Healthcare Domain Specialist worked on requirement engineering for various payer and provider projects such as Hospital Information System, Payer System, Billing System, ICD 9 to 10 Conversion, 4010 to 5010 Conversion, ePrescribe, Health Information Management System, Over Payment Mining, Claim Management, Benefit Coding.
Have sound knowledge on US Healthcare, HIPAA, EDI Standards, Coding Standards (CPT Code, Rev Code, DRG Code) HL7, Various Health Plans (TC, PPO, HMO, POS, Cafeteria Plan). Exposed to Commercial Insurance, Medicaid, Medicare, Medi Gap, Tri Care.
On hand exposure on sourcing Companion Guide & Billing Manual, Medicaid Transmittals, and Identifying potential Billing.