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 the regular work.
• Experience in working on projects which are based out of Agile & Waterfall Model.
• Also prepared the waterfall models which helped in projecting the cash inflow for clients.
• Have extensively been on the project start-ups and project closures.
• Defined the scope of the projects starting and also resolved the challenges while data loads and processing.
• Assisted the Audit & Compliance team for the audits on ISO & CSAT certifications.
• Also worked on preparation of BE Scorecards and Table F at the top level management.
• Hands on experience on MIS reporting which included RFPs, Staffing, Invoice generation, attrition management and other internal assignments.
• Designed and implemented the complicated SQL queries.
• Have a sound knowledge about the ICD-9 and ICD-10 in the Healthcare Industry.
• Worked on Electronic Data Interchange (EDI) which helped in coding/decoding of healthcare data with the insurance companies.
• Also worked on other Microsoft applications like MS Access, Visio, PowerPoint and Word.
• Prepared macros for the regular projects which required automations.
• Worked on the 835 responses received from insurance companies.
• Experienced in working with Clearing House (Emdeon) for submission of medical claims electronically.
• Have been a bridge between the 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
• Have 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:

• The core job was to work on SharePoint and provide analyze the projects under PMO group and provide my insights on it.
• Working projects by following Agile Methodology, with different PMO Managers on the projects assigned.
• It also included the reporting of project status under PMO group and the high level presentation with the trends and findings.
• Planning and leading strategic processes that result in alternatives and choices which have a positive impact on client deliverables.
• Was responsible for managing work strategy for a team of 20 to 30 resources and the role included - managing entire project statistics, quantitative and qualitative analysis of team’s performance, developing and accessing internal processes which best suit the 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 the 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 the handling of errors by the ETL team
• Conducted tuning for SQL and PL procedures Informatica objects and Views
• Collaborated with team members, customers, developers, analysts DBAs and IT in the creation of analytical solutions
• Supported the Oracle Data Warehouse
• Mentored DBAs and developers in the 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 the 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 the data management on Oracle SQL, report generation using Excel, Access and preparing the final client presentations used for Director meetings/reviews
• Defining project scope and objectives.
• Automating the day to day and weekly activities to reduce manual touch and simultaneously providing additional time for the team to work on other deliverables
• Preparation of BE Scorecard and Table F for the practice, month on month basis
• Assisting leadership on preparation of audits for ISO, CSAT & other major certifications
• Allocating junior staff to tasks and then tracking the 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 the EDIs (Electronic Data Interchange) and providing final output to operation team.
• Working on patient eligibility requests (270) and the responses to it (271)
• Analyzing the Remittance Advices received from insurance companies in the form of 835 responses.
• Providing the results of 835 responses to the operations for quick resolution of claims.
• Preparation of presentations for the monthly client meetings which includes the trends and analysis done throughout the month.
• Applying the Denial Management strategies for quick resolution of the claims pending for payment.
• Following up with the 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 the role included - selection of a right team - effectively led and cohesive, quantitative and qualitative analysis of team’s performance, Maintained track of productivity reports and shared performance feedback with the 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 effective performance standards.
• Maintained records of overall performance for each new hire with feedback points to share with their respective counselors for the year end evaluation.
• Produce and analyze standard monthly reports that assist in the monthly forecast process. Liaise with leadership team and office staff to resolve issues and outstanding problems in the 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 the 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 the 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 the federal and commercial insurance firms for the status of claims submitted by hospital
• Working with the coding and billing teams to ensure the accuracy of data mentioned on the claims
• Prepared Data flow diagram and business process models that would comply with ICD-9 CM.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims
• Analyzed System flows of various department of the 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 the providers with payers for various departments and physicians
• Credentialing of providers helped increasing the speed of collections