Kapil Singh Shishodia

• Delivering Apex value proposition in Air ticketing across all major airlines.
• Managing potential clients for tour packages.
• Providing Visa and Forex Exchange services ensuring timely processing.
• Generated reports on sales performance based on weekly and monthly data analysis.

Project- AMO Services for Independent Health

• Served as a Project Lead on HealthEdge product functionalities to enhance coordination and understanding between offshore and onsite teams.
• Managed a team of 15 associates from analysts to product testers across different locations.
• Facilitated client meetings to ensure clear alignment of project objectives, resulting in timely delivery of major initiatives.
• Collaborated with cross-functional teams to formulate and execute strategic business plans.
• Followed Agile methodology for project sprints to meet client SLA.
• Conducted gap analysis, research and competitive analysis for potential opportunities.
• Developed comprehensive user training materials for HealthEdge Product Suite.
• Provided training, mentorship, and guidance to offshore team on domain.

Project- HealthRules™ Configuration for Aetna

• HealthRules™ Configuration: Supplier Contract, Benefit Configuration, Member Setup, Provider Setup, Account Setup, Product Setup, Business rules configuration etc.
• Configuration of HealthRules Designer & HealthRules Manager using HealthRules Language (HRL) ™.
• Manual Testing - Unit Testing, UAT using CTT & CTR testing tools from HealthEdge.
• Mentoring of new team members, coach & develop the team. Provide refresher training in line with process development and updates.

Project- BCBS VT (HIX Enrollment & Configuration)

• Serve as Domain expert and resource for the Enrollment Services Department.
• Document Business process for assigned project and create SOP for process improvement.
• Ensure enrollment processing, group and member enrollment processes adhere to Federal and State law.

• Handled End-to-End operations of RCM including Eligibility & Benefits, Electronic Claim Submission, Denials & Appeals.
• Responsible for handling rejections from clearing house (Emdeon and Optum).
• Worked on Healthcare electronic standards X12(834, 835, 837, 270, 271, 276, 277, 999) data mapping.
• Monitor EDI file processing and perform troubleshoot on processes to resolve all transaction file issues