Principal Consultant & Delivery Manager – HealthCare (Payers & Providers)
The Principal Consultant & Delivery Manager (PCDM) leverages combined people, process, analytics and technology competencies to support large-scale, complex customer engagements
The Principal Consultant & Delivery Manager (PCDM) is responsible for driving customer value through client facing advisory and delivery services. A subject matter expert and trusted advisor for Payers, Providers, Clients & Program Management Team and works closely with engagement and technology team to define strategic and tactical direction
Collaborates with Leadership, Product, Infrastructure &Security teams to configure solutions and deliver value to customers. Responsible for identifying and solving business / systems issues
Contribute to the delivery and execution of complex, large scale, multi-year (high cost, high complexity and/or high risk) client enterprise transformation programs
Deliverables include leading major work streams and projects, supporting pre-sales and sales activities, owning deliverables, building key customer relationships, building and sharing institutional knowledge, and developing junior professionals
Build, share, and maintain expertise in both practice area and client environment, regularly interface with Product, Infrastructure, and Security teams to deliver on customer commitments
Contribute to operational readiness, organizational change management, solution capability, packaging, and estimating, planning and delivery management
Contribute to pre-sales and sales activities for revenue growth
Lead major engagement work streams and projects to meet milestones on time, and to deliver with high quality and within agreed to budgets
Plan, organize, staff, direct and control the operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority
Use Data Analytics & information sets for analysis, creating hypotheses and presenting recommendations to team; developing client specific requirements, standard operating procedures (SOP), functional roles & responsibilities, process flow and user guide per SOW
Manage & Lead Project Initiations, Estimates, SOWs, Budgets, Charter, Scheduling, Plan, Risks etc in support of on-going client needs and new opportunities
Managing complex plans to resolve client production incidents and service requests through understanding of client priorities and internal processes. Tracking to plan and working across the organization to effectively meet the client’s business needs. Establishing positive relationships with clients and program resources through effective communication and on-time delivery of commitments
Responsible for Client Relationship Management (CRM), Voice of Customers (VOC), Solutions and Escalations that demand a high degree of diplomacy, discretion, insight, and judgment
Managing SOW / contract scope to include establishing agreed upon contract deliverables, roles, responsibilities and budget
Lead and directly manage a team of resources, in particular as it relates to the delivery of project-based activities
Participate and contribute thought leadership to help drive Professional Services & Business Development strategies
Acts as a liaison between various internal organizations (Marketing, Finance, Product Management, etc.)
Managing and developing agendas and action logs for all client meetings. Tracking open items in action log and ensuring timely delivery across the organization
Managing and facilitating weekly and monthly client meetings and reporting on projects at a line level up to senior executive level
Managing multiple operational projects on time, budget, and quality while accommodating competing priorities
Managing multiple project teams to completion in parallel within time and budget and completing all project close-out activities.
Managing project environments through the product lifecycle including procurement, build and configuration, network and security configuration, and coordinate and schedule resources
Proactively identifying gaps in internal change, incident, service request, batch and problem management plans and external expectations; and managing client expectations regarding risks and issues mitigation
Provide delivery engagement for existing & client portfolio. Manage client level P&L
Strong presentation skills with ability to effectively communicate through written or verbal forums and strong interpersonal skills
Working with Communication Team and Project Managers / Program Manager to disseminate project status, information, and expectations to internal and external client resources and stakeholders and reporting on projects at the executive level.
Working with technical leadership to ensure their client program is properly resourced based on scope, skillset and timeframe for delivery. Escalating production issues quickly and driving resolution while communicating status and resolution path to client. Proactively escalating to resource teams to avoid risk of missing client deliverables.
Data & Analytics Adoption Model in HealthCare for Access, Cost, Quality (ACQ)
Three stages of data management via EDW – 1) data collection 2) data sharing / access and 3) data analytics
Bulk of Data Collection are done via electronic health records (EMR/EHR) and health information exchanges (HIE/HIX)
Data & Analytics is playing a big role in Health System Quality improvement and cost reduction efforts
Healthcare Analytics Adoption Model borrows & leverage recommendations from HIMSS EMR Model, Health & Human Services (HHS), Food & Drugs Administration (FDA rules for Clinical Trials) and Center for Medicare & Medicaid (CMS)
The Adoption Model may include – evaluating the industry’s adoption of analytics, roadmap for measure progress toward analytics adoption and evaluating vendor products for improving the quality of care while lowering costs and enhancing clinician and patient satisfaction
8 Stages of the Data & Analytics Adoption Model
Adoption Stage 1 – Enterprise Data Warehouse (EDW) using Physical or Virtual Servers
Adoption Stage 2 – Registration & Billing System including Patient Registries via Personal Portal
Adoption Stage 3 – Electronic Health Record &Electronic Prescription System (EMR & eRX) for clinical observations and lab results
We at Techcusp.com can help build – ground up & comprehensive, web based Claims Management System.
We can custom build claims system for P&C Insurance, Workers Comp Insurance, Insurance Brokerage, Health Insurance, TPA’s and Reinsurance firms. Claims Management System (CMS) will be designed to support all phases of the policy lifecycle, which includes:
Cancellations & Reinstatements.
Browser based multi-line system will be designed to support carriers, third-party administrators, public entities and self-insured organizations in administering claims for all lines of business. Its interface will be intuitive and easy to use.
Case Management for complex claims & processes like fraud and subrogation.
Claims Analytics – Dashboard.
Easy link to all external documents.
HIPAA, ACA, PHI Compliant.
Mail Merge Letter generation, PDF and form filler and design flexibility.
Open source or Microsoft SQL database for simple.
Reporting and Data Exports – Canned, Ad hoc, Statutory or Custom Reporting.
Tech Cusp does deliver one of the best Claims Services. We believe that our Software Engineers & Consultants have deep exposure & understanding of Claims Services for both Insurance and HealthCare. Reach out to us for our seasoned & domain rich IT Consultants; Developers & Software Engineers for short term or long term projects.