Nitin Bansode Email & Phone Number

•Health Rules Payors Configuration: Benefit Configuration, Pricing Configuration, Provider Setup, Account Setup, Plan Design, Product Setup, Billing Cycle Configuration, Supplier Contract Configuration, Re-insurance Configuration, etc.• Handle customer relationships and expectations by developing a communication process to keep others up to date on the project results.• Serve as a liaison between the business operations and the IT professionals to assist or gather the business requirements needed for system modifications, enhancement, and implementation of strategies.• Maintain logs for meeting minutes, meeting schedules, project summaries, and updates.• Hold meetings with the project team regularly to review project deliverables and ensure that the deadlines are met• Create monthly reports on the overall performance and the targets achieved; point out the areas of improvement and give recommendations accordingly.• Identify and capitalize on improvement opportunities efficiently.• Benefit Plan setup, Implementation Projects, Provider Maintenance, Functional Testing• Support activities to maintain data within the core claims processing system within the areas of Provider, Pricing or Rules. • Managing of credentialing variables and demographics (credentialed and non-credentialed providers), contract or fee schedule assignment and network affiliation based on weekly Excel files submitted from the clients to Valence.•Dictionary/master file maintenance such as research, set up and maintenance of all diagnosis, CPT and other medical codes•Support fee schedule maintenance including terms, affiliations and contract maintenance•Troubleshoot and resolve claims that suspend in work queues for configuration intervention in the claims processing system•Support the work to troubleshoot and resolve claims issues introduced by user, configuration, system or reporting errors; working multiple issues simultaneously support activities to update configuration within the core claims processing system, typically within the areas of Provider, Pricing or Benefit Plan/Adjudication Rules. •Update credentialing variables and demographics (credentialed and non-credentialed providers), contract or fee schedule assignment and network affiliation update group/benefit configuration including benefit plans (coinsurance, deductible, copay, out of pocket) and benefit plan rules support fee schedule changes including terms, affiliations and contract maintenance Updates to general system configuration such as workflow, dictionary/master file update.

Listed skills include Business Analysis, Outsourcing, Customer Relationship Management, Business Process Outsourcing, and 12 others.

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  New English School Pune