Harsh Jadav, PMP, MBA, CSPO

Experience

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  Freedom Health & Optimum HealthCare

  May 2009 - Oct 2014

  Operation Research Analyst

  ▪️Successfully completed a project to automate Vendor material including CMS Enrollment letters and Monthly billing invoices to members▪️Took on a 4 months AEP project for a client that included training for staff about 15 employee, oversight, daily production reporting, issue resolution and keeping client up to date on daily activities and successfully completed it▪️Worked on Medicaid process and report improvement including Medicaid 834 process, management reports and routing of member inquiries▪️Worked with fulfillment vendor on Researched system (iKA system) issues and worked with system BA for resolution. Show less

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  Global TPA

  Apr 2014 - Mar 2016

  Sr. Operation Research Analyst

  ▪️Working on a project of improving Provider Portal, an interface that allows providers to connect to claim system and submit auths and referrals. Project includes setting up issue resolution process, system release, testing and approval process.▪️Full time worked and successfully completed a project of Developing and Designing Medicare Enrollment System that supports Medicare and Medicaid Enrollments. ▪️In accordance to Medicare guideline (chapter 2, 3) building system logic that determines members eligibility, submits data to CMS, processes CMS daily and monthly files, does complete reconciliation, letter automation and identifies any possible discrepancy.▪️Working on a project of setting up process of testing Claim system including Adjudication logic, call center logic and benefit plan set up.▪️Wrote logic and tested complete Member sync between Medicare Enrollment and claim system.Managed complete project of testing Enrollment system per CMS guidance which included writing test cases. Show less

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  BEACON HEALTH SOLUTIONS, LLC

  Apr 2016 - Oct 2020

  Team lead, vendor and fulfillment operations

  • Lead a fulfillment project for Annual Enrollment Period (AEP) which includes preparing a project plan for annual mailing of Annual Evidence of Coverage (ANOC EOC) and set up of member ID cards, Welcome kits, LIS riders and other Enrollment letters, provider and member payments and Explanation of Benefits (EOB) mailing.• Lead a project for new client implementation for fulfillment service set up which includes fulfilling Member ID cards, Welcome kits, Enrollment letters, provider and member checks and Explanation of Benefits (EOB) mailing through vendors.• Lead projects that included working with clients, vendors and across multiple teams within company to come up with project plan that included scope, planning of work to be completed, project schedule, communications channels, work owners, mitigating risk areas and communication to project stakeholders.• Lead a project for new fulfillment vendor implementation that includes working with new vendor to get price estimate for the work, comparing with current vendor and providing valuable analytics to management to facilitate decision making process.• Worked on setting up provider payments via checks mailing, ACH deposit and Virtual cards.• Worked and oversaw project of Enrollment letters’ automation with new Fulfillment Vendor that includes mapping of CMS letters (for 6 LOBs), setting up exception logic, test scripts and working with QA team.• Worked on Medicaid 834 EDI file automation project that includes writing requirements and working with developers, providing SME and working with client for 834 automation• Lead project for TPA Enrollment activities for a client during AEP which included working with client IT for user interface set up and enrollment processing• Worked on supporting Provider portal operations that included coordinating with Provider Relation (PR), Utilization Management and IT team Show less

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  HealthAxis Group

  Oct 2020 - now

  Manager

  • Leading a team of Analysts (Business Analysts and Operations Analysts) who oversee set up of fulfillment activities with Vendors and work with HealthAxis Data and EDI team for file and job set up which overseas and work on new client implementation, client expansions, Annual update projects for Member and Claims material with print vendors• Overseeing set up of Medical claims payment to providers via payment vendors this includes new set up and annual update • Claims member material set up includes Per claim Evidence of Payment (EOP), per claim Evidence of Benefit (EOB), monthly EOB and Quarterly EOB.• Member fulfillment material set up includes but not limited to Member Enrollment letters (CMS Ch.2, Ch.4, LIS letters, etc.), ID cards and Welcome kit material, Annual ANOC EOC mailing, Errata mailing, etc.• Lead multiple client implementation projects that included coordination between client, HealthAxis and print vendors for vendor interface set up.• Overseen 25-30 projects at a time part of End of the Year updates for all Fulfillment material and data file updates across 8-10 clients with total of about 50k membership. Show less