Ruchi Parihar

Jersey City, NJ

Mobile- 973-***-****. Email- acqazf@r.postjobfree.com

US Citizen

SUMARY

Healthcare profession with excellent understanding of ACA, FIDA, ICD10.

Solid understanding of all phases of software Development Life Cycle (SDLC) methodology (such as requirement analysis, Design, data modeling, business process modeling, Implementations and deployment) Good knowledge of Oracle SQL,RDBMS, Hadoop(basic)

Capable of managing multiple project simultaneously and completed in timely manner.

Knowledge of Electronic Data Interchange, data format, data mapping, automation and testing.

EDUCATION

New York University, New York, US May 2014 Master of Science in Management Information Systems. Major Database technologies

SOFTWARE SKILLS

Database Software: Oracle 11g, SQL server, Tableau

Other software tools: SAS, SPSS, Python

Medical Software: MHSPower, Epic, Edifices, EXTOL

Others: MS Project, MS Office, MS Visio, SQL Reporting, Crystal Report

NYC Health and Hospital Corp, NY Apr 2014- Apr 2015

EDI Business Analyst

Solely responsible for testing, maintaining, enhancing, and supporting HIPAA EDI (837, 835, 834, 270, 271, 276, 277, 278) transactions and applications.

Translate 834,837 automation, FIDA, ICD10 conversion projects requirements into detail technical specifications, created test plans, performed user acceptance testing and move projects to production.

Provides mid-level development and support for Electronic Data Interchange (EDI) processes and utilities, including testing, implementing and maintaining EDI transactions.

Monitors and oversees scheduling of daily batch production jobs including job scheduling, maintaining accurate records of all production processing, problem resolution/escalation, and daily request processing

Monitors and communicates progress on the assigned tasks related to ERA Enrollment process.

Software used: SAS 9.0, SQL, Edifices, Extol, MHS Power

NYC Department of Health and Mental Hygiene NY

Project Management Intern Jan 2014 – Mar 2014

Principle intern to design, develops, and implements moderately complex database in for NYC HIV Prevention department using MS Access and SQL queries.

Detailed technical requirements of existing and proposed database systems and develops technical, structural and organizational specifications to include access methods, access time, job control language, statistical methodologies, device allocation, validation checks, protection and security.

Software Used: SAS 9.0, Access.

Santa Clara Valley Health Plan, Santa Clara, CA,

Claim Consultant Oct 2010- Dec 2010

Auditing processed claims and providing feedback to the processors. Reviews claim requests to determine eligibility for processing and escalate to management as necessary.

The recovery of overpaid claims through refund request or recoupment. Reporting potential re-insurance claims and filing actual claims.

Identifies process improvements, offers solutions to claim problems, and communicates recommendations to management.

Plum Healthcare, Los Gatos, CA,

Medical Billing Consultant Oct 2009- Oct 2010

Managed HMO and third party billing for 120 beds skilled nursing home.

Supervises and directs maintenance staff and monitors performance of their assigned responsibilities.

Oversaw billing of over $26 million per year with improved collection rate from 92 % to over 97%. .

Managed month end closing along with cash, bank and trust reconciliation

Air Trade International Mountain View, CA,

Accounting Consultant Jul 2008- Sept 2009

Oversaw monthly reconciliation of over $ 4 million, financial reporting to Airline Reporting Corporation.

Responsible for the monthly close as well as maintenance of all accounting ledgers including monthly review of all account reconciliations and journal entries. .

Review revenue and expense account analysis and bank reconciliation and oversee fixed asset management. High volume electronic data invoicing and payable.

Lead and manage a team of ten professionals, including selection/hiring, objective setting, performance management, coaching/development and training.

Care South Healthcare, Campbell, CA,

Medical Billing Consultant Mar 2007 – June 2008

Maintained ongoing communication with case managers, discharge planners, and physician office staff; conducting frequent presentations, both formally and informally, in order to build a strong network of referrals.

Documenting all supporting records in accordance with regulations of applicable regulatory agencies

Managed home health facility with thirty employee, handled therapy billing, accounting and payroll.

Coordinated schedules of home health therapists and aids with the clients. Overseas the proper clinical documentations and provide updates to physicians and hospitals.

Golden Gate Living San Jose, CA,

Medical Billing Consultant Apr2006- Feb 2007

Managed Medicaid billing and account receivable for 110 bedded psychiatric skilled facility.

Improved client collections and cash flow by developing and implementing system for intensive and comprehensive follow-up for non-responsive insurance companies that resulted in collection of $300 K in four months.

Renegotiated the renewed contract rate and terms of condition with state and insurance carriers. Responsible for timely and accurate payable, account receivable and payroll.

Financial Management – plans and forecasts budget for operation and maintenance, recommends and estimates facility repairs and improvements

Kaiser Permanente, Pasadena CA,

Consultant Feb 2005 – Mar 2006

Research and developed a zonal report for Small Business Unit (SBU) based on the new claims inquiry from various cities in California.

Received an appreciation letter for SBU report that was also used by marketing department.

Designed and created patients satisfaction surveys (on line and paper) zonal report of 300 doctors and submitted it to VP of Medical Staff.

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