Melisa Tankersley
Dolton,IL
Summary
To obtain a Professional position to further develop skill and knowledge in the Health Insurance industry. Self-motivated Analyst with experience in detailed technical specifications. Offers collaborative style and has outstanding communication skills. Expertise in test reporting and defect resolution. With outstanding oral and written communication skills. Solid background performing quality assurance testing and consultative services for customers.
Overview
18
18
years of professional experience
Work History
Quality Assurance Analyst
Evolent Healthcare
04.2020 - 07.2023
- Work with IT Quality Assurance (QA) Leadership to achieve company goals
- Development of subject matter expertise on various Evolent platforms
- Authorship and maintenance of both automated and manual functional test cases
- Creation, management, and execution of test cases in Test Rail
- Defect Management to include defect creation, interacting with developers for clarification and resolution
- Participation in full SDLC as a member of a Scrum team attending daily standups and other required meetings
- Work with Product Owner and Developers to ensure the delivery of high-quality product and take ownership of functional requirements, communicating effectively with developers (to explain requirements) and product owners (to provide feedback and suggestions for improvement of requirements)
- Assist and advise on best practices for testing, as well as make recommendations to improve efficiency and performance
- User Acceptance testing
- Regression testing
- Creation and status updates of tasks, consolidation of data for status reporting and measurement of performance.
- Collaborated with development teams to identify, track, and resolve software defects in a timely manner.
- Determined server operating limits with weekly load tests.
Configuration Analyst
Evolent Healthcare
03.2017 - 04.2020
- Create and maintain all Provider Fee schedules and affiliations, terms and contract changes
- Collaborate with client to develop, implement and improve cross functional work processes which support claims processing and proper provider payment
- Create business rules for claims to route to proper claims queues
- Claims Adjudication/Payer Compass
- Maintain correspondence and communication with Health Plan’s and Client representatives
- Highly involved in Company configuration of all new client implementations
- Identified critical issues and provided support to expedite resolution
- Configured updates in test environment, oversaw testing and configured updates in production environment
- Develop configuration components for new business requirements and updates to existing requirements, following established architecture and global design
- Develop and Maintain rate and reimbursement inventory per client
- Correct production configuration problems and provided support where necessary
- Modify procedures / configurations that solve complex business problems with due consideration to rate of change, flexibility and ease of maintenance of these configurations
- Create, analyze and revise existing configuration documentation and policy and procedures
- Identify patterns within quantitative data, draw conclusions and recommend solutions
- Manage multiple assignments while maintaining quality standards and meeting assigned deadlines
- Creating and maintaining Design Documents for configuration changes.
- Enhanced project management skills by defining and presenting system solutions and timelines for business needs or technical problems.
- Created and maintained version description documents and worked with version control library.
Credentialing Rep/CSR II
Blue Cross Blue Shield of IL
05.2006 - 03.2017
- Processing Credentialing/PPO/Blue Choice application and contracts for providers in Illinois and Northwest Indiana
- Updating Providers data in premier systems
- Answering status line speaking to providers, hospitals etc
- Lead/Senior role of various special projects as assigned
- Research and update providers’ information in database for Credentialing Review
- HMO directory review updates and corrections
- Facility (Cross maintenance updates, corrections, and hospital changes)
- BCA (Blue Cross Association) quarterly audit
- Internal and external audit projects.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Answered constant flow of customer calls with minimal wait times.
Claims Processor
Blue Cross Blue Shield of IL
04.2005 - 05.2006
- Processing medical claims for labor department
- Make phone calls to providers to verify information
- Adjust claims
- Find resolutions for error messages prompts
- Test and research claims adjudication issues.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Monitored changes in legislation that could potentially impact ways claim's are processed or paid out by insurance companies.
Education
Bachelor of Science - Health Care Leadership
National L. University
Chicago, IL06.2017
Associate of Applied Science - Medical Insurance Billing/Coding
Taylor Business Institute
Chicago, IL12.2005
Skills
- User Acceptance Testing
- Jira, Kanban Board
- Documentation skills
- Teamwork and Positive Attitude
- Scrum Methodology
- Excellent analytical, problem-solving, and decision-making skills
- Word, Excel, Access, PowerPoint, SharePoint
- Root Cause Analysis
- Quality Assurance
- Excellent analytical, problem-solving, and decision-making skills
- Agile Methodology Understanding
- Outstanding research and detailed documentation
Timeline
Quality Assurance Analyst
Evolent Healthcare
04.2020 - 07.2023
Configuration Analyst
Evolent Healthcare
03.2017 - 04.2020
Credentialing Rep/CSR II
Blue Cross Blue Shield of IL
05.2006 - 03.2017
Claims Processor
Blue Cross Blue Shield of IL
04.2005 - 05.2006
Bachelor of Science - Health Care Leadership
National L. University
Associate of Applied Science - Medical Insurance Billing/Coding
Taylor Business Institute