Medical Billing Business Analyst
Resume:
MANOJ GHADIGAONKAR
************@**********.***
Knoxville, Tennessee 37923
"BUSINESS ANALYST, MEDICAL BILLING & CODING SPECIALIST" - US Healthcare I am working as Healthcare professional and dealing into health payer business & provider business. I have US B1 Visa & I have carried out multiple transition for new Clients & supported implementation handover activity. I have completed CSM
(Certified Scrum Master) Certification from Scrum Alliance which helped me to lead Development team multiple projects. I am also demonstrating LEAN SIX SIGMA expertise as I am Green Belt certified by ASQ (American Society of Quality). Enthusiastic and Innovative to run business at next generation level to automate the processes which will lead to high performing business.
WORK EXPERIENCE:
Sr. Business Analyst with CitiusTech Healthcare Technology Pvt Ltd. – Knoxville, Tennessee – May 2019 to Till Date. Responsibilities:
• Working as Product Owner & helping for Product goal setting and the creation of a vision for product development.
• As Product owner responsible for the generation and management of the list of work to be completed by the development team. This involves writing product backlog items along with acceptance criteria and ordering them to achieve the product vision.
• As Product owner I would be accountable for good economic decision-making during development at the sprint, release and product level. Cost/benefit of each product backlog item can also be used to determine the ordering of work.
• As Product Owner closely working with Development team & provide vision for Business workflow which help for product solutions & understand Business requirement to developer. As Product Owner I am key participant of development events including planning, refinement, review, retrospective, the sprint and daily scrum.
• During planning activities, I am coordinating with stakeholders to determine the content and steps required to deliver the next iteration at a sprint, release or product level.
• By conducting weekly refinement sessions, I coordinate with the development team to define, elaborate, estimate, order or delete product backlog items.
• As Product Owner leads reviews to ensure the product increment is examined in the optimum way to elicit feedback and determine the route forward for development.
• During retrospectives, I collaborate as part of the team in determining and selecting improvement actions.
• During the sprint, I coordinate with Scrum team, including answering questions and accepting product backlog items as they are completed.
• I attend daily scrums to coordinate and collaborate with the development team on development work being performed within the sprint.
Sr. Software Engineer / Sr. Business Analyst with Allscripts Pvt Ltd. – Pune, Maharashtra – August 2016 to May 2019. Responsibilities:
• Working as Project Manager conducting Transitions of new Clients & supporting implementation activity of Allscripts Products in Client environment.
• Managing entire Business Operations end to end for US Healthcare Payers & Providers.
• I have carried multiple Client demo & provided Business presentation to Client for our Sunrise product.
• I am closely working with Sunrise Development team & provide vision for Business workflow which help for product solutions & understand Business requirement to developer. So, we have developed BI Tools & Web Applications I.e. Sunrise Clinical Performance Management & Sunrise Financial Performance Management.
• I have exposure to prepare system delivered BI reports as well as custom delivered BI reports which helps to maintain operational dashboard & provide overview of business stake holders.
• Handling product defects & Triaging it to Change Control process, so we have Bug fixes or hot fixes delivered in form of PR & CU.
• Preparing custom reports for Client by SQL queries from Report writing team. Preparing reports for Senior leadership & Operational team & providing strategic decision to streamline revenue workflow by running analytics on data.
• Seeking scope for automation & enhancement of system to provide dollar saving to Client or organization.
• Strong expertise into maintaining the system configurations insurance master config, transaction master config, Bill Codes & Edits, Room & Event Charging.
• Demonstrate expertise in creating automated workflows from Financial system which we can schedule as Job and receive output at scheduled location or perform action like Nightly Billing or Charging.
• I have expertise into maintaining Financial system Job dashboard and monitor them and cascade the system logs for further analysis in case if we receive any failure alter or error.
• Managing EDI Batch File repository and provide update to Client how many Claims are sent out for billing & also maintain ERA processed by system in case any issue happens we check the Header & segment of electronic remit.
• I have strong knowledge of US multiple i.e. Commercial & Federal Payers. In different area, such as Claims, EDI Transactions, Medicaid/ Medicare, Clearing houses, Payment processing & integration of Third-party vendors.
• I have strong knowledge of Functional testing, Regression Testing, UAT (User Acceptance Testing) & Integrated Testing. Creating testing cases also creating automated workflows to perform test steps so manual efforts are reduce which lead to FTE saving & $ saving.
Business Analyst with Accenture Services Pvt Ltd. - Mumbai, Maharashtra - August 2014 to July 2016. Responsibilities:
• Handling Client call. Managing transition of new processes.
• Managing Inventory. Forecasting of resources & managing their utilization.
• Training resources accordingly so the skill matrix is maintained. Creating knowledge sources such centralized knowledge bank or share point which can be accessed by internal & external stake holders.
• Assigning the workload to team members & managing to complete it within committed SLA's as per TAT and Quality parameters.
• Financial planning of business by calculating resource utilization against available work volume &researching for new scope of work queues which can lead new process formation.
• Conducting one & one session with team members resolving their queries guiding them for new career opportunities.
• I have strong knowledge of US multiple i.e. Commercial & Federal Payers. In different area, such as Claims, Member Enrolment Process, Medicaid/ Medicare, On-Exchange & Off-Exchange, Plan product, Membership maintenance.
• Working on RCA for errors citied & trying to build CAPA (Corrective Action & Preventive Action) plan for its, we can deliver business at high performance.
• Working on Automations, Innovations & Customizations so the business is accelerated and run with emerging ideas of next generations which lead to unique work delivery system.
• Working on challenges & risk management so the process is run smoothly & minimal risk.
• Working on claim processing, claim pre-processing, Pricing, Financial Operations I.e. Invoicing, Billing & Payment, Triage Queue, Adjudication.
• Working on Provider data management i.e. assigning Provider to Policy as per PPO or HMO network. Accomplishments:
• I have given $1 Million saving to Accenture by Automating the process workflow which lead to process improvement & increase in efficiency.
• Successfully completed transition on new sub processes leading to new work scope.
• Working with client to fix system & network errors so there is delay in rendering services to end customer.
• Working with teams of both locations Manila & Mumbai and calibrating them so team from different location can work on standard SOP.
• Maintaining quality percentage as per SLA and rebutting all the errors incorrectly charged to team. Skills Used:
• Work with all analytical skills to run process smother & with high performance.
• Training team members & educating them, so they are skilful to complete assigned task.
• Generating new ideas to automate the business so less head count and minimal manual intervention is needed resulting in high quality work delivery.
Quality Analyst with Gebbs Healthcare Pvt Ltd - Mumbai, Maharashtra - September 2013 to August 2014. Responsibilities:
• Working on monitoring the quality of different processes.
• Conducting training for all the team members and educating them to upskill them.
• Working with Transition team establish new process and making them stable.
• Assigning the quality samples to other QA and monitoring their quality by cross audit.
• Working with operations team to complete their assigned inventory resolving their queries.
• Handling client call & assisting client with current status and progress of work.
• Working with client to customize their system as per the requirements so work can be delivered with high-quality and performance. Accomplishments:
• I have established many processes of multiple states of US completed their transition successfully.
• Monitored the quality of Anaesthesia process which was at high risk & achieved the quality SLA successfully.
• Worked on Sports medicine and orthopaedic practice and increase their revenue by monitoring payment posting and performing billing analysis.
• Worked on departmental analysis which help provider (Doctors) to know CPT is highly paid under which department and which procedure is inappropriately paid.
Skills Used:
• Worked on Quality skill to monitor the quality of different process.
• Worked on CAPA (Corrective action and preventive action plan) to prevent erroneous processing.
• Trained multiple teams on different projects & processes.
• Successfully applied transition skill to stabilize new upcoming business. Medical Billing & Coding Senior Specialist with Caliber Point Business Solutions Pvt Ltd. - Mumbai, Maharashtra - March 2011 to April 2013.
Responsibilities:
• Allocating the work to all Team members & taking care of assigned TAT by Client for work delivery.
• Maintain all the production logs, inventory, excel reports & all Client’s data.
• Performing the QC of Charge capturing, Denials, Payment Posting, Resolving Clearing house rejections & submitting them to respective insurance company.
• Working on different aging buckets & reducing the AR of all practices. Accounts Receivable follow-off.
• Diagnosis code & procedure code finding physician billing practices.
• Coding for Internal medicine, Surgical centres, Radiology Services, Gynaecology services, Pathology Services, Cardiology Services, etc
• Charge capturing, generating electronic claims, paper claims & transmitting them to respective insurance company.
• Payment posting, EOB posting, creating patient statement. Preparing query log & resolving queries.
• Maintaining data of patients in electronic EMR tool and also Indexing the medical records of all patients as per the specialty.
• Accounts Receivable follow-off working on aging buckets to recover the aged revenue of different practices by analysing denials
& rebilling the claims.
Medical Billing and Coding Senior Associate with Southside Healthcare Solutions - Mumbai, Maharashtra
- March 2008 to March 2011
Responsibilities:
• Working on Charge entry of internal medicine & Obg-Gynaec practices.
• Working on Payment Posting on internal medicine & Obg-Gynaec practices.
• Working on Denial Management of different practices by recovering the revenue from aged buckets.
• Working on the Medical coding of Internal medicine practice performing coding of Diagnosis & procedure performed by provider.
• Working on Patient statement which helps to provider recover his revenue from patients.
• Working on Medical records Indexing in EMR software which facilitate the provider to categorize there document as per the specialty.
• Working on Rejected claims forwarded by clearing house & resolving the errors due to which claim was not transmitted to payer. Accomplishments:
• Working on Charge entry facilitates the provider to claims their medical Invoices in timely manner due to which revenue flow was increasing.
• Working on Payment posting facilitates the provider to analyse the growth of multiple departments of multiple specialty.
• Practice analysis helps the provider to understand by billing which CPT code provider can maximum revenue under different medical
& pathological conditions.
• Working on Patient Statement helped the provider to recover the revenue from patient which is not paid by. Insurance Payer as patient responsibility.
Skills Used:
• Utilized medical terminology skill to perform medical coding.
• Worked on Analytical skill by performing departmental analysis which gives notification to provider about revenue collection of his various department.
• Payment posting helps provider to understand how much the revenue flow & which CPT code is are getting paid appropriately. C.S.S.D Technician with Lilavati Hospital and Research Centre - Mumbai, Maharashtra - July 2006 to July 2007
Responsibilities:
• Managing & Operating of all types of Sterilizer of any made
• Keeping Inventory of Surgical Instruments implants, Green linen Etc.
• Quality assurance and quality control of Dressing materials, Surgical instruments Implants & Greenline Etc.
• Can prepare any surgical instruments sets for all departments such as Orthopaedic, Neuro, CVTS, ENT, Ophthalmic, Gynac and General Surgery, Etc. Assisting surgeries to Surgeon of all specialty.
• Specialty in keeping Inventory of Ortho, Craniofacial, Maxillofacial implants.
• Dealing with companies for Consignment of Instruments Implants and Suture Materials Etc.
• Complete knowledge of Human Anatomy, Medicine, Diseases, Pathological condition. EDUCATION:
• Post Graduate Diploma in Clinical research in Clinical research is study, conduct trial of new drug & marketing as well as post marketing survey of new drug molecules from AICMS Business School - Mumbai, Maharashtra in 2006 to 2007
• B.Sc. in Microbiology from Mumbai University - Mumbai, Maharashtra REWARDS RECOGNITION:
1) Awarded Star Performer by Caliber Point in Jan 2013. 2) Awarded Good Samaritan by Accenture in Dec 2014. 3) Awarded Numero Uno by Accenture in Jan 2015.
4) Awarded GEM Award by Allscripts in Oct 2017.
5) Awarded SPOT Award – Extraordinary People by Allscripts in Oct 2017. 6) Awarded SPOT Award – Business App Monthly Award by Allscripts in March 2018. 7) Awarded PEER APPRECIATION Award by Allscripts June 2018. 1
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