Dr.Kedar Rajmane

Designation:

Lead Process Consultant: Jan 2020 to Present
Process Consultant: Jun 2019 to Dec 2019

Key Roles:

Consultation:

• Evaluated diverse organizational systems to identify best methods during integration cycle of two claims engine platforms.
• Conferred with existing and potential solutions to assess requirements and proposed optimal solutions in the form of Projects, System enhancements, Tools and Guidelines.
• Analyzed Finance data and reported monthly insights to management to reduce claims adjustment cost to the company.
• Devised strategies to improve organizational efficiency and optimize existing processes. E.G. Maintenance process guides, Various tools for process efficiency.
• Developed strategic component development plans to support future projects. E.G. Program framework, Enhanced Metrics.
• Improved existing insights based on finance data by creating Dashboards with the help of developers and core team
• Analyzed data and proposed various excel based tools to gain process efficiency and reduce errors.
• Reviewed internal errors and organized training plans to address areas in need of improvement. E.G. Policy training

Project Management:

• Project Management by planning, designing, monitoring and scheduling through 'Microsoft Project'
• Identified plans and resources required to meet project goals and objectives by setting realistic timelines and checkpoints.
• Executed projects within strict timeframes and provided management with business analysis, documentation and data modeling using expertise in 'Microsoft Visio' and 'MicroStrategy'.
• Supported other business verticals with insights and consultation around various claims analysis and finance data.

Product Development:

• Determined process demands, client requests and complex areas to build tool-based solutions to gain process efficiency and reduce manual errors.
• Brainstormed with peers and other members to design various excel based tools/add-ins and its features
• Suggested enhancements to existing product design that would improve reporting and user experience.
• Managed implementation of new features by outlining plans and specifications and collaborated with development teams to ensure smooth execution and delivery of requirements.
• Converted project specifications into drawings and other materials (Visio process flow/diagrams, process guides) that would be used to create product

Business Analytics:

• Analyzed key aspects of business to evaluate factors driving results and summarized into presentations.
• Worked closely with software development and testing team members to design and develop robust solutions to meet process and reporting for functionality, scalability and performance.
• Assisted in planning of JIRA and MicroStrategy software enhancements and system testing efforts.
• Conducted meetings with key business users to collect information on business processes and user requirements.
• Led cross-functional teams to analyze and understand enterprise-wide operational impacts and opportunities of technology changes.
• Developed Team Metrics derived from raw JIRA data to track improvements in organizational efficiency and reporting.
• Created workflow diagrams and Gantt charts to clearly demonstrate processes and timelines.

Designation:
Clinical Content Lead: Jan 2019 to May 2019
Senior Research Analyst: Jan 2017 to Dec 2018
Research Analyst: Jan 2015 to Dec 2016
Key Roles:

• Medical Policy maintenance according to State Medicaid guidelines and Medicare updates on periodic basis.
• Supporting US Research Medical directors/US client Medical directors and Client Policy managers to provide research material from Medical Policy and Client Services.
• Supporting policy configuration team to implement quarterly/annual updates in collaboration with US Research Medical Directors for medical policy maintenance.
• Involved in various product development projects.

Key roles :

• E&M Medical Coding - Process trainer for Noida & Pune centers.
• Quality Compliance Auditor
• Claims Processing & Medical coding.

Key roles:

• Examined patients, diagnosed conditions and devised treatment plans for disorders involving cardiovascular, endocrine and other internal systems.