18+ years of stellar experience with growing leadership responsibility and spearheaded the complex teams in Data Science, Risk Adjustment, Clinical Informatics, Data Engineering, Payor Data Engineering and Clinical Data Engineering in health plans space at current company health administration solutions and ACO. ⧮ Managerial Summary 📌Strategy, planning and delivery of various analytics/data science products in TPA/Value Based Care settings (ACOs) 📌Direct working with C-level layer of organization 📌Senior-Level Department Management including Business Presentations, SOPs, SLAs, OLAs. 📌Financial Leadership while owning project plans, resource projections, budgets and performance 📌People Leader with history of highest level of employee engagement in BU ⧮ Technical Summary 📌Hands-on leader in statistical modelling, machine learning, nlp at researcher level understanding working with top notch data scientists and medical professionals 📌Worked on most of BI tools available in the market at different juncture of my career 📌Proficient in designing scalable enterprise level architecture for cloud based data lakes ⧮ Healthcare Experience Summary 📌Health Plans/ACOs - - Utilization Management (Prior Authorization Intake, Authorization Approval) - Care Management (Risk Stratification, Transition Care, Readmission Risk) - HEDIS and STARS improvement program - Risk Adjustment, Suspecting, CMS Risk Models, Machine Learning based Risk Engine - Providers (Provider Matching, Provider Directory Accuracy) - Payor Data Engineering (New Payor Data like Claims, Rx, Eligibility etc onboarding) - Clinical Data Engineering using HL7/ADT/ORU/CCDA/CCD - Familiarity with X12 documents (837p, 837i, 835, 270/271) - Familiarity with Alternative Payment Models (APMs) for providers (MSSP ACO) - Claims adjudication, revenue cycle, eligibility, provider contract, risk bearing contracts 📌Life Sciences – Clinical Decision Support, Personalized Treatment, Epidemiology, Cohort Design, APLD, Commercialization, Clinical Trial Design, EHR/EMR data 📌Co-author of research paper in clinical area using claims/machine learning. (joint work by pharma giant/CitiusTech & pending publication). ⧮ Education 📌Bachelor of Technology from India’s top 10 engineering college (IIT Roorkee) 📌Certification of Business Analytics (which is now Advanced Management Program in Business Analytics) from top 10 B-school (Indian School of Business, Hyderabad)