Vivek Dubey
Navvis Healthcare
Montville,NJ
1
Certification
16
years of professional experience
Healthcare expert with extensive 16 years of experience working with Payer and Providers to manage healthcare operations from managing risk adjustment and quality to reducing utilization, keeping patient safe in the community, and generating performance incentives for the organization as an outcome.
Work History
Sr. Director, Client Parter Implementation
3 Years- Managed entire NJ market Value Based Care operations for the largest hospital system RWJBH, by managing several strategic initiatives, like quality improvement plan, utilization plans to reduce Inpatient and ER admits, while optimizing risk adjustment to ensure shared savings achieved, and quality targets achieved across different payer contracts. Successfully achieved more than budget incentives for Three consecutive years.
- Worked with biggest hospital and provider systems in Mid West, SSM, and managed their performance insights, and ensured operations have been enabled based on performance insights to improve quality, optimize risk adjustment and reduce utilization.
- Led strategic planning for value-based care initiatives, aligning clinical operations with organizational growth priorities.
- Directed cross-functional teams to improve care coordination workflows and streamline provider engagement processes.
- Developed governance frameworks for population health programs, ensuring consistent execution across business units.
Sr. Project Manager (Consultant)
1 Year 3 Months- Managed project and engaged with RWJ Barnabas Health for effective operation of value-based care programs.
- Project managed and coordinated pilot value based care programs for Horizon Medicaid plan that was established between RWJ Barnaba Health and Newark Beth Israel Medical center
- Collaborated with business owners to establish and manage strategic initiatives, achieving targeted value-based objectives.
- Coordinated closely with care management, practice optimization, and analytics teams to streamline and execute operational activities promptly.
- Close coordination with Care Management, Practice Optimization and Analytics team to ensure the operational activities have been streamlined and timely executed
- Worked with RWJ population health team and ensured effective establishment of their customer service operations needed for benefit education.
- Employer- Sharp Decisions Inc. Client- Navvis Healthcare
Sr. Project Manager (Consultant)
11 Months- Managed multiple health care management initiatives, achieving significant cost savings for the organization.
- Transition of Spine and Cardiac services- This project effectively transitions the services from one delegated entity to the other who is delegated for full risk.
- Established data file exchanges for membership, providers, authorization history, and claims to operationalize services.
- Ensuring the operational workflows and policies and procedures have been established
- Oversaw communication plan, ensuring timely provider notifications and effective internal and external communications and training.
- Coordinated with vendors and internal teams to ensure seamless transition of services, preventing service interruptions and duplication.
- Advancement of prepayment capabilities- This project enables the delegation of prospective coding validation and retrospective clinical chart validation for both Commercial and Government program market segments
- Employer- Sharp Decisions Inc. Client- Horizon Blue Cross Blue Shield of New Jersey
Director, Revenue Management
5 Years 2 Months- Led project and program management for system implementation and operational initiatives, enhancing financial sustainability.
- Risk Score Optimization- Historically led the Medicare risk adjustment for VNSNY CHOICE by operationalizing several risk adjustment activities. Assisted organization in achieving financial neutrality by gathering additional premium from CMS (approximately $24M) between 2016 and 2020.
- Led efforts to recoup $1.5M in premium by identifying and reconciling rate code discrepancies and timely resubmitting claims to DOH, while streamlining and automating premium billing process.
- Managed the Medicare bid for the organization over three years and submitted the Medicare BID in HPMS.
- RAPS/EDPS Encounters Submissions- Ensured the automated logic has been established within Facets (TMG) for all existing EDPS rejections, and improved the rejection rates from 77% to 98%.
- MMR Reconciliation- Led the operation to receive CMS recoveries on the last 5 years of members where the member was not MSP (Medicare as Secondary Payer), however we collected capitation payment as MSP from CMS. Resulted in additional $3M recoveries.
Sr. Project Manager (Consultant)
1 Year- Project managed multiple retail/digital projects through the following activities:
- Managed the project from its initiation to the deployment/warranty
- Monitored project LOE (Level of Efforts) to maintain variance within +/-10%.
- Planned project milestones and associated activities/tasks, ensuring timely completion.
- Managed the LOE (Level of efforts) of the project, and ensured variance to not exceed +/-10% Variance
- Ensured project financials, schedule, and quality remained on track, maintaining overall project health at 'Green'.
- Employer- Sharp Decisions Inc. Client- CVS Health, Florham Park, NJ
Sr. Project Manager (Consultant)
3 Years 9 Months- Led EPMO initiatives as Project Manager.
- Redesigned RAPS and submitted to CMS for Medicare, facilitating adherence to regulatory requirements.
- RAPS redesign and submission to CMS- Medicare
- ICD-9 to ICD-10 Remediation Program Implementation- Across the enterprise
- HARP (Health and Recovery Plan) program implementation- Medicaid
- Employer- Sharp Decisions Inc. Client- EmblemHealth, New York, NY
Business Analyst (Consultant)
7 Months- Collaborated with the MMIS team to gather business requirements and implement system changes.
- Fee Schedule- 2011
- Managed MMIS claims system change requests addressing issues identified by payers on Medicare/Medicaid cross-over claims, improving claim processing accuracy.
- Created 837 I, P, and D files through File-Viewer, ensuring compliance with regulatory standards for claims submissions.
- Client- Department of Health and Human Services, Lincoln, NE
Education
Master of Science - Industrial Engineering and Management
Specialization: Engineering Management (Project management), Manufacturing System, Quality and Reliability
- Research Assistant
- Examined the advanced skills to improve the MEMS (Microelectromechanical Systems)
- Developed the Virtual Factory using Microsoft Visual Studio 2005/2008/2010, Pro-E wildfire4.0 and Coin 3D.
- Participated as a demonstrator of the VR Simulation to the scholar school students for their career advancement
- References:
- Http://www.youtube.com/watch?v=itrBNFp3FAY
- Http://www.youtube.com/watch?v=DZXP1CI08pM
Graduate Assistant (Excel based VBA developer)
Bachelor of Engineering - Mechanical Engineering
Skills
Collaborative leadership
Cultural transformation
Key performance indicators
Team building and motivation
Organizational development
Value-based care
Team management
Policy development
Certification
08/2018- 2022 Certified Scrum Master (Badge URL- http://bcert.me/sfvlcgmf), 12/2009 Certified Six Sigma- Green Belt, Year- 2013 Microsoft Project- Orange Belt, Year- 2013 Project Management Fundamentals
Timeline
Sr. Director, Client Parter Implementation
Navvis Healthcare
09.2023 - 09.2026Read More
Sr. Project Manager (Consultant)
Sharp Decisions Inc.
06.2022 - 09.2023Read More
Sr. Project Manager (Consultant)
Sharp Decisions Inc.
07.2021 - 06.2022Read More
Director, Revenue Management
VNSNY CHOICE
05.2016 - 07.2021Read More
Sr. Project Manager (Consultant)
Sharp Decisions Inc.
05.2015 - 05.2016Read More
Sr. Project Manager (Consultant)
Sharp Decisions Inc.
08.2011 - 05.2015Read More
Business Analyst (Consultant)
Department of Health and Human Services
01.2011 - 08.2011Read More
Oklahoma State University
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Bhilai Institute of Technology
Bachelor of Engineering from Mechanical Engineering
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Oklahoma State University
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Oklahoma State University
Master of Science from Industrial Engineering and Management
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