Bhargav Chennamsetty
NASHUA,NH
Summary
Claims Subject Matter Expert and Pharmacy Benefits Manager with extensive experience in claims processing, pharmacy benefit management. Proven success in enhancing efficiency, conducting audits, and training teams. Skilled in claim adjudication, HIPAA compliance, and developing streamlined SOPs, offering deep expertise and proactive solutions to drive continuous improvement.
Overview
8
8
years of professional experience
Work History
Claims Subject Matter Expert
Mphasis Pvt. Ltd
04.2022 - 07.2023
- Supported claims processing for key clients, including Archare and Troy Medicare, as part of a pilot project, leading to a successful 7-year agreement within 4 months.
- Enhanced claim processing efficiency by 10% through streamlining workflows and implementing time-saving strategies.
- Conducted regular audits on completed claims to identify areas for improvement and implemented corrective measures, ensuring continuous process enhancement.
- Trained two batches of new hires on adjustment claims and pre-check claims processes, including managing client submissions via SharePoint, ensuring team readiness and accuracy in claim handling.
- Managed high-volume caseloads by prioritizing tasks to ensure timely completion of claims, adhering to claim aging protocols and multiple process requirements.
- Collaborated with the Quality Management team to develop streamlined SOPs and flowcharts, enhancing efficiency to process over 100 claims per day with 99% accuracy.
- Assigned Claims Incident Tickets through the JIRA platform, ensuring alignment with client requirements and efficient resolution.
- Maintained strict confidentiality of Protected Health Information (PHI) in compliance with client HIPAA guidelines, ensuring adherence to privacy and security standards.
Claims Subject Matter Expert
Optum Global Solutions
12.2016 - 03.2022
- Served as a Subject Matter Expert for the Home Delivery Pharmacy (HDP) pilot project under Pharmacy Benefit Management, specializing in NCPDP rejection codes for members' prescription orders through Optum Home Delivery, contributing to improved medication adherence and patient satisfaction by delivering a cost-effective and convenient home delivery solution.
- Trained and mentored 10 batches of new hires from the Hyderabad team and 2 batches from the Philippines team as Pharma Benefit Analysts, ensuring their proficiency in role-specific tasks and contributing to overall team success.
- Audited 50 Data Entry Rejection code orders daily, ensuring compliance with HIPAA guidelines and contributing to enhanced team efficiency and productivity.
- Transitioned to the Therapeutic Interchange Protocol System (TIPS) project, empowering pharmacists to interchange drugs between generic and brand options without prior prescriber consent, in alignment with patients' drug coverage plans.
- Certified in Six Sigma Lean Project from Optum, collaborating with the Optum Excellence Team and Master Black Belt to optimize TIPS and DEX Holds, significantly accelerating the processing of prescription orders and minimizing delays.
- Earned consecutive nominations for Best Employee of the Year in 2018 and 2019 for successfully onboarding and skill development of new hires, as well as significant contributions to overall project success.
- Streamlined processes to boost efficiency, collaborating with the IT team to build macros within the database, enabling analysts to complete tasks ahead of schedule.
Pharmacy Benefits Manager
Artech Infosystems Private Limited
08.2016 - 12.2016
- Worked as a contract employee on the Prior Authorization Project at Optum Global Solutions, handling patients' medication prior authorization approvals to ensure timely and accurate processing.
- Mentored 50 team members by providing clarifications and guidance, helping them achieve higher efficiency and productivity in their tasks.
- Promoted internally to Subject Matter Expert and full-time employee for the Home Delivery Pharmacy pilot project, in recognition of exceptional performance and expertise.
Supply Chain Executive
MedHimalays Solutions Private Limited
06.2015 - 06.2016
- Forecasted demand and ensured product availability by managing weekly stock replenishment, maintaining optimal inventory levels.
- Organized and oversaw inventory management by maintaining a detailed database of available stock and projected usage per project, ensuring accurate and efficient inventory control.
- Optimized warehouse operations by ensuring efficient utilization of space, maximizing storage capacity and improving workflow.
Education
Master of Science - Health Informatics
New England College
Henniker, NH05.2025
Bachelor's of Pharmacy - Pharmacy
Nalla Narasimha Reddy School of Pharmacy
Hyderabad, India11.2015
Skills
- Training and mentoring
- Strong analytical skills
- Deep expertise
- Teamwork and Collaboration
- Excellent Communication
- HIPAA Guidelines
- HCPCS and CPT Knowledge
- ICD-10 Proficiency
- US Healthcare
- Medicare and Medicaid process
Timeline
Claims Subject Matter Expert
Mphasis Pvt. Ltd
04.2022 - 07.2023
Claims Subject Matter Expert
Optum Global Solutions
12.2016 - 03.2022
Pharmacy Benefits Manager
Artech Infosystems Private Limited
08.2016 - 12.2016
Supply Chain Executive
MedHimalays Solutions Private Limited
06.2015 - 06.2016
Master of Science - Health Informatics
New England College
Bachelor's of Pharmacy - Pharmacy
Nalla Narasimha Reddy School of Pharmacy
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