SUMMARY

• 8 plus years of experience as a Business Analyst in Insurance domain includes healthcare insurance, life insurance, medical billing, Accounts Receivable, Health Insurance Portability, Accountability Act, EDI Transactions, HIPAA, MMIS, Medicare and Medicaid.
• Experienced in interacting with business users to identify their needs, gathering requirements and authoring Business Requirement Documents (BRD), General system Design (GSD), Functional Requirement Document (FRD) and Software Requirement Specification (SRS) across the deliverables of a project.
• High degree of computer literacy in MS Office: Word, PowerPoint, advanced Excel skills (formulas, pivot tables, VLOOKUP functionality), Visio, project, Access, and SharePoint for document sharing/collaboration.
• Excellent knowledge of Medicare Part A, B, C and D and Medicaid Health Insurance Policies like CHIP, Personal Injury Protection PIP insurance, billing experience in life and disability in health plans etc.
• Experienced in EDI and HIPAA with multiple transactions involving claims handling and processing, with HealthCare payer and provider experience (270 & 271, 276 & 277, 820, 837 P/I/D, 834, 835) Proficiency in documenting Test Cases, Test Plans, Test.
• Extensive use of MS Office tools like MS Access, MS Word, MS Excel, MS PowerPoint MS Project for data migration in to the CI System Knowledge Data Base in Microsoft SharePoint. Designed and developed Use Cases, Activity Diagrams, Sequence Diagrams, OOD using UML.
• Extensive experience with Health and Human Services programs, Medicare, Medicaid MMIS, Child Welfare, HMO, PPO, POS, Managed Care, Life, Health Insurance Exchange HIX, Health Information Exchange HIE, HIPAA regulations, Electronic Health Records EHR, Electronic Medical Records EMR, and Electronic Patient Records EPR, SHBP (STATE HEALTH BENEFIT PLAN).
• Extensive experience in business analysis, requirement gathering and eliciting efforts for application development projects including devops practice involving Agile, Waterfall, Agile - Waterfall Hybrid methodologies.
• Demonstrated experience and understanding of the methodology testing in a DevOps environment, which include experience in using Jenkins for auto deployment of a build.
• Experienced using Azure DevOps for raising defects, defect tracking, maintaining test results, System Test Plans, Designing SQLs, Test Scripts / Test Cases, Test Case Executions and Test Completion Reports for web applications & client-server applications and status reporting
• Participated in Joint Application Development (JAD), brainstorming sessions, reviews, walkthroughs, and customer interviews to gather customer requirements.
• Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
• Experienced with multiple Relational databases like MySQL, Oracle, SQL server and in-depth knowledge in ETL tools (Pentaho, SSIS).
• Experienced in Logs the bugs in JIRA and assists the developers in the resolution of bugs.
• Strong Data Mapping experience using ER diagram, Dimensional/Hierarchical data modeling, Snowflake modeling using tools like Erwin, E/R Studio and Sybase Power Designer.
• Solid understanding in developing & automating reports, iteratively building & prototype BI dashboards using Tableau to provide insights at scale, solving for analytical needs of business teams.
• Experienced in conducting GAP analysis, User Acceptance Testing (UAT), Risk Analysis and mitigation plan, Cost benefit analysis and ROI analysis.
• Skilled in designing and preparing monthly status reports, assisting in corporate projects in health care, health economics model, and evaluating all clinical trial data.
• Exposed to Medicare and Medicaid domains of the healthcare systems and industry for inpatients, outpatients, Reimbursement Methodology and Medicaid Management Information System MMIS.
• Experienced in the healthcare sector with prime focus on Claims Adjudication, Migration, Provider, Eligibility and Prior Authorization for Medicare and Medicaid program.
• Experienced in FACETS and its modules such as Claim, Member/Subscriber, Billing, Provider, Medicare, Medicaid and experienced with several Facets Batches.
• Well experienced as a Validation Consultant and as a Validation Associate by validating computer systems and software as per FDA regulations and GxP and GMP guidelines.
• Experienced in split claims in HB billing and performed scenarios for split claims.
• Knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax such as ANSI X12.
• Extensive knowledge Qualified Health Plans (QHP), Qualified Dental Plans QDPs, Health Insurance Exchange (HIX) and Affordable care Act (ACA).
• Experienced in HL7 Standards, HIX, EHR - Electronic Health Records, EMR - Electronic Medical Records, CMS regulations, Health Care Reform, EMTALA, PPO, POS and HMO.
• Adequate knowledge in Health Administration - Claim’s processing (auto adjudication), COB, EOB/ Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HER, HIX, Confidential, Medicaid, CDHP (consumer driven health plans).
• Possess an in depth understanding ofGAP Analysisand defined theAs-IsandTo-Be business processesto help the organization with designing the new system and collaborated withSMEsto understandKey Performance Indicators(KPI’s) andService Level Agreements(SLA’s).
• Experience in handling/tracking the requirements using Azure DevOps (VSTS), JIRA, good understanding of Data Virtualization methodology and tools such as Microsoft Reporting services, Visio, IBM Rational Rose Tableau.
• Extensive Claim experience for Provider, Payer, Clearinghouses, Pharmacy Expert level knowledge of healthcare industry applications and processing, EDI transaction sets and formats.
• Varied experience including Medicaid (MMIS, MITA, MECT), Medical Billing, Medicare, General Insurance (Health Claims).
• Working knowledge of Amazon Web Services (AWS) and Cloud Data Management.
• Strong analytical, problem solving and interpersonal skills; acquired credentials of the medical profession having zeal to treat patients with empathy and compassion.
• Extensive Knowledge about all the phases of Business Analysis Life cycle like Requirements Elicitation, Requirements Analysis, Requirements Documentation and Requirements Management.
• Expertise in reviewing Test Procedures, creating Test plans, defining System Integration Test Cases, executing Test Cases, Test Data reviewing and maintaining and executing detailed Test scripts for User Acceptance TestingUAT,analyzing bugs, interacting with team members in fixing.

PROFESSIONAL EXPERIENCE

Confidential, Texas

Sr. Business Analyst

Responsibilities:

• Gathered and documented Business Requirements into the Medicare Advantage (MA) requirements database. and created the Project Requirements Document for the three functional areas.
• Prepared business process models for projects and demonstrations at the Centers for Medicare and Medicaid (CMS) using business process model notation and enterprise architecture.
• Involved in HIPAA/EDI Medical claims analysis, design, implementation and documentation.
• Analyzed change requirements for Providers, Contracts and Claims processing modules configuration in Facets system for Medicaid and Medicare Advantage Plans.
• Performed data mapping by matching the billing file and EDI claim file record claims received from Medicare and Medicaid agencies.
• Exposed to using coding standards in Medicare and Medicaid domains of the healthcare systems and industry for both inpatients, outpatients, Reimbursement methodology.
• Worked on CMS Center for Medicare and Medicaid Services checklist, MITA, HIPPA and GAP analysis
• Responsible for data management, submission and reconciliation as well as analyzing and reporting for Medicare and Medicaid RAPS and EDPS risk adjustment programs.
• Worked with Medicare operational management to monitor, trend, and report on operational metrics such as timeliness, workload, and staff trending, customer satisfaction, and other key measures to facilitate performance excellence.
• Responsible for providing Medicare Operations support, with a focus on leading configuration activities for Medicare Part D operations.
• Verified accuracy of billing information and codes before processing Medicare and Medicaid forms, as well as other third-party insurances.
• Involved in developing and integrating the tasks performed and uploading the resources to SharePoint for access across the organization.
• Worked on writing write Users Stories in Visual Studio Teams Services (VSTS) as followed SDLC Agile model. Conducted the daily stand-up calls, sprint planning, grooming as well as the training sessions to the internal steak holders on VSTS Azure DevOps.
• Captured business requirements for reconciliation reports and designed metrics in MicroStrategy
• Worked with Microsoft Azure cloud products likeSQL Server,PowerShell,ARM Templateand takeSQL backup- Full back-up, Differential back-up, Log back-up, Compressing Database, Setting Retention policy and restoring with in Optimizing the existing Azure architecture.
• Involved in Implementing revised architecture using Azure MigrationSQLandDocker Containers
• Worked on the Production Environment to capture the data from the applications and keying it the same onto the high-level spreadsheet and updating the results onto the SharePoint.
• Responsible for detecting, correcting, and preventing Medicare and Medicaid fraud, waste, and abuse.
• Worked on the Log and document all allegations of Fraud, Waste, and Abuse reported by Health Integrity, Office of Inspector General, Center for Medicare and Medicaid Services (CMS), beneficiaries, employees, and anonymous witnesses.
• Created and maintained requirement documents for Facets for the different modules like Billing, Member enrollment and Claim adjudication.
• Validated member eligibility and eligibility inquiry in the facet’s application to the legacy application in order to confirm the migration successful or not.
• Experienced working on HIPAA implementation guides relates to Claim Testing and Medical Billing
• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for processing of Medicare/Medicaid Claims.
• Acted as a liaison between client and payer/intermediary. Experienced in payer rules, requirements, governmental regulations and HIPAA compliance.
• Documented various key elements of HIPAA compliance and made sure that they were understood by the development teams and ensured that the test cases written for the project were HIPAA complaint.
• Worked in payer domain System Integration with Health plans eligibility and claim information. Strong understanding and Claims Processing/adjudication, Memberships and other standards.
• Used different ad-hoc analysis, the Reports assist in defining strategy for each customer category. Informatics was used for ETL process and Business Objects.
• Reviewed EDI companion guides for all payers to ensure compliance, edit integrity and maintain up-to-date list of payer contacts.
• Created overview document for data conversion, data mapping documents, detailed instructions, specification documents, pre-requisites, sample files, loader formats and business test cases.
• Involved in developing metrics and generate reports on Key performance Indicators (KPI) through SQL queries from multiple data sources, Data mining, Data Visualization using visual dashboards for leadership and business.
• Involved in designing the Logical Model into Dimensional Model using Star Schema and Snowflake Schema on PowerDesigner to build data warehouse.
• Coordinated testing for contract set-up, enrollment and claims processing for four new managed care contracts for Confidential mental and physical health providers.
• Analyzed and resolves problems and complaints about payment of claims for Health services provided to Medicaid recipients. Prepares letter responses and answers inbound and outbound telephone inquiries from Medicaid providers.
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers. The Claims were processed, co-pay is calculated, and the pricing is calculated using the IBM systems for both Retail and Direct Claims processing flow.
• Involved in developing system integration test plans, test scenarios, test cases, test data and test scripts from the Business requirement document.
• Involved in ETL/BI testing and Backend testing using T-SQL Queries. And used JIRA for the defect management, Azure Devops for project management.
• Assisted QA team in developing Test Scripts, Test Cases and Test Plans for the User Acceptance testing (UAT), generate key performance indicators (KPI) reports using various tools and SQL
• Created Business Process Mapping Diagrams and Documentation for the process improvement recommendations.
• Involved in the execution of UAT test cases, test scripts; captures test results, test metrics and reports.

Confidential, Ohio

Business Analyst

Responsibilities:

• Gathering requirements as well as scheduling a daily scrum meeting to elicit, analyze, verify, and manage the needs of the project stakeholders, customers and end users.
• Organized and facilitated Agile and Scrum meetings, which included Sprint Planning, Daily Scrums or Standups, Sprint Check-In, Sprint Review & Retrospective.
• Worked on Data mapping, logical data modeling used SQL queries to filter data within the Oracle database tables
• Responsible for overall documentation development and editorial cycles for DevOps and other IT Infrastructure groups using Confluence Wiki.
• Involved in all aspects of Agile development through Scrum processes, used JIRA for backlog management, Azure Devops for project management.
• Worked with Senior Developers, Architects, Project Managers, DevOps Engineers, Release Managers, SCM Team Leads, and other Infrastructure team members on and offshore.
• Conduct JAD sessions to gather and document requirements that enhance a wide range of functionalities including claims processing, eligibility and enrollment, provider networks, and electronic data interchange.
• Responsible for analyzing Eligibility for State Welfare Program, Children’s Health Insurance Program (S-CHIP), Food Stamps (SNAP), Child Care and Temporary Assistance to Needy Families (TANF) (CHIP, SNAP, and TANF).
• Worked on electronic Medicaid eligibility verification system and the Medicaid and Medicare intermediary along with their roles in claim processing.
• Experience in working with CMS and Medicaid Programs. Experience in implementing Healthcare Compliances like ACA, HIPAA, MOOP.
• Helped lead the transition of Requirements Management in the Business Analyst Team to the agile methodology by creating and managing user stories and Requirements Traceability Matrices in the JIRA toolset.
• Preparing the traceability matrix connecting High Level Business Needs, Expanded Business Needs, Epics, and user stories
• Worked on the EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets
• Participated in Requirement gathering, Business Analysis, User meetings with both onshore and offshore team, discussing the issues to be resolved and translating user inputs into ETL design documents along with capturing specific data and analysis of the root cause of the problem.
• Worked on troubleshooting performance and connectivity issues in Azure SQL databases, facilitate sprint planning and backlog refinement meetings to refine user stories acceptance criteria.
• Analyzed Service Requests and Change Requests available in JIRA and pertaining to everyday business need
• Knowledge of several functionality available in the Facets several applications such as Billing, Member/Subscriber, Accounting, and Utilization Managements.
• Worked with providers and Medicare or Medicaid entities to validate EDI transaction sets or Internet portals. This includes HIPAA 834, 837, 835, and 270/271
• Performed MIS/Reporting for the operations team to ensure rating/underwriting backlog management as well as KPI tracking.
• Involved in Developing and executing Test Plans, Test Case, FRD, TriZetto Facets 4.x and Medical Billing, Test Scenarios, also performing functional, usability testing and ensuring that the software meets the system Requirement.
• Worked as liaison between software developers and users of EMR systems to create better electronic medical record systems.
• Worked on Tested claims adjudication and group and enrollment in for new Medicare advantage members.
• Worked on Medical Claims in Process Documentation, Analysis and Implementation in 835/837/834/270/271/ Standards processes of Medical Claims Industry from the Provider/Payer side.
• Worked as an active member of the PDP team, interacting with developers, business users and subject matter experts SME to analyze and configure PBM Web-Portal functionality based on Business Requirement.
• Involved in maintain and track deliverables via Azure DevOps (Agile Taskboard - utilizing Epic/Feature/Tasks) format
• Documented the UAT Plan and worked with the UAT Team to ensure the acceptance criteria for every requirement has been included in the UAT task plan.
• Collaborating with the IT Data Modeling team to ensure data model design is consistent and accurate with the business requirements.
• Involved increating database and normalizing or de-normalizing data according to business requirements and Creating snowflake schemas.
• Responsible for Medicaid Claims Resolution/Reimbursement for state healthcare plans using MMIS.
• Managing and Billing Medicare, Commercial HMO/PPO claims daily.
• Worked on the claims related to Medicare (Part A, Part B, Part C, Part D)
• Responsible for mapping documents, creation of test plan, test scenarios, test cases for unit, system and system integration testing.

Confidential, Wisconsin

Business Analyst

Responsibilities:

• Validated Active Renewals and Passive Renewals for “Qualified Health Plan (QHP)” and “Medicaid” (MCD) Members based on their effective plan dates.
• Gathered requirements for making changes to the existing Electronic Medical Records (EMR), Electronic Health Records (EHR) and Ambulatory Services for the existing Epic Interfaces.
• Administered HMO, PPO, HSA, POS, EPO, FFS, DSNIP and Medicare Supplemental (Medigap) contracts.
• Involved in developing EDI specifications and applications structures for data feeds and mappings for integration between various systems, including XML and performed back-end testing on the Oracle database by writing SQL queries
• Worked on Medicare/Medicaid Claims processes from Admin/Provider/Payer side which were later part of the training program to vendors.
• Documented logical, physical, relational and dimensional data models. Designed the Data Marts in dimensional data modeling using star and snowflake schemas.
• Used HIPAA Gateway to comply with HIPAA standards (270/271, 276/277 & 837) for EDI transactions
• Worked with HIPAA, Facets, CHIP claim adjustments, claim processing from point of entry to finalizing, claim review, identifying claims processing problems, their source and providing corresponding solutions.
• Analyzed federal and state regulations/ policies for Medicaid and Children’s Health Insurance Program (CHIP) reimbursements.
• Scaled Agile Framework for the Enterprise Safe Leading transformation. Rally Dev Agile Tools. DevOps.
• Worked on Medicaid and CHIP program requirements, including complete end to end life cycle data flow of eligibility, enrollment, claims, encounters, payment and post-payment.
• Conducted multiple JAD sessions between various organizations such as DHS, DCCA, and OIMT to elicit system requirements using stakeholder analysis, RACI chart and prototypes.
• Responsible for delivering recommendations in establishing data exchanges between the State's Medicaid Management Information System (MMIS) and the Federally Facilitated Exchange (FFE) via the Federal Health Information Exchange (HIX) Hub for Affordable Care Act (ACA) requirements.
• Committed to establishing FFM / FFE (Federal facilitate Exchange) under HIX (Health Insurance Exchange) that meet the functional requirements of Patient Protection and Affordable Care Act (PPACA).
• Used FACETS to provide seamless transactions between the provider, members and the plan.
• Performed data mapping of HL7 messages into relational database.
• Defining Data/Attribute Modeling and ETL load required to integrate into MicroStrategy.
• Performed GAP analysis by comparing the past HIX reports with present Contractual Reports to create the Future Reports.
• Validated member Eligibility, benefit and claim status in a system and parallel testing.
• Involved in writing Queries in Visual Studio to create customized dashboards on Azure DevOps for tracking project status and work items.
• Created different complex sheets with QlikView Sheet objects including various charts types, List boxes, Table Box, Buttons, KPI's for Management Dashboard reporting based on client requirements.
• Maintained transparency with Project managers on the project update to track if the requirements are met and the stories are updated in Azure.
• Worked and supported on EDI Translators to analyze EDI files submission for Professional, Inpatient, Outpatient, pharmacy claims and dental claims.
• Used Microsoft SharePoint as the version tracking tool for managing the requirements documentation.
• Created user stories in Jira, documented in detail entire work flows in confluence, managed scrum master responsibilities with Sprint Span of two week.
• Coordinated with project management, lead and managed Scrum Team for Agile Solution Delivery and MDM implementation, managed team project and deliverables in Atlassian JIRA.
• Worked in all phases of healthcare insurance processing like defining Membership Eligibility and Enrollment and various Medical Claims processing.
• Worked on Medical Billing Rules and Regulations to bill the claims to the Insurance offices to get paid.
• Worked on the EPIC Medical software application (EMR, HER) as it relates to hospital workflows and setting up the infrastructure for a software implementation in a clinic environment.
• Worked on Healthcare system implementation including enterprise Electronic Medical Records (EMR) and Electronic Health Records (EHR) software.
• Created documentation such as BRDs and FSDs (Business and Functional design specs) with elaborate Use Cases and process flows.
• Collaborated with the Clinical SIT and Business teams for generating Test Cases for SIT (System Integration Testing) and UAT (User Acceptance Testing) respectively, using Business Process Modelling workflows and ATGen.

Confidential, Massachusetts

Business Analyst

Responsibilities:

• Completed Agile/SCRUM project to allow a direct exchange method to send and receive secure patient EMR data between care providers to support coordinated care.
• Organized and facilitated JAD sessions as part ofRequirementelicitationsessions based on User Stories and identifyingBusinessand FunctionalRequirementand detailed discussions
• Assisted with DHS complaints and resolution by effectively communicating with key stakeholders and working with internal departments
• Gathered the Requirements for Medicare Systems as part of Patient Protection Affordable Care Act (ACA)
• Extensively used SQL queries for data validation in both Medicare/Medicaid and commercial HIX
• Worked on writing data mapping documents, data transformation rules and maintaining data dictionary, data migration and interface requirements documents. Able to update Microsoft share point portal with the updated project documentation.
• Involved in developing, testing, modify and manage EDI (x12 standard) maps using B2B mapping tools in the Healthcare industry.
• Involved in project planning, coordination and QA methodology in the implementation of the Facets in the EDI transaction of the claim’s module.
• Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 997, 999 HIPAA EDI Transactions using MS Word, MS Excel, MS Access and Facets PROD PPMO
• Responsible for attaining HIPAA EDI validation from Medicare, Medicaid and other payers of government carriers.
• Served as a liaison between the internal and external business community (Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management) and the project team.
• Acted as a liaison between business staff and technical staff to articulate needs, issues and concerns as per GxP and IRB department requirements.
• Extensively used ETL to load data from different sources and prepared ETL specifications and Creating Mappings in Informatica PowerCenter/Power Mart for the incoming data.
• Used Jira Agile management tool to maintain team metrics and make visible to team (including burn down charts) and Work as a Jira admin assign new user to project, delete user and Create Project.
• Worked with the various Claims Transactions such as: 837 submit medical claims, 835 medical claim payments, 270 benefit/eligibility inquiry, 271 benefit/eligibility response, 276 claim status request, 277 claim status notification, 820 premium payments, and 834 enrollments.
• Involved in developing the new child only pediatric QHP compliant QDP plans and adult dental insurance products for the IU65 segment on and off exchange.
• Analyzed the impact of new HIPAA standards on targeted systems, processes, and business-associate relationships
• Worked on Medicare Advantage (A, B, C), Medicare Part D (MA-PD), Medicaid Options (Under 65 and Over 65) and Managed Care (Care, Disease & Case Management and in Insurance regulations & Claims Processing).
• Worked as a liaison between the business client and development team for the implementation 5010 transition in compliance with HIPAA standards.
• Worked on Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid and Medicare.
• Worked on the validation of connectivity between the external systems and CMS Confidential database for electronic submission of documents by verifying the gateway logs and SAML assertions.
• Conducted user interviews, gathered requirements to help create Business Requirement Documentation, using MS Word and MS Visio.

Confidential, Tennessee

Business Analyst

Responsibilities:

• Successfully collaborated with business stakeholders and Sponsors to capture requirements for new development projects. Manages requirements and resources through the SDLC.
• Worked on Medicaid Management Information Systems (MMIS), National Provider Identification (NPI), Electronic Data Interchange (EDI), Health Level -7 (HL7), HIX (Health Information Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA).
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI x12 Transaction, Code set and Identifier aspects of HIPAA.
• Prepared business requirements and related technical documentation based on needs of various Divisions and Offices within DHS via industry standard techniques such as data modeling, workflow analysis, reverse engineering or requirements decomposition.
• Incorporated HIPAA standards, EDI (Electronic data interchange), Implementation and Knowledge of HIPAA code sets.
• Created Use-Cases and Requirements documents to document business needs and involved in creating use cases based on HIPAA standards.
• Analyzed Medicaid Eligibility Determination System for Children’s Health Insurance Program (CHIP) and enrollment transaction 834.
• Practiced agile methodology, lead sprints and prioritize line items based on key business initiatives with respect to the Affordable Care Act (ACA) mandate and Health Care Reform Act.
• Involved in ETL of EDI transactions, creating work flow and activity and use case diagrams. Created validation documentations for the claim process.
• EDI Claims Processing documented enhancements to the EDI Claims Processes EDI 837, 835, 276, 277 to ensure accurate processing of claims of members.
• Involved in testing the billing and rendering provider, member subscriber, and payment modules of FACETS in the UI as well as in terms of database validation through SQL Queries.
• Wrote Standard Operating Procedures (SOP s) for all aspects of the validation life cycle, in accordance with FDA regulations, particularly 21 CFR Part 11 and GxP regulations.
• Assisted the implementation in the GXP environment to adhere to regulatory and risk management compliance.
• Medical Claims experience in Process Documentation, Analysis and Implementation in EDI X12 Standards processes of Medical Claims Industry from the Provider/Payer side.
• Involved in designing and developing various Business Intelligence reports against ODS, Claims systems such as Facets, HER systems such as NEXTGEN and Care Management systems, Network Management systems, Revenue Cycle Management systems.
• Involved in Medicaid and Medicare claims processing along with CMS, MITA, MMIS, Electronic Medical Health Record (EMR/EHR) and Pharmacy Benefit Management (PBM).
• Worked on setting up Fee Definition and Fee Calculation in FACETS for QHP Individuals, Grandfathered/ Transitional Small Group, QHP Small Group and Large Groups
• Involved in Testing of the various results generated by the reports against the data present in the database tables and used UAT on that data involving the users.
• Assisted in managing and billing Medicare, Commercial HMO/PPO claims on a daily basis.