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•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.
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Healthcare Consultant ICitiustechPune, Mh, In -
Senior Business AnalystCitiustech Feb 2022 - PresentPune, Maharashtra, India -
Senior Configuration Analyst/Subject Matter ExpertCognizant Technology Solutions India Pvt Sep 2017 - Feb 2022Pune, Maharashtra, India
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Process SpecialistInfosys Aug 2016 - Sep 2017Pune, Maharashtra, IndiaBenefit Configuration, Client Account Setup, Benefit Administrator, Claim Adjudication, Policy Administrator• Analyzes and determines if products and services selected by customers are aligned with their benefit needs, and can be adequately supported by existing systems or operating platforms; additionally, seeks solutions and negotiates essential requirements in support of any non-standard plan selections.• Consults and communicates with internal constituents regarding the details associated with new business and revision activity in a timely manner and validates account structure.• Timely and accurate set-up of complex account structure and detailed benefit plans in systems for multiple constituents in order to satisfy both internal and external deadlines for production – impacting a wide variety products and services• Reviews benefit provisions to ensure compliance with state and Federal legislative mandates; evaluation process include assessment of summary plan descriptions and other related documents prepared by the plan sponsor or third party.• Manage internal installation process and maintains case tracking tools to meet constituents expectations and business goals.• Completes required data input into performance measurement systems in support of key business and management initiatives. -
Senior Practioner Clinical Record ManagementIbm Global Process Services Dec 2009 - Aug 2016Pune, Maharashtra, IndiaClinical Record Management,Medical Reviewer, Clinical data Analysis, Claims Adjudication, Claims Analyst.
Nitin Bansode Skills
Nitin Bansode Education Details
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New English School Pune
Frequently Asked Questions about Nitin Bansode
What company does Nitin Bansode work for?
Nitin Bansode works for Citiustech
What is Nitin Bansode's role at the current company?
Nitin Bansode's current role is Healthcare Consultant I.
What is Nitin Bansode's email address?
Nitin Bansode's email address is nb****@****ibm.com
What schools did Nitin Bansode attend?
Nitin Bansode attended New English School Pune.
What skills is Nitin Bansode known for?
Nitin Bansode has skills like Business Analysis, Outsourcing, Customer Relationship Management, Business Process Outsourcing, Clinical Research, Clinical Record Management, Medical Underwriting, Benefit Configuration, Claim Adjudication, Benefit Ad, Benefit Coder, Claims Management.
Who are Nitin Bansode's colleagues?
Nitin Bansode's colleagues are Nivetha Chandrasekar, Rohit Baikar, Shri Bhor, Vijayadarshan Reddy Algari, Sandeep Singh, Girish Kolhe, Khushi Singh.
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