Project Management Customer Service
Resume:
*************@*****.***
Fremont, CA 94538
Skills
Technical Skills:
Business Modeling Tools: EPIC, SAP, Tableau, MS Visio, UML, Rational Rose, Rational Requisite Pro, ALM Requirement Management, SharePoint, JIRA, CISCO WebEx,
Healthcare Systems: EPIC, SAP, Facets 4.81, QNXT 5.00, QUICKCAP 7.0, Advanced M.D (EMR, Billing, HRSA FQHC Billing
Certification: RHC (Rural health Clinic)
Methodologies: Rational Unified Process (RUP), SDLC (Waterfall Method, Agile Methodology, Iterative Waterfall), Six Sigma
Microsoft Tools: Microsoft Azure, MS Teams, MS Word, MS Excel (SD, Vlook up), MS PowerPoint, MS Project Server, MS Outlook, MS Visio, MS Office,
Team Leadership
Customer Service
Teamwork and Collaboration
Problem Resolution
Verbal and Written Communication
Goal Setting
Education And Training
01/2018
Masters:
Health Administration
MCPHS University
Boston, Massachusetts
01/2011
Bachelors:
Dental Surgery
Dharamsinh Desai University
India
Vidhi Thakkar
Summary
Strong project management skills with experience in organizing planning and executing large-scale projects from vision through implementation Lead the process of CMS Mandate Price transparency Project for Critical Access Hospitals at my current role at Wipfli LLP consulting firm. Excellent client-facing skills and history of significant client exposure (internal within your organization or external) Current work experience in a healthcare management consulting firm and/or a combination of industry and consulting experience Prior healthcare leadership in a County Hospital negotiating managed care contracts and project management Experience in reviewing Chargemaster pricing and utilizing financial modeling against Medicare Cost Report Experience delegating to and directing others in the effective execution of a project plan Experience managing the quality of a team's work product and producing “client ready” deliverables. Excellent negotiating skills, leads with respect and servitude that is key for fundamental growth and success. Critical thinking, analytical and worked a s a strong negotiator for contract inpatient and outpatient rates for hospital after the analysis based on Medicare Physician Fee Schedule economic index factor which derives based on inflation factor
Experience
WIPFLI LLP - Manager
01/2022 - Current
Revenue Cycle Management/Contracts,
Lead the CMS Hospital Price Transparency Solutions team for clients who are critical based hospitals by reviewing the CDM submitted
For Machine Readable template contract review and payer matrix review, creating fee schedules and running them through the Azure Database and development of machine readable and shoppable template solutions
Demonstrated the project management with clients in Successfully negotiating contracts for hospital /Outpatient facility with payer based on Medicaid and Commercial contracts
Clients with Behavioral health facilities, Critical Access Hospitals contracting with provider and payor sectors, review of managed care contracting strategies, negotiating of contracts including contractual obligations to reduce costs and generate revenue for the client based on Medicare reimbursement
Collaborated with the different teams for RHC project which included reviewing their clinic fee schedules and payer matrix for improvement in the patient access, including contract payer matrix detailed review for fee schedules based on the sliding fee schedule for RHC
Payer Contract Modeling
Analysis of models of Managed Care
Review contracts based on the contractual obligations like Utilization Management and prior authorization audits for Compliance
Reviewing Charge Master and Medicare and Medicaid reimbursement consulting
Provider-based clinic versus provider-based rural health clinic (RHC) analyses
County of Santa, Santa Clara County Health and Hospital Systems - Healthcare Contracts and Analytics Manager
04/2019 - 11/2021
Review Contracts from multiple entities desiring to contract hospital or physician services from Santa Clara Valley Medical Health and Hospital System
Perform program and cost analysis and market research on a variety of hospital, clinic, medical group and health related projects as needed and on an on-going basis
Perform cost analysis of inpatient and outpatient hospital and physician services
Developing and negotiating commercial and Medi-Cal contracts with HMO; s, PPO, working on non-contracted letter of agreements, transfer agreements for hospitals and payors, MSOs, also with out of county hospitals
Coordinate with various hospital departments to ensure contract compliance including utilization management, case management, claims, billing, admitting, and finance;
Identify revenue producing opportunities for hospital and physician group within healthcare community;
Act as primary contact/liaison for operational problem between hospital departments and health plans;
Worked on SAP module for healthcare contracts B5Y processes for county contracts and procurement
Provide in-service training to other departments relative to contract implementation; -Serve on inter-departmental committees on a regular basis and ad-hoc basis for contracting, planning, and marketing related activities;
Prepare Request For Proposals for vendor selection for SCVH&HS and other county agencies; -Facilitate the selection process of outside vendors and negotiation and preparation of contracts with such vendors;
Identify program problems, determines appropriate action and makes recommendations for problem resolution; assists in the implementation of program enhancements and service improvements;
Analyze and interpret existing, new and proposed legislation for cost and program impacts;
Worked on Tableau for analysis of Medicare cost reports and cost analysis for rates of hospital negotiations – Did Tran Analysis to evaluate all the patient data, admitting dates and hospital discharges for patients
Excel MSO, Independent - Configuration Management Analyst
10/2017 - 03/2019
Overseeing, implementing and maintenance of provider system agreements, fee schedules, financial risk with payers, providers and facilities and related processes; and work with various departments in order to ensure that system agreements are in line with provider contracts and amendments
Monitoring end-to-end pricing (DOFR, fee schedules, provider) configuration to identify, report and track potential issues that could affect claims outcomes and the claims don't go out of compliance and policies
MANAGED CARE – Perform analysis of actual payments to contracted terms and fee schedules
Perform analysis of denials and identification of internal issues impacting reimbursement
Work with revenue cycle team members to improve efficiencies and reimbursement
Monitor risk pools and incentives as defined by contracts
Project incremental reimbursement associated with performance
Working knowledge of QUICKCAP claims processing software
Responsible for maintaining a comprehensive knowledge of all regulatory and IEHP requirements, including Policies and Procedures, DOFR, IPA reporting requirements, related to Delegation Oversight and IPA delegated responsibilities
Reviews current benefit and DOFR configurations and suggests improvement processes to ensure systems are working more efficiently and improve quality
Configured and maintains provider contract reimbursement, financial responsibility tables and benefit options
Initiate benefit configuration to include: load HP EOC benefit options i.e., co-pays, non-covered services and exceptions
Provider Contract interpretation on Medicare and Medical fee schedules
Maximize reimbursement by analyzing payer contracts, understanding, and analyzing government regulations and reviewing and analyzing payments for correct billing and correct payments from payers
The Reimbursement Analyst will understand and be able to interpret reimbursement methodologies, billing and medical language so that effective analysis is provided
Strong critical thinking and analysis skills; verbal and written communications, and interpersonal interactions (e.g
Partnering, conflict management, consulting, etc.)
Understanding of professional and hospital reimbursement methodologies, including medical terminology, and working knowledge of CPT, HCPCS, ICD-10, and ICD 910 codes.
Blue Shield of California - Business System Analyst
Sacramento, CA
04/2017 - 06/2017
As a BSA, was working under Care1st Member Migration, of Blue Shield of California and Care1st Health Plan
In the Member Migration responsibilities include oversight of all business and system activities necessary for successful migration of all members into Facets Database, which is a large scale, complex, and system-wide initiative including people, process and technology impacts related to the Care1st Health Plan migration to Blue Shield of California Core Facets and Ancillary Systems
Responsibilities
To write requirements based on meetings with business partners to support member migration and Care1st integration
Was working as a requirement analyst for supporting requirements gathering and facilitation to generate a BSC vBRD to pass to IT and configuration to support development
Provides complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
Conducted extensive analysis on migration and conversion of Provider and Member data, Group configurations, plan codes, benefit set-ups, fee schedules, provider pricing, capitation set-ups on Facets
Defines complex business requirements and provides analysis toward operational efficiency by conducting CISCO WebEx sessions and JAD sessions with IT and Configuration to coordinates with internal and external stakeholders
Made presentations to various levels of management
Works under limited supervision, using established procedures
Advanced knowledge of and ability to perform analyses such as, GAP analysis, process mapping, root-cause analysis, risk analysis and requirements gathering
And making BRDs, and walkthroughs internally with BSC and externally with Care1st Health Plan
Having a good experience and knowledge on Facets Core Applications such as Subscriber/family, Claims Processing, billing and Provider, PCP assignment
Very well experienced with ALM, involved in writing the Requirements on ALM and REI (Requirements Elicitation Integration) and prepared Requirement Traceability Matrix(RTM) in the Requirement Management in ALM
MS Office Suite, MS Visio JIRA, SharePoint and MS Project software.
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