Divakar K
Avadi, Chennai
Summary
Experienced professional consultant with a proven track record of delivering valuable insights and strategic solutions to diverse clients. Leveraging strong analytical skills and deep industry knowledge, consistently driving impactful outcomes that exceed expectations. Recognized for fostering team collaboration and thriving in dynamic environments, ensuring project success and client satisfaction.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Consultant
Thryve Digital Health LLP
08.2022 - Current
- Worked as business consultant for enGen Solutions, which is a wholly owned healthtech subsidiary of Highmark Health
- Will act as a bridge between stack holder and product teams within our enGen architecture
- Will do pre analysis on business needs drafted with high level vision scope document
- Will ensure that required information is available within that document
- Before proceeding with solutioning process
- During Solutioning process will interact with technical architect to identify the impacted product areas (Claims, Membership, Benefit coding, Provider Management, Portals, Data Warehouse, Marketing, Sales etc.) for the business requirements within our enGen systems
- Will perform lean Impact assessment along business conceptual flow for business requirement with impacted product areas to identify high level work activities
- Based on the work activities, assumptions and dependencies collected during lean Impact assessment will do a range estimation with help of blue print we have for our domain capabilities
- Lean Impact Assessment document will be shared with business to review
- If business is fine with approach and estimate will request for business sign-off for delivery movement
- During solutioning stage business consultant will be acting as Project Manager and BA
- During Refinement and Delivery stage will work with Developers, Product Owners and testers to work and capture detailed requirements
- Once we receive tech spec documents from product areas will closely work technical architect to finalize the design
- Once Design is finalized will review business requirements with Business Owner along with Internal and External Leadership teams
- In parallel will work with product owners on estimates
- During Re-estimates stage as a business refinement lead will ensure that whether the estimates from teams are estimated properly with respect to their requirements
- Will share final estimates with business for their review and approval
- Once business approved for B&T will work with test architect and test lead for test framework, master test plan, master test strategies
- Will handle change controls for the project if there is any new requirements /new scope identified or added within the project during pre-implementation stage
- Will Join weekly scrum calls of impacted product areas to ensure the progress of development and test work
- Work closely with project manager to have a track on burn rate of project estimates
- Having exposure on working with enhancements, product projects, Migration projects for Highmark business types of HHP, IBC, BCBS ND, WV, DE, PA and NY
Senior Issue Resolution Analyst
ATHENA HEALTH TECHNOLOGIES PVT LTD
07.2018 - 08.2022
- Worked with U.S customers to understand requirements and provide exceptional service
- Optimized department efficiency by analyzing procedures and data regarding charting and patient flows
- Mapped current business and operational processes and recommended areas for improvement
- Applied both qualitative and quantitative analysis techniques to continuously improve end- user experiences
- Own relationship with the customers and requirements for provider initial and re-credentialing data, delegated credentialing data, provider demographics maintenance, contracts configuration, claims adjudication and provider portal systems
- Manage IT project execution to ensure adherence to customer requirements and Sprint schedule
- Maintain healthy relationships with external and internal vendors/stakeholders for successful project implementation and maintenance
- Point of contact for Provider Operations team
- Assess current or future customer needs and priorities through communicating directly with customers, exploring automation feasibility approaches, including as-is and to-be state analysis, and cost comparison analysis
- Develop workflow, UML and use case diagrams
- Provide clear, detailed business requirements to the development team such as Solution Architects, Data Architects, Developers, Software Testers
- Mapped process activities to identify shortfalls and propose options to rectify operational inefficiencies
- Evaluated user research to convert abstract ideas and requirements into planning tools such as journey maps, user personas and storyboards
- Conducted research by interviewing users, external customers, and various stakeholders
- Managed quality assurance program including on site evaluations, internal audits and customer surveys
- Developed creative sales tools, including presentations, trend reports, kitted assets, and product data sheets
Senior Process Executive
COGNIZANT TECHNOLOGY SOLUTIONS
01.2018 - 06.2018
- Maintained and updated collections tracking spreadsheet to help organize payment information
- Managed collections claim for unpaid bills against estates of debtors
- Printed and reviewed monthly patient aging report and solicited overdue payments
- Accurately posted and sent out all medical claims
- Evaluated patients’ financial status and established appropriate payment plans
- Monitored outstanding invoices and performed collections duties
- Developed rapport with clients and vendors to cultivate loyalty and satisfaction
AR Executive
OMEGA HEALTHCARE MANAGEMENT SOLUTIONS PVT LTD
03.2016 - 01.2018
- Improved revenue for most recent provider over32% with same patient load
- Experienced billing for Family Medicine, Ophthalmology, Dermatology, and Mental Health specialties
- Ensure claims are entered and submitted with48 hours of receipt
- Research and resolve incorrect payments, EOB rejections, and other issues with outstanding accounts
- Ensure accuracy of insurance claims
- Verify correct ICD-9 and CPT codes for a variety of specialties
- Set up new patient accounts
- Set-up practice management software for submission of electronic claims to clearinghouse
- Work with clearinghouse to resolve file compatibility issues
- Retrieve Electronic Remittance Advice (ERA's)
- Send secondary claims upon processing of primary insurance
- Monthly processing of patient statements
- Answer and resolve patient billing inquire
- Follow up on Insurance and patient aging
- Re-submit insurance claims as necessary
- Knowledgeable in timely filing restrictions
- Ensure office practices are in compliance with HIPAA regulations
Education
Bachelor of Engineering - Electronics and Communications Engineering
Arignar Anna Institute of Science & Technology
Sriperumbudur01.2015
Higher Secondary - State Board of Tamil Nadu
Vijayantha Model Higher Secondary School
Avadi, Chennai01.2011
Skills
- ICD-9, ICD-10, CPT, HCPCS & Medical Terminology
- Worked for Highmark Health payer solutions
- Worked with Managed Care Organization (HMO, PPO, POS & EPO’s)
- Worked for Hospital, Professional, Dental, Vision, Auto liability, SNF, Contract payers, HRA, HSA & FSA, Workers Comp claims & payer engagements
- Vast Knowledge about US Federal and Commercial Insurances (BCBS, UHC, AETNA CIGNA)
- Handled Various Practice Management Software products for its enhancement and development (NEXTGEN, MEDDATA & ATHENA)
- Knowledge about Policies and Acts followed with US Healthcare such as HIPAA Compliance, COBRA, CARES Act, PHI
- Online Claim Submission & ERA File Formatting (ANSI)
- Payer and Provider Enrollment skills
- Claim processing and Denial exposure
- Clearing House and Insurance EDI engagement
- End to End RCM operations cycle and payer Claim processing cycle Exposure
Certification
SAFe5 Certified Agilist
Certified UX Professional
CBAP Certification Professional
Timeline
Consultant
Thryve Digital Health LLP
08.2022 - Current
Senior Issue Resolution Analyst
ATHENA HEALTH TECHNOLOGIES PVT LTD
07.2018 - 08.2022
Senior Process Executive
COGNIZANT TECHNOLOGY SOLUTIONS
01.2018 - 06.2018
AR Executive
OMEGA HEALTHCARE MANAGEMENT SOLUTIONS PVT LTD
03.2016 - 01.2018
SAFe5 Certified Agilist
Certified UX Professional
CBAP Certification Professional
Bachelor of Engineering - Electronics and Communications Engineering
Arignar Anna Institute of Science & Technology
Higher Secondary - State Board of Tamil Nadu
Vijayantha Model Higher Secondary School
Similar Profiles
Aruna BanjaraAruna Banjara
Healthcare Consultant at Thryve Digital Health LLPHealthcare Consultant at Thryve Digital Health LLP
Loganathan SLoganathan S
Team Leader - Claims adjudication (Payer) at Thryve Digital Health LLPTeam Leader - Claims adjudication (Payer) at Thryve Digital Health LLP
MOGUTALA CHANDANA GOUDMOGUTALA CHANDANA GOUD
Senior Analyst at Thryve digital health LLPSenior Analyst at Thryve digital health LLP