Tushar Shah
Manager at Optum
- Role
- Manager at Optum
- Location
- Princeton Junction, NJ, US
- LinkedIn followers
- 500 followers
About Tushar Shah
Manager in the System Integration practice of Optum Advisory Services, with more than 18…
Experience
Manager
Aug 2011 — Present · Basking Ridge, NJ, US
Served as Test Technical Lead for Medicaid Health Plan to support MLTSS system integration testing /QA, go-live support, issue tracking and resolution procedures.• Provided Systems Analyst services in Veteran Affairs – Community Care Network (VA CCN) initiative to support requirements gathering, analysis and design activities for a large data warehousing project. Key deliverables included creation of functional design specifications for pharmacy claims in NCPDP format, data analysis to define business rules, Visio flow documents for EDI 837 institutional, professional and dental claims, Create user stories and tasks within Rally (CA Agile Central), Collaborate on backlog grooming sessions for future sprints.• Acted as an advising EDI Claims internal SME to support analysis for EDI 837 claims and EDI 835 payment transactions. Developed EDI claims use cases and claim examples to understand and build technical requirements for claim processing vendors. Worked with data architects on the EDI 837 claims, EDI 835 payment, EDI 278 referral and authorization transactions data model design.• Provided EDI consultant services in Payer Provider Collaboration Project with Optum 360 Revenue Cycle practice to implement real time claim adjudication and claim estimation pilot for Hospital facilities. Key de-liverables included the development of end-to-end process-flow, Requirements, EDI mapping documents, test scenarios for processing real time claims and estimates 837 (Institutional), 835 (remittance advice), 270/271 (eligibility request and response), TA1, and 277 Acknowledgment (error Response) transac-tions. • Assisted in designing the Retail Health Pay (RHP) portal to be used by the hospitals to securely transmit EDI HIPAA compliant real-time claim and estimate transactions.
Education
University of Detroit Mercy
MS, Engineering
1981 — 1983
Shivaji University
B.E., Mechanical Engineering
1977 — 1981
Skills
- Interviews
- Health Insurance
- Business Analysis
- Data Analysis
- Project Management
- Program Management
- Icd-10
- Healthcare
- Employee Benefits
- Hipaa
- Sdlc
- Edi
- Security
- Requirements Analysis
- Testing
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