Manikanda Swamy

Developed and implemented healthcare back-office solutions tailored for the US and UAE provider markets.
Pioneered a Radiology-as-a-Service model for the US imaging market, integrating RCM, PACS, Billing, and AI technologies.
Facilitated growth in back-office operations for assisted living and skilled nursing facilities in the US market.
Successfully increased Price per Modality from $110 to $145 within 6 months through enhanced revenue strategies, optimized collections processes, and efficient outsourcing initiatives.
Conducted comprehensive due diligence for a hospital in Michigan, presenting a proposal for substantial improvement in their revenue cycle management.
Devised market strategy for KG Invicta in the UAE, enhancing positioning and service delivery.
Formed strategic partnerships with three AI-based automation firms for front, middle, and back-office operations, as well as post-discharge support services.

Developed and led teams specializing in Revenue Cycle Management (RCM) within the Radiology, Assisted Living, and Dermatology sectors.

Overall span of 220 employees

As a strategic consultant, I specialize in developing content for US healthcare back-office services. We have deployed training programs and trainers for the healthcare insurance and provider markets in the BPO space. Additionally, I have established partnerships with over 20 colleges to enroll their final-year students, preparing them for the BPO industry. We provide trained resources to BPO service companies within both payer and provider sectors.

As a senior delivery leader, I am accountable for overseeing day-to-day operations including claims processing, provider data management, and inbound provider call center activities for a leading US health insurance plan. My role spans cross-functional expertise in operations, solution design, strategic management, quality assurance, cost management, team leadership, project coordination, and comprehensive understanding of the US health insurance landscape.

Key Responsibilities:

Customer Relationship Management:

Act as the primary point of contact for all customer-related delivery matters.
Establish and maintain effective account escalation protocols.
Ensure proactive engagement of team managers and customer-facing staff.
Drive Net Promoter Score (NPS) initiatives and develop action plans to enhance customer satisfaction.
Financial P&L Management:

Lead forecasting, budgeting, and Accounts Receivable (AR) management activities.
Contract Compliance:

Oversee adherence to contractual obligations, compliance requirements, and ensure SLA attainment.
Account Growth:

Develop strategies and initiatives to foster account growth.
Transformation and Efficiency Plans:

Drive transformational projects and efficiency improvement plans.
Performance Planning:

Develop and implement performance improvement plans to optimize operational efficiency and service delivery.
This profile highlights my extensive experience and responsibilities in managing critical aspects of healthcare operations and customer engagement within the dynamic US health insurance sector.

Title: Director of BPO Delivery - Healthcare Payer Operations

I am accountable for overseeing Business Process Outsourcing (BPO) delivery in Healthcare Payer Operations, specializing in Third Party Administration (TPA) services, Account Care Organization (ACO), Commercial and Medicare space. My expertise spans claims processing, provider and member enrollment, and mailroom services.

Key Focus Areas:

Tailored Solutions and Best Practices: I employ a focused approach to understand each customer's unique business needs, delivering solutions and implementing best practices to maximize operational outcomes and establish trusted partnerships.

Continuous Quality Improvement: I have implemented robust Continuous Quality Improvement (CQI) processes as a cornerstone of our service delivery, ensuring ongoing enhancements and efficiencies.

SLA Management and Customer NPS: I prioritize SLA management to meet contractual obligations and enhance Customer Net Promoter Score (NPS), driving customer satisfaction and loyalty.

Account P&L Management: I oversee financial performance, including forecasting, budgeting, and profitability analysis to ensure sustainable growth and profitability.

Workforce Development: I am dedicated to developing a cohesive and engaged workforce, fostering a positive work environment and enhancing team performance.

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Title: Service Delivery Manager - Healthcare Insurance Accounts

As the Service Delivery Manager based in Chennai, I oversee 8 accounts for a healthcare insurance client, totaling $32 million in annual revenue. My role focuses on implementing standardized processes and systems across all US healthcare insurance accounts, ensuring uniformity and efficiency.

Key Responsibilities:

Financial Management: Meet annual financial and savings goals while ensuring profitability across accounts.

SLA Compliance: Ensure effective delivery to earn SLA bonuses and avoid penalties by closely monitoring SLA performance and addressing any misses proactively.

Customer Satisfaction: Achieve corporate customer satisfaction goals through strategic initiatives and continuous improvement.

Efficiency Improvements: Lead projects such as Auto Adjudication rate enhancement, reduction in adjustment and rework rates, and minimizing duplicate submissions.

Six Sigma Projects: Implemented 55 Six Sigma projects over FY13-FY15, resulting in substantial savings and improvements in cycle time, productivity, quality, and backlog reduction.

Knowledge Management: Launched Knowledge Quest programs across payer verticals, significantly increasing overall healthcare industry knowledge from 55% to 85%.

Operations Management: Manage volume spikes and backlogs through cross-training, rapid ramp-up strategies, automation, macros, and effective communication protocols.

Customer Relationship Management: Conduct regular customer business review meetings and governance to manage expectations effectively.

Employee Engagement: Foster a participative work environment to enhance employee satisfaction and productivity.

Claims Platform Optimization: Conduct process studies to optimize claims platform capabilities, implementing solutions to enhance performance and productivity in Facets and Xcelys environments.

Information Security: Ensure operations are information secured and HIPAA compliant, successfully passing 2 customer Information Security audits overseen by KPMG.

I oversee Business Process Outsourcing (BPO) delivery for 6 major US health plans, managing a team of over 750 back-office processors and 25 managers/ Teamleads. My responsibilities span various critical areas of operations and management within the healthcare sector.

Key Responsibilities:

Site Management: Ensure effective site operations, including facilities management, infrastructure, and compliance with operational standards.

Cost Management: Responsible for budget oversight, cost control measures, and financial performance across the operations.

Process Standardization: Implement and maintain standardized processes across all accounts to ensure consistency and efficiency in service delivery.

Transition Management: Lead successful transitions of new accounts or processes, ensuring seamless integration and minimal disruption.

Quality Management System: Develop and enforce a robust quality management system to meet client expectations and industry standards.

Internal and External Audits: Manage both internal quality audits and external client audits to ensure compliance and continuous improvement.

Employee Engagement and CSR: Foster a positive work environment, promote employee engagement initiatives, and oversee Corporate Social Responsibility (CSR) activities.

Identified and transitioned a US client in Market Research Support services, focusing on Data Cleaning & Archiving, Database Management, and Data Analysis.

Assisted in preparing Service Level Agreements (SLAs) and contract documents. Created detailed Process Maps and delivery documents to streamline operations. Coordinated with HR for recruitment support, ensuring team readiness and continuity.

Servicing and trouble shooting heavy earth moving machinery in Central Coal Fields Ltd. Ranchi. Imparting technical assistance and training the client’s team. Coordinating the service team of 15 members