SUMMARY

• Healthcare professional with more than 12 years’ experience in the healthcare industry in acute care hospitals, multi - specialty academic medical centers, US Healthcare Plans (Commercial &Federal) and various healthcare technologies
• Primary areas of expertise - Healthcare IT, Healthcare Services delivery, Operations management and process improvement, with functional and technical experience in Revenue Cycle Management-Accounts Receivable reduction and reimbursement improvement. Other areas include online claim status applications - WebMD, TUFTS, Medicaid - and coding Web sites using Encoder pro and Flash Code.
• Hands on experience on various EMR-Healthcare Technology applications like- EPIC, McKesson, ECLIPSYS, MIDAS, MAPS Health Suite, Apollo Life Line, MEDINOUS, and Spirit Enterprise from Sphere Health Systems etc.
• Served as Subject Matter Expert in patient accounting/ business office implementations, responsible for development of methodologies, services, and delivery in these areas. Worked on a variety of patient accounting applications, including McKessonParagon/HBOC Star, Meditech, DDE, Medipac, and CUBS.
• Certificate in Computing (CIC), IGNOU, New Delhi; and Certificate in Programming, APTECH, New Delhi. Internship included rotational training in clinical specialties - Medicine/Surgery/ Obs and Gyn/Pediatrics/ENT/Ophthalmology/Dermatology/PSM/Psychiatry/Orthopedics and Traumatology.
• Trained & Certified on design and build of healthcare solution software in Eclipsys SCM (Allscripts) - Sunrise Clinical Manager. Trained on Six- Sigma Green Belt
• Languages: C, C++, UNIX. Proficient in Russian, Hindi, Malayalam& English.

TECHNICAL SKILLS

• Healthcare Information Technology
• Offshore-onshore model
• Client Relationship Management
• SDLC-Agile & Waterfall
• Operations Transformation
• Business Process Reengineering
• Patient Accounting Business Office
• Project Management&Strategic Planning
• Revenue Cycle Management,
• Accounts Receivable Reduction
• Healthcare Services Marketing

PROFESSIONAL EXPERIENCE

Confidential, Powell, Ohio

Product Analyst

Responsibilities:

• Understand the business objectives and rationales behind high levelproductfeatures, and analyze and translate them into detailed software requirement specifications (Define BRD, Draft FRS, etc.)
• Specify and document software requirements in story format (Agile methodology) with proper acceptance criteria that meet the business requirements. Act as the owner for the acceptance of newproductfeatures. Define Release Scope and assist in Sprint planning.
• Define requirements for Medicare Advantage plans-CMS-Medicare Star Ratings, NCQA/HEDIS Measures, Appeals & Grievances, Discharge Planning, Medication Reconciliation, Medicare RAF Scores, Predictive Modelling
• Service/Single Case Agreement, Benefit Accumulators, Utilization Management, Concurrent Stay Review, Case Management, Disease Management, Clinical Pathways/Assessments
• Claims System (Payor), Eligibility, Provider and Eligibility/Enrollment files integration
• Closely work with theProduct Management and Senior Leadership to understand theproductvision, strategicproductdirection, andproductroadmap. Understand the customer base that will benefit from theproductfeatures, and coordinate as needed with the professional services teams responsible for those customers
• Communicate within theproductmanagement team and other business groups on the important Engineering priorities and implementation considerations that would likely impact the timeline ofproductdelivery, and help to manage the project delivery risk. Work with theProductManager to maintain theproductbacklog to ensure a sufficient level of backlog items for the engineering team, and also to manage the proper priority of theproductbacklog.
• Attend industry webinars and be the SME to understand trends and solution software requirements
• Demonstrate completedproductfeatures to both internal and external key stakeholders. Functional Testing.
• Lead and/or participate in user groups for keyproductfeature sets, in periodic customer onsite visits, in the annual user conference, in internal training and noledge transfer for keyproductfeature sets

Confidential, Plano, Texas

Lead Business Analyst

Responsibilities:

• Responsible for the overall implementation of JIVA Care Management platform. Lead all phases of the application lifecycle from analysis, coding, testing, documentation, implementation and maintenance. Oversee scope, schedule, cost, and quality of all activities and deliverables. Creating detailed project assessments and work orders/SOW. Responsible for Revenue recognition, forecast pipeline inventory, Project timelines, Project costs and high customer satisfaction. Work closely with the Client and ZeOmega Senior Management to ensure on time, quality delivery of the product.
• Engage with the stake holders (Nurses/Physicians/CMO) on the Client side and understand workflows and process gaps. Managed team of Business Analysts across various modules to ensure Client requirements are accurately captured. Work with PMG (Product Management Group) to identify potential product gaps and evaluate business case to be incorporated as future product offerings.
• Works collaboratively with Clinical Services, Development teams and Business Analysts to ensure clinical content fully supports Utilization management, Case Management, Disease Management, Wellness/Health education, and performance improvement initiatives. Ensures that Sentinel Health Rules packages, Clinical content adheres to established evidence-based guidelines and remains NCQA and/or URAC compliant.
• Lead and manage group of Business Analysts, Development team, QA teams, Build& Release teams
• Oversee Requirements elicitation. Conducting JAD sessions. BRD (Business Requirement Documentations) & FRS (Functional Requirement Specifications) document creation.
• Assist in Use Cases and Test Cases creation for QA team testing purposes
• Lead and managed teams of onshore - offshore working model from requirements gathering through to development, testing, implementation and support. Periodic reporting of Project Status and Project Performance to the Management. Negotiate priorities and resolve conflicts among project stakeholders.
• Oversee QA activities and ensure appropriate test/use case scenarios are accounted for.
• Ensure compliance to deployment check lists and oversee Release/Install-Emergency releases to Client environments. Client support with UAT. Ensuring Client preparedness for Go-Live.

Confidential

Healthcare IT-Consultant/ Project Manager

Responsibilities:

• Responsible for providing second and third level production support for multiple applications for large US based healthcare systems. Security, Policy governance, Application Maintenance, Server Monitoring. Applications include McKesson Paragon & Epic. HIT Gap analysis evaluation.
• Hands on experience on various HIS applications like- Epic Hyperspace/Chronicle SER, McKesson Paragon, Eclipsys/Allscripts, MIDAS, Cerner-Powerchart, MAPS Health Suite, Apollo Life Line, MEDINOUS, Spirit Enterprise-Sphere Health Systems, etc.
• Epic-InSecurity Basket rights allocations, SER/EMP-account creations/inactivation, various configuration changes in Epic Text Space (Chronicles) and Hyperspace with privileged Admin access. Editing of Records and deletion in Chronicles. Template modifications. Paragon-FDB (Formulary Drug Base) uploads. Weekly/monthly server maintenance jobs. Change Control Management. Manual Testing before and after the implementation of application. Change Request Management. Doing all dictionaries based and access related issues of the Client in reference to Administration, Clinical and Financial Modules. Closely monitoring the daily basis jobs related to activities of the Hospital (me.e., Printing, Fax Queues, Reports, Physician Web Station Master, etc.)
• Experienced on application support tasks like user provisioning, termination, access management and worked on solving trouble shooting tickets on applications like GE-IDX Term/Flowcast,Lawson,Kronos,Omnicell,Misys,etc.
• Incident Management and resolution. SLA compliance. Vendor Management.
• Client interaction and interviewing to initiate and introduce automated healthcare environment.Documenting, tracking and following-up on all reported problems, enhancement requests and system change requests for various HIS modules.Client interaction, in terms of understanding the requirements and documenting requirements for further processing
• Coordinate with the onsite team, Consultants and offshore team as point-of-contact for pre and post go-live phases of hospital implementations. Work in conjunction with the Report development team.
• Business development for Middle East & EU market. Pre-sales demo readiness. Prepared Clinical test cases. Developed RFI/RFP bid documents.
• Best practices implementation and hospital workflow restructuring. Clinical workflow analysis. Analyzing current state departmental & patient workflow and prepare process mapping.

US Health Insurance

Confidential

Responsibilities:

• Evaluated current process flows in Revenue Cycle Department and introduced new processes to improve revenues and incremental cash flow for hospital services. Improved reimbursement rate from 68% - 83%. Improvised monthly cash collections on an average by $412,000. Brought down A/R days from 92 to 78.
• Trained and worked on multiple Accounts Receivable applications-Meditech,Mediapc,CUBS,IDX,etc.
• Developed denial management tracking system. Managed Commercial (HMO, PPO, POS, BCBS, etc.), Federal Healthcare Plans (Medicare/Medicaid), and Worker’s Compensation claims. Worked on ICD/CPT/HCPCS codes.
• HCFA1500/UB92/Super bill/Charge capture, Provider contracting, Annual CPT and HCPCs Code Updates
• Lead a team of 18 Associates. Developed customized training documentation and conducted end user training sessions.
• Developed policies and procedures for revenue cycle areas for improvising lesser claims denial and AR collection. Creation of financial dashboards for executive management review.Management
• Project management - Worked on multiple international projects (Sharjah-UAE, MoH-Bahrain, Manpower-UK). Participated in project team and project management status meetings.
• Was also responsible for the delivery of administrative functions for employee strength of 7000+ across all sites of ACS, India. Reporting directly to the Country Director.
• Team management -Virtual team management across geographies. Recruitment/Training assistance.
• Transitioned multi-level process. Developed policies and procedures.
• Maintained status reports, required schedules and issues list. Coordinated production rollout.
• Managed performance improvement initiatives addressing financial and service improvements

Confidential

Marketing Manager-Healthcare Services Delivery

Responsibilities:

• Served as clinical liaison between the Physician community/management and technical staff. Negotiated business proposals. Organized symposiums/press meets. Recruited and trained Marketing executives. Conceptualized and designed innovative marketing materials for utilization by the field force. Assisted withWebsite/brochure development and advertisingAchievements
• Streamlined operations and enhanced customer satisfaction
• Decreased TAT for insurance card delivery. Implemented checklist procedure for insurance claims submission
• Developed business opportunities and new marketing strategies
• Achieved the set target for insurance policies from the first month and sustained steady profit generation.
• Received appreciation letters from Senior Executive management
• Primary care physician for three doctor practice. Responsible for the diagnosis, treatment, and referrals of patients, as well as for database management.

Confidential

Resident Medical Officer/ Supervisor

Responsibilities:

• Providedfirst aid and advanced emergency medical assistance arising out of trauma, sickness, etc. Assisted with advanced critical-care life support. Conducted Obstetric deliveries and assisted in various surgeries. Independently handled general medicine cases in OPD
• Responsible for daily operations. Streamlined healthcare services delivery. Streamlined expenditures. Investigated, identified, and prepared proposals to solve specific operational problems within all clinical operational areas, working closely with unit managers and division heads as directed and authorized
• Served as liaison with TPAs for insurance coverage approval, between departments, management, physicians, patients and other staff membersAchievements
• Implemented operational changes to lower costs and enhance profitability
• Improved quality of patient service and length-of-stay