Arjun Ginka
Team Lead
Hyderabad
Summary
Us Healthcare with 15 years of experience enhancing operations for organizations through information systems solutions. Proven track record of transforming specific business goals related to growth and efficiency improvements into new system designs. Knowledgeable innovator known for recommending new technologies to enhance existing systems and introduce new systems.
Excellent planning, organizational and communication skills.
Self-reliant to perform analysis and make recommendations.
Talented in data modeling and client management.
Overview
15
15
years of professional experience
7
7
years of post-secondary education
4
4
Certifications
3
3
Languages
Work History
Team Lead- Configuration
AMPS HealthCare India Private Limited
04.2023 - Current
- Requirements gathering for IPU (Intelligent Policy Update) – Inbuilt application for payment integrity, claims adjudication & denials and appeals
- Following and Creating industry standard medical policies
- Collaborate with UX & engineering team – Understanding Policy engine logic, working in product design and development
- Creating Medical policies that are value added to organization by running through savings reports (Power BI dashboard)
- Jira creation (Epic/Feature/Story), testing & audit in UAT before policies go live into production environment.
- Prioritization of backlogs and ensure completion of sprints
- Monthly/Quarterly/Annual/Adhoc updates to medical policies & maintenance to ensure policy logic is up to date with industry standard guidelines (cms.gov).
Implementation Analyst - DREXI
AMPS Healthcare India Private Limited Company
07.2021 - 03.2023
- Enhanced project management skills by defining and presenting system solutions and timelines for business needs or technical problems.
- Oversaw document development across project workstreams to create internal control statements per compliance and regulatory standards.
- Analyzed existing systems and databases and recommended enhancements to solve business needs
- Collaborated with upper management to drive strategy and implement new processes.
- Documenting Monthly Prior Authorization billing process based on ProPBM Application.
- Adding Clients to ProPBM - Creating and adding a broker, a TPA, an advocacy provider and an analytic provider to the DREXI database and then associating them to a hierarchy of a customer, client, group, and plan.
- Building plan rules and drug coverage rules in ProPBM adjudication engine to allow claims to pay properly.
- Extraction and retrospective analysis of Claim Activity Reports.
Senior Analyst – Client Services
Cotiviti India Private Limited, Hyderabad India
04.2014 - 06.2021
- Organized and detail-oriented with strong work ethic.
- Acted as a team leader in group projects, delegating tasks and providing feedback.
- Exercised leadership capabilities by successfully motivating and inspiring others.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Client Policy Maintenance: Implementation of Client specific policies through each release cycle to keep consistent with current Industry payment guidelines and conduct production audit.
- Client inquiries: Providing resolutions to Policy & Payment related inquiries.
- Opportunity analysis: Providing new policies to the clients by conduction review of payment guidelines from (CMS/State Medicaid/Medical specialty associations/Payer Health plans).
- Performing multi-faceted analytics on data and report analysis:
- Data and report analysis on various requirements as requested by the Client/Client teams pertaining to coding, billing, payment methodology and policy standards of the industry and client customization.
- Arriving at derivations by performing thematic claims trend analysis (High Dollar claims review/high frequency/provider billing trends etc.) and update the client teams for looking at the potential opportunities or missed opportunities.
- Effective communication with various members of client teams.
- Work and provide some of the analyzed data to help Client Presentations.
- Data Analytics: Perform claims analysis to track provider reporting trends like unbundling, modifier misuse, multiple claim submission, multiple units etc.
- Process Documentation: Develop training job aids/process documents/ production metrics)
- Training: Conduct process training and mentor resources.
- Periodic internal review of the process to improve and close process related gaps.
Process Executive - Payer Services
iSpace Global Services India Private Limited
05.2010 - 04.2014
- Reach targets defined as per SLA’s in terms of productivity and quality.
- Training new joiners on process knowledge.
- Allocate work to team members as and when needed.
- Provide floor support to team members in case of any clarifications.
Education
High School Diploma -
Nehru High School
Hyderabad 06.2004 - 04.2005
Intermediate - M. E. C
Nava Chaitanya Junior College
Hyderabad 06.2005 - 04.2007
Bachelor of Commerce - B. Com (Computers)
National Degree College
Hyderbad 06.2007 - 05.2010
MBA - M. B.A (Finance)
Aradhana School of Business Management
Hyderabad 06.2011 - 04.2013
Skills
Operating Systems: Unix, Linux, Windows XP/7/8/10
Office Packages: Office 365
SharePoint , Lotus Notes, RMI (Rules Maintenance Interface), IPU (Intelligent Policy Update)
Jira , ServiceNow, eLL (Electronic Logic Library) and ECL (Electronic Content Library)
Certification
Typing Lower from SETWIN
Accomplishments
Performance Excellence Award - Cotiviti Operational Excellence for Years 2012, 2013, 2014, 2016 and 2017.
Additional Information
SOFT SKILLS
- Demonstrated ability to make strategic operational decisions with minimal supervision, escalating issues and risks as needed to ensure program remains aligned to strategic objectives.
- Flexible and ability to work effectively under stressful environment
- Participate and contribute to organizational growth.
- Facilitate and participate proactively in knowledge sharing sessions.
- Ability to develop credibility, establish rapport and maintain communication with stakeholders at multiple levels, including those external to the organization.
- Conduct performance appraisals and ad Hoc check-ins with team provide constructive feedback.
- Manage attrition and absenteeism
Timeline
Lean Six Sigma Green Belt - Benchmark 6ix sigma
06-2023
Team Lead- Configuration
AMPS HealthCare India Private Limited
04.2023 - Current
Implementation Analyst - DREXI
AMPS Healthcare India Private Limited Company
07.2021 - 03.2023
CRESTCOM - The Bulletproof Manager(BPM)
11-2019
Senior Analyst – Client Services
Cotiviti India Private Limited, Hyderabad India
04.2014 - 06.2021
Microsoft Office Specialist and Expert from Microsoft
04-2012
MBA - M. B.A (Finance)
Aradhana School of Business Management
06.2011 - 04.2013
Process Executive - Payer Services
iSpace Global Services India Private Limited
05.2010 - 04.2014
Typing Lower from SETWIN
04-2010
Bachelor of Commerce - B. Com (Computers)
National Degree College
06.2007 - 05.2010
Intermediate - M. E. C
Nava Chaitanya Junior College
06.2005 - 04.2007
High School Diploma -
Nehru High School
06.2004 - 04.2005
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