Medical Quality Assurance
Resume:
Sunita Chaganti
abxzq4@r.postjobfree.com
. To utilize my strong and versatile domain experience in US healthcare and
reimbursement with excellent technical skills to share my expertise with
an organization that can provide opportunities to enhance my skills and
further develop qualities of higher leadership.
Professional Synopsis
. 8 years plus of experience in US health care Quality Assurance Process
. Good understanding and Exposure to all stages of Software Development
Life Cycle
. Proficient in Agile SCRUM process
. Played key role in requirement analysis process
. Proficient in developing Test Strategies, Plans and Test Scripts and
perform test execution
. Presenting test cases to Product Owners (BA) and Development teams
. Assisted in Automation of testing process
. Storing the test cases in Quality Center
. Executing test cases through Quality Center
. Reporting defects using Devtrack application
. Excellent Knowledge of EDI X12 4010 and 5010 versions
. Good understanding of Healthcare EDI transaction sets like 837 PID, 835,
834, 270, 271,276, 277 and 997
. Certified Scrum Master
. Certified Professional Coder from AAPC
. Trained in HL7 2.7
. Trained on ICD-10-CM transition process
. Team player with good communication, written skills and also a self-
motivated individual with exemplary analytical and problem solving skills
and TECHNICAL SKILLS
. Worked at Client site for 3 months (OptumInsight)
. Expert in US Healthcare Process
. Six Sigma (DMAIC) Trained and Tested
Career Highlights
August 16th 2010 - Present - Cognizant Technology Solutions as Senior
Associate
Currently holding H1B visa - valid till October 2013
Project # 1: Velocedi - Payer Edits
Description:
Payer Edits is a set of business rules using which the claims are
validated against payer specific rules. Payer Edits is a part of Faciledi
product which in turn is a product in Claredi which offers a suite of
healthcare EDI products. The Payer specific validation rules are set by
the Payer Edit developers, and are loaded into the Velocedi engine
(Faciledi database).
Website: www.optuminsight.com
Roles & Responsibilities:
. Velocedi - Payer edits product Testing which involves X12 files for
4010A1 and 5010 version related transactions like 837 PID, 270, 271, 276,
277, 278, 820, 834, 835 and 997) and also code sets updates
. Participating in requirement analysis process with onshore team
. Developing Test cases based on requirements
. Test case walk-through with BA and Developments teams
. Manual Testing of Test cases once QA build is ready with requirements
. Verifying Automation Test plan
. Reporting Test activities to Onshore Test Manager
. Involved in Daily Scrum activities
. Involved in the requirement study of ICD-10 Remediation
Environment: QTP, Claredi Application, Notepad
Project # 2: Claredi Classic
Description:
Claredi Classic is the industry-leading and first comprehensive HIPAA
testing solution for pre-production transaction testing and
certification. Test and certify your HIPAA transaction sets with Claredi
Classic, to help ensure your EDI transactions are compliant with
standards, regulations and payer requirements.
Website: www.claredi.com
Roles & Responsibilities:
. Participating in requirement analysis process with onshore team
. Developing Test cases based on requirements
. Test case walk-through with BA and Developments teams
. Manual Testing of Test cases once QA build is ready with requirements
Environment: QTP, Claredi Application
April 19, 2010 - August 10, 2010 at HCL technologies, Noida as Senior
Consultant
Roles & Responsibilities:
. Data Mapping between 4010 and 5010 & vice versa
. Analyzation of gap in between 4010 version and 5010 version
. Working on Unit Test Cases for changes occurred in 5010
. Worked on creating Functional Test Cases for the changes occurred in 5010
. Analyzation of gap analysis between ICD-9-CM and ICD-10 version
. Developed around 31000 Test cases for the full fledged conversion of
HIPAA 4010 to 5010.
. Developed Manual Test cases for attaining the minimal no. of ICD-10 codes
for a particular ICD-9 code.
October 1, 2007 - April 15, 2010 at Genpact, Gurgaon as Business Analyst
Description:
Has been working for the same client OptumInsight (formerly called as
Ingenix) for the same project Velocedi - Payer Edits. Worked for Three
months at Salt Lake City, Utah
Roles & Responsibilities:
. Analysis of data and report out the variation to the business and
preparation of dashboards on the same
. Building and Setting up of expectations on new projects and communicating
the same with the customers
. Good understanding of business requirements and writing test scenarios.
Analyzing and understanding complex business and technical concepts
. Contribute in various Project reviews, project status Calls with clients
. Understanding of Software Development Life Cycle and SCRUM methodology
. Single point of contact for new joiners and knowledge transfer through
one on one and class room trainings
July 2004 - July 2007 - Promantra Synergy Solution as Senior Medical
Coder and
In August and September for Transcribewell Transcription as Medical
Coder-Shift Manager
Medical Coding
. My primary responsibility is to code medical charts for out-patients
through the understanding of medical terminology, AMA guidelines,
anatomy, physiology and procedures and assigning the appropriate CPT, ICD-
9-CM, HCPCS and special access codes based on medical documentation in a
timely and accurate manner.
. Associate the diagnosis codes to the appropriate procedure codes (CPT)
and sequence the codes in such a way as to ensure proper reimbursement.
. Determining the provider and keying the information into the system and
accurately apply, differences in coding requirements for various payers,
clients and state programs.
Medical Billing
. As a Quality Analyst, my responsibility is to do a 100% quality check on
all the entries made on a daily basis to avoid errors. We maintain a
100% accuracy rate.
. Responsibility of transmission of medical claims to the insurance
companies.
. Responsible for handling Clearing House Rejections.
. Worked closely with AR team in explaining coding and Billing errors
. Successfully transitioned end to end processes of Clients.
Technical Skill Set
Operating Systems : UNIX, Windows 95, 98, 2K, XP, MS-DOS
Core Skills : Manual Testing, SQA Concepts
Testing Tools : QTP, Quality Center
Versioning Tools : CVS, SharePoint
Agile tools : Rally Dev
Medical Billing Software : Medisoft Advanced, CareTracker
Qualification Highlights
Bachelor of Science (Microbiology, Botany, Chemistry), Osmania University
Certified Medical Coder
Certified Scrum Master
Certified in ISTQB
Contact Details
abxzq4@r.postjobfree.com or abxzq4@r.postjobfree.com
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