamlined process for receiving new/updated/changes to regulations received from CMS in order to achieve compliancy.
Able to make spontaneous decisions and manage emergencies that help to avert crisis and ensure steady pace of project development.
Develop, track and maintain workload schedules on a daily basis while monitoring milestones and project plan on a weekly basis while instituting any changes to the project.
Ensure deliverables are met timely.
Utilize SharePoint system to maintain information and share throughout the organization
Monitor COGNOS reports on a regular basis to complete weekly, monthly and quarterly financial reports and statistical metrics used in validating deliverables.
General Dynamics (ViPS) for CMS May 2006 – December 2008
Financial Analyst II - Retiree Drug Subsidy (Medicare Part D) Team Lead
Lead, create, design, develop and implement the accounts receivable processes for the RDS division, including writing SOPs based on CMS regulations for Medicare Part D
Manage the coordination between CMS, business owners and IT department to collectively develop and implement new account receivable process.
Test and validate data to utilize new accounts receivable collection system for RDS.
Participate in various meetings (internal and external) with the customer to brainstorm the implementation of the A/R system and to gather metrics for tracking progress on the project.
Develop, document and implement the EVM process for the company to accomplish certification for the ability to secure new government contracts.
Train management and teams on new EVM process and procedures.
Assist Control Account Managers with development of project charge codes, completion of WBS, OBS, with exposure to other facets of EVM reporting.
Utilize WBS, OBS, using Budgeted in comparison to Actual Work Performed information.
Establish and maintain program schedules, budgets and forecasts, report and analyze earned value management system (EVM) metrics and variances to budget and schedule.
Performing analysis and providing feedback on trends and impact of EVM.
Proposal writing (RFP) and contract modifications (Statement of Work) SOW.
Prepare and analyze financial reports.
Coordinate and/or perform research/analysis due to subcontractor inquires.
CareFirst of Maryland - Medicare Audit & Reimbursement Department May 1984 to May 2006
Medicare Part A Financial Reporting Supervisor – Reimbursement Analyst – Cost Report Analyst
Monitor receipt of cost report for all types of facilities from initial receipt to final settlement
Issue corresponding demand letters for A/R and track in CMS POR (Provider Overpayment Report system) through collection to CNC(Currently Not Collectible) process
Track bankruptcy cases through to settlement and collection or write-off as needed
Develop process and procedures (SOPs) on an ongoing basis in accordance with CMS change requests and implementations; subject to audit controls.
Prepare risk assessment to determine high, medium or low risk.
Acted as a liaison during external audits conducted by OIG and CMS for CFO and Accounts Receivable audits. Tracked data requests from auditors for all related areas and ensured information was collected and submitted in a timely manner. Discuss and assign preliminary findings with audit team and corresponding areas. Track corrective action plans to findings for division until completed.
Implement findings from external or internal audits, including creation of Standard Operating Procedures (SOPs) or other internal procedures as required.
Track corrective action implementation and document for compliancy.
Establish and maintain program schedules, budgets and forecasts, report and analyze metrics and variances to budget and schedule.
Identify, analyze and communicate Medicare requirements by reading and interpreting CMS manual revisions and other data provided by CMS.
Interface with Claims and Service, MSP, Audit and Treasury departments on a regular basis for testing.
Developed and maintained Business Continuity Process/Disaster Recovery for Medicare division.
Manage the reporting for various Medicare financial reports to (Centers for Medicare and Medicaid) CMS which included processing, validating and/or approving. These reports captured various financial transactions including accounts receivable and accounts payable data; budget allocations for the department; and monitoring the savings of Medicare dollars.
Managed entry of account receivables to CMS; entry of enrollment applications into CMS database (PECOS) for provider applications on a daily basis.
Conduct meetings and conference calls while maintaining agendas, minutes, notes and action items as needed.
Served as liaison between clients, quality assurance and development staff for financial testing.
Assist with development and design of general ledger system (HIGLAS).
Implement AP/AR functionality (Financials) in an environment where the financial system is integrated with other COTS products (HIGLAS).
Corporate System Conversion departmental liaison for XP migration; NT migration, Y2K.
Provide testing and implementation for changes in FISS (Medicare payment system) on a quarterly basis.
Manage processing of cash receipts, credit and debit memos and general ledger posting.
Staff development including on-board of new hires, training, and performance management for all staff.
EDUCATION AND CERTIFICATIONS:
Essex Community College - Associate Arts degree in Accounting
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