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.

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.

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.

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.

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.

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