Sanjay Pathak Email & Phone Number

Bengaluru, Ka, In

Bengaluru, Karnataka, India

In my current role, I lead strategic initiatives and drive operational excellence within the healthcare division. This includes a deep understanding of the industry landscape, including market trends, regulatory challenges, and emerging technologies. I collaborate with cross-functional teams to develop innovative solutions that enhance patient outcomes and improve organizational efficiency.Key responsibilities and achievements include:• Developing IT Strategy: Formulated an IT strategy to promote innovation and create tailored solutions for Healthcare and Life Sciences sectors, including Payers, Providers, Pharmaceutical/CROs, and Medical Devices.• Business Growth and Market Expansion: Contributed to the growth of business unit.• Digital Transformation and Cost Reduction: Led digital transformation initiatives and IT cost reduction based large deals, enhancing digital health, patient experience, remote virtual care, and value-based care (VBC).• High-Level Solution Design: Crafted solutions and articulated perspectives, offerings, and capabilities, presenting high-level pitches to executives to address client needs effectively.• Subject Matter Expertise: Acted as a Subject Matter Expert (SME) to support sales and delivery teams in the successful execution of projects.

Bengaluru Area, India

During my tenure at this organization, I led the development and execution of healthcare and insurance solutions tailored to the industry. I worked with diverse teams to enhance our service & solutions offerings, streamline processes, and ensure compliance with industry standards. Leveraging my expertise in the healthcare environment and insurance market trends, I drove initiatives that improved operational efficiency and elevated customer satisfaction.Key responsibilities and achievements include:• Revenue Impact: Managed the Healthcare and Insurance practice, generating over $15 million in revenue.• Corporate Strategy: Directed the corporate strategy for the services division with a focus on geographic expansion and growth initiatives.• Market Expansion: Developed and implemented strategies for entering new markets, including the integration of innovative technologies such as conversational AI, robotic process automation (RPA), and blockchain.• Blockchain Practice: Established a Blockchain practice from scratch, leading to the acquisition of new clients and the execution of targeted marketing plans for the services division.

Bengaluru Area, India

As a Practice Head, I am responsible for driving the strategic development, execution, and oversight of innovative healthcare and insurance solutions that enhance patient care, improve operational efficiency, and boost overall business performance. I lead a diverse team and collaborate with key stakeholders across the organization to identify market trends and create value-driven solutions tailored to our clients' needs.Key responsibilities and achievements include:• Market Entry Strategy: Developed and executed a market entry strategy, establishing and managing a Centre of Excellence (CoE) focused on Healthcare, Insurance.• CoE for Core platforms: like HealthRules (HealthEdge) and Facets• Subject Matter Expertise: Served as the Subject Matter Expert (SME) for presales activities and project delivery, creating proof of concepts, solutions, and frameworks in areas including core administrative services, Big Data analytics, mobile applications, customer experience enhancement, conversational AI, and digital initiatives.• Sales and Market Strategy: Partnered with sales teams across various regions to refine solution and service offerings and effectively implement market strategies.• Client Engagement: Conducted due diligence processes, workshops, and consulting projects to support clients and address their needs.

Austin, Texas Area

As a Management Consultant, I utilize specialized knowledge to deliver strategic advice and innovative solutions for Core Administrative Processing Systems (CAPS) such as HealthRules, to help Payers enhance operational effectiveness, drive growth, modernize legacy systems, and achieve their business goals. I work closely with clients to evaluate their workflows, identify improvement opportunities, and implement customized strategies tailored to their specific needs. My role involves comprehensive assessments to uncover strengths, weaknesses, opportunities, and potential challenges.Key responsibilities and achievements include:• Project Management: Led projects from start to finish, defining scope, estimating resources, drafting Statements of Work (SOW), identifying risks, and coordinating with leadership.• Strategic Advisory: Offered strategic guidance on business and project implementation, managing both onsite and offshore teams for effective project development and setup.• Client and Development Team Liaison: Served as the main link between clients and development teams during product creation, ensuring that client requirements were met.• Product Configuration and Deployment: Directed the configuration and deployment of products like HealthRules and acted as a Subject Matter Expert (SME) in requirement gathering, configuration, and testing.

Dallas/Fort Worth Area

Commercial Payer & MEDICAID Enterprise: Medicaid is state program based on title XIX of Social security act (1965) which is the largest source of funding for medical and health-related services for America’s poor people. Other major insurance providers are commercial payers. Payer system has complex claims processing and other ancillary systems to support HC Insurance. To assist states and commercial Payer manage their complex program and claims, HP has Healthcare Payer solution product customized to state Medicaid management programs or Commercial Health Plans which includes workflow, Rules engine, and Health care portal. Responsibilities:• Lead Project Teams as Lead Business Analyst/SME for integrated Payer solution for government and commercial health insurers.• Initiated process automation and customization using BPM and BRE.• Developed Business Architecture for Health Care Payer System and Health Care Portal System• Collaborated JAD sessions to Analyze as-is business processes and to-be process (gap analysis) leveraging Visio (BPMN2.0) and process modeling techniques• Established business documentation process & procedure for the company’s new strategy. • Documented high level and detailed Process specifications, designed process workflows, Test scenarios to facilitate requirement elicitation for the healthcare Payer application• Administered the management of tools like Borland Caliber-RM, Star Team and EA• Hands on experience with Provider, Portal, Claims, Multi-Payer, Benefit, Financial, and Security.• Coordinated overall business process for both onsite & offshore team.• Key member of strategy and methodology team to direct process and approach for Payer application.• MITA Assessment: Good knowledge of Business Architecture, Information Architecture of MITA 2.0 & 2.1 Framework.• Identified new opportunities in healthcare space like HIE, Telemedicine, ICD10, EDI5010

E-Medical Bill ManagementBill Management work for e-Medical includes sending the medical bills from e-medical locations to a Data capture vendor, mapping the Key from Image results, associating the bill to the correct Cause of Loss person on the claim, sending medical data to Medical Bill Review vendor, and displaying the reviewed results from Medical Bill Review vendor in the Claims Components application.Data Capture & Bill Review ProcessData capture and Medical bill review process (MBR) were the key process to support Bill management. Data capture converted the Paper to electronic format with help of external vendor which were adjudicated by external third party vendor (Mitchell International, Inc.) application called Decision Point®.Responsibilities:• Lead a team of 10 members as medical Bill type lead.• Redesigned & developed requirements for Medical Provider Matching & association to include the new National Provider Identifier (NPI). • Worked as a SME for the CMS 1500 (HCFA), UB92/04 (Institutional) & dental medical forms and bill review process.• Developed functional requirements, Use cases & UI mock-ups as per customer's business needs. Developed context diagrams & process maps for the business flow.• Prepared detailed instruction for a data capture vendor to capture data from paper bill.• Coordinated the requirements with the external vendor and internal development team & Medical Management Group.• Worked extensively on the EDI 837, 824, 275, 997 (X12) guides for electronic data interchange. • Proposed and created tools to generate claims (CMS1500/HCFA, UB92/04/Institutional & dental) both paper and EDI data for testing requirements which provided immense saving due to removal of manual process.• Coordinated over 6000 hours of work with the onsite-offshore model.• Prepared a white paper on ‘Medical Bill Review’ process for automobile bills.

New Delhi Area, India

Performed Research & Development for various organizations like LG, DRDO, and Anergy Instruments on DSP, Micro controllers, C, ORCAD, Assembler platforms.Responsibilities:• Analyzed the feasibility of the project, Implementation of designs and testing.• Implemented designs for Microprocessor subroutines in C, assembly and testing.• Involved in selection of electronic hardware and design of control circuits.• Designed and developed complete microcontroller circuit and its control.

M Tech, Instrument Design & Development

Be, Electrical

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