Highly organized and self-motivated Anlytics professional with 19+ years of experience in US Health Care Insurance domain enabling both Payer and Provider business domain. Skilled in developing and implementing strategies to increase efficiency and performance. Passionate about driving business growth and creating positive work environment.
Hi, I’m
Anupam Mishra
New Delhi,Delhi
Summary
Overview
20
years of professional experience
4
Certification
Work History
Optum Global Solution
Associate Director Analytics
10.2015 - Current
Job overview
Team Size : 75,
Responsible to drive delivery on multiple work streams in Payer (E2E claims value chain) and Provider (E2E RCM) business of US Healthcare Insurance Business
- AI/ ML deterministic rule development, deployment, maintenance via data engineering effort to improve accuracy of transaction processing across Payer and Provider processes
- Cloud Infra deployment, Data pipeline creation, Data Streaming service enablement, Solution onboarding, Daily Analytics Operations
- Cognitive Automation to specific business need using AI / ML Analytics and RPA
- E2E Product Development, Deployment and Maintenance based on JAVA, Angular JS, .NET
Solution Architect to design right and appropriate infra to host the solution - Digitization of Structured or Unstructured formats and storage for further usage
- Document Indexing to identify specific clinical / non - clinical information and utilizing for further automation or decision enablement for MD/ Nurse
- OCR engine deployment for text extraction as service and further digitization
- Utilizing NLP techniques to comprehend clinical notes and utilize for automation or process enablement
R1 RCM (Erstwhile Accretive Health)
Manager Quality and Process Excellence
03.2013 - 10.2015
Job overview
Team Size : 80
- Managing Quality process for end to end RCM process of Eligibility verification, Patient visit scheduling, Prior Authorization, Billing, Cash Posting, AR Follow up, Correspondence, Patient AR.
- Manage transactional quality supporting headcount of 1000 + service delivery organization Responsible for developing and implementing quality management system and process for new transition
- Develop, Monitor and Change Business processes in driving performance and minimizing risks in Service delivery o Define internal metrics for service delivery to meet Client’s SLA
- Manage Customer Care Resolution portal to address customer’s feedback or opportunities
- Lead best practice sharing forum internally and face to onshore team
- VOC action planning and translate major actionable to improvement projects o Performance management, Career progression, skill enhancement
- Developed and deployed production control plans and created work instructions and procedures.
- Developed quality planning for multiple new processes transitioned by verifying customer requirements and implementing it
- Managed and archived quality documentation and participated in internal and external quality audits.
NuFuture Digital India Pvt. Ltd.
PMO Manager
07.2011 - 03.2012
Job overview
Process Transition, New Product Development and Deployment, Quality and Compliance Process Implementation for B2B, B2C process in retail domain of O2C, R2R, MDM, etc. supporting 3000 + strong team
IBM Global Process Services
Deputy Manager Business Operations
02.2003 - 06.2011
Job overview
8.5 yrs. experience US Healthcare Claims Business in different roles starting Claims Associate, Training & Quality, Compliance and Business Operations
Education
IMT GhaziabadGhaziabad
MBA from Finance And Marketing
08.2018
University Overview
University of DelhiUniversity Of Delhi
Bachelor of Arts from Maths And Economics
07.2001
University Overview
Kendriya VidyalayaBokaro Steel City
10+2 from Science
06.1992
University Overview
Kendriya VidyalayaBokaro Steel City
10 from All Subjects
06.1990
University Overview
Skills
- Data Engineering
- Data Analytics
- Robotics Process Automation
- Product Management
- Project Management
- Cloud Computing
Accomplishments
Accomplishments
As Analytics Lead has engaged and delivered numerous solutions for both Payer and Provider work streams to reduce cost of operations, improve accuracy of transaction processing, Interest avoidance, Penalty avoidance, reduce write-offs for Provider, Improve speed of cash for RCM etc.. Below are some of major solutions developed during tenure with Optum. And there are many more which are actively contributing to KPI improvement.
- Billing Audit Tool - 100+ different types of defect determination on Pharmacy Claims Billing and report for same day remediation to decrease Claim Denial, Improve collections and speed of collection in RCM.
- Data Mining and Analytics Tool - GUI based tool which supports Payment Integrity team to identify Overpayment opportunities and fix the issue upstream to avoid rework and Provider abrasion.
- Clinical Research & Pharmacy Benefit Automation - E2E Pharmacy appeal handling by integrating multiple data source on 1 platform and using AI/ ML capability in enabling Pharmacists take faster decision on Upheld/ Overturn of Part D appeals.
- System Error Audit Logic Tool - AI/ ML Deterministic rules hosted on Big Data Infra/ Cloud Infra to identify, report and get the defects remediated same business day stops incorrect payment to provider and thus improves payment accuracy, Provider NPS.
- Cash Posting Cognitive Automation - RCM Cognitive Automation solution to extract bank statement from portal, digitize the structured / non structured data templates, parse to required format, run business rules to identify exceptions and payments. Bucketize the transactions into different exception handling bucket for next best action and process all eligible automation transactions.
- RCM Workflow Tool - Aggregate payer EOB using API services from different Payer groups. Analyze the EOB and accordingly create strategy to maximize AR collection . Use AI / ML rules to identify non workable inventory for AR and triage them to relevant buckets for further action.
- Cloud Infra Set Up for Pharmacy Operations - Strategic initiative to reduce cost of infrastructure for hosting all automation solution and other important tools.
Benefit Configuration Automation Tool - Using OCR and Document indexing capability identify the benefit config changes, compare with existing values, update changes, generate exception report of fall out to be handled manually.
- Patient Profiling Tool - Developed tool to perform sentiment analytics and historical behavior study to assign a score to each Patient and thus able to highlight high risk buckets which can translate to Patient recovery delays or leakage.
Certification
- PMI ACP certification – Credential ID – 2645321 (Yr. 2019)
- Masters in Data Science – Simplilearn (Python, R & Tableau) (Yr. 2018)
- AHM 250 – AHIP (Yr. 2017)
- Six Sigma Black Belt – RABQSA & Benchmark Six Sigma ( Yr. 2012)
- PMP Training – QAI (Yr. 2012
Timeline
Associate Director Analytics
Optum Global Solution
10.2015 - Current
Manager Quality and Process Excellence
R1 RCM (Erstwhile Accretive Health)
03.2013 - 10.2015
PMO Manager
NuFuture Digital India Pvt. Ltd.
07.2011 - 03.2012
Deputy Manager Business Operations
IBM Global Process Services
02.2003 - 06.2011
IMT Ghaziabad
MBA from Finance And Marketing
University of Delhi
Bachelor of Arts from Maths And Economics
Kendriya Vidyalaya
10+2 from Science
Kendriya Vidyalaya
10 from All Subjects
- PMI ACP certification – Credential ID – 2645321 (Yr. 2019)
- Masters in Data Science – Simplilearn (Python, R & Tableau) (Yr. 2018)
- AHM 250 – AHIP (Yr. 2017)
- Six Sigma Black Belt – RABQSA & Benchmark Six Sigma ( Yr. 2012)
- PMP Training – QAI (Yr. 2012
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