Management Health
Resume:
Mobile: 888-***-****
E-mail:*************.**@*****.***
DR. KARTHIKEYAN CG
Career Objective: -
To scale new height in field of Healthcare, impart professional knowledge & skills by being a part of organization that provides new avenues for growth & innovation.
KEY SKILLS SET
Healthcare electronic domain expertise with healthcare analytics. Also hold exceptional skills in computing and analysing financial records with the aid of computer software and programs and Sound knowledge of National Health Services clinical / non clinical flow. I have additional hands on experience on Coding using DRGs and AR-DRGs version 6.
Extensive experience in implementing policies and drafting guidelines for the operations of the facility. Expertise in quality and safety in patient centred care. Applied knowledge of current and emerging knowledge on the insurance Policy Underwriting and Claims process management and Worked for Payer / provider side billing i.e., claims generation and delivery, Reinsurance. Concrete understanding of Business Requirement gathering, Business Process flow, Business Process Modelling and Analysis, design documentation.
Excellent interpersonal communication skills and with the ability to manage stressful situations with clients
Predictive Analytics, Knowledge of Blue Button, Expertise in Healthcare Billing, Good Understanding of Lab Information Management system (LIMS) and Hospital information system (HIS), Payer-Provider platform and exchange data centre management.
Broad Knowledge in reviewing Test Procedures, creating Test plans and detailed test plans for UAT, Test scenario, defining Test cases, both System & Integration and executed many test cases Test Data reviewing and maintaining and executing detailed Test scripts for UAT, analysing bugs, interacting with team members in fixing errors and User Acceptance Testing (UAT) and also assisted in post –Production support. Worked on Black box and White box Testing.
Knowledge with ORACLE, MySQL SQLSERVER database with knowledge on SQL queries to run basic data report and export. Also knowledge in SCRUM / AGILE mode methodology and processed ‘X12’ and ‘HCFA (CMS1500), (UB42) ‘files for claim clearance.
Project management including planning, design and development, supervision, client/construction stakeholder liaison. Material technologies relevant to Healthcare I domain expertise with permanent member of HISA (Health Informatics society Australia
DR. KARTHIKEYAN CG Email:*************.**@*****.*** M:888-***-****
Professional experience-
S.NO
ORGANISATION
PERIOD
FROM TO
DESIGNATION
1
Nextgen Healthcare
From Jan 2017-Present
Senior Business Analyst
2
Ubic Health Ltd
Vizak India
From 3st June 2014- Dec 2016
Product manager
3
Re-medinet Techno Bangalore India
Dec.2012 to June. 2014
Functional Analyst
4
Ceva Healthcare
Sydney Australia
From Jun 2011to Nov 2012
Sr. Implementation Consultant
5
Madhevi General Hospital Bangalore India
Feb.2009 to Jan.2011
Medical Insurance Head/ Senior Medical Coordinator
Education
Masters of Health Service Management MHA (Health Informatics)
University of Technology Sydney [UTS], NSW, Australia 2012
Bachelor of Dental Surgery
Rajiv Gandhi University of Health Sciences, Karnataka, India 2009
Bachelor of computer application
Karnataka state open university Mysore, Karnataka, India 2014
PROFESSIONAL MEMBERSHIP
1. Permanent member of Indian Dental Association (IDA) - 2010 to present (ID- 81375)
2. Registered Permanent member of Karnataka state dental council -2010 to present (ID-264521 A)
3. Temporary member of Australian Dental council-2012 ref no: Z11/429
4. Member of ACHSM (Australian college of Health Service Management)-2012
5. Temporary member of HISA (Health Informatics society Australia)
WORK EXPERIENCE (NATURE OF JOB)-
Senior Business Analyst (RE) Jan 2017-Present
Currently working on Healthcare analytics on Population Health on Nextgen Ambulatory Care System
Currently working on analysis of population Health HMO project in United states as a Product owner.
Office in IRVINE CALIFORNIA, we work with US counter parts on understanding the requirement, creating backlogs and align them with sprints.
Worked on products such as Entrada, Medi-touch, EDI, Via tracker, QDW and KBM.
I have also used tools such as swagger to build in FHIR API for QDW application for appointment scheduling.
Some of my roles involve Proactively engage with onshore on requirements related matters, and act as a liaison between onshore and offshore
Ability to translate unstructured business issues into organized business requirements
Develop functional design document and Effectively document technical system requirements into a high level process workflow document using Confluence and Balsamiq
Assist development in building technical design documents and development phase
Key stakeholder in defining testing road-map while working with Front end team, Product Architect and User Experience
Assist testing team in building test scenario and test case and help with test data set-up and test case execution.
Coach testing teams on quality and domain concepts
Product Manager
Healthcare IT solutions Ubic ltd Vizak India June 2014-Dec 2016
Contributed to the development of multiple products focused on East African and Nigeria market of healthcare. Products namely 1. Payer provider health insurance platform with portal connecting the stake holders, 2. Hospital management system with e-mobile EHR integrated and 3. The payer provider Bio-Smart card with integration Savannah informatics Ltd platform. These platform was developed end to end following the agile methods of SDLC process wherein undertook research and development activities including the identification, development and communication of relevant innovations, to facilitate the provision of quality and commercially smart solutions to meet the end user and client.
Responsibilities
Product R & D
Product and its P and L statement
System Concept Development
Product Design, Development & Delivery
Product & Project Implementation
Customer Relations Management
Team Management
Pre & Post-Sales Support
Market Analysis
Hiring and Training
Achievements
Contributed to the review and development of application Standards, User Manuals. The documents were made user friendly and clearer with more sketches and diagrams which helped the clients to better understand and apply the information, significantly reduced queries from the clients hence increased overall efficiency
Involved in the product design and development of the system Architect with the CTO of the company to develop one of Africa biggest exchange platform with flexible features. their successful installation on the Hospitals and GA insurance Kenya, resulting in a Ubic Ltd first and project completion to all client scope, time budget and performance specifications, notwithstanding Quality and Client Sign off.
Bought about two system integration with web services flow namely with a three way integration i.e. Health insurance platform to Savannah exchange to Hospital management system. This was the first of its kind integration to the three entities, the Payer, exchanger and the Provider.
The above helped to reduced turnaround time, hospitals could ensure that the patient is discharged as soon as the treatment and the recuperation time are over. They do not have to wait for confirmation from the insurance companies about the claim settlement which usually takes 4-5 hours. With faster discharge, there is optimum utilization of beds available at the hospitals thereby enhancing their profitability.
Senior Product Owner (Payer side)
Project: The Blue shield and General Michigan HIPPA EDI Project was about conversion from 4010 to 5010. BCBSM initiated three phases of testing to pass and validate the 4010 to 5010 conversion. The project was based on testing the 310 partners for the BCBSM and working with 3 types of Trading Partners comprising validation of Professional, Institutional and Dental 837 Transaction. Prior to the submission of claims to the BCBSM the analyst monitors the 3 step of test process that software should pass. Testing in validator, which is a self-testing tool that checks Level 1-6 based on requirements from the ANSI ASC X12N. Testing in Subsystem, the claims will process against our production stream while in a test environment returning the response files same as they be returned in Prod environment and Testing in End to End Production files received “P” test files and go through 5010 Process. Conduct in depth pharmacy claims and data analyses to monitor Medicare Part D Pharmacy. Payers would be BCBSM, FEP, Blue Care Network, Medicare Advantage, Medicare A, B and D, and Medicaid.
Responsibilities:
Locate the 837 transactions and reports in the file that are in error and validate the data in the transactions. Dealt with the 837 and 835 ANSI X12 transaction
Experience with AGILE Tool and worked with Six Sigma methodology.
Experienced with HIPAA – 4010/5010 standards
Monitor Medicare Part D PBM contract including, but not limited to, rebate amounts, claim pricing and benefits, formulary coverage/tiering application and contractual performance measures. Performance measures include validation of claim adjudication accuracy from both a pricing and benefit perspective. Participate in User Acceptance Testing to ensure system corrections are accurate.
Functional Analyst
Re-medinet technologies, India Dec 2012 – 2014
Re-medinet is India’s no.1 Payer-Provider platform with huge market presence both in payer and provider side. The company had three teams and I worked for the Product Functional team which focused on platform management, various project management with clients, Maintains and service management with stakeholders and the team was primarily responsible for SRS FRS and techno-functional designs and delivery and R&D with product enhancement. I also contributed in terms of Health-Economics research because of my sound knowledge of different healthcare environments globally.
Responsibilities/Work Activities
Product & Project Implementation
Requirement Gathering & Gap Analysis
Software Solution Functional QA testing
Pre & Post-Sales Support
Evaluating Project Risk, Time, Cost & Quality
Customer Relation Management
Hiring and Training
Team Management
Product Functionality Enhancement
Technical support to aid in software development
Projects worked and Achievements
Chief Minister Comprehensive Health Insurance Scheme (CMCHISTN)
Client – Tamil-Nadu State Government – Chennai, India
Contributed with the team in developing functional modules such as Member Enrolment and Online Verification, Online Empanelment, Zone Group Management, Package Management, Auto MIS, Automated e-Payment system, Online Health Camp Management
Revenue Cycle Management & Centralised Claim Validation
Client - Client Hospitals across India
Contributed with the team in developing functional modules such as Online and Offline Claims Management with Semi-Automated Centralized Claim Validation, courier Management, Query Type / Denial Type analysis, Auto-Email Alert Mechanism.
Vajpayee Arogyshree Health Scheme
Client - Karnataka State Government India
Produced several technical advice reports for service and delivery management of Integrated Member Verification, Online Empanelment, e-Payment system, Online Claim Validation, Automated reporting system, Online Health Camp, Automated e-Payment system
Prepared several scopes/design briefs for clients for refurbishments and renewal options reports and analytical reports to ensure the reporting engine and data integrity of information is comprehensive and accurate.
Kingsgate community based Health cover Nigeria
Client – Kingsgate med-solutions Nigeria
Contributed with the team in developing functional modules such as Capitation module, claims management, fee for service management of funding, e-Direct claims, e-payment with cheque and offline payments record.
Also designed the complete integration between the insurance system and their financial system so as to process the remittance process without any manual interpretation.
Handled the complete SRS, FRS documentation and end to end design and sign off the project during my work period in the company.
Linda Jamii -- Changamka Microhealth Ltd
Client – Changamaka Microhealth Ltd Kenya
Changamka Microhealth (CMH) is a Kenyan integrated health financing mechanisms for delivery of affordable healthcare to the low-income market using innovative technologies such as mobile phones and smart cards. Changamka (through subsidiary Changamka Microinsurance Ltd) partnered with Britam(Insurance company) and Safaricom (Mobile provider)to form a consortium which resulted in the Linda Jamii Product application development.
Handled the complete SRS, FRS documentation and end to end design and sign off the project during my work period in the company.
Headed the implementation of the project in Nairobi Kenya and end user training with successful implementation of the same.
Healthassyt – Checkin-Radioassyt-US client
Client – Healthassyt Microhealth and community Outpatient check-in
Healthassyt is a division of Healthsprint networks now a company of its own. Had a team which worked on checkin assyt app and radioassyst application which was involved in outpatient automation for check-in process for patients. Also worked on products named radioassyst, which is focussed on radiology department streamlining scheduling and waiting period time management
Handled the complete SRS, FRS documentation and end to end design and sign off the project during my work period in the company.
Headed the implementation of the project in Nairobi Kenya and end user training with successful implementation of the same.
Junior Implementation Analyst (Full time and Intern Part time) June 2009- 2011
Ceva Healthcare- USA & Australia
Job- Responsibilities
Worked as Jr implementation consultant, well versed with the company’s different products (SCM, SMM, ED, Ambulatory, Clindoc, etc.)
Participating different projects at a time and coordinate with the North American’s counterpart.
Requirement gathering, analysis & validation of different process & tasks during the Implementation cycle.
Also as a SME facilitating Knowledge transfer to new team members and ensuring quality deliverables meeting client expectations.
Involved in the projects like- S2V (Speed to Value) for unit testing, functional testing
Get worked done through Report & MLM writers & then testing these Reports & MLM before delivering to clients.
Taken care of project timelines along with the quality of the work which always exceed client expectations.
Incident Management including tasks
On-site Responsibilities-
Client sites –visited multiple times for configurations & activations support having very good experience with the client requirements & have successfully implemented the solutions.
Hospitals- to train the hospital staff like physician, surgeon, residence, nurses & pharmacist about the product, discuss with them to implement new things with hospital’s current functional environment.
Handle multiple clients from requirement gathering, analysis to go live including activation support in the Australia
Work with South counterpart and send work to Indian and Kenya office & get it done.
Worked at Sydney, South Australia with the clients.
I.Dental Care Center (Associate Dental Surgeon) Feb 2008 – September 2010
1. Investigation, Diagnosis and formulation of a treatment plan.
2. Performing extractions, root canal treatment, restorative, preventive work and Counseling on tobacco cessation
Training/Certification:
Sunrise Acute Care Documentation (Clinical Documentation)
Indian Dental Association (IDA) - 2010 to present (ID- 81375)
Registered to Karnataka state dental council -2010 to present (ID-264521 A)
Australian Dental council-2012 ref no: Z11/429
ACHSM (Australian college of Health Service Management)-2012 no; k20091986
Personal Details:-
Date of Birth: - 16th May 1980
Linguistic skills: - English, Hindi, Tamil.
Marital Status: - Married
Address: - 201. Sogo nest apartments, no4 ramkrishnappa road cox town, Bangalore.
DATE: Yours Faithfully
PLACE: Bangalore Dr. Karthikeyan CG
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