Healthcare Consultant

• 3-5 years of experience in healthcare consulting, business strategy, or healthcare transformation roles.

- Working knowledge and certified on payer and provider applications including EPIC, Cerner, e Clinical Works, FACETS, QNXT, Health Edge, Health Rules and All Scripts.

• Experience in atleast 2 or more areas of HS&W, that includes Health Insurance, Pharma, PBM, Hospital Management, HIS/EMR systems, Care Management, Case Management, Utilization Management, Dental, Vision, Medical, Mental Health, Drug management, drug delivery, sales, Provider management,

Network Management, Outreach and Advocacy, Community Programs, prevention and wellness.

- Working experience on Core Insurance solutions for Medicare, Third-Party Claims Administration (TPA), Auto-Adjudication, Claims Adjustment, Explanation of Benefits (EOB), Policy checking, Renewals, Co-pay & Coinsurance, ICD-10, CPT codes, HCPCS codes, HIPAA, Fraud, AML etc

• Consulting engagements included POV's, Market research, Client Profiling, competitor analysis, SWOT Analysis, GTM strategies, post M&A assessments for existing business across geographies. Built Market understanding Post Obamacare that including Medical Loss Ratio and New Rating Rules, ACOs and HIXs.

- Sound knowledge on HIS modules like Registration, Admission Discharge Transfer, Appointment Scheduling, Financial modules like Account Payables/Receivables, Patients' Accounting & Insurance, EDI , Clinical modules like Care Summary, Clinical documentation, Enterprise Orders and Pharmacy, Electronic Prescribing, Results Reporting and Maternity.

• Have exposure to working on HIPPA, ICD9/ICD10, CPT4, and SNOMED. Sound knowledge of HL7 which is used for interface purposes.

• Project management, Bid management, Daily cadence, brainstorming with the client partners and internal stakeholders to provide qualitative and customized solutions to the prospect.

• Leading healthcare presales and solutions development bids with end-to-end functional ownership for response to RFP/ RFI/proactive pitches and sole discovery opportunities.

• Immense experience in working on large deals, creating transformative solutions, and contributing during all stages of the Sales and Solutions cycle for both Payer and Provider functions.

• Knowledge and experience of working on various financial pricing models to suit to the customers' requirements.

- Develop proposal storyboards and case studies and conduct proposal quality reviews, client visit management.

• Has managed multiple client implementation simultaneously. Handled teams and multiple other stakeholders

• Has worked on cloud-based solutions with exposures to functional and technical aspects. Ability to do the estimation and total cost of ownership (TCO) of the implementation

• Ability to create future operating model for client

• Has carried out current state and future state analysis and able to do the gap assessment both functional & technical. Provide consultancy to client for the best approach for solution implementation

Has created work breakdown structure for a product implementation to a client.

- Has been responsible for product planning and execution throughout the Product Lifecycle, including gathering and prioritizing product and customer requirements, defining the product vision, and working closely with offshore team