Praneeth V Email & Phone Number

California, United States

Responsibilities include researching a quicker and more efficient way to implement HL7 interfaces by using FHIR.Facilitated interview, one on one and brainstorming sessions with SME's User's in understanding the requirements pertaining to billing Origination to billing Processing.Developed HL7 messaging for bi-directional case and disease report exchange, in text and XML formats, in accordance with HL7 specifications.Interviewed stakeholders and validate “Current State” and “Future State” business and system processes; and developed business process flows using Business Process Modeling Notation (BPMN)Facilitated the Implementation of Fast Healthcare Interoperability Resources (FHIR) to enable healthcare data exchanges between Provider Manager and various Claim Engines.Created meaningful reports for analysis and integrated the Performance Testing in the SDLC.Worked on message formatting, mapping and translation to ensure the HL7 messages conform to the destination application and end user requirements.

Columbus, Ohio Metropolitan Area

Managed the team of consultants responsible for developing on-demand Medicaid Management System reports.Reviewed the data model and reporting requirements for Cognos Reports with the Data warehouse/ETL and Reporting team.Used knowledge of Health Care Information Systems EMR model to develop proposed workflow in MS Visio.Knowledge in guidelines and principles for practice-based clinical applications, including various practice management and EMR systems.Involved actively and had experience with one complete Implementation Cycle of Epic EMR.Used project management & ticket tracking software to effectively manage the team's backlog and sprint-committed items.Worked with EPIC, EMR systems, EPIC bridges, EHRs, Mirth and Production support processing problems by being one of the chief sources and providing alternative solutions using best practice models and principles.

New York, United States

Migrated legacy data integration processes from another platform to QNXT, ensuring a smooth transition for the client's Edifecs workflows. Leveraged TriZetto QNXT's provider network management tools to ensure accurate and up-to-date network data for efficient claims processing. Involved in EDI automated first-pass claims adjudication, requiring thorough understanding of claims processing, both front and backend operations.Worked with various salesforce.com objects like NFR, BRD, JAD, Accounts, Contacts, Leads, Campaigns, Reports and Dashboards. Automated data validation routines within QNXT to guarantee data accuracy before transmission via Edifecs. Configured Facets to handle specific EDI transaction types (e.g., invoices, remittances).Designed the online screens and reports for the Medicaid Online Electronic Claims Submission System.Generated EDI 835 remittance advices to communicate payment details to vendors based on EDI 837 healthcare claim data.

Chicago, Illinois, United States

Mapped TANF data elements to existing system data structures and identified data quality issues.Used MS-Visio BPMN for developing Medicaid AS-IS and TO-BE business process flow. Involved in creating documents and diagrams for Claims Processing and Claims Management according to the HIPAA Compliance Standards for Claims Processing.Created data migration plans for transferring Temporary Assistance for Needy Families (TANF) -related data into the target system.Performed data analysis and reporting on FIP program performance metrics, providing actionable insights to inform decision-making and identify areas for improvement. Analysed EBT Bridge Card eligibility criteria and integration points with various healthcare systems.Designed and executed test cases to validate TANF eligibility calculations and system performance.

Chicago, Illinois, United States

Ensured the timely signoff of the BRDs from business. Understand the client's business process/architecture for Business Analysis tasks. Deep dive into clients Life Insurance products and business process to better integrate in proposed tactical solution. Conducted requirement walkthroughs for the technical team (developers, testers, data analyst and tech lead) Create wireframe and review with business for signoffs. Go to person for any queries related to requirements and project. Communicate and manage change request to appropriate stakeholders for approvals and awareness. Worked in a distributed agile environment to fulfil the project's goal and deliverables. Facilitated and participated in daily stand-ups, Agile Planning sessions and Retrospective sessions.