Email ID: adlp7u@r.postjobfree.com Location: Pune

Contact No: 981******* Date of Birth: 15-09-1989

Career Summary:

Have rich experience in both clinical and non-clinical field. Have worked with both Payer and Provider. Have done dental practice for a year and a half after which I pursued MBA in Healthcare Management. I started working with Medanta – The Medicity Hospital as an IPD manager. Later, I joined insurance industry and worked in different TPA’s under various managerial & functional roles. Presently I am working with Cotiviti India as Business Analyst – Healthcare in Pune.

Work Experience: 2 Years and 5 Months

Organization

Designation

Duration

Job Role

Cotiviti

Business Analyst

Aug 2019- Present

To analyse, document, communicate, collaborate and manage requirements set by clients

Coordinating with US research team to manage accuracy and updating payment policy library

Responding to research related queries pertaining to ICD codes and medical policy raised by client

Creating a BRD and locking the stories on project management tool Jira

MD India TPA

Business Analyst/ Manager - Operations

Nov, 2017 – July, 2019

Gathering information and analysing business requirement by making workflow analysis

Managing reimbursement claim processing of big corporate client accounts.

Supporting team during functional validation and deployment of solution

Key member of Fraud control and analytical team

Identifying new methods of cost control, analysis of daily reports

Medi Assist Healthcare Pvt Ltd

Team Lead – Business Development

Nov, 2016 – Oct 2017

Pitching for business – insurance and wellness - in public sector units.

Maintaining the quality of service to retain the existing business.

Medanta - The Medicity Hospital, Gurgaon

Assistant Manager – Admin

April 2016 - Nov 2016

Managing daily operations in the department.

Audit for quality control in IPDs

KPMG

Intern

3 Months

Secondary research and Market Screening activities

Dental Clinic

Dentist/ Clinic Manager

1 year

Clinical Practice

Job description:

Organization: COTIVITI INDIA PRIVATE LIMITED

Job Objective: Auditing claims of US Healthcare and Researching on error free payment gateways

Designation: Clinical Content Analyst

Key Responsibilities:

1.To analyse, document, communicate, collaborate and manage requirements set by clients

2.Understanding and translating user business requirement into detailed functional design for development and implementation

3.Supporting team during functional validation and deployment of solution

4.Taking Sign off from Policy owner before the task goes into production

5.Responding to research related queries pertaining to ICD codes and medical policy raised by client

6.Coordinating with US research Medical director to manage accuracy and updating payment policy library

7.Contributing in designing test strategy, test plans and making use of SQL to test the business logic.

8.Reviewing test plans, test cases and defects of the testing team

9.Support quarterly and annual updates in ICD codes in collaboration with US research medical director

Organization : MD INDIA HEALTH TPA PVT LTD

Job Objective: Operations manager – Managing corporate portfolios with end to end claims settlement

Designation: Manager

Key Responsibilities:

1. Manage corporate claims processing team independently

2. Gathering information and analysing business requirement by making workflow analysis

3. Supporting team during functional validation and deployment of solution

4. Key member of Fraud control and analytical team

5. Handling big Corporate clients like IBA, LIC, CITI Bank, ICAI, SAIL with business of >100cr premium

6. Grievance handling and maintenance of settlement TAT of claims

7. Identifying new methods of cost control, analysis of daily reports

8. Initiate process enhancement for improving daily processing

9. Conducting key user training

10. Daily manpower planning and monitoring team production

11. Managing grievances from IRDA/ Ombudsman/ Insurance companies and resolving them

Organization: MEDI ASSIST HEALTHCARE PRIVATE LIMITED

Job Objective: Business Development - Pitching for business – insurance and wellness - in public sector units.

Designation: Team lead

Key Responsibilities:

1. To pitch for business by connecting with the Insurers/ Agents.

2. Engagement with the Insurer to plan various activities like agents meet, heath camps for staff as well

as for customers.

3. Conducting presentations to explain the know- how of a TPA and claim processing technique,

Usage of technological advancements offered by Medi Assist.

4. Collecting feedback and planning strategies for improvisation.

5. Planning strategies for improvisation and retention of existing business

Organization: MEDANTA - THE MEDICITY HOSPITAL, Gurgaon

Job Objective: To ensure the smooth functioning and coordination of inpatient services.

Designation: Assistant manager HR And Admin

Key Responsibilities:

1.Solve real-world challenges with modern theories of leadership, management

2.Act as liaisons among governing boards, medical staff and department heads.

3.Develop procedures for quality assurance, patient services.

4.Medical Record audit and checking completeness of Medical Record File.

5.Achieving key performance indicators and Coordinating ward unit performance.

6.Addressing patient problems.

7.Providing refresher trainings to nurses, doctors, ward secretaries.

8.Taking Soft skill training sessions for staff and new management trainees.

Summer Internship Projects:

Organization: KPMG, Delhi

Job Role: Analyst - Infrastructure and Government Services, Advisory Management Department

Industry: Healthcare Consultancy

Duration: 3 months

Project 1 Title: Business plan for setting up a hospital and Centre of Excellence in a Tier II city.

Brief: Performed Market Screening activities for medical education, medical research and overall healthcare market in India including healthcare infrastructure and human resource demand-supply gap assessment across primary, secondary and tertiary service areas; identified opportunities and threats in catchment areas.

Project 2 Title: Feasibility Report involving supporting research for development of Public Private Partnership (PPP) Super speciality Hospital in Tier II city.

Brief: Performed supporting research activities covering country comparison for healthcare scenario, India’s healthcare policy and performance and assessment of existing super speciality hospitals.

Achievements & Recognition:

Prepared proposals and presentations to get business for wellness from Govt banks in TPA.

Have taken soft skill training sessions within my work organisation.

Demonstrated leadership in planning and organizing academic, and professional activities.

Have been a part of JCI Audit and Quality Assurance Committee in Medanta hospital.

Managed a team of 50 people to ensure smooth functioning of operations on the IPD floor.

Appointed students’ committee head of the ‘Academic Committee’ of Batch of 2014, SIHS

Awarded Best Scientific Poster Presentation in Intercollege Poster Competition, 2013, Subharti University, Meerut.

Educational qualification:

MBA – Healthcare Management (2014-2016), from Symbiosis, Pune with GPA of 9/10

BDS (2007-2012), from ITS – CDSR, Meerut University

10+2 (2007) from Manav Sthali School, Rajinder Nagar, New Delhi

Class 10 (2005) from Manav Sthali School, Rajinder Nagar, New Delhi

Additional Skills:

Computer Proficiency: Microsoft Office, JIRA, SQL, Oracle, SDLC, Agile

Languages Proficiency: English, Hindi, Punjabi

Others: Quick learner; good communication and presentation skills; team player.

Date: 01-03-2021 Location: Pune

Contact this candidate