Experience

IRIS Technologies

• Software Development

• VICE PRESIDENT

  • Jul 2010 - Present

  REPORTING TO : CHIEF EXECUTIVE OFFICER Responsible for ensuring that cost effective operations and infrastructure are in place to support all operations. Ensures that the organization is well positioned in a rapidly evolving and competitive environment by being an agent for ongoing organizational change. Ensures that strategies are clearly understood by all employees and that the organization is achieving its strategic goals at the optimum pace. In conjunction with the President and Management Team this position identifies and leads new business development opportunities. Also ensures highly productive relationships and partnerships for the benefit of the organization. Liaises with Government organizations and representative for promoting the goals of the organization. In conjunction with the President, this position acts as a representative and ambassador to promote positive relationships and strong partnerships for the benefit of the organization. Show less



IRIS TECHNOLGIES

• Sweden
• Software Development
• 1 - 100 Employee

• GM

  • 2006 - 2010

  Traveled extensively to assist clients and consult experts and local counsel with case analysis, claim management, and case preparation. NETWORKING EXPERIENCE: Managing the network of healthcare providers [hospitals, clinics, pharmacies ( PBM systems), diagnostics, etc.]: including negotiating preferred tariff rates. Provider classifications and categorization, Network Optimization and Provider Continuous review and renegotiation on provider tariffs. Technical enhancement at network providers for faster claims processing, approvals, reconciliation. Managing 24x7 Patient service division for efficient TAT's and better patient relations. CLAIM PROCESS EXPERIENCE: Was responsible for setting up back offices at Srilanka and India. Routine and persistent follow-ups on all pending claims and reimbursements Analyzed, coded, and abstracted inpatient/outpatient medical records using ICD-9 CM, CPT-4, HCPCS codes . Proficient in physician coding, inpatient hospital coding, outpatient coding, and facility coding. Applies rules and regulations to the DRG Validation review process. Customized monthly statistical and analytical reports and spreadsheets tracking business activity and productivity. Ensuring proper tracking of physical claims and claims processing work flow to avoid any bottle neck and back log accumulation to happen. Periodic MIS, Claims Analysis, and provide critical Underwriting and Actuarial inputs when writing new and renewing existing business books. BUSINESS DEVELOPMENT EXPERIENCE: Recent Projects: • Processed 300,000 Abudhabi based Insurance Co with adjudication. • Processing I.P. claim adjudication for a Government in South Asia (approx.3 million lives). • Coordinating with insurances companies and re-insurance companies regarding policies administration. • Motivated 40-manager team; developed "zone concept" -- implemented company-wide within a year -- by dividing large team into smaller zones to focus on needs of those markets. Show less