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Category Archives: Claims

Principal Consultant & Delivery Manager – HealthCare (Payers & Providers)

Posted on July 29, 2016 | Categories: ACOs, Analytics, Apps, Big Data, Care Management, Claims, Clinical Services, Clinical Trials, Consulting, Data Analytics, Health Exchange, Health Insurance, HealthCare | Posted by: admin

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

 

Contact Manish for Sr HealthCare Consultant @ 646.644.3049 or manish@techcusp.com

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Delivery Director – HealthCare IT

Posted on July 27, 2016 | Categories: Account Manager, Claims, Consulting, Health Insurance, HealthCare, HealthCare IT, Program Manager, RCM, Senior Consultants | Posted by: admin

Delivery Director – HealthCare IT

 

 

  • 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.

 

Contact – Manish @ 646.644.3049 or manish@techcusp.com

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Data & Analytics in HealthCare

Posted on July 26, 2016 | Categories: Big Data, Claims, Clinical Trials, CMS, Data Analytics, Data Mining, Data Scientist, Database | Posted by: admin

Data & Analytics in HealthCare

 

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
  • Adoption Stage 4 – Management & Internal Reporting Tool / Dashboard
  • Adoption Stage 5 – Statutory& External Reporting Tool / Dashboard i.e. Meaningful Use Reporting
  • Adoption Stage 6 – Fraud & Abuse reduction using Claims Data
  • Adoption Stage 7 – Population Health Management (PHM) & Care Management Analytics
  • Adoption Stage 8 – Predictive Analytics (PA) leveraging PHM, CM, UM Data for Preventive Care to Cost Curve and Patient Care / Patient Satisfaction

 

Top use cases for data and analytics for Health IT organization

  • Adoption Analytics – Clinical Workflows & Applications
  • Claims Analytics – Fraud & Abuse
  • Cost Analytics – Planning & Control
  • Customer insight Analytics – Customer Care
  • Discovery/search Analytics – Clinical Trials
  • Meaningful Use Analytics – Positive Outcome
  • Operations Analytics – Customer Service
  • Predictive Analytics – Bend the Cost Curve
  • Risk and Compliance Analytics – PHI & HIPAA

 

How much data and analytics contribute to Health organization’s decision?

  • Differentiate
  • See the future
  • Drive revenue growth or Bend the Cost Curve
  • Clinical Workflows & Software Applications
  • Customer Care
  • Fraud & Abuse
  • Guide future strategy
  • PHI & HIPAA Compliance
  • Planning & Control
  • Product research and development
  • Product research and development – Clinical Trials for Drugs discovery & approval for medical equipment by FDA
  • Sales/Marketing

 

Challenges in Health organization in adopting data and analytics strategy

  • Budget & Priority
  • Information Explosion
  • Inoperability of Data
  • Managing Data Vs Analyzing Data
  • PHI / HIPAA Challenge
  • Quality of Data – Data duplication or Data Integrity
  • Varied Application System within Health System

 

Metrics or benefits /business outcomes for data and analytics in HealthCare

  • Cost Curve
  • Ethical intent
  • Go-to-Market for Drugs
  • Interoperability
  • Legal compliance for PHI (Privacy) & HIPAA
  • Population Health Management (PHM)
  • Transparency

 

Proof of Data & Analytics working for Health Organization

  • A code of ethics around data and analytics
  • C-level support
  • Claims Dashboard
  • HEDIS STAR Rating
  • Meaningful Use Metrics
  • Pain Management Dashboard
  • Prescription Dashboard for Controlled Substances
  • Tracking customer views
  • Transparency on what customer data is being used

 

 

 

 

Project Management for Insurance & HealthCare

Posted on March 18, 2016 | Categories: Account Manager, Agency Systems, ALIP, Analytics, Change Management, Claims, Clinical Services, Consulting, Development Project Manager, Document Management, EMR / EHR, ePrescription, eRx, Health Insurance, HealthCare, HealthCare IT, Insurance IT, IT Services, Medicare, MLTC, Mobile Health, PACE, Payers, PBMs | Posted by: admin

Project Management for Insurance & HealthCare

 

  • Casualty Insurance
  • Health System
  • Hospital Care
  • Life & Annuity Insurance
  • Property Insurance
  • Physicians Group
  • Inpatient
  • Out-Patient
  • Emergency Room

 

PMI approved Project Management – Scope, Time and Cost

 

  • Change Request Management – identifies and develops strategy for changes in scope, schedule, and cost.
  • Communications Management – creates and manages communications with stakeholders providing relevant details for informing and decision making in status reporting.
  • Cost Management – develops, monitors, and assesses project budgets through the entire project life cycle providing full transparency to stakeholders.
  • Documentation Management – Creates appropriate project documentation. Effectively negotiates tradeoffs between scope, schedule, and budget
  • Communication Management – Excellent communication, interpersonal, Presentation and written skills.
  • Implementation and Transition Management – creates transition plan, identifies lessons learned, and applies the lessons learned to future projects.
  • Integration Management – identifies and manages project interdependencies.
  • Quality Management – identifies relevant quality standards and defines governance, communication, and quality processes across SDLC – Dev, QA and Prod stages
  • Resource Management – identifies appropriate staff, defines roles and responsibilities, develop project organization chart and governance structure.
  • Risk & Issue Management – identifies and creates mitigation plans for risks and issues. Utilizes available tools for identifying and tracking issues.
  • Schedule Management – creates, manages, and understands impacts to project scope, constraints, and schedule via MS Project Plan and CA – Clarity
  • Organizational Management – Ability to work well on cross functional project teams including IT and business subject matter experts

Call us for Project Management & Program Management

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Claims System – By Techcusp.com

Posted on May 18, 2015 | Categories: Claims, HealthCare IT, Insurance IT | Posted by: admin

Claims System – By Techcusp.com

 

Tech Cusp is Insurance, HealthCare & Banking focused Technology Services & IT Consulting firm with sweet spot into Software Development, Mobile Apps, BI, Portal and System Integration.

 

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:

  • Application Processing.
  • Issuance.
  • Commissions.
  • Billing.
  • Audits.
  • Reporting.
  • 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.

 

Claims System for Insurance & HealthCare Includes:

  • Affordable Care Organizations (ACOs).
  • Auto Insurance.
  • Casualty Insurance.
  • Commercial Insurance.
  • Dental Insurance.
  • Employee benefits.
  • Excess Lines Insurance.
  • Health Coop.
  • Managed Care Organization (MCOs).
  • Medicaid (MMIS).
  • Medicare Advantage (MA/PDP).
  • Private Health Exchanges.
  • Property Insurance.
  • Self-funded plans.
  • Workers Comp (WC) Insurance.

 

Tech Cusp delivers the following Software Features for Claims System:

  • 360-degree view of customers/members.
  • Authorizations.
  • Automated Re-Pricing.
  • Capitation.
  • Claims Adjudications.
  • Case Management for complex claims & processes like fraud and subrogation.
  • Claims Analytics – Dashboard.
  • Data Warehouse.
  • Easy link to all external documents.
  • EDI Interfaces.
  • HIPAA, ACA, PHI Compliant.
  • Mail Merge Letter generation, PDF and form filler and design flexibility.
  • Multi-client support.
  • 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.

 

Potential Clients, leave your requirements here – http://www.techcusp.com/get-a-quote.php

 

Contact – Careers with Techcusp.com or

Debanuj Sengupta

Manger Sales – IT Consulting & Technology Services

debanuj@Techcusp.com

Phone: +1 646.644.3049 / 201.258.4704 / 201.589.5962

www.TechCusp.com

Insurance IT | HealthCare IT | Banking IT | Staffing

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425 Washington Blvd.,
Jersey City, New Jersey 07302, USA

Phone: +1 201.258.4704
Fax: +1 201.604.3480
E-mail: Contact@TechCusp.com

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