Lauree Pittman

*** *. **** ******

Chester, PA **013

Phone: 484-***-****

Technical Experience:

ONXT 5.8, CSC System, Facets 2.96 – 5.80, HealthRules, Amisys 6.4.3, Click4Care, SaleForce, Honeybee, Microsoft Suite products, Windows 2000 & XP, Visio, Tidal, Remedy, DataStage, FTP Client, HIPPA Gateway, Visual Enabler, Crystal Reports 11, Business Objects, Netscape Navigator, Macess, I-MAX, MACESS, Toad, Team Track, MEDecision, BizTalk, Etalk, Healthcare, Word Perfect, Sybase, Unix, Oracle, SQL Data Warehouse, Acuity, SharePoint and Mercury Test Director, ALM, SharePoint, Facets Automated Testing, Jira, Xpress Claim Test Pro, Argus, Luminex, EdgeServer, Stripe Payment System, HealthSherpa - Web Member Coverage 834 Files, Zelis Claims Payments - Claims Bundling and Unbundling, Seed State System, Confluence, Government Intelligence EAAS enrollment software, Optum RX software.

Professional Experience:

Oxford Consulting 06/22 – Present

Consulting United healthcare, Medicaid/Medicare clients,

Facets Product QA Test Lead

Serves as the liaison between the Applications Development, Business Owners, and Management for necessary clarification of current operating procedures and clarify test objectives to support the project life cycle.

Responsible for testing business requirements needed for the implementation of new business to the Facets environment for Medicaid, utilizes the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Performed regression testing on new functionality between Facets System (Medicare) and other 3rd party vendors.

As the QA Test Lead, I am responsible for the design and execution of the test models, scenarios, cases, and scripts cases, scripts, and test activity support applications, processes, and tools.

Developed test cases and tested for Enrollment, Claims, Customer Service, Provider, Workflow, Billing, Benefit Configuration, Reports, Member/Provider and other Application Groups within Facets System, and EaaS Enrollment System.

Performed testing for SalesForce product for sales and customer service representatives. Responsible for gathering data for the SalesForce IT team, validating business requirements, creating and Testing business test cases and IT test cases.

Represented the quality function in an Agile Development environment based on a Scrum Framework through application of quality principles.

Worked on software verification and validation.

Communicated with developers as needed to isolate the root causes of defects.

Assisted the Client with understanding High-Level Test Data Requirements.

SourceEdge Consu 11/20 – 1/8/2022

Consulting with various healthcare, (Ascension Healthcare, CareSource Healthcare) Medicaid/Medicare, and

Commercial clients

Project Manager/QA Test Lead

Serves as the liaison between the Applications Development, Business Owners, and Management for necessary clarification of current operating procedures and clarify test objectives to support the project life cycle.

Responsible for gathering business requirements needed for the implementation of new business to the Facets environment, utilizes the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Responsible for system conversions from legacy system to Facet for Providers, Members, Authorizations, and claims. Also created test cases and tested to ensure that conversion data was loaded into Facets correctly

Performed regression testing on new functionality such as Benefit Elevation to ensure that it did not affect existing functionality within the Facets System

Oversee and Leaded the implementation of SalesForce/Honeybee product for sales and customer service representatives. Responsible for gathering data for the SalesForce/Honeybee IT team, validating business requirements, creating and Testing business test cases and IT test cases.

Assisted with NetworX Agreement build (i.e Group, Parent Group, Class.Plan, Subgroups, Service Definition, Service Payment, Service Rules, Premium Rate Table, etc.). Interpreted institutional, ancillary and professional contracts and fee schedules with NetworX pricing configuration.

Make configuration updates within lower environments (i.e. Service Definition, Service Payment, Service Rules, etc.)

• Perform Benefit Configuration Peer Reviews

Created desktop procedures/based on the business requirements that were available for the Benefit Elevation and Split Claim process.

Oversee and Lead the testing efforts of the QA Testing Team and submit daily project status reports to Project Management and the Business Owners.

As the QA Test Lead, I am responsible for the design and execution of the test models, scenarios, cases, and scripts cases, scripts, and test activity support applications, processes, and tools.

Developed test cases and tested for the Enrollment, Provider, Claims, Billing, Capitation, Benefit Elevation. Pricing/Agreements (NetworX), WorkfFlow, (Plan/Product), Split Claim, Member/Provider Match Application Groups, and Benefits Configuration, UM, Customer Service, SalesForce, Honeybee, Stripe Payment System, HealthSherpa, Zelis Claims Payments, Batch analysis within Facets System.

Represented the quality function in an Agile Development environment based on a Scrum Framework through application of sound quality principles.

Managed requirement and reported defect in Application Lifecycle Management (ALM).

Worked on software verification and validation.

Perform Configuration Peer Reviews

Communicated with developers as needed to isolate the root causes of defects.

Assisted the Client with understanding High-Level Test Data Requirements.

Analyzed, designed and built testing procedures to deliver the client’s goals and provided clients with maximum value and added into JIRA.

TATA Consulting, Edison, NJ 11/14 – 09/19

Project Manager/Facets Product Consultant Testing Lead

Serves as Testing Lead for Applications Development, Business Owners, and Management to support system conversions and upgrade of Facets and 5010/ ICD-10 project.

Responsible for planning, executing, and finalizing upgrade projects according to strict deadlines and within budget. This includes acquiring resources and coordinating the efforts of team members and third-party contractors and other consultants in order to deliver projects according to plan.

Responsible for updating and creating test scripts and test cases.

Consult on client related process,

Assist Sale Department with writing RFP responses,

Responsible for defining the project’s objectives and overseeing quality control throughout the project life cycle.

Contributes to the development of implementation plans and provides support to facilitate system implementations, Membership, Providers, Claims, Customer Service, Utilization Management, EDI 5010 process, ICD-10 and Patches, System Enhancements and testing of Facets 5.01.

Responsible for system conversions from legacy system to Facet for Providers, Members, Authorizations, and claims. Also created test cases and tested to ensure that conversion data was loaded into Facets correctly

Created and gathered business requirements documents from the business for Facets upgrade.

Creates and execute test cases and test scripts via Quality Center

Converted Providers, Members, Authorizations, and claims from current system to Facets. Also created test cases to ensure that conversion data was loaded into Facets.

Responsible for testing of Facets 5.01 by utilizing the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Responsible for managing Facets 5.01. Testing Team Members.

Responsible for configuration.

Manages and configures benefit plan configuration methodologies within specified timeframes into claims payment system

Tests and audits claims payment accuracy against benefit configuration loaded into claims payment system

Partners with other departments to ensure appropriate data is collected and maintained

Interprets and configures benefit and fee schedule terms and claims coding in a risk-based environment

Understands health insurance benefit administration in a risk-based environment

Responsible for implementing and configuring new benefit plan information for new business strategies

Responsible for creating test cases for all system changes for Benefits, Membership, Providers, Claims, Customer Service, Utilization Management, 5010/ICD 10 changes and all related system processes effected by 5010/ ICD-10 change, such as testing membership, providers, claims, customer service, utilization management, HIPPA Gateway, 834, 834C, 820, 837 I/P, 276, 277, reports and third party vendors processes for all configuration changes to the system.

Responsible for test coordination with third party vendors.

Responsible for testing processes and working with end users to resolve system issues and test issues.

Intelli-source Inc. 12/13 – 11/14

DST, Birmingham, AL

QA Test Lead

Serves as Testing Lead for Applications Development, Business Owners, and Management to support implementations of Amisys, ICD-10, and FIDA projects.

Responsible for planning, executing, and finalizing upgrade projects according to strict deadlines and within budget. This includes acquiring resources and coordinating the efforts of team members and third-party contractors or other consultants in order to deliver projects according to plan.

Responsible for defining the project’s objectives and overseeing quality control throughout the project life cycle.

Creates and execute test cases and test scripts via Quality Center.

Responsible for testing of Amisys and third-party software by utilizing the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Responsible for managing Amisys 6.4.3 Testing Team Members.

Responsible for creating test cases for all system changes, FIDA, Amisys, ICD 10 changes and all related system processes, such as testing HIPPA Gateway, encounters, data management, membership, providers, claims, utilization management, 834, 834C, 820, 837 I/P, 276, 277, reports and third-party vendors processes for all configuration changes to the system.

Responsible for test coordination with third party vendors.

Responsible for testing processes and working with end users to resolve system issues and test issues.

Contact Management, Tarrytown, NY 6/13 – 12/13

HealthEdge, Tarrytown, N

Consultant Testing Lead

Serves as Testing Lead for Applications Development, Business Owners, and Management to support system conversions to HealthEdge project.

Responsible for implementing testing processes and procedures.

Responsible for planning, executing, and finalizing projects according to strict deadlines and within budget. This includes acquiring resources and coordinating the efforts of team members and third-party contractors or other consultants in order to deliver projects according to plan.

Responsible for defining the project’s objectives and overseeing quality control throughout the project life cycle.

Contributes to the development of implementation plans and provides support to facilitate system implementations, membership, providers, claims, utilization management, customer service, EDI 5010 process, ICD-10, data management and Patches, System Enhancements and testing of Facets 4.71.

Creates and execute test cases and test scripts via Quality Center.

Created and gathered business requirements documents for business processes.

Responsible for testing of HealthEdge by utilizing the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Responsible for managing HealthEdge Testing Team Members.

Responsible for setting up testing processes for Acuity Citrix project.

Responsible for the development and training of the testing process for HealthRules. Develop test plans, quality assurance and audit procedures for new systems. Supports corporate goals by ensuring that activities and outcomes are in compliance with partner, client and government contracts and internal strategy.

Intelli-souce Inc.

CareSource, Dayton, OH 2/11 – 6/13

Facets Consultant Testing Lead

Serves as Testing Lead for Applications Development, Business Owners, and Management to support system conversions and upgrade of Facets and 5010/ ICD-10 project.

Responsible for planning, executing, and finalizing upgrade projects according to strict deadlines and within budget. This includes acquiring resources and coordinating the efforts of team members and third-party contractors or other consultants in order to deliver projects according to plan.

Responsible for defining the project’s objectives and overseeing quality control throughout the project’s life cycle.

Contributes to the development of implementation plans and provides support to facilitate system implementations, EDI 5010 process, encounters, data management, ICD-10 and Patches, System Enhancements and testing of Facets 4.71.

Created and gathered business requirements documents from the business for Facets upgrade.

Creates and execute test cases and test scripts via Quality Center

Responsible for testing of Facets 4.71 by utilizing the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Responsible for managing Facets 4.71 Testing Team Members.

Assisted with NetworX Agreement build (i.e Group, Parent Group, Class.Plan, Subgroups, Service Definition, Service Payment, Service Rules, Premium Rate Table, ect)

Make configuration updates within lower environments (i.e. Service Definition, Service Payment, Service Rules, etc.)

Perform Configuration Peer Reviews on Benefit Configuration

Responsible for creating test cases for all system changes, 5010/ICD 10 changes and all related system processes effected by 5010/ ICD-10 change, such as testing HIPPA Gateway, 834, 834C, 820, 837 I/P, 276, 277, reports and third party vendors processes for all configuration changes to the system.

Responsible for test coordination with third party vendors.

Responsible for testing processes and working with end users to resolve system issues and test issues.

Computer Task Group, Inc. 05/08 – 02/11

MVP Healthcare, Schenectady, NY

Facets Consultant Testing Lead/Project Manager

Serves as Testing Lead for Applications Development, Business Owners, and Management to support system conversions and upgrade of Facets and ICD9 and ICD-10 project.

Managed a team of more than 15 testers nationwide.

Responsible for planning, executing, and finalizing projects according to strict deadlines and within budget. This includes acquiring resources and coordinating the efforts of team members and third-party contractors or other consultants in order to deliver projects according to plan.

Responsible for defining the project’s objectives and overseeing quality control throughout its life cycle.

Contributes to the development of implementation plans and provides support to facilitate system implementations, Patches, Consumer Directed Healthcare Account Management Module, Enhancements and testing of Facets 4.5 & 4.71.

Creates and execute test cases and test scripts via Quality Center

Responsible for testing of Facets 4.5 by utilizing the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Responsible Facets 4.5 Testing Team Members.

Key player in setting up and testing Facets Implementations and Upgrades.

Responsible for configuration.

Responsible for testing processes and working with end users to resolve system issues.

Computer Task Group, Inc., Buffalo NY

Industry Expert/Business Analyst – Vendor Evaluation 10/07- 4/08

Provide subject matter support for the engagement, including reviewing draft documentation in a timely manner.

Provide technical knowledge in areas of expertise.

Participate in facilitated or other information gathering sessions.

Support the plans and schedules as defined.

Provide effective and timely communication.

Complete the engagement activities within budget and on time.

Share a mutual accountability for the success of the engagement as a whole.

HP Technologies, Phoenix AZ 03/07-09/07

MVP Healthcare, Schenectady, NY

Facets Consultant Project Manager/ Business Analyst – Information Technology

Serves as liaison for applications development, business owners and management to support system conversions and upgrades, contributes to the development of implementation plans and provides support to facilitate system implementations.

Responsible for assisting TriZetto Hosted client with Facets System upgrade from 2.96 to 4.31 and ICD-9 project.

Responsible for Customer Service upgrade, configuration, workflow and testing. Also responsible for training and training documentation for the Customer Service staff.

Working knowledge of Facets claims adjudication process, financial billing, provider, member, benefits, reporting, Clinical Editing configuration, and Customer Service.

Responsible for gathering business requirements needed for the implementation of new business to the Facets environment, utilizes the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Key player in setting up and testing Facets Implementations and Upgrades.

Responsible for testing processes and working with end users to resolve system issues.

Catalyst Search, Denver, CO 09/06 – 03/07

Amergroup Healthcare, Virginia Beach, VA

Facets Consultant Business Analyst – Information Technology

Serves as liaison for Information Services to Client Services, Business owners and Management to modify, support system conversions and upgrades, contributes to the development of implementation plans and provides support to facilitate system implementations.

Working knowledge of Facets claims adjudication process, financial billing, provider, member, benefits, reporting, encounters, data management and Clinical Editing configuration.

Responsible for gathering business requirements needed for the implementation of new business to the Facets environment, utilizes the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Key player in setting up and testing Facets Implementations and Upgrades.

Responsible for training end-users on Facets Application.

Responsible for testing processes and working with end users to resolve issues.

Supports corporate goals by ensuring that systems activities and outcomes are in compliance with partners, client and government contracts.

Keystone Mercy Health Plan, Philadelphia PA 09/02 – 09/06

Facets Business Analyst Specialist /QA Testing Business Analyst Specialist – IS/Operations

Served as Testing Lead for Applications Development, Business Owners, and Management to support system conversion of CSC to Facets.

Served as liaison for Information Services to Client Services, Business owners and Management to modify, support Facets system conversions and upgrades, contributes to the development of implementation plans, and provides support to facilitate system implementations.

Responsible for system conversions from legacy system to Facet for Providers, Members, Authorizations, and claims. Also created test cases and tested to ensure that conversion data was loaded into Facets correctly.

Coordinate production batch processing activities.

Develop batch processing guidelines and standards for production jobs, based on error and root cause analysis.

Make analysis and recommendations for production job scheduling to support business requirements and to ensure Production Job Schedule is not interrupted with failures.

Performs analysis of processes, procedures and practices, in department or assigned area, and identify the area in which improvement recommendations should be made.

Work directly with developers to correct system issues.

Working knowledge of claims adjudication process, billing, capitation, membership, benefits and provider configuration.

Responsible for the development of documentation and training of KMHP’s Facets Batch Operating Guidance for all functional areas (Claims, Capitation, Billing, Provider) .

Responsible for training end-user on Facets Application.

Set-up, configures, executes, and performs “dry-run” of production deployment for Claims, Capitation, Billing, Crystal Reports, UNIX batch processes, and Sybase and Oracle processes in development, testing, and training environments.

Responsible for one-on-one training in the Facets system on claims, provider set up, capitation process, claims payment process, and billing process.

Document and track metrics to assists tech leads in tuning jobs for optimum performance.

Developed Team Based Installation process to ensure contracts are interrupted correctly and configured correctly in Facets.

Develop test plans, quality assurance and audit procedures for new systems or system enhancements. Supports corporate goals by ensuring that activities and outcomes follow compliance with partner, client and government contracts and internal strategy.

Utilizes the Project Life Cycle Methodology to ensure successful project conclusions as measured by meeting Department and Corporate objectives.

Keystone Mercy Health Plan, Philadelphia PA 1997 – 2002

Quality Specialist II

Completed audit reviews of Facets Staff.

Identified system, operational issues effective quality standards.

Assisted end-users and trainers with clarification of processing rules.

Served as the Project Manager for Facets Claims Processing Issues.

Was a key player in the testing of the Healthcare System, MEDecision Interface and Facets.

Participated in the Facets Workgroup to identify and correct Facets System problems.

Was the point person for all phases of claims processing, auditing and cost containment.

Keystone Mercy Health Plan, Philadelphia, PA 1996 – 1997

Medical Claims Analyst

Processed, reviewed and approved Code Review Applications/Clinical Editing.

Implemented guidelines for Manual Drug Pricing.

Identified system, training and fee schedule issues.

Developed processing policies and procedures.

Education

University of Phoenix, King of Prussia Current

Bachelor’s Degree – Information Technology

Harcum Jr. College, Bryn Mawr, PA 1984

Associates Degree – Business Administration

Learning Tree International 2006

Identifying and User Requirements

Learning Tree International 2006

Software Quality Assurance

Learning Tree International 2006

Crystal Reports 11

American Society of Professional Education 2005

Developing Requirements with Use Cases

Mercury Educational Services 2005

Test Director

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