Pune Division, Maharashtra, India
Experienced Project Manager with a demonstrated history of working in the health wellness and fitness industry. Skilled in Dentistry, Volunteer Training, Healthcare Information Technology (HIT), Healthcare Management, and Project Management. Strong program and project management professional with a MBA-HHM focused in Health/Health Care Administration/Management from Symbiosis Institute of Health Sciences.
Leading Team of doctors in medical record reviewing & claim adjudication in Cashless claims department · Assisting our Doctors Team with implementation of Upgraded Software interface such as Healthbuzz & TCS BANCs for claim adjudication and management · Hands-on experience building integration projects, Collaborated with product team to implement changes, prioritize bug fixes & Feature requests in TCS Bancs · Working as mediator between IT & Medical processing team in troubleshooting in trial phases · Trained teams on healthcare claim processes on Software like proclaim; TCS Bancs, Health buzz ensuring accurate and efficient claim adjudication & settlements.
Heading a team of 5 team leads & 20 executives to handle Corporate Healthcare account Handling policy renewal process including presentation & guidance to all corporates regarding their healthcare policies; counseling and guiding employees related to process Co-ordination between third parties, corporate and insurance companies regarding annual Healthcare claim process. Handling escalations & special cases in corporate healthcare accounts. To Keep track of functioning of corporate healthcare account; query resolution and quarterly & monthly follow-up on policy guidelines & resolving claim related grievances. Training the team related to healthcare claim process; Co- ordination with all the departments such as investigations, document verification, enrollment, billing & claim settlement process and enabling proper functioning of process in order to settle the claim in give TAT
• To review medical records of claimant and provide precise summaries covering all relevant medical facts required for claim adjudication process. • To identify key morbidity and mortality factors for medical impairments esp. post casualty or accident events, injuries, fractures, soft tissue deformities, trauma and pain management related disorders. • Good experience in Indian/US/UK claim adjudication process as well as expert comprehension of medical literature/hospital notes, diagnostic information and treatment modalities along with higher typing skills
• Handling all operations which involved pharmacy, laboratory, staff, logistics & inventory of a 200 bed covid hospital • Patient care management & counseling. Maintaining co-ordination between hospital & Patient’s families • Follow up & evaluation regarding treatment protocols. Supervision and introduction of New protocols for convenience • Maintaining HIS for hospital and follow up regarding daily updates of patient status on Portal • Staff allocation, staff management and duty scheduling • All documentary analysis regarding basic details obtained from HIS and preparation of Analysis report • Decision making in case of major process related emergency, medical assistance, DAMA & other related management • Reporting to higher authorities regarding updates, evidences & regular function of Hospital
• Professional Training and of doctors and supporting staff regarding Mechanism and use of Versius Robotic System in Laparoscopic Surgeries • Observation of LAP surgeries performed by Versius in order to help in enhancing Efficiency of robotic system and adaptations • Assistance in virtual training for surgeons • Conduction, Arrangement and planning of training session as well as assistance to Educational trainers. • Attending Various Clinical trial Cases operated by Versius and study of system