PATRICK GEORGE
Dublin,United States
Summary
Over 15 years of extensive experience in healthcare industry including configuration, data management/analysis, development and testing of various healthcare applications. Profound knowledge of Healthcare and Managed care business processes. EPIC CRM and Benefits certified. Expert level experience in QNXT Architecture, Technology and Configuration. Detail oriented and adapt to changing project requirements quickly to meet business goals.
Overview
16
16
years of professional experience
Work History
Supervisor, Application Configuration
Hill Physicians Medical Group
01.2020 - Current
- Supervisor for the Tapestry CRM Workgroup for Managed care business Implementation
- Implemented claim appeal Letters in Tapestry CRM
- Facilitate meetings with Business users to capture business requirements accurately and discuss optimal configuration solutions
- Collaborate with business users to discuss optimal configuration solutions for new and changing business requirements
- Produce key metrics and periodic status updates to IT and operations leadership
- Certified in Epic Benefits an CRM.
Lead Analyst
Hill Physicians Medical Group
01.2015 - 12.2019
- Expert level experience in QNXT Architecture, Technology and Business Processes
- Designed the data migration process for QNXT operational maintenance
- Identified and implemented the Redgate tool for automatic data migration
- Provide optimal configuration solutions for business requirements during QNXT Implementation
- Operational maintenance of various QNXT modules like Benefits, Contracts, Providers, Fee schedules, UM Templates for authorizations, Claim rules, Call tracking, New CPT/HCPCS/ICD10 codes configuration, EDI 837, 834, 278 transactions, ClaimsXten etc
- Created complicated SQL queries and packages in MS SQL Server for data analysis/reports, test data identification and backend configuration of various QNXT modules.
Team Leader
Blue Shield of California
01.2013 - 01.2015
- Led a team of over 10 members as an Onsite Project Lead
- Collected and evaluated business requirements, functional specifications, project schedules, and documentation
- Worked on testing Claims, Subscribers, Medical Plan and Providers data from FACETS
- Migrated 100K members data from legacy system to Facets system through a critical module in Employer Portal
- Created FMG Facets Membership Generator tool which is the automated solution for Facets membership needs
- Converts data from excel based templates into Facets MMS keyword format
- Launched the business requirement collection approach based on the project scope and AGILE Methodology
- Worked in 837 Claims Instructional, professional and dental), (inbound and out bound), 834 Enrollment, 270/271 Eligibility inquiry and response, 835 Remittances and 276/277 Claims Status Inquiry
- Created reusable data set(Member, Claims) for data governance team therein mirroring production like data, saving time, effort & reducing cost.
System Analyst Team Lead
Cognizant
01.2008 - 01.2013
- Analyzed business requirements and determined the optimal configuration solutions for the requirements in CURAM
- Created use case documents based on the business requirements document
- Performed functional, Backend and System testing of the application
- Interacted and arranged meetings with Business and End users to gather business requirements for configuration of Benefits with various other systems
- Identified, documented and analyzed business needs, contributed in the design of solutions, and assisted in the implementation of solutions
- Worked on defining requirements and analyzing the business process to create a business process model.
Education
Master of Information Technology -
Griffith University
12.2008
Bachelor of Computer Science and Engineering -
Anna University
12.2006
Skills
- EPIC Benefits
- EPIC CRM
- QNXT
- FACETS
- C
- C
- Oracle
- MS SQL Server
- PL/SQL
- Solar Winds
- RedGate
- Visio
- MS Excel
Accomplishments
- Spearheaded the implementation of Tapestry CRM for Epic Tapestry Implementation.
- Designed and Implemented an automatic Data migration process using Redgate Tool for QNXT operational maintenance.
Passions
Finding joy in creative problem-solving, innovation, and bringing new ideas to life.
Timeline
Supervisor, Application Configuration
Hill Physicians Medical Group
01.2020 - Current
Lead Analyst
Hill Physicians Medical Group
01.2015 - 12.2019
Team Leader
Blue Shield of California
01.2013 - 01.2015
System Analyst Team Lead
Cognizant
01.2008 - 01.2013
Master of Information Technology -
Griffith University
Bachelor of Computer Science and Engineering -
Anna University
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