Santosh Acharya Email & Phone Number

Chapel Hill, Nc, Us

Aliso Viejo, Ca, Us

Worked as Test Lead for Medicare Enrolment using advalent payment system. The project implement enrolment CMS Medicare Member to different Election period like Annual Election Period –AEP, Initial Coverage Election Period ICEP , Open Enrolment Period –OEP and Special Enrolment Period SEP. As part of Enrolment process validated MARx File , DTRR-TRC codes , Cavulus file . Generated MARx file , prepared DTRR validated different TRC and Transaction code like TC 61-Enrollment effective date , TC 51/54- Disenrollment , TC 76 Residence address change .

Bangalore, Karnataka, In

Worked as technical test lead on multiple conduent project.The Project implements EMR /EHR system. A Health information exchange that queries remote data repositories to receive and process clinical and demographic information for a client. Participated in creating, Testing, and validating different HL7 Messages using HL7 V2.X, XML Schema, Inbound and outbound transaction Validate different EDI transaction for different state client and make sure all transaction completed successfully via different channel.

Gardena, Ca, Us

CMS encounter data processing system from RAPS to EDS, for generating 837 files. Involved in end to end testing of EDS file generation and submission to CMS. Performed Risk Analysis and HCC calculation.

Us

As part of the Affordable Care Act (ACA) with Risk Adjustment (RA) and Reinsurance (RI) programs, this 3RDD project mitigates the impact of adverse selection of plans and provide stability for Issuers by calculating and forecasting the exact impact of Healthcare Reform programs on premium rates based on Policy, Plan, Member, Medical Claims, Rx Claims, Premium data from UDW for various source platforms 3RDD captures and utilizes the UDW source data to perform shadow calculations, "Premium Allocation Smoothing", YTD Gross Premium Amount logics to make each month's allocation to be consistent at subscriber level by applying the Policy Subscriber, Coverage Level, and Group Plan Allocation Rules

Teaneck, New Jersey, Us

Software Test Engineer, California MMISCA-MMIS was the claims processing and reporting management system of the State's Medicaid program which processed approximately 156 million Medi-Cal claims yearly utilizing 1,500 edits/audits which affect approximately 86,000 Health Providers. CA-MMIS was launching the Systems Replacement Project (SRP). SRP was a major multi-phased project that would replace the existing CA-MMIS legacy system using Design, Development and Implementation (DDI) approach. Environment : SQL Developer 2008, Agile, Microsoft Outlook 2010, Application, Microsoft Office packages 2007, RQM/CQ, SharePoint, Version One, MMIS

Mclean, Virginia, Us

State of Maryland was replacing their existing MMIS with a new system, Medicaid Enterprise Restructuring Project (MERP) that supported commercial of the shell solution, call center, Document management and CRM Activities. The new MERP system was geared towards ability to support future Department of Health and Hygiene service orientated architecture that integrated development of waiver, long term care and state-run program eligibility solution to directly address the inefficient eligibility determination process and eliminate stovepipe system and improving care and Recipient management.

Boston, Ma, Us

Blue Quote Individual (BQI) is a web based application (hosted by Connecture) that will replace the following three existing/current systems that handle Individual market new and renewal business process. Individual Family Quoting System (IFQ): IFQ is an intranet web application that is designed / used for processing Individual NEW Business processing.  E-Health: E-Health is a customer facing web based application (Hosted by a Vendor) that is designed / used for quoting and accepting medical insurance applications from Individual Marker customer. Inter BCBSMA sales associated manually enter eHealth application into IFQ.  Blue Quote Plus (BQ+): BQ+ is a web application (hosted in BCBSMA network) that is designed / used for processing Small Group and Individual Market.

Global, Us

State of Maryland was replacing their existing MMIS with a new system, Medicaid Enterprise Restructuring Project (MERP) that supported commercial of the shell solution, call centre, Document management and CRM Activities. The new MERP system was geared towards ability to support future Department of Health and Hygiene service orientated architecture that integrated development of waiver, long term care and state-run program eligibility solution to directly address the inefficient eligibility determination process and eliminate stovepipe system and improving care and Recipient management.

Schenectady, New York, Us

Revenue Data Management (RDM) team handled all the inbound and outbound EDI 837 between MVP and NYS, including vendor files. Worked with other development teams to teach them the correct usage of Agile and created document templates that acted as the baseline for other projects.Environment : MS Office Tools, UML, MS Visio, Windows XP, Oracle, TOAD, MS Project 2003, Siebel, HP Quality Center, Rational Rose, BD2, FACETS 4.41

Woodland Hills, Ca, Us

Farmers Insurance one of the Largest insurer of both private personal line passenger automobile and homeowners insurances, and also provide wide range of other insurance and financial service product. NWCS (National Worker compensation system) is Web Base Application developed in Siebel oracles. NWCS is migrated project, the existing system WC (Worker Compensation) WCS Flat file to NWCS Siebel Oracles. NWCS is many external system like Pega (Hero for Claim creation) , Financial Engine for Financial transaction, Coverage for Claim coverage verification. Lotus Note, Bill Review (NDC and PMSI), use Portal access for document upload to the NWCS system from external System by Insured and employee. QAS address verification for contact and Vendor.Preliminary Workers Compensation Claim handling is done manually, vendor creation, Payment and Reserve for vendor and Contact.

Mba, International Business

M.Sc Environmental Science, Water Resources