Hi, I’m
Amar Shrestha
Sr Systems Analyst
Virginia Beach,VA
Summary
- Results-oriented System Analyst skillful in managing and breaking down large volumes of information. Proactive at heading off issues in operations, workflow and production by uncovering trends affecting business success.
- Proficient in conducting JAD sessions, Workshops, Brainstorming, and user interviews as a facilitator to gather requirements and Conducted SCRUM meetings with key stakeholder/product owner and project SMEs
- Good knowledge on different modules within healthcare (Membership, Billing, Enrollment, Claims, Capitation, Providers)
- Experience working in Medicaid, Medicare Billing standards and processing.
Overview
8
years of professional experience
2
Certifications
Work History
Elevance HealthNorfolk, VA
System Analyst Sr
06.2016 - Current
Job overview
- Engaged as Sr. Analyst for WARP (WellPoint Auxiliary Reporting Portal) to report membership sales and lapse for all GBD (Government Business Division) based on COA values to respective business for audit purposes.
- Worked on both Billing, invoicing, and refund processes for all Medicare and Medicaid Line of Business.
- Worked on designing and implementing and testing COINS to accurately report member eligibility and initially premium for Commission processing for both Anthem internal and external brokers.
- Gathers requirements, designed, and implemented Dual PDP Refund process to process Auto refund process successfully and accurately for various termination events.
- Extensively worked on product price configuration along with invoicing and delinquency process for new GRS (Group Retiree Solutions Program) implemented for year 2021.
- Worked as SME on State Health Benefits Program (SBHP) and implemented changes to ALEGEUS MEABT HRA Outbound file for correct and accurate updates to GBD FACETS and Member Contribution to correctly process claims refund.
- Established, enforced and optimized billing procedures to streamline operations and minimize aging balances.
- Reviewed and analyzed contracts to resolve billing issues with vendors and carriers.
TMG HealthJessup, PA
Quality Analyst
02.2016 - 06.2016
Job overview
- Developed, created, modified, and executed test cases based on the business requirements for different modules within FACETS, mainly Enrollment, Claim and Eligibility modules.
- Extensively worked on claims, reports and letters related to CRs and COs within the UAT/SIT environment.
- Created members in Facets for validating Crosswalk table configuration.
- Developed and maintained manual test cases as well as automated test scripts for Medicaid/Medicare projects for new functionality ad retested existing functionality.
- Accepted MA-PD, MA and PDP enrollment data to TMG Enroll – an in-house application.
- Exported enrollment/disenrollment, correction and change transactions for submission to CMS from TMG Enroll
- In-loaded weekly/monthly Election Transaction Reply Files (TRR)
- Created and enrolled members into specific Group Class Plan (GCP) to verify and validate configuration hierarchy enhancements.
WellPointVirginia Beach, VA
IT Quality Control Analyst
10.2015 - 01.2016
Job overview
- Analyzed the requirements from Benefit Plan Matrix document for enrollment, benefit coverage, copayment, coinsurance, benefit limit, restriction, and authorization required
- Created requirements, Test Case design and Test execution for testing purpose to map with Zephyr testing tool
- Created members through queries from the Production environment using an automated claims testing tool called Claim Test Professional (CTP) to ensure realistic scenarios for test execution
- Created Test Scenarios for business process management application (Compass) to meet the requirements from various Requirement Design Documents
- Managed defect tracking process, which includes prioritize bugs, assign bugs and verifying bugs using Zephyr Test Tool
- Developed automation test scripts for performing regression testing on the application
Education
Southwest Minnesota State UniversityMarshall, MN
Master of Business Administration
Skills
Tools: TriZetto Facets 501/53, Claims Test Pro (CTP)
Certification
Scaled Agile Inc - SAFe DevOps Course
Timeline
System Analyst Sr
Elevance Health
06.2016 - Current
Quality Analyst
TMG Health
02.2016 - 06.2016
IT Quality Control Analyst
WellPoint
10.2015 - 01.2016
Southwest Minnesota State University
Master of Business Administration