Confidential

Zena/Mohammed

Transaction Quality Assurance Analyst/Auditor

Location: Georgia

Professional Summary

• 28+ Years in Healthcare Insurance

• 5+ Years in Healthcare Insurance -Claims Operations and Quality Assurance Audits

• Various roles including:

o Transaction Quality Assurance Analyst /Auditor

o Claim Processor/Specialist

o Performs Transactional Quality Audits bases on Predefined Audit Parameters o Perform ATA & Detect Errors

o Managing and Distributing Team Inventory

o Compile and distribute Bi-Weekly and Monthly Reports to Management o Maintain and populate Reports

o Maintain and Resolve Rebuttals for team Reports

o Support team with inventory directives

Experienced Quality Assurance Audit analyst able to provide expertise in Quality Assurance Audit functions and process flow. Ability to perform audits on transactions, detect errors and identify root causes for errors. Good working knowledge and demonstrated ability utilizing systems, tools and procedures to accomplish job. Ability to meet deadlines and escalate issues. Sharp attention to detail. Strong comprehension, organizational and communication skills. Excellent at managing time, supporting multiple tasks, and working under pressure. Application Experience

Highlights

• Oracle Health Information System (OHI)

• Provider Search System (XRM Provider)

• Insurance Liability Recovery Search

System (XRM ILR)

• Member Search System (XRM Member)

• SunGard-Macess/FileNet

• SunGard- Formworks

• Encoder Pro

• PDM System

• Macess UAT

• Macess Production

• NDM Production

• Encoder Production

• Quality Assurance Databases –

FoxPro and Access

• SharePoint

• Microsoft Office (Excel, Word,

Access)

• EDIFECS

• HIPAA Printer

• AMISYS

• Members SOB and Handbooks

• Enrollment Billing Database

• Doc Management System

• NPPES

• Accurately reports the required data/results for projects/initiatives NTT DATA, Inc. Healthcare Consulting Group

Confidential

Work Experience

Facility:

Dell Systems/NTT Data-@Point32 Health 2021 to Present

•

Dell Systems/NTT DATA – @ Harvard Pilgrim Health Care 2015 to Present Position/Title: Transaction Quality Assurance Sr. Analyst Primary Responsibilities:

• Quality Assurance Audits Ability to perform on tractions, detect errors and identify root causes for errors.

• Responsible for Running Weekly/Monthly Reports for Departmental Use.

• Assign work to the QA team

• Review ILR Rebuttals to determine the root cause

• Enrollment Billing Report

• Development and delivery of assessment findings and recommendations on reports Facility: Dell Systems/NTT DATA – @ Harvard Pilgrim Health Care 2002 – 2015 Position/Title: User Acceptance Tester – Senior Business Analyst, NTT DATA, Inc. Healthcare Consulting Group

Confidential

Education

1. Commonwealth Avenue, Boston, Massachusetts

Executive Secretarial Course

Jeremiah E. Burke High School

Boston, Massachusetts

Commercial Course

Primary Responsibilities:

• Perform system User Acceptance Testing to ensure the configuration of provider contracts, benefits and HPHC policy reimbursement data has been configured in the OHI Test Systems & HP Amisys claims processing system according to the HPHC’s business owner requirements.

• Review all source documents to identify any inconsistencies prior to test plan development and testing. Responsibilities also include the organization of walk-through meetings with business owners to discuss business requirements to ensure that all conditions are within the scope of tasks and projects. Maintenance of testing audit trails, chronological records and system activities that are sufficient to enable the reconstruction, reviews, and examination of the sequence of all testing from the inception to the output of the results.

• Assist with Benefit testing as needed. Maintain a professional working relationship with Benefits Administration, Contracting, Policy and Reimbursements in conjunction with other Dell and HPHC teams.

• Adhere to strict deadlines in order to avoid service level agreement penalties. Provide UAT metrics to Dell Management.

.

Facility: Provider Data Coordinator-Harvard Pilgrim Health Care 1995-2002

Position/Title: Coordinator Specialist

Primary Responsibilities:

• Responsible for accurate and timely intake analysis, research, and dissemination of HPHC provider demographic and financial information. Research the provider information to determine the completeness and impact on various financial and reporting systems and if need be problem solving to provider related issues. The information is entered and maintained in the Corporate Provider Database.

• Complete uploads and downloads of information via electronic transfers. Interact directly with HPHC providers and internal customers to respond to requests for status, and intake new or change information. Respond to internal and external requests for information and products. Maintain and provider mailing labels/disks for provider mailings.

• Create and distribute reports on Provider Related Information. Assist with cross -functional and interdepartmental training on Provider Information Practices. NTT DATA, Inc. Healthcare Consulting Group

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