Sanjay Kumar

(CSM, CPC, CPC-H, CPMB, HIPAA Certified)

adbh4o@r.postjobfree.com

+1-919-***-****

Resume Summary

• Masters in Business Administration & Bachelor in Science with 12+ years of experience in IT Information Technologies and Information Technology Enable Serves (ITES). I am member of IIBA (International Institute of Business Analysis) Certified professional coder for physician and hospital, certified biller, HIPAA Certified

• Certified Scrum Master (CSM) from scrum institute.

• Worked in different insurance, general and healthcare with different geography like USA and UK.

• 9+ Years of experience in Business Analysis in creating functional specification document, user requirement document and business specification document.

• 4+ years of Experience in Data and statistical analysis in (SSAS)

• 7+ years of experience in software testing in Insurance and Healthcare. Aviation

• Experience in working different SDLC methodologies like Agile and Water fall.

• Expert in Process flow diagram, use case model diagram, business process design document creation and power point presentation.

Experience in ETL Testing or data testing and analysis.

• Conducting JAD sessions for Requirement Analysis and Risk Analysis with the management and IT teams.

• Excellent experience working on Microsoft office tools like Excel, Visio, word, ppt.

• Writing, update and modifying simple and complex Oracle, SQL queries for data validation engine tool, override tool in Oracle database.

• Strong ability to create, analyze and present the report and data analysis.

• Direct weekly cross-functional team meetings as part of the forecast, inventory, and sales operations continuous improvement process.

Automation EDI claim testing

• Knowledge about PL-SQL programming and trained on HADOOP designing.

• Well versed with HIPAA compliance, HCPCS/CPT, ICD-9/ICD-10 coding, ANSI X12 standards, EDI 4010/5010, software testing techniques.

• Well versed on Health Insurance Claim Processing application i.e. “iiiput” and ACES, FACETS, QNXT.

• Experience in working on test scenario and test scripting, testing on Optical Character Recognition (OCR).

• Well versed with software testing using Quality Center tools JIRA/HP Quality Center.

. Well aware about BABOK V3 guideline in IIBA

• Experience of working onsite (USA) for

• Consulting assignment of HIPAA and ICD 10 transition.

• Process transition

• Benefit Structure configuration in Healthcare Claim System

• ETL or Data Testing with SQL scripts.

• Worked on consulting activities on general insurance of Home and Motor Pricing Service.

COMPETENCIES

Category Major Skills – Primary Minor Skills –

Secondary

Vertical’s Insurance, Healthcare, ETL Testing, Tableau Data Testing Domain/Programmin

g Skills

Insurance, Healthcare, Database, Oracle SQL PL SQL Operating Systems Windows Server 2000/2003/2008 Linux, DOS MS office

MS words, Excel, P Pt & MS Visio

MS Access

Database/tools PL-SQL editor, Oracle, Goldengate Architecture Analytics Tools Qlickview, Crystal Reports, SSAS

Testing/ Tools HP quality Center Java, Mainframe & Visual basic

Computer Assisted

Coding tools (CAC)

3M Encoder, TrueCode, Encoder pro, Online DRG tools, CCI Tools.

Revenue Cycle /

Clearing house /

Claim Process tools

AdvantaX, Invision, McKession STAR,

ACES SSI, iiput

Mysis Tiger, Surgisure

Scrum Tools TFS, JIRA

PERSONAL ACCOMPLISHMENTS

Degree/Certification/Publication Year of

Passing –

Academic

Qualification

Master in Business Administration from SCDL

Bachelor in Science Kurukshetra University

2014

1995

Certifications Certified Professional Coder for Physician (CPC) from AAPC Certified Professional Coder for Hospital (CPC-H) from AAPC Certificate in Professional Medical Billing (CPMB) Business Communication Skill Certificate from Hero Mindmine American Association of Professional Coders, Membership ID 01060908.

HIPAA Certified

Member of IIBA Membership # 168418

Certified Scrum Master

2007

2008

2009

2006

2012

2017

2018

PROFESSIONAL ACCOMPLISHMENTS

Zensar Technologies Ltd Pune From June 2012 to Present Project Worked:-

1. Dignity Healthcare

2. ICAn for ICD 9 to ICD 10 Conversion:

3. Assurant Health Milwaukee (WI):

4. Automobile Association Basing Stoke (UK)

5. L& T Financial Services

6. Lloyds or Celesio Pharmacy

7. Indigo Airlines (Interglobe Aviation)

8. CISCO Systems

Contributions/Highlights:

Collaborating with business stakeholders including executive and management person to understand the business requirement.

Creation of business requirement document, functional requirement or specification document use cases as per business requirement.

Creation of user stories, creation or evaluation of test cases and to create requirement traceability matrix (RTM) in case of Agile environment.

Writing test cases and test scenarios, creating test report and test library for the mandate.

Involved in unit level testing, functionality testing, regression testing etc. Estimation and planning of regression testing.

Remediation activities on ICD 10 impact on different application for chain of Hospitals.

Part of BPM team for development of a tool on Denial Management for prospective client

In Data analytics experience in CUBE creation in SSAS and reporting services.

Reporting to client Manager for Production Support and Health Service Ticket resolution.

Benefit Configuration after analysis of US healthcare state mandate in health claim management system

Automation testing for EDI healthcare claims.

Worked in HP Quality center for manual testing project.

Implementation of benefit changes in different tables into claim Adjudication System

Testing of Medical and pharmacy claim data file sending directly to edge server i.e. to HHS.

Creating SQL Queries to verify the data from Oracle database for valid values and business rules.

Validating the healthcare data in production environment.

Convert the data in different schemas as specified by third party vendor.

Verify and test the change request send by third party administrator for Risk Score calculation.

Working process for all line of business-like Road, Motor, Home & EBC etc. in an agile environment.

Requirement gathering on different process of business like New business, MTA,Cancellation and renewal.

Reply of queries from technical team.

Serco International Mumbai February 2011 to June 2012 1. ICD 10 Readiness consulting program with Elkart General Hospital Indiana 2. RFP / RFI Preparation

Contribution / Highlights :

Meeting with stakeholders for all department of Elkhart General Hospital informing them about this transition.

Understanding their process of working and finding out the area of their impact. Consulting US Healthcare project for business transformation offshore and onshore.

Pre-sales activity in discussion with reporting officer.

PPT preparation for prospective client.

Assist in preparing RFP/RFI etc to Reporting officer.

Process Mapping and Consulting

Development of ICD 10 tools for 2013 or latter development.

Assist software team in about different EDI used in healthcare application. Tricom India Ltd Mumbai May 2009 to Feb 2011

1. Watertower Surgery Center Chicago IL

2. UHG Application Development

Contribution

Worked with software team for the development of software for the as per client

Consulting activity for different forms like HCFA, UB, Dental & Prescriptions.

Software testing and providing feedback for further development in software.

Responsible for development of documentation for the process including process.

Also prepare the PPT for the process including costing, accuracy, attrition etc. in the process.

Handing a team of 85 people.

Production Management including meeting SLA,s, TAT and continuous follow up on accuracy.

Prepared audio-visual training material for the claim processing using different application e.g. Camtasia, Zing, and BSR.

Worked on client place for medical report coding and other medical billing activities.

Provide daily analysis report on aging report of collection and payment outstanding.

Worked on offshore and onshore model

EMR Techventure Pvt. Ltd Gurgaon August 2007 to March 2009 1. HCFA Claim Adjudication system application testing and requirement 2. HCFA / UB claim Data entry project

Contribution / Highlights:-

Handling a team of 25 people related to the process termed as Claim Adjudication.

Managing the process with team building and motivation.

Interact with client for any queries and feedbacks.

Submission of different reports and reconciliation related to the process.

Other administrative process like participate in interview process.

Participate in security auditing of the process. Prexus Health India Pvt. Ltd March 2006 to July 2007 Contribution / Highlights :

Assign to implement clinical and billing data repository application and trained to onsite staff.

Auditing of medical codes (CPT, ICD, HCPCS) coded by Coder I.

Sharing the feedback with coder I.

Discuss with onsite coder about problems and receiving the feedback.

Participate in Interview process to hire new staff

Working with AR team to solve the reason of denial

Participate in conference call for coding education Pacific Venture Pvt Ltd July 2003 to Feb 2006

Contribution / Highlights :

Auditing of medical codes (CPT, ICD, HCPCS) coded by Coder I.

Sigma Software (IP) testing for quality & efficacy.

I also have experience in software testing on Sigma software in-house designed for Medical Coding.

Providing Individual feedback to the Coder 1, to improve quality.

Ensure deliverables percentage of reports to satisfy the process standards. Ramtech Corporation October 2001 to June 2003

Contribution / Highlights :

Part of software testing team for migration project.

Converting the audio recording into transcript data files.

Part of testing team while transitioning from one system to another.

Passing the feedback to trainee transcriptionist.

Implementing the feedback received from auditors. Name : Sanjay Kumar

DOB : October 8, 1975

Experience : 13+ years IT and ITES

Education

:

MBA, B.Sc., CPC, CPC-H, CPMB, HIPAA Certified

Email/Cell

:

adbh4o@r.postjobfree.com / 857-***-****

Passport Details : Old Passport No- E0878067

New Passport No – J9392661

Issued at Chandigarh

Date of Issue 17-11-2011Expiry date 16-11-2021

Status (ECR/ECNR) ECNR

Visa Details : US Visa H1B

Declaration:

The above statements are true to the best of my knowledge and belief. Place: Pune Name: Sanjay Kumar

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