Project - Addressed Accounts receivable issues between providers and payer amounting to billions of dollars• Led multiple teams to work on high priority providers with Account Receivables of ~$200M to perform detailed AR remediation and identify patterns by analyzing key attributes to accelerate root cause analysis and remediation effort• Developed use cases that addresses key challenges and identified areas of improvement to avoid similar issues in future• Collaborated with client… Show more Project - Addressed Accounts receivable issues between providers and payer amounting to billions of dollars• Led multiple teams to work on high priority providers with Account Receivables of ~$200M to perform detailed AR remediation and identify patterns by analyzing key attributes to accelerate root cause analysis and remediation effort• Developed use cases that addresses key challenges and identified areas of improvement to avoid similar issues in future• Collaborated with client stakeholders to ensure discrepancies identified are getting resolved and being communicated back to provider• Accelerated value delivery by automating root cause analysis and by providing the end user with probable next steps for each identified issue patternProduct Development - Developed Digital Product to help shape the future of Healthcare Industry • Led teams of highly motivated professionals to design and build AWS cloud based real time claims adjudication platform where in providers can use web-based UI to receive a real time response with claim pricing and patient liability• Collaborated with Provider Adoption, Security, Compliance, and other relevant stakeholders to identify critical gaps and construct the plan to fix them along the wayLarge Scale Migration – • Managed the delivery of migrating Host claims processed on three different system to a single target ecosystem resulting in annual saving of $44M • Led a multi-vendor engagement for a Large National health plan client to migrate 6.5M members across 12 states and four legacy systems to a target system resulting in annual saving of $150M• Co-Designed a modern smart claim engine that can handle the intake and processing of ~2M health care claims a day • Developed testing framework to validate integrity and scalability of transactions with high degree of accuracy & speed which helped in testing 62M Claims before go-live Show less

• Performed data mapping, gap analysis to understand deltas between desired Claim Adjudication Process and existing ones. Implemented enhancements to deal with discovered gaps hence making the system compliant to industry standards and HIPAA guidelines• Conducted brain storming sessions, to review and analyse criticality of functional and non-functional requirements for Provider Termination letter requirement. This analysis helped identify and eradicate redundant requirements and reduce… Show more • Performed data mapping, gap analysis to understand deltas between desired Claim Adjudication Process and existing ones. Implemented enhancements to deal with discovered gaps hence making the system compliant to industry standards and HIPAA guidelines• Conducted brain storming sessions, to review and analyse criticality of functional and non-functional requirements for Provider Termination letter requirement. This analysis helped identify and eradicate redundant requirements and reduce project cost by 15% • Acted as a single source of coordination between teams located in Hartford and ones located in India. Efficiently translated business requirements into technical specs for development teams to improve overall efficiencies within the project.• Designed and developed detailed RACI matrix including all stakeholder roles associated with the project. Detailed communication plans were built around the RACI matrix which helped streamline communication flow between different teams located across the globe and reduced delivery and sign off time by 30%• Developed DB2 stored procedures to use by web services to read data for business reporting of the client communication sent out from Aetna.• Worked with implementation, and other technology teams to resolve critical outstanding defects. • Partnered with the principal architect in designing software architecture of the system to improve the efficiency and performance. Show less

• Developed Multiple screen using CICS, COBOL, VSAM to add, update delete and browse business rules from front end.• Fragmented the existing COBOL module in Mainframe into 5 logical sub modules based on functionality to achieve maintainability and performance• Successfully developed and implemented requirements for 3 critical modules for pricing the claims for Coventry health care. After Coventry was bought by Aetna, the claims filed by providers in contract with Coventry needed to be… Show more • Developed Multiple screen using CICS, COBOL, VSAM to add, update delete and browse business rules from front end.• Fragmented the existing COBOL module in Mainframe into 5 logical sub modules based on functionality to achieve maintainability and performance• Successfully developed and implemented requirements for 3 critical modules for pricing the claims for Coventry health care. After Coventry was bought by Aetna, the claims filed by providers in contract with Coventry needed to be externally priced. • Designed and delivered the process of calling external rule system for applying recommendation on hospital claims to check for Claim authenticity to avoid incorrect payment and fraud claims processing.• Created high level test plans, case flows, and performed integration testing for the entire application to ensure code efficiency Created high level test plans, case flows, and performed integration testing for the entire application to ensure a code with minimum errors • Fragmented the existing module in Mainframe into 5 logical sub modules based on functionality to achieve maintainability and performance• SPOC at offshore for managed services Show less