Vinod Waghmare
US Healthcare | Lead
Pune
Summary
Personable and results-driven professional with talent for motivating teams and fostering collaborative work environment. Possesses comprehensive knowledge of project management and team coordination, excelling in strategic planning and performance optimization. Committed to driving impactful results and achieving organizational excellence.
Overview
12
12
years of professional experience
3
3
years of post-secondary education
Work History
Team Leader Manager
Mdi Networx
06.2024 - Current
- Led employee relations through effective communication, coaching, training, and development.
- Conducted regular performance reviews, providing constructive feedback and coaching to facilitate continuous improvement among employees.
- Enhanced team productivity by implementing efficient workflow processes and setting clear performance expectations.
- Stayed calm, collected and logical during stressful moments to identify and implement optimal solutions.
- Managed service schedules and made sure commitments were met according to the Statement of Work (SOW).
- Monitored support functions to ensure services were delivered on time and met agreed quality standards.
- Maintained high performance in service-related processes and worked to improve them.
- Managed project scope, timelines, quality, and budget, keeping communication clear with all teams.
- Led the service delivery team, built a skilled team, and made sure best practices were followed.
- Worked with program teams to solve problems, manage risks, and ensure smooth project delivery.
- Understood how different tasks and changes affected each other, making sure everything worked together.
- Took action to consistently exceed Service Level Agreements (SLAs) and improve customer satisfaction.
- Created and improved production plans to ensure timely delivery and meet turnaround time (TAT) targets.
- Reviewed and improved trends in data related to client satisfaction, productivity, accuracy, and efficiency.
- Make sure that all work followed company rules, policies, and objectives.
- Enhanced problem-solving skills within the team through facilitating brainstorming sessions and encouraging creative thinking.
- Defined clear targets and objectives and communicated to other team members.
Team Lead
Eversana India Pvt Ltd
01.2022 - 06.2024
- Ensuring that the team meets or exceeds the defined Service Level Agreements (SLAs) by monitoring key performance metrics, identifying areas for improvement, implementing corrective actions, when necessary
- Monitor individual and team performance metrics, such as claim turnaround time, accuracy rates, and productivity levels
- Stay informed about changes to healthcare regulations, billing guidelines, and coding practices
- Collaborate with other departments to resolve complex claims issues, address system issues, and improve cross-functional processes
- Incorporate expertise in Medicare and Medicaid regulations and policies into claim processing workflows, ensuring compliance and accurate adjudication, while providing guidance and training to team members on navigating complex reimbursement rules and eligibility criteria
- Reporting - Use of Excel sheets and interactive dashboard for daily reporting
- Demonstrated experience working with ICD 9/10 guidelines, CPT, and HCPCS classification systems
- Create/collate periodic reports for client report meetings
- Provide timely feedback, and hold regular team connect meetings and project meetings for various issues and updates
- To see adequate resourcing, and work allocation for proper utilization across studies
- Serve as an SME to Medical Reviewers regarding the coding activities and guidelines
- Process Improvement - Develop or improve business processes
- Identify the priorities & get the work done within the timeline
- Willing to handle work pressure
- To know and be aware of team performance against shrinkage and attritions
- Developing macros for processes based on automation required
Sr. Analyst
Tech Mahindra
08.2021 - 01.2022
- Participated in the calibrations
- Responsible to Enroll new members and dependents with benefits as per request
- In addition, give refresher or share updates with the team
- Provide Effective coaching and feedback for all the quality monitors
- Mentored new hires, resulting in stronger staff development and increased productivity
- Knowledge and awareness of the HIPPA Act and compliances
- Effective planning for self, team, and time management for self-organization
- Resolved escalated claims when required
- Distribution of inventory over the team
- Developing macros for processes based on automation required
- Proficient in reviewing medical records to interpret clinical documentation and access accuracy
- Doing team audit to enhance team performance
- Ensure prompt escalations to the Supervisor / Ops Manager
- Giving new recompletions for newly establish projects
- Fulfilled TAT for the high escalated claims
- Proficient in reviewing medical records to interpret clinical document and assess accuracy
- Knowledge about COBRA law and enrolling member with guidelines for the same
- Work with onshore partners and build professional relationship
- Taking active participation in process improvements and automation
- Hands on experience on concept of COB, Authorization, Duplicate ETC
- Supervise the team in learning and other activities as and when required
Sr. Analyst
Concentrix Daksh India Pvt Ltd
09.2015 - 08.2021
- Responsible to Process claims of Physicians and Hospitals
- Based on the process instructions, reading all documents and Health plan we have
- Knowledge and awareness of HIPPA Act and compliances
- To deliver claims within TAT, worked on pended claims from client side
- Participated in the calibrations
- Take quality hurdles for team and share growth
- Processed Hospital high dollar claim/Payment Accuracy
- Demonstrated experience working with ICD 9/10 guidelines, CPT, HCPCS classification systems
- Process an understanding of claims data, Including ICD-10, CPT codes, DRGs, health status
- Knowledge of insurance and payment methods - Medicaid, Medicare, Value-based payment models, managed care risk contracts
- Provide training and refreshers day by day also sharing feedback in systematic manner
- Handling escalation and maintain PAN India data of the reversal
- Mentored new hires, resulting in stronger staff development and increased productivity
Backoffice Executive
Edictate IT Solutions Pvt Ltd
09.2012 - 08.2015
- Working on Excel, Word for different documents and generating various reports
- Generating MIS reports for Daily, Weekly & Monthly Productivity
- Generating Reports for user targets
- Working on conversion of data from EMR to excel
- Working in Outlook for client emails and responding their queries
- Handling customer queries through Phone calls and Chat
- Importing member demographics into company system with specific manner
Education
B. Sc - Computer Science
Solapur University
Solapur, India 06.2009 - 05.2012
Skills
Advance Excel
Excel VBA
Communication Skills
Organizational Skills
Time Management
Research & Planning
Creativity
Problem Solver
Timeline
Team Leader Manager
Mdi Networx
06.2024 - Current
Team Lead
Eversana India Pvt Ltd
01.2022 - 06.2024
Sr. Analyst
Tech Mahindra
08.2021 - 01.2022
Sr. Analyst
Concentrix Daksh India Pvt Ltd
09.2015 - 08.2021
Backoffice Executive
Edictate IT Solutions Pvt Ltd
09.2012 - 08.2015
B. Sc - Computer Science
Solapur University
06.2009 - 05.2012
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