Mukesh Pathak Email & Phone Number

Navi Mumbai, Maharashtra, India

Product Consultant and Scrum Lead with 18+ yrs of experience. • Lead configuration teams for Implementation, BAU, Cloud migration projects• Work with multiple agile teams/Projects to define project scope, effectively prioritize backlog to bring the project to speed and streamline• Experienced in Plans and product configuration on Trizetto Facets. NetworX and Facets Workflow configuration.• Ideate and design process enablers\utilities\scripts to automate analysis, build or Auto Adjudication improvements. Oversee BOTs development to make sure BOTs align with process requirement.• Configuration solutioning to improve system performance, Auto Adjudication rate

• Coordinating all testing activities with client from Discovery phase to Warranty support for Facets Upgrade 5.01 releases (R9 to R13) • Requirement analysis and translate them in test scenario and cases. Design test cases during SIT phase and provide test cases walkthrough to client to get their consent on the coverage of requirements.• Understanding customer business and providing to the point coverage in REGRESSION testing different business scenarios.• Testing 5.01 upgrade changes, Regression and E2E scenarios on Core Facets, Extensions, Interfaces and Surround applications.• Understanding the requirements to identify the core functionalities of the project. Participated in joint requirement gathering session. • Provide SME analysis to test different Facets Modules like Workflow, NetworX, Medical Plan, Claims processing and Application support.• Helped the team in identifying test cases based on the business requirements and translating Test cases to Test scripts• Daily task allocation to the team and tracking them to closure• Defect logging, testing and review.• Request and maintain Test data• Prepare and testing End 2 End business scenarios• Test estimates preperation• Prepared Detailed Test plan and provide walkthrough to the customer• Project Implementation and coordination activities• Providing Metrics, Test Execution dashboard

Mumbai Area, India

Facets Configuration - * Involved in Business Rule Design and Configuration, Preperation of Benefit Build Documents and setting up in the Facets for various line of business. * Configuration of Provider Agreements, Utilization Management, Workflow Management. * Requirement Analysis and translating into functional specifications. * Working on different FACETS sub modules-Benefit Plan, Claims, Provider, Subscriber/Member, Accounting, Appication Support, NetworX, Workflow.* Claims Testing.* Scenario testing and Defects resolution after Benefit configuration is done in Facets.* To update different Fee Schedules under NetworX and test pricing on claims.* Creation of Professional/Facility Agreements.

Pune Area, India

both Peak Practice and MediNotes e applications PeakPractice is a web-based suite product for the small to mid-sized ambulatory market (including both Practice Management and Electronic Medical Records). MediNotes e is an EMR designed for the small ambulatory market. Job Profile:My knowledge of both applications allowed Eclipsys to market my valuable services to clients such as:Conversion of Clinicians' templates from MediNotes e to Peak PracticeMigration of legacy data to PeakPracticeMy duties also included:Assisting clients with their application training questions and issues Conducting client online training sessions to educate on using the application features (Functional Training). This involves working with the office administrator on the set-up as well as the end usersTraining and working on a client site for a month period to understand the patient workflow and to assist the end users with their application related questions and issues

Underwent Business Rule Configuration live training for QNXT & Facets from client and configured Medicare HMO plans for 5 different states in USIn QNXT configuration I have worked on different Projects which involved the following modules of QNXT system for a number of sub-clients: Members, Providers, Contracts, and Benefit PlansExternal/Internal Rules for Claims ProcessingWorked closely with the Business Analysis team in the same project and learn the SDLC process. Helped BA's in requirement gathering and analysisTeam Lead of Claims Operations & Business Rule Configuration (FACETS)Team management One of the main operational liaisons between TELA & its clienteleInventory monitoring and production planningTeam motivationProviding ideas for better client satisfactionHaving good practical knowledge of troubleshootingManaged to meet and exceed client expectations while coordinating with cross-functional teams

Pune, Maharashtra, India

Have complete knowledge of Facets claims processing cycle, e.g. provider/member eligibility, plan benefit guidelines, provider pricing and clinical editing through checking of revenue codes/diagnosis codes and procedure codes coverageWorked extensively on FACETS, Macess, MC-400 & QNXT Platforms in claims adjustment, claims processing, member/provider credentialing and managementFacets claim adjudication and solving adjustment and appeals for commercial and governmental (Medicare & Medicaid) plansAuthorized for processing high dollar claimsProcessing COB claimsResponsible for handling the third party discountMaintain the standard turn around time of 48 hrsDaily processing procedural quality average of 97% or above and financial statistical quality of 98%; Client calls (both in bound and out-bound)

Worked as customer care executive in a calling process.

Data processing for various indigenous clients e.g. (LIC of India, Novertis)Worked on Tally 5.4, 6.5FORMAL TRAININGCertificate in Computing from IGNOUFormal in-depth training on Business Rule Configuration & Adjudication for FACETS & QNXTUnderwent several training programs on leadership skills, team management, and client communication

B.Sc, Biology

Continuing professional education in Project Management, Leadership Management, Communication and Quality Assurance

Cic, Computer Fundamental