Satish R A
Business System Analyst Lead
Hyderabad,Telangana
Summary
18+ years of US healthcare industry experience with solid understanding of the Healthcare Payor & Provider Business application workflows. Proficient in Business Requirements Gathering, Process workflow, Functional & Technical Design documentation.
Overview
11
11
years of professional experience
5
5
Languages
Work History
Business System Analyst Lead
UnitedHealth Group
5 2014 - 6 2023
- UFE (United Front End) & B2B (Business to Business), single-entry point of HCFA 1500 & UB 92 Claims, Member Enrollment, Benefit coverage , Provider data for all the UnitedHealth Group segments
- Based on the data entered/Submitted, UFE & B2B entity will validate & verify member Enrollment data, Provider data, ICD 10, CPT codes and all other fields in Claims forms and convert the claim to a UnitedHealthcare internal format, and route the claim electronically to the appropriate claims' engine for adjudication
- Successfully executed multiple business requirements from various Business Segment Application by Analyzing issues and providing solutions. Worked involved updating Member, Provider, and Benefit Enrollments, Claims Denials,
- Evaluated vendor proposals to select the most suitable solutions for business needs while maximizing cost efficiency
- Provided exceptional customer support through timely resolution of system-related issues while maintaining a high level of professionalism at all times
Claims Operation Manager
UnitedHealth Group
06.2011 - 02.2014
- Process: UMR - United Medical Resource is one of the largest provider Network in USA
- Optum provides administrative services for UMR claims for both Provider and Hospital claims
- Claims received from UMR are repriced in Mainframe as per UHC provider network and adjudicated for payments/denials.
- Conducted thorough investigations into suspicious or potentially fraudulent claims, reducing financial risk to the company
- Coordinated responses to regulatory inquiries or audits regarding claims operations, ensuring compliance with industry standards and legal requirements
Assistant Manager Operations
Hinduja Global Solutions
04.2007 - 12.2010
- Process: Commercial Business Claims adjudication
- Aetna
- Rx Prescription drugs claims adjudication - CVS
- Workmen's compensation benefit Claims adjudication - Aetna.
- Evaluated operational metrics regularly to identify areas for improvement and implement corrective actions accordingly
- Managed daily staff scheduling, ensuring optimal coverage during peak hours while minimizing labor costs
- Improved customer satisfaction rates by closely monitoring service quality and addressing issues promptly
- Developed and maintained a high-performing team with ongoing training, coaching, and performance evaluations
- Handled escalated customer complaints effectively by resolving issues while maintaining strong client relationships throughout the process
- Conducted regular audits of departmental procedures to ensure adherence to established guidelines, reducing instances of noncompliance
- Reported issues to higher management with great detail
Claims Processor to Group Lead
Hinduja Global Solutions
06.2003 - 03.2007
- Processed HCFA 1500 (Provider, Independent labs, radiology, Dental Claims) and UB92 Claims (Inpatient and Outpatient Claims) in Mainframe based Rumba application to meet target of 180 claims per day.
Education
Bachelors Degree -
Vidhyapeeth University
Pre-University Degree - undefined
GES - Bangaore University
Devops Engineering - undefined
EXIN
Scrum Master - undefined
Lean Six Sigma - undefined
Skills
- Leadership - Expert
- Business System Analysis
- Lead - Expert
- Professional Scrum Master Experienced
- Enterprise Records Information Management Expert
- ANSI X12 Standard EDI transactions - Expert
- Business Operations Management - Expert
- Process Transition - Expert
- Automation - Expert
- Devops Engineering Experienced
- Linux - Experienced
- SQL - Experienced
- Python - Experienced
- Git - Experienced
- ERT Diagram - Experienced
- Database Design Experienced
- Pharmacy Benefit Management - Expert
Timeline
Claims Operation Manager
UnitedHealth Group
06.2011 - 02.2014
Assistant Manager Operations
Hinduja Global Solutions
04.2007 - 12.2010
Claims Processor to Group Lead
Hinduja Global Solutions
06.2003 - 03.2007
Business System Analyst Lead
UnitedHealth Group
5 2014 - 6 2023
Bachelors Degree -
Vidhyapeeth University
Pre-University Degree - undefined
GES - Bangaore University
Devops Engineering - undefined
EXIN
Scrum Master - undefined
Lean Six Sigma - undefined
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