jessica claire 100 montgomery st 10th floor 555 4321000 resumesampleexamplecom summary organized professional 19 yrs experience enabled services us healthcare insurance domain payer business 16 yrs experience claims rework appeal provider benefit config etc provider rcm 10 yrs frontend backend processes strong track record executing multiple working domains like analytics automation process excellence compliance project management training quality facilitating successful performances skills management work planning prioritization performance management program management technical skill big data engineering data analytics experience associate director analytics 102015 current abb ltd san diego ca team size 75 program management robotics process automation product management aiml model domain us healthcare insurance payer provider responsible drive delivery multiple work streams payer e2e claims value chain provider e2e rcm business us healthcare insurance business aiml deterministic rule development deployment maintenance via data engineering effort improve accuracy transaction processing across payer provider processes cloud infra deployment data pipeline creation data streaming service enablement solution onboarding daily analytics operations cognitive automation specific business need using ai ml analytics rpa e2e product development deployment maintenance based java angular js net solution architect design right appropriate infra host solution digitization structured unstructured formats storage usage document indexing identify specific clinicalnonclinical information utilizing automation decision enablement md nurse ocr engine deployment text extraction service digitization utilizing nlp techniques comprehend clinical notes utilize manager quality process excellence 032013 102015 r1 rcm erstwhile accretive health city state team size 80 managing quality process end end rcm process eligibility verification patient visit scheduling prior authorization billing cash posting ar follow correspondence patient ar manage transactional quality supporting headcount 1000 service delivery organization responsible developing implementing quality management system process new transition develop monitor change business processes driving performance minimizing risks service delivery define internal metrics service delivery meet clients sla manage customer care resolution portal address customers feedback opportunities lead best practice sharing forum internally face onshore team voc action planning translate major actionable improvement projects performance management career progression skill enhancement retention team pmo manager 072011 032012 nufuture digital india pvt ltd city state individual contributor managing end end transition process improvement product deployment p2p o2c r2r processes retail domain deputy manager business operations 022003 062011 ibm global process services city state 85 yrs experience us healthcare claims business different roles starting claims associate training quality compliance business operations education training mba finance marketing 052018 imt ghaziabad ghaziabad bachelor arts maths economics 072001 university delhi delhi 102 science 061992 kendriya vidyalaya bokaro steel city 10 061990 kendriya vidyalaya bokaro steel city accomplishments analytics lead engaged delivered numerous solutions payer provider work streams reduce cost operations improve accuracy transaction processing interest avoidance penalty avoidance reduce writeoffs provider improve speed cash rcm etc major solutions developed tenure optum many actively contributing kpi improvement billing audit tool 100 different types defect determination pharmacy claims billing report day remediation decrease claim denial improve collections speed collection rcm data mining analytics tool gui based tool supports payment integrity team identify overpayment opportunities fix issue upstream avoid rework provider abrasion clinical research pharmacy benefit automation e2e pharmacy appeal handling integrating multiple data source 1 platform using ai ml capability enabling pharmacists take faster decision upheld overturn part appeals system error audit logic tool aiml deterministic rules hosted big data infra cloud infra identify report get defects remediated business day stops incorrect payment provider thus improves payment accuracy provider nps cash posting cognitive automation rcm cognitive automation solution extract bank statement portal digitize structured non structured data templates parse required format run business rules identify exceptions payments bucketize transactions different exception handling bucket next best action process eligible automation transactions rcm workflow tool aggregate payer eob using api services different payer groups analyze eob accordingly create strategy maximize ar collection use aiml rules identify non workable inventory ar triage relevant buckets action cloud infra set pharmacy operations strategic initiative reduce cost infrastructure hosting automation solution important tools benefit configuration automation tool using ocr document indexing capability identify benefit config changes compare existing values update changes generate exception report fall handled manually patient profiling tool developed tool perform sentiment analytics historical behavior study assign score patient thus able highlight high risk buckets translate patient recovery delays leakage certifications pmi acp certification credential id 2645321 yr 2019 masters data science simplilearn python r tableau yr 2018 ahm 250ahip yr 2017 six sigma black belt rabqsa benchmark six sigma yr 2012 pmp training qai yr 2012