MILAN AGARWAL

Role:

• Managing the encounter system implementation project for the state of Tennessee
• Led the requirements gathering and design sessions with the MMIS stakeholders for Encounter file ingestion, Encounter processing, Response file generation, Standard reporting and T-MSIS reporting
• Performed fit-gap analysis on the HealthTranslate(Deloitte asset) and the Tennessee Encounter Processing requirements
• Provided expertise on the X12 EDI and NCPDP transaction set
• Created data mapping for the Member, Provider reference Data set for the product
• Validated the TennCare business rules and provided recommendations on enhancing the business logic
• Tracked development, SIT and deployment progress and communicated risks in advance to effectively manage the SDLC
• Developed and implemented strategies to achieve business goals
• Managed and motivated employees to be productive and engaged in work.

Role:

• Managing the encounter system enhancement project for the state of Nebraska for onboarding a new MCO
• Led the requirements gathering sessions with the MMIS stakeholders for Encounter processing, Standard reporting and T-MSIS reporting
• Provided expertise on the X12 EDI transaction set
• Tracked development, SIT and deployment progress and communicated risks in advance to effectively manage the SDLC
• Planned and budgeted accurately to provide business with resources needed to operate smoothly.
• Developed and implemented strategies to achieve business goals
• Managed and motivated employees to be productive and engaged in work.

Role :

• Leading the Healthcare Data Analytics team in gathering requirements for 837 and 277CA transactions for Encounter processing
• Facilitating meetings with the Texas HHSC stakeholders for monthly reporting of State rejected encounters
• Healthcare data analysis by querying Claims and encounter databases in FACETS and Edifecs Transaction manager
• Creating Financial Statistical Report for every quarter for TX Medicaid, Dell Children's Health plan and Louisiana Medicaid
• Remediating Pends and rejects for different markets by analyzing the trends in the encounters submissions
• Training other analysts in identifying ways to remediate Encounter pends and rejects for different markets
• Processing Monthly batch for encounters for the state of Texas, extracting data, creating files, ensuring compliance and submitting the files in time
• Reporting of the Encounter submissions to the State
• Creating 'Business Operations Market Manual' and training material for the team
• Providing encounter data feed to the risk management initiatives.

Project Description :- Encounters System Migration, Vendor Implementation, Encounters Pend and reject Remediation and Market support for Texas, Texas MMP, Colorado, Nevada, Louisiana, California, California MMP markets

Role :Senior Systems Analyst for Encounters IT Team

• Leading the system migration effort for Texas Caid, TX DCHP, TX MMP, Colorado and Louisiana Medicaid markets from MDE system to Edifecs system
• Leading the new vendor implementation for Liberty Dental, Access2Care, Meditrans, Aspire Health on the encounters system
• Understanding business needs for system enhancements, defects and providing the viable solution by healthcare claim and encounter data analysis
• Gathering requirements for 837 and 277CA transactions for Encounter claims processing for multiple State MMIS systems (Texas,California,Colorado,Nevada,Washington) and DSNP programs (TX MMP and California MMP)
• Provided feedback on the State's mandates notices for research
• Worked on the Office of Inspector General (OIG's) Audit requests and provided the encounter data as sent on encounters files for the Audit to ensure compliance
• Healthcare data analysis by querying claims and encounter databases in EDInet, FACETS,ODW,Express Encounters Pro,EIDS and EDIfecs backend database using SQL server
• Mapping fields between FACETS claims database to encounters database and encounters database to X12 837 and 277CA files
• Translating Business requirements into Technical requirements
• Facilitating meeting between the business and the IT stakeholders
• Creating User stories in JIRA and defining the acceptance criteria
• Defining Test Strategy, creating test approach and test plan for the Business requirements and User stories
• Executing test cases for User acceptance testing
• Performed test results validation
• Release Coordination and planning

Project Description :- Encounters System implementation

• Role :Leading the Healthcare Data Analytics team in gathering requirements for 837 and 277CA transactions for Encounter processing
• Healthcare data analysis by querying Claims and encounter databases in FACETS and Express Encounters Pro
• Defining Test Strategy, creating test approach and test plan for the open BRDs
• Financial Statistical Reporting for the encounters submission every quarter by comparing the claims count and amount paid out to the providers with the number and paid amount of encounters and submitted to the state
• Remediating Pends and rejects for different markets by analyzing the trends in the encounters submissions
• Training other analysts in identifying ways to remediate Encounter pends and rejects for different markets
• Processing Monthly batch for encounters for the state of Texas, extracting data, creating files, ensuring compliance and submitting the files in time
• Reporting of the Encounter submissions to the State
• Creating 'Business Operations Market Manual' and training material for the team

Project description:- The Texas Medicaid & Healthcare Partnership (TMHP) is a group of contractors who administer the Texas Medicaid and other state health-care programs on behalf of the Texas Health and Human Services Commission.

• Role:-Leading the Base Enhancement team(BET) and acting as a liaison between the business community and the technical developers, including participating in user and task analysis, system design, and system testing
• Leading on projects dealing with Claims, Authorizations, Provider Enrollment, Member Eligibility, Appeals and grievience business areas
• Strategizing the project with direct client interactions and establishing consensus among teams
• Handling projects of medium to high complexity to lead the team in identifying and defining detailed product functional requirements and use cases.
• Facilitating meetings with multiple technical groups to understand current capabilities of systems Consulting customers in translating business requirements and use cases into test conditions and expected results for product, performance, and user acceptance testing
• Leading the testing team to conduct product testing, trading partner testing, user acceptance testing
• Ensuring system capabilities by transitioned requirements and use cases to the technical developers
• Guiding the team by reviewing day to day tasks throughout the software development lifecycle of the projects.
• Organizing Training Sessions and educating the team on topic like Quality Centre, ALM , Paper Claims processing, EDI Claims Processing, Error Handling.
• Resource allocating and tracking the availability of resources to help forecast effort and budget for upcoming projects
• Representing the team for weekly and monthly status reporting
• Showcasing recent developments in the Medicare and Medicaid health industry in the monthly team meetings so as to build the knowledge base and awareness among the team
• Participating in the Request for Proposal activities, including writing or evaluating RFP/RFQ/RFIs.

Ika system implementation project aimed at enhancing SCAN's abilities to deliver Right Healthcare at the Right cost. IkaSystems platform allowed SCAN to reduce administrative cost by 20% and provided SCAN an effective compliance program by timely, accurate and controlled reporting of the compliance metrics.

• Role: Led the business analyst team in assessing the impact of the IkaSystem solution module on current business processes, roles, and other business applications
• Supervised team in defining the business process flows and dependencies with work groups
• Defined the required business rules with work groups in which the system must comply
• Developed detailed use cases and functional designs for integration, reports and customizations Led client sessions for translating requirements and use cases into test conditions and expected results for product, performance and user acceptance testing
• Monitored the Deliverable quality by defining metrics and performance goals for the module Performed Functional Testing and led session for the User Acceptance Testing Provided inputs to the Change control management for creating training documents
• Led sessions to formulate templates for client deliverables
• Writing policy or procedure handbooks/manuals for use in an eligibility business operation.

• Techno-functional role:- Technical Role: Involved in Code, Build and unit test the application programs as a COBOL and C++ developer for HP OpenVMS platform.
• Also performed Production support activities on the ad-hoc basis.
• Involved in all the phases of SDLC.
• Functional Role: Created High level design and Detail design document, Test case document preparation, Weekly Application Status reporting.
• Overall Experience: Medicare Part D: Created functional specification and detail design documentation for identifying enrolled Medicare Part D members and application code implementation for providing drug transition letters to eligible patients.
• HIPAA:Designed the data mapping of claim fields and coded the logic for conversion of pharmacy claims transactions version 5.1 into D.0.
• Functional Requirements and Solution Design: Created solutions by gathering requirements through user interviews and developing functional specifications for various business initiatives, including optimizing and changing the ESI billing cycle from weekly to daily, designing the integration of "Medispan" as new drug price source, implementing ICD-10 codes in the Home Delivery System (HDS), defining code logic for processing suspended prescriptions, implementing drug distribution control logic to comply with new drug control laws enacted in 6 states.
• Master Data Management : Defined schema of Prescriber information to ensure integrity, quality, security and general governance of the database.