SUMMARYClaims Testing ManagerA dedicated and hardworking healthcare professional with extensive experience in claims management, production scheduling, project management, system management, testing, performance evaluation, business analysis, technical support, training, and database management. Uses analytical and decision-making skills to analyze data and workflow processes. Enjoys research and analysis, with the strong ability to monitor and motivate staff members to resolve issues and achieve goals.SKILLS SUMMARYMedical Terminology ICD/9 DX coding CPT/HCFA coding.Revenue code/ Bill Type coding DRG Reimbursement APC/APR Testing procedureMedical claims processing Hospital Claims Processing Task Plan/Test Plan procedures Claims Training manuals Claims Policies-Procedures EXPERIENCEHIPA, HEALTH INSURANCE PLAN ADMINISTRATORS, Hollywood, FloridaManager, Claims System Support/ Project Management, 2005-2015• Oversaw workflow and testing team of up to 14 Business Analysts • Managed multiple projects and planning to ensure project met desired requirement • Organized team members and assigned roles/responsibilities based on project requirements • Monitored and controlled activities performed to ensure project delivered as planned • Provided support to director to ensure projects were tested and completed accurately and in a timely manner • Reviewed Business Requirements and supported programmers to ensure system changes and fixes met submitted requirements for implementation• Analyzed testing strategies and made recommendations for improvements. Developed test/task plans• Monitored work plans for multiple system projects. Facilitated and conducted project meetings for each project assigned• Performed monthly/yearly team performance evaluations. Mentored and provided support to business analyst for issue resolutions• Created training documents for system testing. Monitored and updated PendAdmin system/workflow, CATS, and OCR systems

HIP Health Plan AdministratorsClaims Business Analyst, 1997-2005• Performed testing and coordinated implementation of projects with IS department • Assisted IS with development and design of new database systems for claims department usage • Provided support to claims management/teams on system issues and discrepancy resolutions for all sites • Developed user training documents for system upgrades and trained trainers on system changes. • Performed training for HIPA/HIP and VYTRA on CATS, PendAdmin/CIRS workflow and validation system• Audited all database systems and made recommendations for changes and upgrades

EARLIER EXPERIENCEHIP Health Plan of FloridaClaims Clerical Method Business Analyst, 1996-1997. Evaluated examiners and clerical work methods policies/procedures and workflows. Reviewed current claims department practices and made recommendations and suggestions on ways to improve department efficiencies for claims processing. Provided support to claims management, trainer, and staff to assist with issues and discrepancy resolutions. Created documentation and monitored implementation of new/improved processing/working methods, policies/procedures, and workflow.

HEALTH OPTIONS/BLUE CROSS BLUE SHIELD, Miami, FloridaClaims Trainer, Quality Auditor, 1993-1996. Developed, coordinated, implemented, and monitored all claims department training programs, including employee motivational programs.