MADHULIKA JAMWAL
Summary
Business analysis professional with experience in healthcare industry business process analysis, data-driven decision-making, and strategic planning. Adept at gathering and analyzing requirements, identifying opportunities for process improvements. Demonstrated ability to effectively manage stakeholders, gather requirements, and make data-driven decisions. Collaborative team player focused on achieving results and adapting to changing project dynamics.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Project Management/Operations Integration Lead
Commonwealth Care Alliance
09.2022 - Current
- Engaged with cross-functional internal stakeholders to understand current processes/systems and pain points to elicit detailed business needs.
- Led requirements-gathering sessions with multiple stakeholders with minimal dependency on Lead or Manager.
- Partnered with IT an Clinical teams to identify and capture requirements for transitioning Health Plan users from EMR to a Care Management Platform.
- Identified inter-dependencies/impact of the transition across all domains.
- Developed current and future state process flow diagrams and reporting requirements.
- Acting as a liaison between Business stakeholders and IT for identifying requirements and implementation.
- Created Requirements Traceability Matrix for Annual Enrollment Period to ensure all the requirements are met and tracked throughout AEP or until 1/1, as applicable.
- Facilitated meetings and engagement-specific workgroups, as needed.
- Timely development, management, and execution of integration plans for acquired entities in to CCA core, centralized function.
Regulatory Operations Analyst
Centene Corporation
02.2020 - 09.2022
- Perform regulatory filings in SERFF and HIOS for CMS and various states.
- Analyze and interpret proposed or enacted legislation and communicate out to impacted departments.
- Respond to internal and external requests for information required by the organization for its regulatory filings.
- Respond to inquiries from state and federal regulatory agencies pertaining to regulatory filings.
- Demonstrate effective verbal and written communication skills to collaborate with key stakeholders across different levels of the organization.
- Assist in the maintenance and implementation of department policies, procedures, and work processes.
- Experienced in identification, analysis, and resolution of issues.
- Independently managed regulatory filings and corresponding regulatory requirements for 5 states within United States.
- Conduct research projects to analyze, interpret and disseminate guidance on legal, contractual and regulatory requirements to the cross functional teams to ensure product compliance.
- Working knowledge of health products, procedures, and state insurance regulations.
Commercial Benefits Communications Coordinator
Viva Health
06.2019 - 02.2020
- Maintain and update commercial Certificates of Coverage, Summaries of Benefits & Coverage and other regulatory items required by federal and state law.
- Perform regulatory filings in SERFF and HIOS.
- Research potential benefit changes, including a market analysis of coverage; assist in the development of plan language to reflect revised coverage of benefit changes.
- Assist the sales team to ensure plan designs are keeping with current laws and regulations.
- Stay abreast of emerging clinical technologies and treatments and ensure plan documents reflect the intended coverage of new technologies.
- Assist in ensuring compliance and communicating requirements and changes throughout the company.
Research Assistant
UAB Centre for the Study of Community Health- Evaluation and Assessment Unit
01.2018 - 09.2018
- Conducted and transcribed translational science focused structured interviews of Principal Investigators (PI) under Centre for Clinical and Translational Science (CCTS) to assess the impact of CCTS on investigators.
- Contributed to the writing of manuscript for Scale Back Alabama 2018.
- Collected and analyzed the data for the Scale Back Alabama Program to determine inclusivity of the program.
Intern
UAB Centre for the Study of Community Health- Evaluation and Assessment Unit
06.2018 - 08.2018
- Conducted programmatic evaluation of Scale Back Alabama Program.
- Conducted literature reviews and analyzed survey results to determine the impact of the program on people with mobility limitation and intellectual disability.
- Evaluated effectiveness of the program using web-based research tool, Qualtrics.
Management Consultant
Octavo Solutions Pvt. Ltd.
02.2015 - 01.2016
- Analyzed and compiled primary data to report performance of 114 healthcare units in the state of Uttar Pradesh for the Uttar Pradesh Health System Strengthening Project (UPHSSP).
- Designed, implemented and monitored Quality Management System for the units within Uttar Pradesh Health System Strengthening Project (UPHSSP).
- Conducted hospital survey, GAP analysis and made gap report as per the NABH/ISO standards.
- Prepared internal audit reports, corrective and preventive action (CAPA) reports and root cause analysis.
Management Intern
Octavo Solutions Private Limited
01.2015 - 04.2015
- Have been a part of Facility management of six District Hospitals in Uttar Pradesh, India with following responsibilities:
- Periodic visit to the facility to assess the service delivery system.
- Proposed a definite action plan to overcome the gaps and make the facility compliant with the NABH standards.
- Performed audits of all the departments.
Management Intern
Alchemist Hospital
05.2014 - 07.2014
- Planned, organized and controlled the flow of materials from their initial purchase to service point through distribution
- Managed and maintained record of items issued to different departments of the hospital.
Associate Dentist
Gujarat Multispecialty Dental Clinic
05.2012 - 02.2013
- Performed restorative procedures, tooth extractions, oral prophylaxis and fabrication of prosthesis.
- Provided patients with preventive care techniques to ensure optimal dental health and personal wellbeing.
Clinical Intern
MN DAV Dental College and Hospital
04.2011 - 04.2012
- Independently diagnosed oral diseases, planned appropriate dental treatment, counseled the patients and followed up.
- Hosted free dental diagnostic and treatment camps for the underprivileged children and elderly.
- Performed restorations, tooth extraction, oral prophylaxis and fabricated dentures.
Education
Master of Public Health - Health Care Organization and Policy
University of Alabama at Birmingham
Birmingham, AL04.2019
Master of Business Administration - Hospital & Healthcare Management
Jamia Hamdard University
04.2015
Bachelor of Dental Surgery -
MN DAV Dental College & Hospital
04.2012
Skills
- Data analysis and reporting
- Regulatory Compliance (HIPAA, ACA, CMS, Medicare, Medicaid)
- Microsoft Office (Word, Excel, PowerPoint)
- SQL, SPSS
- Stakeholder Management
- Teamwork and collaboration
Certification
- Health Insurance Portability and Accountability Act (HIPPA)
- Institutional Review Board (IRB)- Basic Course
Languages
English
Full Professional
Hindi
Native or Bilingual
Timeline
Project Management/Operations Integration Lead
Commonwealth Care Alliance
09.2022 - Current
Regulatory Operations Analyst
Centene Corporation
02.2020 - 09.2022
Commercial Benefits Communications Coordinator
Viva Health
06.2019 - 02.2020
Intern
UAB Centre for the Study of Community Health- Evaluation and Assessment Unit
06.2018 - 08.2018
Research Assistant
UAB Centre for the Study of Community Health- Evaluation and Assessment Unit
01.2018 - 09.2018
Management Consultant
Octavo Solutions Pvt. Ltd.
02.2015 - 01.2016
Management Intern
Octavo Solutions Private Limited
01.2015 - 04.2015
Management Intern
Alchemist Hospital
05.2014 - 07.2014
Associate Dentist
Gujarat Multispecialty Dental Clinic
05.2012 - 02.2013
Clinical Intern
MN DAV Dental College and Hospital
04.2011 - 04.2012
Master of Business Administration - Hospital & Healthcare Management
Jamia Hamdard University
Bachelor of Dental Surgery -
MN DAV Dental College & Hospital
Master of Public Health - Health Care Organization and Policy
University of Alabama at Birmingham
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