Ritesh G. Email & Phone Number

Atlanta, Ga, Us

Atlanta, Ga, Us

Remote

Alpharetta, Georgia

Cumming, Georgia

Greater Atlanta Area

Project: Implementation of Encounter, Estimator, Eligibility verification, Payment Solutions, Professional Claims that includes submission, processing, error correction, adjudication, adjustments and payment details. Responsibilities:• Elicited requirements with business owner and converted business requirement into Use Cases.• Conducted JAD sessions, interviews, and surveys to collect the requirements• Conducted walk-through meetings with the off-shore development and QA team to elaborate requirements• Provided support for production work• Elicited requirements with the stakeholders located across various countries/time zones to design an application for processing/converting electronic claim submissions (837P) originating from paper claims (CMS 1500).• Working on the project documentation for end users and health care plan’s representative. • Performing pre-UAT on various browsers using SAUCE LABS for Windows and MAC.• Participate in Daily Defect Triage while collaborating with offshore and onsite teams. • Assisted in testing various scenarios to test EEE (Eligibility, Encounter, Estimator) application• Ensured that the team complies with the 837 Professional Companion Guide during development and further helped in creating data mapping tables for teams’ better understanding.• Created, modified, generated and exported (Excel, CSV) reports for clients using SQL server 2008 R2 and shared it on JIRA dashboard.

Alpharetta

Project 1: My Active Health Portal Project: This project was undertaken to build full featured, claims populated and member-reported electronic Personal Health Record. It includes following features- Online components to an NCQA-accredited Disease Management program, Lifestyle Coaching program, client customized Digital Coaching program. Active Challenge, powered by partnership with Shape Up, is a year-round wellness offering for employees.Project 2: Incentive Redesign Project: This project was undertaken to enhance The Rewards Center, which is designated to accommodate various client incentive program configurationsResponsibilities:• Conducted GAP analysis of the different reports that are being presented to clients to accommodate their requirements.• Utilized Agile Methodology to configure and develop process, standards, and procedures to create a Business Requirement Document (BRD).• Created artifacts such as Use Cases, Activity Diagrams, and Sequence Diagrams using MS Visio.• Participated in team meetings to improve overall implementation process.• Conducted JAD sessions, interviews with the product team and surveys to collect requirements and converted it into functional requirement document.• Created User Stories for the sprint and conducted walk through sessions with the developers and testers to explain the User Stories and requirements• Provided daily support to the production issues• Created Release notes for the Product go-live.• Performed UAT Testing before handling product to the product owner• Monitored all the HIPAA transactions through the gateway.• Played a key role in planning, testing, and implementing system enhancement requests

Tallahassee, Florida Area

Department of Health Florida is a state govt. facility overseeing the health applications for the state run clinics. Project: Electronic Health Record Management system Electronic health record management system was built comprising of clinical and billing needs for the physicians for the state run facilities across Florida.The purpose of the software was to provide the nursing staff to input patient’s clinical information in the system and billing personnel to bill the patient service to the appropriate entity.Responsibilities-• Wrote Use Case diagrams to facilitate requirements gathering process and ensuring documentation compliance process.• Wrote Business requirement documentation for ICD-10 implementation based on Affordable Care Act and EDI transaction sets 835, 837, 270, 271, 276, and 277.• Conducted meetings with business users and SMEs to identify and gather various functional and non-functional requirements • Created Communication management plan to inform affected stakeholders about the new ACA changes• Conducted GAP analysis and suggested measures and recommendations to improve the new application’s performance• Conducted Joint Application Development (JAD) sessions, workshops, interviews sessions with Subject Matter Experts (SMEs)/ end users/development team• Contracted with the Medicare Centers and Medicaid Services (CMS) to provide quick, easy, and affordable access to the health care service of their choice.• Participated in team meetings to improve overall implementation process.• Functioned as the primary liaison between the business line, operations, and the technical areas throughout the project cycle.• Involved in the creation and maintenance of the Workflow plans and artifacts.• Collaborated in getting HMS Electronic Health Record Certification based on Affordable Care Act from Drummond group.• Extensively wrote test cases, test scripts, in the Jazz Rational team concert for the clinical and business functionalities.