Dr. Jaya Raghuveer Bhamidipati
Healthcare Professional
Greater Noida
Summary
Seasoned healthcare professional with over a decade of experience in clinical operations, healthcare innovation, and claims management. Possesses expertise in claims adjudication, healthcare automation, fraud risk assessments, and contracting with healthcare providers. Skilled at implementing medical protocols, internal control mechanisms, and process optimization. Currently pursuing a PhD in Public Health Management to utilize extensive knowledge in healthcare administration and claims management for driving positive outcomes for organizations.
Overview
11
11
years of professional experience
2
2
Certificates
7
7
Languages
7
7
years of post-secondary education
Work History
Head of Mentorship
Galgotias University
Greater Noida, Uttar Pradesh
12.2024 - Current
- Led mentorship initiatives to support learners' holistic development through structured guidance and career-oriented programs.
- Designed and developed a comprehensive mentorship program, including curriculum, relevant content, and assessment questionnaires.
- Created session plans to ensure an engaging and progressive learning journey for mentees.
- Provided personalized mentorship, addressing academic, professional, and personal growth needs.
- Collaborated with faculty and industry experts to enhance the mentorship framework and align it with career development goals.
- Monitored progress and implemented feedback mechanisms to improve program effectiveness.
Assistant Professor, Hospital & Healthcare Department
GLA University
Greater Noida
7 2023 - 10.2024
- Deliver lectures on Introduction to Medicine, Ethical and Legal aspects in Healthcare and Public Health Systems.
- Serve as Acting Associate Director during the absence of the Associate Director, overseeing day-to-day faculty operations.
- Lead the review and implementation of internal quality audits to ensure compliance with healthcare management protocols.
- Created materials and exercises to illustrate application of course concepts.
- Mentored students and communicated internship and employment opportunities.
Lead Assistant Manager, Medical Claim Reviewer
EXL Service
Greater Noida
07.2021 - 07.2023
- Managed claims processing for US healthcare, ensuring adherence to strict TATs for claim settlements.
- Conducted fraud risk assessments and shared findings with investigation teams to mitigate risks in claims adjudication.
- Monthly the claims review for 38 claims on an average with the review scores of average 99.5% and TAT average score per quarter was 98%.
- Built strong relationships with customers through positive attitude and attentive response.
- Assisted with new hire processing and existing training programs.
- Maintained team flexibility and embraced change to adapt within dynamic markets.
PMU Consultant, AB PM-JAY Scheme
IQVIA Consulting Service Pvt. Ltd.
Delhi NCR
02.2020 - 07.2021
- Developed and standardized medical protocols for state and national health programs under Ayushman Bharat.
- Managed claims adjudication and worked with healthcare providers to establish better tariff agreements and discounts.
- Participated in insurance review meetings to improve claims processing and cost containment strategies.
- Played a key role in setting up internal control processes and ensuring adherence to policy terms and conditions.
Orthopaedic Registrar
Muhimbili Orthopaedic Institute
Tanzania
10.2016 - 10.2019
- Managed Orthopedic patients and oversaw clinical operations in Emergency Department as well as performed 3 surgeries on an average per day.
- Managed mass casualties scenarios twice during tenure, where the leadership skills were utilized to provide the better care outcomes for all patients.
- Participated in research projects focused on advancing orthopedic treatments, contributing valuable insights to improve patient care practices.
- Reduced hospital readmissions by implementing evidence-based post-operative care protocols.
- Optimized surgical outcomes by skillfully performing a wide range of orthopedic procedures, including joint replacements, fracture repairs, and arthroscopies.
- Streamlined clinic workflows by effectively managing caseloads and prioritizing urgent cases.
- Skillfully utilized diagnostic imaging modalities to aid in the evaluation of orthopedic conditions, facilitating accurate diagnoses and targeted interventions.
- Improved patient outcomes by accurately diagnosing and developing comprehensive treatment plans for orthopedic conditions.
- Collaborated with multidisciplinary teams to provide optimal patient care, ensuring timely intervention and recovery.
- Maintained detailed patient records, facilitating accurate diagnoses and effective communication among healthcare providers.
- Effectively managed perioperative complications with prompt recognition and decisive interventions.
Lead Medical Auditor
Vidal Health TPA Pvt. Ltd.
India
07.2015 - 10.2016
- Led a team of 20 medical auditors in claims review and adjudication, optimizing the claims settlement process.
- Developed process automation tools to streamline claims processing and improve turnaround times.
- Attended regular meetings with the insurance company and State Health Authority as a medical auditor, providing insights on claims trends, fraud risks, and policy compliance.
- Established strong relationships with healthcare providers leading to better tariffs and discounts through strategic negotiations.
- Assisted with the implementation of electronic health record systems to optimize data management processes within the organization.
- Improved overall compliance by conducting regular audits of coding practices and providing recommendations for improvement.
- Maintained an up-to-date understanding of evolving healthcare regulations by engaging in continuous professional development opportunities.
- Led training sessions on medical coding guidelines, contributing to a knowledgeable workforce capable of upholding compliance standards.
- Contributed to cost savings by identifying areas of potential billing related issues in medical claims processing.
- Streamlined the audit process for increased efficiency by developing and implementing standardized procedures.
- Collaborated with healthcare providers to ensure accurate documentation for improved patient care quality and safety.
Medical Officer – Emergency & General Medicine Department
Vijaya Health Centre
India
02.2014 - 07.2015
- Managed 30 inpatient emergency cases per day on an average and led team of junior doctors and nursing staff.
- Provided comprehensive medical care in both emergency and general medicine.
- Monitored patient progress and adjusted treatments accordingly.
- Improved patient outcomes by implementing evidence-based medical practices and protocols.
- Assisted senior physicians and surgeons during assessments, examinations and surgical interventions.
- Enhanced patient satisfaction with thorough assessments, diagnoses, and treatment plans.
- Reviewed complex cases alongside colleagues during peer consultations to develop consensus on appropriate courses of action for challenging scenarios.
- Applied continuous process improvement strategies to enhance case management, programs and clinical management.
Education
Ph.D. - Public Health Management
Noida International University
Greater Noida, India 09.2024 - Current
PG Certificate Advanced Healthcare Management - Advanced Healthcare Management
IIM
NAGPUR 11.2024 - Current
Postgraduate Diploma - Clinical Research
Apheta Institute
Delhi, India 05.2013 - 12.2013
MBBS - Medicine And Surgery
Luzhou Medical College
Luzhou, P.R. China 10.2006 - 03.2012
Skills
Medical Protocol Development
Claims Management & Cost Containment
Process Automation & Optimization
Risk Assessment & Fraud Mitigation
Healthcare Provider Contracting & Negotiations
Regulatory Compliance & Internal Audits
Strategic Claims Review & Trend Analysis
Customer Complaint Resolution
Public Speaking
Mentoring students
Certification
AHIP AHM 250, Healthcare Management – Nov 2022
Accomplishments
- Published Claims Manual 2.0 for Ayushman Bharat scheme.
- Deployed end-to-end software for healthcare claims audit.
- Led EMR/EHR implementations across multiple hospital departments.
- Contributed to national healthcare programs and government flagship schemes.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Languages
English: Fluent
Hindi, Gujarati: Proficient
Telugu, Tamil, Chinese, Swahili: Intermediate
Timeline
Head of Mentorship
Galgotias University
12.2024 - Current
PG Certificate Advanced Healthcare Management - Advanced Healthcare Management
IIM
11.2024 - Current
Ph.D. - Public Health Management
Noida International University
09.2024 - Current
Lead Assistant Manager, Medical Claim Reviewer
EXL Service
07.2021 - 07.2023
PMU Consultant, AB PM-JAY Scheme
IQVIA Consulting Service Pvt. Ltd.
02.2020 - 07.2021
Orthopaedic Registrar
Muhimbili Orthopaedic Institute
10.2016 - 10.2019
Lead Medical Auditor
Vidal Health TPA Pvt. Ltd.
07.2015 - 10.2016
Medical Officer – Emergency & General Medicine Department
Vijaya Health Centre
02.2014 - 07.2015
Postgraduate Diploma - Clinical Research
Apheta Institute
05.2013 - 12.2013
MBBS - Medicine And Surgery
Luzhou Medical College
10.2006 - 03.2012
Assistant Professor, Hospital & Healthcare Department
GLA University
7 2023 - 10.2024
References
Available upon request.