Quality Assurance Artificial Intelligence
Resume:
Melody Carlisle
*********@*******.***
SUMMARY
Accomplished professional with over 18 years of experience in QA testing, business/system analysis, and technical management. Expertise in managing complex projects, leading diverse teams, and implementing innovative testing methodologies. Proficient in a wide range of software tools and technologies with a proven track record of delivering high-quality results in fast-paced environments. Strong organizational and interpersonal skills, with the ability to prioritize tasks, meet deadlines, and drive project success.
QA and Testing 18+ Years of Practical Experience
Organization 18+ Years of Practical Experience
Interpersonal 18+ Years of Practical Experience
Technical 18+ Years of Practical Experience
Various Software 20+ Years of Practical Experience
Management/Lead 18+ Years of Practical Experience
Business/System Analysis 18+ Years of Practical Experience
EMPLOYMENT
Contracting/Freelance Writer and Editor, Software Tester, 7/2023 to Present
Tracked budget expenses and ensured adherence to financial guidelines throughout the duration of projects.
Managed multiple projects simultaneously by coordinating timelines, and resources.
Negotiated contracts with vendors to secure cost-effective deals and favorable terms for project execution.
Prioritized tasks and deadlines effectively to optimize time management and project delivery.
Communicated regularly with clients to provide updates, address concerns, and maintain positive relationships.
Write, review and edit documents for individuals: Resumes and Grants and other documents as needed.
Assist in testing new software from emerging companies.
Implemented controls and strategies to address risks and ensure Artificial Intelligence model’s integrity.
Checked Artificial Intelligence for potential security issues and ethical concerns.
Researched and analyzed newest Artificial Intelligence to validate reliability and maintainable.
Reviewed Artificial Intelligence policies and procedures.
Outlier - Artificial Intelligence (AI) tester
Upwork – Emerging company software testing, product reviews, editing and writing process documents
Highmark Health, Program Manager 2/2022 to 7/2023
Led daily reporting to senior leadership on the acquisition activities and project progress for newly acquired companies.
Conducted risk analysis, documented issues, and resolved blockers to ensure smooth project execution.
Collaborated with cross-functional teams, including testers, developers, and project managers, to facilitate the seamless integration of new companies into Highmark Health.
Played a key role in setting up role-based security and working with IT security teams to ensure data access was restricted to authorized personnel.
Analyzed business needs, assisted in writing requirements, and implemented a management information system to streamline the integration process for both software and personnel.
HealthNow Blue Cross/Blue Shield, QA Test Lead, Analyst, 9/2013 to 2/2022, New York
Projects and testing included, but were not limited to the following:
oQuality Assurance Lead for PEGA – Lead testing efforts for claims preprocessing system. Assigned testers’ duties, worked with development and business to assure code and configuration was sound for release into production by upholding and implementing quality test standards. Pega Upgrade and Pega Initiatives
oTDM – Test data masking for de-identification of data and integration of masked data into testing.
oBusiness Process Automation (BPA) – Managed and lead testing for supplemental table configuration project. Technical testing and business testing. Manage day to day testing activities. Lead testers locally and off shore.
oThree year multi-million dollar project using scrum and agile methodology. Managed and lead multiple testing projects under ICD-10 and lead upgrade of underwriting system. Implemented resource allocation formula for quality assurance. Generated test schedules and plans as well as defect tracking and reporting. Lead quality assurance and business testers. Implemented efficient testing methods to eliminate redundant testing. Tested claims for federal employee program.
Claims and Benefits – COB, configuration analysis, claim testing from ICD-9 to ICD-10 coding. Tested claims for CMS, including Children’s Health Insurance Program (CHIP).
Extracts and Analytics – Authorization and overall ICD-10 report testing
Financial and Operational Neutrality – Validation of similar financial payment for ICD-9 to ICD-10.
Inbound and Outbound files – ETL, EDI customized files and 837 professional and institutional files
Configuration – Benefit set up and configuration for membership.
Pricing – Set up pricing for benefits and payments to providers in alignment with contractual obligations.
Provider testing – External ICD-10 file testing with providers and facilities with 835 generation, validated health rules for payor was intact with no adverse affects. Ensured payors’ claims were equivalent to contractual amounts. Worked with providers to change from manual system of submission of claims to electronic (HITECH).
Adhered to HIPAA guidelines throughout testing.
EDI: 834, 837, 835 as well as other transactional datasets were transmitted, modified and generated for various testing efforts.
Facets Upgrades: Implemented Facets upgrade to most recent version in order to stay within software compliance. Assured testing and quality control adhered to technical and business requirements.
oStepwise – Underwriting system upgrade and changes, requirements analysis
oPrimary Software and Tools used:
oSQL DBX Database Query tool Application Lifecycle Management (ALM) Pega
oPayspan (vouchers) Conversion application ICD-9 to ICD-10 Facets 5.40
oOn Demand (reports and EOBs) Change Test Management (CTM) Daptiv
oKanban Boards Jira (used for agile tasks) ServiceNow
CareFirst Blue Cross/Blue Shield (Consulting) Lead Business Analyst, 3/2013 – 9/2013, Maryland
Claims Business Analyst for Health Care Reform (HCR) – Gathered requirements for Health Care Reform laws to be implemented in accordance with Affordable Care Act (ACA). Wrote project requirement documents (PRDs), evaluated and documented current and future state business diagrams and processes. Mentored non-claims team to teach them about claims and healthcare. Worked with business and other teams to determine processing needed for claims to accurately capture and report to federal government. Worked on ICD-10 requirements gathering and Facets 5.01 upgrade.
Primary Software and Tools used:
Application Lifecycle Management Facets 4.71 MS Office (Word, Excel, Visio, Access)
Blue Cross/Blue Shield of LA (Consulting) QA Manager, 12/2012 – 3/2013, Louisiana
Managed Quality Assurance Team – Managed day to day activities for a core team of twelve test analysts and consultants. Planned resource allocations, handled personnel issues, and reported to management. Testing oversight on several projects while overseeing benefit configuration testing for new groups, renewals and benefit changes. Wrote test plans, test schedules and test case generation and execution by QA test team and testers from the business. Implemented test case traceability to requirements and test efficiencies were introduced to lessen testing time frame while making certain quality was maintained.
Projects and testing included, but were not limited to the following:
Health Care Reform (HCR) Project - Government mandated health care reform
ICD-10 Project - International Statistical Classification of Diseases coding
Tested health rules payor (HRP), via claims payment processing while maintaining integration of all systems for new coding.
Front End Edits Project - Electronic Data Interchange for claim files loaded to Facets
Sybase to SQL Transition Project – Migration of Facets from Sybase to SQL
oPrimary Software and Tools used:
Facets 5.01 Custom Pre-Claims Software Application Lifecycle Management
Plan View Claims Test Pro Server Query Tool
MVP Healthcare (Consulting with HP Technologies) Test Lead, 9/2009 – 11/2012, New York
Test Lead for multiple projects and initiatives - Simultaneously lead testing for various projects. Wrote test plans, schedules, test cases and scripts. Reviewed with technical and business teams. Assessed resources and gave resource allocations. Guided IT testers in test case generation and execution while assisting the business in testing methodology. Testing included; reports, letters, extracts, interfaces, defect tracking and analysis, and management reporting.
Projects and testing included, but were not limited to the following:
Managed Cost Containment – Cost containment testing for managed care for members
Enterprise Program Project Changes – Claims, COB, reports, letters, extracts, and Workflow.
Tested all software relative to claims, including Facets, various websites and QNXT.
Managed ACA – Tested and project managed affordable care act (AKA Obamacare). Test various levels of coverage of benefits. Managed product implementation.
ICD-10 – Lead testing and planning, while assisting in mapping decisions, research and meetings.
5010 EDI Claims and Enrollment – Tested EDI mapping of increased field lengths.
Enterprise Program Phase 1 – Medicaid conversion from Amisys to Facets. Managed project testing for applications, interfaces, reports and letters. Used Business Objects for reporting.
Primary Software and Tools used:
Facets 4.71 Remedy Lawson Custom Pre-Claims Software
Toad Web Interfaces QNXT SQL Oracle Query Tool
Macess MaxMC Application Lifecycle Management
Cognos Reporting Business Objects
Western and Southern Financial Group (Consulting) Test Coordinator, 5/2009 to 8/2009, Ohio
Coordinating testing for implementing Facets claims processing system. Implemented test methods for move to Facets 4.51. Allocated resources and wrote test schedule. Reviewed and maintained test scripts. Developed structure for testing and tracking of issues and assisted in security user group configuration and worked on integration of extensions and interfaces. Worked on Health Rules Payor contractual agreements and tested to ensure accuracy of payments to payor.
Primary Software and Tools used:
Facets 4.71 Amisys MS Office Web Defect Tracking
MVP Healthcare (Consulting with HP Technologies): Test Lead, 8/2008 – 5/2009, New York
Worked on multiple projects. Managed testing in systems integration and user acceptance. Projects managed: Claims editing cost savings using McKesson’s ClaimsXten and RoboClaim, Government Programs eligibility and billing automation and web based health enhancements with external entities. Managed test resources, wrote test schedules, plans, cases, scripts and test strategies. Tracked defects, coordinated testing and reported to management.
Primary Software and Tools used:
Facets 4.51 Remedy Amisys Mercury Quality Center
Toad Web Interfaces MS Office NetWorX
Macess MaxMC Lawson Custom Pre-Claims Software
The Regence Group BCBS (Consulting) Business Process Analyst, 8/2005 – 8/2008, Washington
Requirements gathering and testing duties. Gathered requirements, wrote functional specifications and reviewed technical specifications. Wrote test plans, scripts and cases for: Claims, ITS, Membership, Eligibility, Billing, and Web, Interfaces. Worked with business to change from current legacy systems to Facets 4.31 for claims processing. Standardized all four states to a single system-common process. Future state process modeling, process engineering and overall common process analysis. Executed test cases and test scripts using IBM Rational Test Manager and Manual Tester. Wrote and maintained requirements in RequisitePro, and used ClearQuest.
Primary Software and Tools used:
Facets 4.51 RequisitePro ClearQuest IBM Rational Test Manager
IBM Manual Tester Web Interfaces MS Office Crystal Reports (Business Objects)
Macess MaxMC Lawson Custom Pre-Claims Software
Presbyterian, (Consulting) Claims Processing Test Lead, 7/2005 – 8/2005, New Mexico
Test lead for conversion from Amisys legacy system to Facets client server environment. Planned and implemented claims testing, including gathering requirements, documenting defects. Used MS Office products, custom software, Facets and Amisys. Reported to management, maintain and adhered to tight timelines.
Vista/Ready Corps. at Helping Hand House, Assistant to Development Director, 8/2004 – 7/2005, Washington
Reviewed and wrote grants using MS Office; wrote reports, setup and analyzed computer and network issues. Provided office support for non-profit company that assist homeless families with minor children. Assist in developing website, developed and maintained web-based database. Helped with fundraisers and various events in the community and instructed clients in disaster preparedness. Instructor for American Red Cross, held first aid training classes, and wrote disaster plan for office.
Providence Health Plan, Testing/Business Analysis, 9/1999 – 7/2004, Oregon
Project manager for testing and quality control to convert from Amisys to Facets claims system. Responsible for testing team of eighty personnel; coordinating all testing processes. Implemented testing procedures and processes as well as wrote and executed test cases and test scripts. Wrote requirements, design and specification documents, and other technical documents used MS Office. Tracked defects in Lotus Notes and enabling and maintaining user security within applications. Project lead to infrastructure for phase II of new claims processing system.
Florida Health Choice, Business Analyst: MIS Department, 1/1999 – 9/1999, Florida
Technical analysis, Amisys software configuration, and addressed user problems. Analysis of business usage and requirements. Wrote test plan for upgraded software and trained users on software. Implemented changes for commercial, Medicare and Medicaid with strict adherence to regulatory requirements. Addressed issues for: reporting, ID cards, correspondence, providers (health rules payor, enrollment and programming.
Amisys/HBOC, Programmer/Systems Analyst, 11/1997 – 1/1999, Maryland
Maintained Amisys subsystems: Billing, Accounts Receivable, Membership, Correspondence Generator. Programmed in COBOL, HP3000, using Powerhouse products and used MS Office, Lotus Notes. Analyzed user concerns to determine if software was function as designed. Coded changes, wrote requirements as well as technical specifications for resolution of issues. Unit tested to validate programming modifications.
SKILLS
Possesses strong managerial and organizational skills, with a demonstrated track record of leading teams and projects effectively.
Exhibits exceptional multitasking capabilities and performs well under pressure.
Skilled in prioritizing multiple initiatives, ensuring timely and successful completion of projects.
Proficient in motivating and mentoring team members to realize their full potential.
Decisive and strategic in decision-making, contributing to project success and team efficiency.
Capable of handling numerous tasks and functioning exceptionally well under pressure.
Quick and accurate in prioritizing various initiatives.
Encourages and guides colleagues to excel.
Makes effective decisions.
EDUCATION
oCoursework at Wor-Wic College for Comp TIA (10/2024 – present)
oInformation Technology Service Management (ITSM) Certificate 08/2024
oCertified Information Security Manager (CISM) Certificate 08/2024
oGoogle Sheets 8/2024
oProfessional Scrum Master (PSM) Certification – 4/2017
oPCC, New Horizons, technical training, 10/1999 – 09/2003 - Certificates: SQL, HTML, Front Page, Testing (QA)
oControl Data Institute, Arlington, VA, 09/1990 – 09/1991 - Computer Programming Certificate
oNorthern VA Community College, 09/1982 – 12/1983 - Business Admin.: accounting, record keeping, word processing
oGeorgetown University, 09/1982 – 02/1983 - Paralegal Courses
oDelaware Technical and Community College, 09/1980 – 06/1982 - Business Administration
oAmerican Red Cross, 2005 - Certification: Red Cross Instructor, AED, CPR (Adult, Child, Infant), First Aid, Workplace
oTraining, Violence Awareness; Ergonomics; Managing Stress; Your Heart Matters; Back Injury Prevention, 2005
Contact this candidate