Priyanka Mane

Experience

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  WNS

  May 2007 - Aug 2008

  Customer Service Analyst

  Responsibilities:• Provided customer support for an US inbound auto insurance process.• Handled policies with updating changes and provided support by educating and acknowledging customers with their benefits.• Solved queries and complaints related to policies and general insurance questions for effective service delivery• Handled the billing process and took responsibility for the policies for the updates and changes.• Worked on CITRIX based applications for updates and changes on the policies.• Worked for an outbound healthcare process for promoting the generic drug awareness program by using generic medications instead of certain branded products and drugs.• Interacted and communicated with the physicians offices by giving them the drug information of specific patients.• Sending faxes to the doctors for prescription changes. Show less

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  Care Management International

  Sept 2008 - Sept 2011

  Senior Customer Service Representative

  Responsibilities:• Worked for a leading US based outbound process for promoting the generic drug awareness program by using generic medications instead of certain branded products and drugs where I interacted and communicated with the physicians offices by giving them the drug information of specific patients. Also sent faxes to the doctors for prescription changes.• Prepared and maintained daily reports.• Worked for a for a US based outbound process for surveying members for a benefits compliance program for ensuring compliance with their medications.• Educated members of ways and benefits for being compliant with medications. Also documented the medical information provided by the members and scheduled appointments from registered nurses to call them.• Worked with a clinical US non-voice process (Peer Clinical Review) as a clinical reviewer where we worked under a team of physicians and registered nurses.• Reviewed the entire medical history and current medical updates of patients by doing case studies and summarised the cases in Microsoft word formats.• Assisted physicians in the preparation of cases and worked with the nurses for understanding the patient files. • Worked for as a front office executive for a US based process (NE Surgery Centre) where we took care of confirming appointments, obtaining insurance referrals from primary care physicians, pre-registering patients for consultations, gaining prior authorizations from insurance companies for procedures and making post-op surgery follow up calls.• Handled all front office functions/responsibilities for client also trained new representatives for process handling and calling clients for the various hospital functions. Show less

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  Allscripts India Pvt Ltd

  Sept 2011 - Jan 2015

  EDI Support Consultant

  Responsibilities:• Provide support to Allscripts software clients for issues with electronic claims and remittance transmission.• Login as administrator to work on client servers for troubleshooting application errors and other issues.• Install send/receive (data transmission) on client servers for claim files/remit transmission between database through Allscripts and the clearinghouse.• We take remote desktop connection to clients PC to troubleshoot compatibility or application error issues.• Adding and deactivating users in Active directory. Also giving security rights and permissions to clients for different areas of application.• Work on clearinghouses (payerpath) for troubleshooting electronic claims/remittances to pass through to insurance payers and e-claims/remits to reach the Allscripts EMR software.• Give access to users for using clearinghouse and to clearinghouse portal.• Correct claims failed in clearinghouse to get transmitted to the insurance payer.• Login to support tool (Itool) to review electronic claim raw file data in Itool to identify information going out on electronic claims in Loops and segments.• Set Allscripts application to output the claim information in correct Loops and segments as required by insurance payer.• Communicate with clients/insurance payers via email/phone for getting details about claim/remits payments. • Troubleshoot to fix the rejected claims to output the correct or missing information so that the claim is accepted and paid. Set application to maintain/store electronic health records and also post payments/transactions for services rendered. Show less

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  Cognizant Technology Solutions

  Apr 2015 - Jun 2018

  Technical Lead (Senior Software Engineer)

  Core Responsibilities as a “Sr. Software Engineer/Tech Lead”Project implementation/development:Estimate project costing and timelines after going through the project scope and requirements.Requirement analysis – which includes obtaining project related information from client necessary for configuring trading partner agreements on Biztalk and developing ETS scripts for file movement.Perform detailed analysis of project requirements and assist in the development of functional specifications. Work with Wintel team to create ftp sites and folder structures on globalscape servers in all environments.Coding of ETS scripts which are a part of Trizetto/Cognizant internal solutions to pass parameters to the master perl program script which is developed for file movement between servers.Implement custom solutions like renaming, zipping, merging, unbundling, splitting and encrypting X12 and flat/xml files as per client requirements.Troubleshoot script/job failure error codes by checking ETS/perl logs.Generate BPO reports with the help of a perl program to output information on Biztalk/QNXT good and bad count which can be used to validate number of files processed in Biztalk as well as QNXT application.Backup ETS scripts by saving and updating the TFS repository in Visual Studio.Biztalk configuration and administration:Create parties using ISA 06 and 08 values for trading partner agreements.Configure Biztalk to create trading partner agreements for validating files and ensuring HIPAA standards are met. Also setup for converting files from X12 to xml format.Configure send ports and receive ports/locations to be linked/attached to the respective trading partners to pick/drop and process the files in Biztalk. Setup the correct filters, schemas and pipelines in send ports. Show less

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  FIGmd, Inc.

  Jun 2018 - Jun 2021

  I am currently in the role of project and delivery manager and am responsible for end to end client delivery providing direction and guidance to project teams and manage projects right from initiation to closure.● Responsible for delivering products and projects using agile methodology like Scrum, Kanban or Scrumban; depending on the product deliverables; Organize, facilitate and lead Scrum ceremonies including sprint planning, backlog grooming, daily stand-up and project status meetings, reviews, retrospectives, release planning and demo’s; Create product backlog, Sprint backlog and manage user stories. ● Responsible for defining the scope, collaborating with stakeholders; facilitate the conversion of the scope into user stories by the BAs; estimate efforts, create and schedule and sprints; prioritize and negotiate deadlines with clients; drive executive meetings to keep stakeholders involved along with distributing scheduled status reports; budgeting and forecasting; expense reporting, risk management and status reporting; costing and processing any contract variations. ● Accountable for sprint planning; monitoring and controlling development, testing; driving UAT and reprioritizing scope on a daily basis; Manage the lifecycle of code development from ideation to sprints until deployment; Prepare project plan, estimation, schedule, milestones, manage risks and mitigate their impact on projects. ● Involved in cross-functional team management to allocate and re-distribute resources based on milestone priorities to avoid risk of delays, address roadblocks, and accommodate client change requests. ● Consult on resource efforts estimation, project cost estimation, project based invoicing and monthly product invoicing with the finance team; propose preventative and corrective actions; Gap and Risk analysis to determine ways to improve business function Show less ● I am currently in the role of project and delivery manager and am responsible for end to end client delivery providing direction and guidance to project teams and manage projects right from initiation to closure.● Responsible for delivering products and projects using agile methodology like Scrum, Kanban or Scrumban; depending on the product deliverables; Organize, facilitate and lead Scrum ceremonies including sprint planning, backlog grooming, daily stand-up and project status meetings, reviews, retrospectives, release planning and demo’s; Create product backlog, Sprint backlog and manage user stories. ● Responsible for defining the scope, collaborating with stakeholders; facilitate the conversion of the scope into user stories by the BAs; estimate efforts, create and schedule and sprints; prioritize and negotiate deadlines with clients; drive executive meetings to keep stakeholders involved along with distributing scheduled status reports; budgeting and forecasting; expense reporting, risk management and status reporting; costing and processing any contract variations. ● Accountable for sprint planning; monitoring and controlling development, testing; driving UAT and reprioritizing scope on a daily basis; Manage the lifecycle of code development from ideation to sprints until deployment; Prepare project plan, estimation, schedule, milestones, manage risks and mitigate their impact on projects. ● Involved in cross-functional team management to allocate and re-distribute resources based on milestone priorities to avoid risk of delays, address roadblocks, and accommodate client change requests. ● Consult on resource efforts estimation, project cost estimation, project based invoicing and monthly product invoicing with the finance team; propose preventative and corrective actions; Gap and Risk analysis to determine ways to improve business function Show less

  • Senior Project Manager

    Nov 2020 - Jun 2021

  • Project Manager

    Jun 2018 - Nov 2020
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  Apisero Inc.

  Jul 2021 - now

  • Director - Delivery

    Sept 2022 - now

  • Program Manager

    Jul 2021 - Sept 2022