Parag S

·       Managing a team size of 9 members for complete digital transformation of claims processing including:

·       Requirement gathering creating change requests, Business requirement documents.

·       Analyzing the gaps in existing process and pitching for resolution with help of digital transformation.

·       Overseeing end to end transformation journey from requirement gathering to testing and post go live support.

·       Complete Vendor management: Complete vendor evaluation, POC (Proof of concept), Adhering to compliance requirements, active participation in negotiations, Vendor on boarding and acting as a single point of contact for smooth deliveries.

·       Policy atomization:

·       Understanding various policies (products) and configuring the policies in to the processing system. Setting up discounts, payment modes and eligibility criteria as per the policies.

·       Configuring Provider Tariffs as per the ICD CPT codes for auto payment calculations.

·       Provider management – Creating and setting up of vendor codes for new empanelled hospitals.

·       Analyzing all tickets related to payment/ discount calculations and taking care of effective resolution.

·       Other roles:

·       Preparing, analyzing and presenting data to provide insights and observations about business trends to support business management and executive decision making.

·       Analyze data to highlight patterns, anomalies, trends and prepare metrics for fraud analytics, with an end objective to control loss ratio.

·       Conducting periodic medical coding and Product training sessions for existing and new users.

·       Training the enrolled candidates for board level certifications in medical coding. Comprehensive medical coding training with expertise in following domains; CPT, ICD 10, Medical Billing, Code Mapping, Clinical documentation, HIPAA, Case management.

·       Training at various corporates like Bharti Axa life insurance, Apollo Medskills

·       Conducting mock exams and practices session for better preparedness for the exams.

·       Tracking the candidate’s performance through the entire course duration.

·       Enrolling candidates for Medesun comprehensive medical coding training programe.

·       Marketing the training modules.

·       Hundreds of satisfied candidates have cleared board level certification exams and enjoying successfully career through Medesun learning programme.

·       Counseling the new candidates.

·       Write ups to create awareness of about need of medical coders.

·       Daily administration of the Mumbai and Pune branch.