Description
PROFESSIONAL SUMMARY: * Over 7+ years extensive Experience as Facets Configuration Consultant in Healthcare Industry with specialization in FACETS implementation and in-depth understanding of Trizetto FACETS data model. * Health Insurance Portability and Accountability Act (HIPAA), Data Warehouse and working on Requirement gathering, Business Process flow, Business Process Modelling, Data Analysis, Data Mapping. * Strong knowledge of managed Claims management process, Knowledge of Medicaid and Medicare Services, CMS, Health Assessment Systems, Medicare and Medicaid Insurance Billing, Hl7 Standards, HIPAA, EDI, Compliance issues, LOINC and SNOMED Mapping, HL7 Message Validation, ICD 9, ICD 10, Electronic Health Records, Electronic Medical Records. * Sound knowledge of Facets Data Model and Business Components including Application Support, Claims Processing, Criteria Maintenance, Medical Plan, Provider and Subscriber/Member * Knowledge and expertise on HIPAA 4010 and 5010, ICD-9 and ICD-10 diagnosis, surgical and procedural codes. * Understanding of backend tables, familiar with writing queries, linking tables and backend configuration via SQL Server and Microsoft Access * Understanding the specifications for Data Warehouse ETL Processes and interacting with the data analysts and the end users for informational requirements. * Wrote BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs. * Strong working experience in the Data Analysis, Design, Development, Implementation and Testing of Data Warehousing using Data Conversions, Data Extraction, Data Transformation and Data Loading (ETL). * Understanding the specifications for Data Warehouse ETL Processes and interacting with the data analysts and the end users for informational requirements. * Proficient knowledge of Complex SQL queries using clients like TOAD and SQL Plus. * Proficient at creating Use Cases, GAP Analysis, Process Flows & Work-flows using UML and Experience with CRM systems in general (SAP, Oracle, Siebel), ModelN. * Conducting and facilitating JAD sessions and brain storming sessions with key user groups emphasizing the scope of the project in order to provide key initiatives in working with users in identifying and defining project and system requirements. * Experience in writing BRD, FRD, use cases, test scenarios, test cases for testing the functional and non-functional aspects of both ETL jobs and Reporting jobs. * Experience in using business modeling tools like MS Visio and Unified Modeling Language (UML) for creating Use Case Diagrams, Business Process Models, Process Flow Diagrams, Class Diagrams, Activity Diagrams, Sequence Diagrams, and workflow diagrams. * 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 Testing (UAT), analyzing bugs, interacting with team members in fixing. * Experience in Gap analysis to compare as-is with to-be business processes and worked with technical resources to draft one or more solutions so that pros and cons can be presented to the business. * Extensive knowledge on performing process reengineering by documenting and evaluating existing business processes. * Ability to work on multiple project requests simultaneously while meeting tight deadlines. * Skilled in Software Development Life Cycle (SDLC) phases such as planning, analysis/design, development, and testing * Proficient in SQL and generating reports with equitable understanding of different relational databases.
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