SUMMARY

• More than 9 years of Business Analytics and Operational experience in PMO Group, Health Insurance Management and Healthcare Management for US.
• With experience in Analysis, SQL, Informatica, Operations - RCMS (Accounts Receivable for US healthcare claims) and Automations in MS Office.
• Extensively worked on PowerPivot which helped in automating teh regular work.
• Experience in working on projects which are based out of Agile & Waterfall Model.
• Also prepared teh waterfall models which helped in projecting teh cash inflow for clients.
• Has extensively been on teh project start-ups and project closures.
• Defined teh scope of teh projects starting and also resolved teh challenges while data loads and processing.
• Assisted teh Audit & Compliance team for teh audits on ISO & CSAT certifications.
• Also worked on preparation of BE Scorecards and Table F at teh top level management.
• Hands on experience on MIS reporting which included RFPs, Staffing, Invoice generation, attrition management and other internal assignments.
• Designed and implemented teh complicated SQL queries.
• Has a sound noledge about teh ICD-9 and ICD-10 in teh Healthcare Industry.
• Worked on Electronic Data Interchange (EDI) which helped in coding/decoding of healthcare data with teh insurance companies.
• Also worked on other Microsoft applications like MS Access, Visio, PowerPoint and Word.
• Prepared macros for teh regular projects which required automations.
• Worked on teh 835 responses received from insurance companies.
• Experienced in working with Clearing House (Emdeon) for submission of medical claims electronically.
• Has been a bridge between teh core IT team and top level management and provided inputs wherever required.
• Diverse experience in BI tools and US Healthcare RCMS.
• Ability to come up with innovative business solutions to meet company’s strategic, tactical, Analytical and operational requirements
• Has a passion for analysis and problem solving. Proven ability to support multiple projects with medium to high complexity.

TECHNICAL SKILLS

Tools: Rational Rose / Microsoft Visio

Databases: Informatica, Oracle, SQL Server, EPM & MS Access

Methodology: Agile and Waterfall

Front end tools: CMS, SharePoint, QlikView, Meditech, Allscripts and Misys Healthcare System

MS Office Tools: Microsoft Excel, PowerPivot, Access, Visio and Word

PROFESSIONAL EXPERIENCE:

Confidential - Southfield MI

Deputy Manager

Environment: SQL Server, SharePoint, EPM, MS Access, MS Excel, MS PowerPoint and PowerPivot

Responsibilities:

• Teh core job was to work on SharePoint and provide analyze teh projects under PMO group and provide my insights on it.
• Working projects by following Agile Methodology, with different PMO Managers on teh projects assigned.
• It also included teh reporting of project status under PMO group and teh high level presentation with teh trends and findings.
• Planning and leading strategic processes that result in alternatives and choices which has a positive impact on client deliverables.
• Was responsible for managing work strategy for a team of 20 to 30 resources and teh role included - managing entire project statistics, quantitative and qualitative analysis of team’s performance, developing and accessing internal processes which best suit teh team.
• Responsible for maintaining and achieving process SLA targets, facilitating and coordinating with onshore partners in US.
• Prepare and publish periodical performance and review performance management by creating teh culture of high performance by systematic coaching and feedback.

Confidential - St. Louis, MO

Deputy Manager

Environment: Informatica, SQL Server, MS Access, Oracle, QlikView, MS Excel, MS PowerPoint and PowerPivot

Responsibilities:

• Conducted design sessions where source to target projects were developed.
• Developed leading routines and data extracts with Informatica and Oracle procedures
• Generated process flow designs
• Drafted standard operation procedures
• Developed and implemented strategies for teh handling of errors by teh ETL team
• Conducted tuning for SQL and PL procedures Informatica objects and Views
• Collaborated with team members, customers, developers, analysts DBAs and IT in teh creation of analytical solutions
• Supported teh Oracle Data Warehouse
• Mentored DBAs and developers in teh application of database standards and practices
• Designed practical and innovative logical and physical data processing infrastructures and models

Confidential - Denver, Colorado

Deputy Manager

Environment: SQL Server, MS Access, MS Excel, MS PowerPoint, CMS, QlikView and PowerPivot

Responsibilities:

• Preparation of high level summaries and reports for leadership review.
• Using a wide range of techniques to capture business requirements.
• MIS Reporting - Directly interacting with teh Directors group and providing reports on Employee engagement, Attrition, FTE planners and project allocations.
• Preparation of RFPs, Staffing, Monthly Invoice generation and Future Invoice Forecast
• Core job also includes teh data management on Oracle SQL, report generation using Excel, Access and preparing teh final client presentations used for Director meetings/reviews
• Defining project scope and objectives.
• Automating teh day to day and weekly activities to reduce manual touch and simultaneously providing additional time for teh team to work on other deliverables
• Preparation of BE Scorecard and Table F for teh practice, month on month basis
• Assisting leadership on preparation of audits for ISO, CSAT & other major certifications
• Allocating junior staff to tasks and tan tracking teh progress of their work.

Confidential - Philadelphia

Assistant Manager

Environment: SQL Server, Meditech, Allscripts, MS Access, MS Excel, MS PowerPoint, CMS, QlikView and PowerPivot

Responsibilities:

• Projection of cash by using Waterfall Model.
• Working on teh EDIs (Electronic Data Interchange) and providing final output to operation team.
• Working on patient eligibility requests (270) and teh responses to it (271)
• Analyzing teh Remittance Advices received from insurance companies in teh form of 835 responses.
• Providing teh results of 835 responses to teh operations for quick resolution of claims.
• Preparation of presentations for teh monthly client meetings which includes teh trends and analysis done throughout teh month.
• Applying teh Denial Management strategies for quick resolution of teh claims pending for payment.
• Following up with teh federal insurance companies (Medicare & Medicaid) for bulk resolution of claims pending for payment.

Confidential - Port Washington NY

Team Lead

Environment: Emdeon, IDX, ARMS, MS Access, MS Excel, MS PowerPoint.

Responsibilities:

• Was responsible for people management and teh role included - selection of a right team - TEMPeffectively led and cohesive, quantitative and qualitative analysis of team’s performance, Maintained track of productivity reports and shared performance feedback with teh team on monthly basis.
• Also worked on creating a Waterfall Model for hospital projecting cash flow by month.
• Involved in motivating, supporting, listening, counseling, directing, monitoring, timely responsiveness, constructive feedback sharing, dispute management, one-on-one sessions, monthly performance evaluations, information sharing on relative performance and upward management stand point for TEMPeffective performance standards.
• Maintained records of overall performance for each new hire with feedback points to share with their respective counselors for teh year end evaluation.
• Produce and analyze standard monthly reports that assist in teh monthly forecast process. Liaise with leadership team and office staff to resolve issues and outstanding problems in teh area of A/R management and revenue cycle process.
• Analyze ATB volumes and dollars across Financial Classes and Ageing groups. Analyze Payment, Collection Reports. Improve cash flow by reducing days in A/R and improving profitability by increasing collection ratio. Identify patient accounts that require follow-up and take teh necessary action to collect unpaid/underpaid claims. Increase cash collections by reducing write-offs and denials.
• Reduce outstanding accounts receivables and denials through process improvement and workflow tools. Responsible for managing teh submission and reimbursement of claims aged greater than 90 days. Manage actions relating to delinquent accounts.

Confidential - New York, NY

Analyst

Environment: Emdeon, IDX, ARMS, MS Access, MS Excel, MS PowerPoint.

Responsibilities:

• Following up with teh federal and commercial insurance firms for teh status of claims submitted by hospital
• Working with teh coding and billing teams to ensure teh accuracy of data mentioned on teh claims
• Prepared Data flow diagram and business process models that would comply with ICD-9 CM.
• Involved in teh full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims
• Analyzed System flows of various department of teh hospital
• Designed project protocol in collaboration with multi-disciplinary team including physicians
• Found various trends related to bulk denials from insurance companies and resolved them
• Credentialing of teh providers with payers for various departments and physicians
• Credentialing of providers helped increasing teh speed of collections