Niraj Lala Email & Phone Number

AHIP/AHM Certified US Health Insurance Industry professional with FAHM, CHSS, and EHBA conferred designations by America's Health Insurance Plans, USA.SAFe Certified POPM - Product Owner Product Manager. ISEB / BCS certified Business Analyst.More than 13 years of experience in IT solution to US Healthcare including Payor, Provider and PBM segment. Expertise in Product Management & Development, Functional Analysis & Design, Hospital Projects & Administration. Well versed in implementing Drug dispensing system, TPA management, embedded system, Clinical tools and CRM. Experience in Health Benefit design, Formulary and Clinical Management Worked in the capacity of Product Owner / Delivery, Domain Consultant, Business Architect, SME for Ambulatory, HIMS, EMR (Paragon), Pharmacy solutions at Healthcare industryUp to date on Healthcare Reforms including regulatory issues like HIPAA 5010, ICD 10, Patient Protection and Affordable Care Act (PPACA).Drug Dispensing System (Retail, Mail Order, Specialty) and TPMS (Third party Management system), Embedded Systems - Healthcare, Clinical Tools, CRMSpecialty Pharmacy Reporting Specialist (ScriptMed)Well versed in Scaled Agile MethodologySpecialties:US Healthcare Domain Expert - Payer, Provider and PBM (Pharmacy Benefit Management) Segment Process Consulting/Re-Engineering, Business Analysis, Gap Analysis, Impact Analysis, Requirement Gathering &Management, Management ConsultingClaims Administration and Adjudication, NCPDP D.0, HIPAA 5010 EDI transactionsElectronic prescription Implementation Specialist (Surescripts)System Analyst - Paragon EMR, ScriptMed, RxClaim, CRM, Rational ToolsHealth Benefit Design, Drug Dispensing System Specialist, Formulary Management, Clinical Management (Referral, PV, DUR, Counseling)Healthcare Reforms - PPACA

Listed skills include Requirements Gathering, Business Analysis, Business Process, Requirements Analysis, and 17 others.

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  National Institute Of Technology Calicut

  Computers