Yaro Fortunoff

917-***-****

MIS Core QA Analyst/Consultant

MetroPlus Health Plan

New York, NY

March 2016 – September 2016

Daily monitoring of Core Configuration Issues Log housed in SharePoint, upon detection of abnormalities such as issues over 7 business days-old, but still flagged as “New” in SharePoint, contacting the party such issue(s) were assigned to in it to change status to demonstrate work progression toward issue resolution.

Running weekly report of “orphaned” members from within PowerStepp – members who do not have corresponding PCP spans for the duration of membership, such record causing multiple errors on several fronts including claims processing.

Creating queries/reports in PowerStepp based on criteria supplied by requestors, from within the department, as well as by other department(s) – claims, provider, and membership eligibility queries.

Upon analysis and explicit organizational approval, such claims would be then forwarded to the responsible party to be mass-reprocessed for the correct(ed) fee-schedules/other payment methodologies to be applied to those claims.

Running daily Core Configuration Log report out of SharePoint having enhanced output with “issue age in days” value for tracking and accountability.

Market Prominence System Administrator

Elderplan/Metropolitan Jewish Health Systems

Brooklyn, NY

November 2011 – June 2014

- Adding users in Market Prominence test and production environments

- Associating new users with departmentally specified security levels of access (from read-only to broader levels of access to Market Prominence based on position and organizational directive)

-Reviewing membership for data integrity and overall correctness – in both Market Prominence and MCO)

- Working on daily exception logs and additional error reports produced by nightly data

feed/incremental from Market Prominence to MCO as MCO is the system claims are processed and paid using)

- Altering erroneously entered appointments for marketing representatives to be correct (changing via Oracle back end the representative a visit is assigned to or changing the visit type value from self-generated to scheduled and any other erroneous data elements)

- Creating monthly eligibility files for multiple vendors and once encrypted where necessary – FTP-ing those eligibility files to the vendor)

- Running Medicaid Surplus Report for the Finance Department on a monthly basis

- Generating COB letters by loading files into Market Prominence

- Running daily 2013 LIS eligibility letters for qualifying Elderplan membership.

- Correcting overlapping contracts in MCO thereby restoring effective/end date continuity.

- Assisting users with unlocking their accounts in Market Prominence and if can’t be remembered resetting their passwords.

- Conducting training session on Market Prominence for newly hired staff.

- Remote-connecting to staff PC's that either don't have Market Prominence installed on them or the versions that are installed are outdated and therefore not working; this process is inclusive of having to connect remotely to such machines and once connection is established, running Oracle Net Configuration assistant adding necessary Market Prominence account via Net Configuration assistant thereby making newly-installed Market Prominence software function as needed on such PC(s).

Senior Configuration Analyst for Business Intelligence, IT, and Health Plan Services departments

Amerigroup Corporation, Fortune 500 Company

Virginia Beach, VA

November 2003 – May 2011

- Pended thousands of claims in Facets Production (average 7000 claims a week) using a Rational Robot script into requested queues (MCTR_REAS)

- Key QA employee - reviewed all fee-schedules-related data in Facets development environments against states' source documents' data to ensure 100 percent match of involved data elements in those environments and source documentation data and/or agreed-upon criteria. Upon both 100 percent correctness proven and receipt of proper departmental electronic (ClearQuest) approval requested migration of targeted configuration to Facets Production account

- Once in Facets Production, performed a final QA step confirming 100 percent correctness of all involved/participating data elements in it as compared to source documentation data and corresponding data in the migrate-from Facets staging environment. Once 100% correctness in Facets Production has been confirmed send notifications of project completion to involved parties

- Regularly visited State web-sites containing needed rate updates comparing newly changed/posted state files against corresponding data loaded in Facets thereby arriving at rate additions, terminations, or updates that were to be implemented in Facets per these regulatory alerts/updates

- Performed regular checks in Facets to ensure reimbursement/fee schedule data integrity - to find duplicate rates or rates whose rate-span history stacks include overlapping rate-spans followed by addressing such findings in accordance with departmental guidelines

Senior Configuration Analyst

Affinity Health Plan

Westchester, New York

March 2003 – June 2003

- Created and modified provider-specific fee-schedules in Amisys

- Created new and modified existing pay-classes in Amisys

- Performed pricing keywords analysis created new pricing keywords and modified existing ones in Amisys

- Created and changed benefits’ authorization requirements based on the applicable line of business adjustments and/or other criteria (Sunrise Unicare Fidelis Family Planning Piece CHP etc.)

- Loaded new industry-supplied HCPCS/CPT codes associated them with specified description treatment type and procedure class values as well as with needed procedure ##-grouping fee schedule and pay-class values in Amisys

- Researched claims held up in the Batch database and performed necessary adjustments to move them out of it and into Claims Payable - in Amisys

- Created audit reports of all claims submitted by non-participating providers with 2002 dates of service containing among others the following data elements:

Total amount billed by provider

Total amount paid to provider by plan

Total amount of claims submitted

Within the claims count by provider – sub-counts of claims by treatment type procedure code diagnosis code status paid flag location code with corresponding provider data as well as an indicator of whether the provider has (or had) participating activity with Affinity Health Plan

Programmer/Analyst/Amisys Membership Configuration Team Lead

MJHS/Metropolitan Jewish Health System

Brooklyn, NY

October 1998 – February 2003

- Created reports via Suprtool HP-3000 job cards Crystal Reports Access and SQL

- Performed SQL built-in-editor Market Prominence extracts for Elderplan. Created and performed data audit routines to ensure data integrity/data being the same on both ends (Amisys and Market Prominence – 2 systems working in conjunction with each other)

- Researched pending/denied medical and hospital claims and determined action plans for successful readjudication

- Trained Elderplan Member Services Enrollment and Administration staff on different aspects of using HP-3000 Amisys and Market Prominence

- Maintained Amisys Elderplan Benefits sub-system

- Created new capitation types and corresponding capitation rates or modified existing ones in Amisys

- Created global alternate provider affiliations in Amisys and attached them to current Elderplan membership

- Resolved errors on capitation extract error reports; maintained general ledger account capitation expense and liability account hierarchies in Amisys

- Modified and added new membership divisions and corresponding premium rates in Amisys per regulatory updates and/or Elderplan Benefits Committee

- Created user manuals on entry and manipulation of Liability & Recovery/Working-Aged data in Amisys for Elderplan Member Services and generating Amisys premium billing extract and research of its error report for Elderplan Finance Department

- Created and assisted in user testing of reports in Amisys test accounts

- Reviewed current (Univision) and new/future (Amisys) systems for accuracy to ensure proper data conversion

- Developed descriptive and logic-defining code sets based on Elderplan’s Policy and Procedures to drive Provider Medical Management and Membership sub-systems

- Created a number of matrix documents mapping Univision data to corresponding data elements in Amisys

- Created the Russian segment of Elderplan Language Survey (HCFA-approved).

Education:

1998 - 2001

Globe Institute of Technology, New York, NY

A.S. is Systems Analysis, Computer Programming and Design

Personal:

US Citizen and no authorization required to work for any employer/agency in the United States. Native in both English and Russian languages.

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