Ruma Das Email & Phone Number

Texas, United States

United States

Canada

Mexico

Hyderabad Area, India

Performed Quality checking of benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of AS400 pharmacy claim adjudication system.Mentored and lead the new joiners (10 member team) & help them to learn the process.Part of the business migration(Medco) & also transition(Catamaran) team, learn the process and coach the new joiner.Performed the Quality analysis of the projects.Worked on AS400 Software application supported by IBM for 5+ years.Designed, developed test strategy, test plans, test data design and provided feedback.Performing UAT testing of new Tools.Analyze benefit requests (Deductible, Co-pays, Co-insurance, MOOP, Ancillary charges, Benefit max, Accumulators, Networks) and secure all necessary data to ensure appropriate implementation based on applied logic of RxCLAIM to Build the Pharmacy plans.Coordinating with business users and IT development team.Has Software Quality Assurance experience with knowledge of testing Methodologies.Testing in AS400 (RxClaim) to ensure the accurate claim adjudication.Scheduled the daily Onshore / Offshore calls for process related issues, representing the offshore site.Managed & prepared various reports on daily, weekly and monthly basis in MS Excel& PPT.Prepared monthly report in MS Power Point for management using graphical & statistical methods using Pivoting. Experienced in research, build and testing of Pharmacy benefit plans.Error analyzing in the process & brings the resource utilization to 100%.Daily maintenance of queue monitor & production volumes,TAT (Turnaround Time) on daily basis.Reviewing & researching the volumes trend & providing feedback on errors trend which would not happen in near future.Lean Six Sigma trained from United Health Group .PBMCT Certified,

Hyderabad Area, India

Designation: Senior Pharmacy Benefit Analyst (2015)Promoted as Sr Pharmacy Benefit AnalystPerform the Quality analysis of the projects moreover supporting any internal audits.Performs the secondary reviews of the projects for new joiners.Schedules the daily Onshore / Offshore calls for process related issues, representing the offshore site.Generate & track required reports from the available data in database. Designation: Pharmacy Benefit Analyst (2013- 2014)Manually creating Claim based on the information received from the provider and subscriber.Perform the Quality analysis of the projects moreover supporting any internal audits.Identify the Coordination of benefits and process the claim.Review the subscriber and patient credentials in order to finalize the claim.Calibrating the team with new updates from the onshore team.Documenting claims benefit to the database (Web-View).Creating Explanation of benefit and upload to the data base.Online transaction processing – Processing of medical insurance claims.Providing timely and accurate claims decisions.Maintaining accuracy and production standards established for claims analyst.Review claims information to determine the nature of member’s illness or Injury.Determine and understand the coverage provided under member’s Insurance plan.Utilize available resources to obtain and record claim information to make proper payment decision.

Hyderabad Area, India

Worked as Pharmacy Benefit Analyst for client UNITED HEALTH GROUP on Payroll of Magna Infotech Pvt. Ltd from 11-June-2012to31-Dec-2012 (7Months).Worked on UAT environments of PBM (Pharmacy Benefit Management) Applications (AS400).Responsible for managing the business and Quality projects. Additionally responsible for PBM Programs for Large US Healthcare Payer Organizations.Implementation of the Healthcare & PBM goals, objectives, end-to-end programs in support of the organization’s goals.Consolidating the projects data (Ex: Time &Motion ) from team and publish to senior management.Work with Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system.Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system.Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system.Ensure timely communication of any issues and/or information needed to complete a plan request.Develop client specific implementation plans and manage implementation processes in accordance with department protocol.Run queries out of the AS400 adjudication system to secure all necessary information to implement plan requests. Develop and Run Macros in AS400 to implement plan requests.Perform claim testing to ensure accurate claim adjudication

Kolkata

Worked on Electronic Health/Medical Record (EHR/ EMR) (US Healthcare IT) based project.Understand and Analyze the Disease, Drug, Allergy, Past Medical History, Immunization, Health Maintenance and Disease Management Data to generate Electronic Medical Records in order to ensure safe and rational medical therapy for the patient.Activities based on clinical process with Clinical Data Abstraction, monitoring of adverse events & drug reactions, chronic disease management, epidemiology study, medication therapy management, identification of drug interaction & duplication.

Bpharm

Bpharm, Pharmacy