Qa Tester Data Entry
Resume:
VEENA PASUMARTI
US Citizen
Ph: 832-***-****, Email: ad0ehh@r.postjobfree.com
Summary:
Overall 11+ years’ experience gaining various skills to include 3+years in Credentialing Specialist, Medical coding, Claims and Medical insurance processes, strong attention to details, ability to work individually or as part of team with great interpersonal skills.
Attributes:
Quick adaptable, proficient in learning, developing and competent in delivering professional services with higher level personnel attention.
Education:
Bachelor of Commerce (Graduated) from Osmania University in the year 1992 – India
Certifications:
Certified in “Creating a Centralized Credentialing Function” from NAMSS – Aug’ 2022
Preparing for CPCS certification from NAMSS – Dec 2022
Work Experience:
Sutherland Global Inc. Sept 2018- Present
Project 3 :- Provider Credentialing Specialist (Anthem)
Credentialing new and established health care providers, and maintenance of information to include primary source verification, follow up, data collection, Data entry, Add a Plan, Review Certificate and create Instances, CAQH document review, Covering States are Health Blue LA, Health Blue MO, Health Blue NE, Simply Healthcare FL, Amerigroup (IA, NJ, TX)
oNational Practitioner Data Bank
oOIG/GSA from Medicare/Medicaid exemption
oDEA Verification
oLicensure Board Certification
oMedicaid Sanctions and Medicare PRE
Environment: CITRIX, ENT Cactus, CAQH, Professional License Verification, Insurance check with Government web sites etc.
Project 2 :- Provider Credentialing Specialist (Anthem)
Responsibilities:
Credentialing new and established health care providers, and maintenance of information to include primary source verification, follow up, data collection, data entry, and document review.
Process and maintain credentialing in accordance with CPC policy and procedure, Joint Commission standards, State and Federal Regulatory regulations.
This will include but not limited to the following verifications:
oNational Practitioner Data Bank
oOIG/GSA from Medicare/Medicaid exemption
oDEA Verification
oLicensure Board Certification
oCLIA
oHospital Affiliations
oTraining Verified
oResidency/Fellowship Peer Recommendation
oProfessional Schooling Verified
Ensure that all credentials files are current and complete pursuant to expiration date of medical licenses, board certification, professional-liability insurance coverage, DEA and other pertinent information, per CPC policy and procedure
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
Tracks license, DEA and professional liability expirations for appointed providers
Responsible for data entry of all information required in practitioners profile/database record related to credentialing.
Submit closed files for audit/final review and secure missing items as identified by audit/final review
Provide par/non-par analysis, submission of enrollment applications, processes all re-enrollment, check on expiration and CAQH re-attestations in a timely manner.
Complete, track, and confirm Medicaid, Medicare, and CSHCN applications
Environment: CITRIX, MACESS, Cactus, Smartcred, Professional License Verification, Insurance check with Government web sites etc.
Project 1 :- Medical Claim Specialist—Health first/APG Claims
Responsibilities:
Reviewed claims on completeness and accuracy for Processing.
Exercise proficiency in coding disciplines of Inpatient/Outpatient facility and Physician’s care
Complete the procedural processing of standardized vouchers for various types of medical expenses.
Researched and processed different sets of medical plans as well as benefits.
Ensured to process assigned claim forms and inspect apt allocation of co-pays, deductibles, reimbursements and co-insurance.
Entered claims data into system while interpreting coding and understanding medical terminology in relation to the diagnosis and procedures
Verify with Hold Codes, SF and CF claims for data accuracy and adjust the amount accordingly
Worked and Processed 120 outpatient claims per day
Wide experience in data entry and medical claim processing
Environment: HF-TRACKER, MACESS, TRUECARE, EVICOR, CCMS, CITRIX, APG, SF and CF
Absolute Medical Coding Institute
(Department of Veteran Affairs) Jan 2017- Feb 2018
Completed training in followings:-
oICD-10-CM
oMedical Terminology
oHCPCS Level II
oEvaluation and Management
Worked as QA Consultant (Various IT Projects) Mar 2013- Dec 2016
Health Insurance Project
Universal American (UAM), Houston, TX Sep 2011 – Feb 2012
QA Tester
Projects: CVS Caremark, Member Move, ANOC, ANOC Errata, ID Cards & Welcome Kit, ID Card Record, OEV, Provider Link Portal
Universal American a family of healthcare companies provides healthcare benefits to people with Medicare. I was involved in testing of Membership, Billing, Claims Medicare data, Financial and Accounting.
Responsibilities:
Involved with Business analyst teams to prepare a detailed Business Requirement document.
Developed test plans, and written test scenarios and cases to cover overall quality assurance testing.
Performed manual testing to test the usability of applications.
Experience in Trizetto Facets Configuration.
Ability to understand Facets Data Model.
Ability to understand various Facets utilities for performance of specific task.
Experience in reviewing the defect logs for MMS.
Conducted GUI Testing, System Integration testing, Functional testing and Regression Testing.
Conducted Back End Testing using SQL.
Wrote user defined functions and reused them by storing them in compiled modules.
Conducted End-to-End testing on applications.
Reviewed test scenarios and test cases in Quality Centre.
Logged the errors and coordinated efforts with the development team to solve the problems.
Responsible for documenting test cases.
Experience in testing for Online Enrollment Verification (OEV) System.
Actively participated in Status reporting meetings and interacted with Development to discuss the technical issues.
Environment: SQL, Trizetto Facets 4.8, Quality Centre 11.0, MS-Access, Windows XP, SQL Server 2008, Prism, Horizon, Macess, Pegasus.
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