SHARAD BHUSAL
Hyderabad
Summary
Dynamic consultant with proven expertise at Thryve Digital, specializing in stakeholder management and data analysis. Engineered a robust claims exchange framework, enhancing operational efficiency and ensuring transactional integrity. Proficient in MS SQL and adept at fostering strong partnerships, driving impactful solutions in Pharmacy Benefit Management and healthcare technology.
Overview
10
10
years of professional experience
Work History
Consultant
Thryve Digital (Now Engen)
Hyderabad
03.2025 - Current
- Engineered a robust claims exchange framework facilitating the ingestion of inbound Rx claims and the transmission of outbound medical data. Automated the cross-platform balancing of benefit accumulators, leveraging technical audits to detect missing claim files and maintain transactional integrity across the PBM ecosystem
- Managed stakeholder tickets across Incident, Request, and Problem modules in ServiceNow. Stakeholders raise Incident tickets related to RX claims missing or accums are not sync.
- Worked on ITS platform to build and integrate Plan Profiles prefix for claims distribution.
- Monitored PBM pharmacy claim transmissions to ensure daily file delivery and validated the synchronization of benefit accumulators between external vendors and internal systems.
- Provided essential administrative and operational support as Offshore Pharmacy Account Manager in Pharmacy Benefit Management (PBM), coordinating across internal teams to deliver organized, reliable, and timely assistance for key activities while fostering strong partnerships and driving departmental efficiency.
- Anticipated operational needs and collaborated with Onshore Pharmacy Account Management partners in PBM operations to maintain accurate documentation, track progress on commitments/deliverables, and support proactive planning and process improvements
Business Analyst
HclTech
Chennai
09.2022 - 03.2025
- Collaborating with the technical teams to develop solutions that meet Customer/stakeholder needs at various levels of the SDLC.
- Proven Knowledge in RCM, Providers (EHR), Payers, Claims and Implementations. Supporting for the production platform Using Mainframe (SQL) insights to gather data's related to Member details, Benefits and groups details.
- Conducted interviews with key business users to collect information on business processes and user requirements.
- Served as an escalation point for complex or unresolved issues, applying expertise in problem-solving techniques to achieve successful outcomes.
- Experience with Trizetto QNXT system implementation, Claims and Benefit Configuration set up and Inbound/Outbound interfaces.
- Reduced incident resolution time with efficient coordination of cross-functional teams and timely communication.
- Good Knowledge of HIPAA Standards, and dealt with EDI 837 and 835 transactions encapsulating in X12 format.
- Strong experience on CMS, Health assessment systems, Medicare and Medicaid Insurance Billing and Claims transactions.
- Ability to develop business rules, USE Case diagrams, relationship diagram and document current state, gap and future state process.
Technical Project Analyst
Athenahealth
Chennai
09.2019 - 06.2022
- Athenanet cloud EHR and third party systems such as ClinicalLab, Radiology/Imaging and Health information exchange (HIE).
- Worked on Data cleansing using Power BI to convert raw data using merge columns and merge queries. Audited internal incident tasks and created reports using Power BI for visualizations purposes.
- Involved in adjusting Business rules, Processes, and data transformation converting raw data into importable data and troubleshooting HL7 interfaces.
- Lead analysis into key operational metrics. To provide support to leadership and stakeholders by producing reports and identifying operational challenges.
- Develop reports to visually explore data using Power BI and Excel and worked on using power query editor in Power BI to perform certain operations fetching file from different source.
- Mapping Inbound(ORU) and Outbound (ORM) HL7 messages to facility and imaging labs.
Software Test Analyst
Exela Technologies
Chennai
09.2018 - 09.2019
- Proven skills in preparation of Test cases and worked on different phases of Testing like Functional Testing, Integration Testing, Regression Testing and Performance Testing.
- Involved in simple mappings for the conversion of EDI X12 transactions and translation of ICD 10 Codes.
- Prioritize issues, creating claims testing schedules to validate and to ensure that system implementations, conversion, contracts and benefit builds were functioning properly on QNXT system.
- Understanding, analyzing and streamlining change Requirement/Requirement Document and creating Test Cases document Writing and Executing SQL statements to check the integrity and validation of data on the database.
- Enhanced software reliability through meticulous identification, documentation, and tracking of defects.
- Achieved faster issue resolution through effective use of bug-tracking tools such as JIRA or Bugzilla for reporting defects accurately and comprehensively.
- Performed Configuration/Compatibility and UAT testing and check claims are received from mailroom, scanned using OCR application and encapsulated with X12 in EDI format to transfer the claims to payer.
Solution Support
Odyssey Technologies
Chennai
02.2016 - 08.2018
- Enhanced customer satisfaction by promptly addressing technical issues and providing effective solutions.
- Mainly worked on a PROJECT called AltaSigna Maple-a window based signer tool designed to meet the needs of banks and financial institution for document delivery and regulatory compliance, Its support for digital certificates issued by public certifying authorities.
- Reduced downtime for clients by efficiently resolving complex technical problems.
- Mainly used for bulk signing and verification, The process was mainly used in banking transaction for verifying and validating.
- Assisted in the development of internal tools designed to streamline support processes, contributing ideas based on hands-on experience in the field.
Education
B.Tech - Electronics And Communications Engineering
Bharath University
Chennai07-2015
Skills
- MS SQL
- HL7, FHIR
- Business Analysis
- Stakeholder Management
- Revenue Cycle Management
- Jira(Scrum)
- Data Analysis
- Mainframe (IBM)
- Data Cleaning
- Process documentation
Timeline
Consultant
Thryve Digital (Now Engen)
03.2025 - Current
Business Analyst
HclTech
09.2022 - 03.2025
Technical Project Analyst
Athenahealth
09.2019 - 06.2022
Software Test Analyst
Exela Technologies
09.2018 - 09.2019
Solution Support
Odyssey Technologies
02.2016 - 08.2018
B.Tech - Electronics And Communications Engineering
Bharath University