Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Prasad Sampath

Bengaluru

Summary

Dynamic leader with a proven track record at MDINetworX, driving AI-driven operational transformations and enhancing efficiency in healthcare solutions. Expert in P&L management and change management, achieving significant cost savings while fostering a culture of continual improvement. Skilled in digital transformation and strategic leadership, delivering impactful results in complex environments.

Overview

32
32
years of professional experience
1
1
Certification

Work History

Head of Operations, Quality, Transition, Implementation, Training, and Business Development

MDINetworX
09.2023 - 10.2024
  • Company Overview: US Healthcare Payer and Provider IT Services Company
  • Revolutionized operations by developing and implementing an AI-driven platform for claims, quality, and contact center, significantly improving efficiency and insights.
  • Streamlined provider maintenance processes, enhancing data quality and ensuring No Surprise Act compliance.
  • Re-engineered the UM intake process, deploying a cloud-based solution and successfully transitioning from Ariel to EPIC Tapestry.
  • Automated eligibility verification processes for a leading RCM provider by implementing a 270/271 transaction solution.
  • Optimized RCM processes (coding, payment posting, EBV, AR), resulting in a 10% increase in efficiency and accuracy.
  • Developed and executed successful marketing and Go-to-Market (GTM) strategies for payer and provider processes.
  • Successfully migrated multiple frontend projects (837 file generation, document indexing, mailroom operations) to a new platform, enhancing efficiency and scalability.
  • US Healthcare Payer and Provider IT Services Company

Head of Healthcare and Life Sciences Delivery Operations

Tech Mahindra
09.2022 - 09.2023
  • Successfully managed P&L for the Healthcare and Life Sciences vertical.
  • Led a successful change management initiative to optimize processes and mitigate risks, ensuring audit compliance.
  • Streamlined revenue collection processes, significantly reducing Days Sales Outstanding (DSO) for the vertical.
  • Supported Center of Excellence (COE) to develop new capabilities within the Healthcare and Life Sciences team.

Global Process Delivery Lead, Healthcare Vertical

Concentrix
06.2016 - 08.2022
  • Directed the design and development of Automated Claims Auditing and Claims Analytics solutions using Agile Methodology.
  • Collaborated with Marketing to create and execute GTM strategies for new products, including collateral development.
  • Led innovation council forums (client-facing and internal) and automation programs across the Healthcare Vertical, achieving over $100K in savings.
  • Identified and implemented opportunities for RPA, Digital Strategy, Analytics, Workflow Solutions, and homegrown tools/solutions.
  • Headed multiple innovative solutions combining transformation and technology assets in Front and Back Office operations (Deal Sizes: $100M to $1Bn).
  • Developed and marketed integrated assets and solutions for the Healthcare Vertical.
  • Achieved annual savings of $100M by implementing key technologies like Robotic Process Automation, Analytics, and CRM.
  • Key project member for Outsourcing Revenue growth and Innovation, managing a budget of $50M and generating $5M in cost savings.

Healthcare Payer Offshore Operations Lead

Dell
03.2015 - 04.2016
  • Administered Payer Operations across India and Philippines (Chennai, Coimbatore, Gurgaon, Manila), managing 12 US payer accounts with an annual top line of $30M and 1500 personnel.
  • Managed processes including Claims, Adjustments, Provider Data Management, Audits, Recovery, and Provider Call Centre Services across Facets, Metavance, Excellus, and Pega Systems.
  • Directed P&L management, overseeing $30M in revenue.
  • Led Automation and Delivery Transformation Projects, achieving $1M in savings through AFTE and RPA implementations, and exceeding a 20% FTE reduction target.
  • Drove new business growth by developing IT and Service-integrated solutions and creating new service line offerings for Network and Medical Management.
  • Identified and evaluated partners for credentialing.

Lead, Healthcare Centre of Excellence

HGS Philippines
09.2012 - 02.2015
  • Achieved 100% revenue growth for a key Healthcare account by creating and executing a robust growth strategy.
  • Attained a CSAT eX score of 100% based on independent client surveys.
  • Expanded business across multiple lines of business and levels (Healthcare, Global Health, Medicare).
  • Developed and delivered transformative solutions for all new Healthcare logos and expansions.
  • Managed a 400 FTE process covering Clinical, Service Operations, Provider Data Management, Medicare, Global, and Workers Compensation.
  • Managed the first-ever implementation of Prior Authorization for genetic testing.
  • Deployed a provider-payer integration model, resulting in a 5% improvement in First Call Resolution (FCR).
  • Successfully integrated two lines of Business, enhancing NPS scores by 3% and reducing transfers by 7%.
  • Led customer reviews, including senior leadership presentations.
  • Developed solutions for integrating Service and Clinical Operations, deployed for the first time in an offshore model.
  • Led 5 solution design workshops with clients and actively participated in C-Level sales pitches.
  • Led solutions for multiple lines of business yielding $8M in revenue across Clinical processes (Prior Authorization, Nurse Helpline, Care Management, Provider Data Management, Genetic Testing Prior-Auth).
  • Supported Sales in Contract negotiation, MSA, and SOW reviews.
  • Developed a Healthcare Payer matrix, a comprehensive compendium for solutions and processes across all LOB.
  • Built robust capabilities in Claims, Provider Data Management, Exchange, Clinical, Product Build, Denial Management, and Service Operations.
  • Led URAC Accreditation for Utilization Management.
  • Participated in roadshows, conventions, and workshops (AHIP, AHIMA, SQM), and was part of the HIMOAP panel of industry thought leaders.
  • Laid the foundation for the Healthcare Academy.

Business Excellence Lead

HGS Philippines
04.2009 - 09.2012
  • Led four distinct Business Excellence functions: Organizational Capability, Audits and Certifications, Operations and Shared Services Quality, and Continual Improvement Group.
  • Achieved savings exceeding $500,000.
  • Implemented the Business Excellence Framework across HGS India and HGS Philippines.
  • Led eSCM Level 4 certification for the geography.
  • Fostered a culture of continual improvement across the geography.
  • Led Black Belt Projects in collaboration with clients and multiple Six Sigma projects across Healthcare, Telecom, Consumer Electronics, and other verticals.
  • Created and led Operations Excellence scorecard and initiatives.
  • Facilitated Client Satisfaction Survey and Internal Customer Satisfaction Survey, managing Voice of the Customer initiatives.
  • Managed ISO 9000, ISO 27000, PCI DSS, HIPAA, GLBA, and URAC certifications.

Managed Operations, Transition, Quality, and Strategy

HGS India
04.2004 - 04.2009

Consultant

QAI
06.2003 - 02.2004

Practice Lead

Think Harbor Consulting Pvt. Ltd.
01.2002 - 03.2003

Sr. Consultant

ECS Ltd.
06.1999 - 12.2001

Engineer

HMPPD.
04.1993 - 09.1996

Education

Master of Business Administration -

S.P. Jain Institute of Management & Research
Mumbai
01.1999

Bachelor of Engineering - Mechanical Engineering

R.E.C Trichy
01.1993

Skills

  • Strategic Leadership
  • Practice Management
  • P&L Management
  • Business Development
  • Change Management
  • AI & Digital First Strategy
  • Healthcare Payer & Provider Solutions
  • Life Sciences
  • Clinical Operations
  • Provider Data Management
  • Claims
  • Revenue Cycle Management (RCM)
  • Product Management
  • New Product Development
  • Solutions Architecture
  • Process Excellence & Automation
  • AI/ML Applications
  • Digital Transformation
  • IT & Service-Integrated Solutions
  • Operations Management
  • Delivery Excellence
  • Quality Management
  • Continual Improvement
  • Global Process Design & Deployment
  • Talent & Capability Building

Certification

  • HI-FIVE: Health Informatics For Innovation, Value & Enrichment (Clinical Perspective) | Columbia University
  • Registered Coordinator Training | COPC
  • Six Sigma Tools and Techniques (Minitab) | Indian Statistical Institute
  • Black Belt Training | IGE and ISI
  • Green Belt Training | QAI
  • Supply Chain Management Program | Indian Institute of Management, Ahmedabad
  • Professional Selling Skills | Achieve Global
  • Advanced Studies in Software Technology Certificate (Oracle, SQL, Case Tool, C, C++, Java, Software Engineering) | ASSET-Aptech

Timeline

Head of Operations, Quality, Transition, Implementation, Training, and Business Development

MDINetworX
09.2023 - 10.2024

Head of Healthcare and Life Sciences Delivery Operations

Tech Mahindra
09.2022 - 09.2023

Global Process Delivery Lead, Healthcare Vertical

Concentrix
06.2016 - 08.2022

Healthcare Payer Offshore Operations Lead

Dell
03.2015 - 04.2016

Lead, Healthcare Centre of Excellence

HGS Philippines
09.2012 - 02.2015

Business Excellence Lead

HGS Philippines
04.2009 - 09.2012

Managed Operations, Transition, Quality, and Strategy

HGS India
04.2004 - 04.2009

Consultant

QAI
06.2003 - 02.2004

Practice Lead

Think Harbor Consulting Pvt. Ltd.
01.2002 - 03.2003

Sr. Consultant

ECS Ltd.
06.1999 - 12.2001

Engineer

HMPPD.
04.1993 - 09.1996

Master of Business Administration -

S.P. Jain Institute of Management & Research

Bachelor of Engineering - Mechanical Engineering

R.E.C Trichy
Prasad Sampath