Mohana Surisetti

About Mohana Surisetti

Healthcare IT & Payer Systems Professional with strong experience in HealthEdge HealthRules Payor (HRP) implementations, provider data management, EDI testing, and claims processing. Proven expertise in configuring and maintaining provider data using HRP Burges Source and HealthRules Data Warehouse (HRDW), ensuring data accuracy and operational consistency.Hands-on experience executing end-to-end EDI testing and validation using Edifecs, SOAP UI, JSON, and XML, supporting HIPAA-compliant transactions including 270/271, 837, and 835. Adept in QA strategies and automation testing across claims, enrollment, and provider workflows to ensure system reliability and regulatory compliance.Experienced in configuring Facets Benefit Plans and NetworX Pricing aligned with CMS and state-specific requirements, and collaborating with cross-functional teams to enhance care coordination and utilization management through Altruista GuidingCare. Skilled in designing and validating system integrations to enable seamless payer–provider data exchange.A proactive contributor to process improvement and automation initiatives, focused on reducing manual effort and improving turnaround times in healthcare operations. Comfortable working in Agile environments, translating complex business requirements into scalable, compliant solutions. Strong analytical capabilities with SQL and Power BI, delivering actionable insights through data visualization and reporting to support informed decision-making.

Experience

1. Senior Analyst - Manager

   Firstsource

   Apr 2025 — Present · Bengaluru, IN

   I’m currently working on HealthRules Payor implementation, focusing on provider contract configuration, HealthEdge Source setup, and GuidingCare letter validation. My role involves validating codes and rates across systems to ensure accurate claims adjudication, compliant provider communications, and alignment with contractual and clinical policies.

Education

• SV University

  Bachelor of Computer Applications, Computer Programming, Specific Applications

• Sikkim Manipal University - Distance Education

  Master of Computer Applications, Computer Programming, Specific Applications

Skills

• Jdbc
• Training
• Jquery
• Java/J2ee
• Vendor Management
• Jsp
• Html
• Oracle
• Requirements Analysis
• Struts
• Tomcat
• Javascript
• Identity Access Management
• Weblogic
• Team Management
• Sql
• Hibernate
• Sdlc
• Healthcare Insurance
• Servlets
• Consulting
• Business Process
• Oracle 11g
• Spring Framework
• Java
• Management
• Business Analysis