uthara yelugala

This module involved Receipt and Claims Form (837) and Claims attachment (275), Claims enquiry and response (276/277), Adjudication Healthcare Claim Payment/Advice (835) as per HIPAA guidelines. Addressed the changes made to the Medicare program and created requirements mapping to that of the system requirements. Identified AS-IS process of claims transactions of 4010/4010A standard and TO-BE processes (ICD-10-CM and ICD-10-PCS compliance requirements) of 5010 standard using the gap analysis. Worked in close collaboration with the Project Manager and business users to gather, analyze and document the functional requirements for the project. Worked in Healthcare Claims Administration – Healthcare Claims Processing (837/835) includes facility claims and professional claims Worked with Trizetto FACETS Team for HIPAA Claims Validation and Verification Process (Pre-Adjudication) Involved in Configuration Management, Requirement management and testing efforts.

* Participated in the identification of business rules, business and system process flows, user administration, requirements and assumptions for various modules I had worked on. * Followed Organization’s BEST practices and methodology for SDLC. * Conducted Joint sessions involving Subject Matter Expert, Project Manager, Development Manager and the end-users regarding the customization of the application to meet the requirements. * Created Concept of Operation, Solution Design and Functional Specification Documents using MS Word and MS Visio * Worked closely with the Development Manager to identify problems and gaps for the product development. Using the Workflow internal application, streamlined the tasks, documentation, delegation and completion of daily assignments. * As part of UAT effort, created Test Plans/test scripts and performed Manual testing using MS Excel and MS Word and lead User Acceptance Testing at the Client site.

Intellicost scheduling tool was developed to meet the staffing needs of nursing facilities to avoid any overtime cost and conflicts. Worked extensively with the users and different levels of management to identify user needs and develop specifications meeting the requirements. Created Use-Cases and Business Use-Case Model after accessing the status and scope of the project and understanding the business processes. Interacted with various cross-functional teams on building business use cases and understand expenses and revenue stream. Interacted with the developers to report and fix bugs. Prepared detailed reports of the Bugs, Pass-Fail report, Comparison Chart Used the Rational change management tool to track changes of multiple artifacts by versioning artifacts, associate requirement specific change requests to streamline the defect/change tracking process.

Business Systems Analyst serving Healthcare client