Quality Assurance Medical Billing
Resume:
Name & Addr: Carmen M Navedo
Edison, NJ 08817
Cell#: 862-***-****
Email# **********@*********.***
Professional Profile:
Experienced QA Software System Analyst/Tester. Self-managed PC proficient, motivated energetic Software QA Tester with 20+ years of working experience, testing Healthcare Insurance Companies. For the last 4 yrs worked with Auto Injury Solutions for clients such as USAA, NTIONWIDE, GEICO & TRIZETTO FACETS SYSTEMS. Task involved reviewing & development of test case to verify healthcare reimbursement meet clients specifications by processing claims, billing to insure reimbursement. Worked in multi-tasking environment & developers to insure quality results. Experience in using SQL in validation of test results at DB backend, identifying defect issues, and good understanding of SQL.
TECHNICAL SKILLS:
Defect Tracker: Logged defect on TeamTrack STARS tool.
Software: MS Office, MS Excel, SQL Server, DBArtisan, RapidSQL.
Database: SQL 2000, SQL2005, Oracle 9i, MS Access, VB script. Microsoft Office 2000, 2003; MS Access; and PowerPoint, Windows NT 4.0 Familiar with Sybase, UNIX, Windows NT, Windows 2003, DBArtisan, RapidSQL, and XML batch execution.
Utilization of Automated Testing Tools: Rational Robot, Mercury QTP & Quality Center
Attending:
QlobalTek Systems LLC - 200 Middlesex Essex Tpk, Suite 100 Iselin NJ 08830
2/06/17 – course taking QA/QC Automation Tools package
Course given for QA Analyst – Automation Tools
QTP Selenium – JAVA, JIRA
QC: Requirements, Test Case testing, Test Plan, Test Lab, Defect tool, export test cases from excel to
quality center, Reports, global delivery model using Waterfall and Agile Scrum methodologies.
Black box, Functional, Regression, Smoke, MS Access – SQL, PowerBuilder,
Mobil Web testing, HP QC/QTP/UFT -SOAP UI, Understanding of XML language, JIRA Software,
Auto Injury Solutions, Iselin, NJ
03/2012 - 06/2016
QA Data Analyst
Experience in Medflow Documentation & Webreprice.
Experience in Healthcare Billing, Medical/Hospital Claims Processing to insure correct reimbursement.
Writing testing cases using business requirements.
Worked in MS Excel & Word, Web testing.Create and manage test data needed for product testing in multi-environments databases.
Sanford Brown Institute in Iselin NJ 12/2010 – 10/2011
Student
Course taken, Medical Billing & Code review.
Dr. Duchine, General Surgeon, NJ 11/2010 – 03/2012
Internship
Worked on the Medical Billing application and claims.
The TriZetto Group Inc., Union, NJ 09/1996 - 11/2008
Quality Assurance Lead (QA Specialist)
Facets Product (Healthcare Group Insurance software).
Development testing artifacts for versions Facets 4.61.
Over 12 yrs. of Facets software development and testing experience executing, documenting, managing and improving multiple test plans and scenarios for product testing by processing claims, billing.
Worked in multi-tasking environment & developers to insure quality results for TriZetto products (Facets) using business requirements, multiple specifications, and/or customer issues.
Facets Product (Healthcare Group Insurance software) Development testing up to versions Facets 4.61
Over 12 yrs. of Facets software development and testing experience executing, documenting, managing and improving multiple test plans and scenarios for product testing for TriZetto products (Facets) using business requirements, multiple specifications, and/or customer issues.
Experienced in using SQL in validation of test results, identifying defect issues, and good understanding of SQL and Oracle database structure.
Adept in the use and administration of automation testing tools such as Mercury: Quick Test Professional (QTP) in testing Web Base Services applications and Mercury Quality Center for the creation and documentation of test plans cases.
Experienced in QA process methodologies, Metrics, QA Testing, Definition, Scope, Functional, Design Specification document and Test Plans, configuration build experience.
Experienced in Healthcare Billing, Medical/Hospital Claims Processing.
Adept creation test scripts in Rational Robot for regression testing.
Familiar with TeamTrack Defect tool tracking system.
Participated in Quality Assurance specification and test matrix reviews.
Knowledge of data modeling and data flow diagrams to determine client area application system requirements for new or modified application programs, experience in dealing with numbers and numerical calc data in testing.
Ensured all client and testing issues are documented and tracked to resolution.
Created and managed test data needed for the business scenario test cases.
Created and managed test data needed for product testing in multi-environments (Sybase/Oracle/Microsoft/Web).
Provided project progress and status reports.
Provided internal application support of basic client/server architecture and computer networks.
Assisted with Facets application product cross-training online and batches, Billing & Medical/Hospital Claims Processing, Provided Capitation Processing - PMPM calculations
Eligibility - Subscriber/Member.
Able to work independently and as part of a team.
Interacted with clients when client issues arise, to work thru issues and determine if defect tickets are needed.
Prudential Insurance, Roseland, NJ 09/1987 - 09/1996
Quality Assurance Analyst
Research test specifications.
Identify test scenarios.
Create and execute test cases to insure accuracy.
Responsible for developing, executing and verifying test plans for multiple plans.
Executed JCL to create regression compare reports to verify new enhancements interact with old releases.
10 yrs. of software development or testing experience
In down time assisted Customer Services when overloaded with customer services calls and issues.
TRW, Fairfield NJ - 07/1986 - 09/1987
Data entry/ Customer Support Rep
Data entered order/billing tickets
System support databases
Customer support client bilingual (Spanish) order calls
EDUCATION:
Taylor Business Institute in Bloomfield college Bloomfield, New Jersey
09/1986 -0 9/1987
Data Entry & Basic computer Programming - course certification- Basic computer programming, RPGII, COBOL.
Sanford Brown Institute in Iselin NJ
12/2010 – 10/2011
Student Course taken, Medical Billing & Code review.
QlobalTek Systems LLC - 200 Middlesex Essex Tpk, Suite 100 Iselin NJ 08830
2/06/17 – 04-2017
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