Abhishek Jha
Clinical Process Associate at Mso @Phoenician Medical Center
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WORK HISTORY
Clinical Process Associate at Mso @Phoenician Medical Center
Gurugram, IN
Support clinical workflows including care coordination, utilization management, and prior authorization•Review and maintain clinical documentation in EHR systems•Ensure compliance with HIPAA, CMS, and other US healthcare regulations•Track quality metrics (HEDIS, STAR measures, utilization KPIs)•Assist with audits, reporting, and quality improvement initiatives•Collaborate with providers, payers,patients and internal clinical teams
EDUCATION
Jesus & Mary Darbhanga
Intermediate
Public School Darbhanga
Matriculation
PCI
Registered Pharmacist Bihar, Pharmacy
Clini India
Associate's degree, Pharmacy
LNCT Group of Colleges
M.pharmacy, Pharmacology
University Institute of Technology, RGPV
B.pharm, Pharmacy, Pharmaceutical Sciences, and Administration
ABOUT ABHISHEK JHA
Began career as a QA Officer – QMS in pharmaceutical manufacturing, gaining strong expertise in cGMP compliance, SOP management, audits, CAPA, and quality systems. Transitioned into US healthcare as an HCC Medical Coder, developing in-depth knowledge of ICD-10-CM coding, CMS risk adjustment models, MEAT criteria, and regulatory compliance to support accurate RAF capture and value-based care initiatives. Currently working as a Clinical Process Associate in US healthcare, supporting clinical workflows, care coordination, utilization processes, quality metrics, and process optimization while ensuring compliance with CMS, HIPAA, and NCQA standards.Brings a unique blend of quality mindset, regulatory compliance expertise, clinical documentation accuracy, and process improvement skills, enabling effective collaboration across clinical, quality, and operational teams to enhance healthcare delivery, compliance, and outcomes.
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