S. Raghavendra Pawar Hcafa

About S. Raghavendra Pawar Hcafa

Summary• Overall experience of 17+ years in US Healthcare Industry (Physician/Hospital/Payer/IT)Area of Specialization:• Payment Integrity & Revenue Integrity, Healthcare Analytics, Product Management (Domain), Healthcare Automation & Process Excellence, Health Information Management (HIM), Revenue Cycle Management, Healthcare Claims, Healthcare Operations & Training, Healthcare Quality & Compliance, Healthcare Policies & data.Certified Healthcare Professionala. American Academy of Professional Coders - AAPC (CPC, CIRCC, CPC-Payer & ICD-10), b. America\'s Health Insurance Plans – AHIP (HCAFA, FAHM, PAHM),c. Certified HIPAA Administrator™ (CHA™)Health Information Management, Healthcare cost containment, Healthcare Product Management:• Product innovation and development in US Healthcare. Develop US Healthcare analytics and rules engine products to identify Payment Inaccuracies, Fraud, Waste & Abuse (FWA) in Healthcare which is ~1 Trillion Dollar problem in US• Other areas of focus are Price Transparency, Population health, Claims retrospective/prospective analytics & episode grouping for multiple usecases which would address contain cost, efficiency of process, quality of care, FWA in healthcare.• Health policies and data: CMS, AMA, Industry codes set policies etcRevenue Cycle Management: Medical Coding & Billing:• Hospital (Facility) & professional coding• Specialty Knowledge: Diagnostic & Interventional Radiology, Surgery, Inpatient & DRG, E&M, ED, Observation, Infusion & Wound Clinic, Pharmacy Billing (NDC). In-depth Claims forms & Billing knowledge. CMS policies & data knowledge. End to end knowledge on Revenue cycle management (RCM)Automation & Computer assisted coding (CAC):• Subject Matter Expert & Feedback panel member for automated coding engine software, testing, implementation & validating final product satisfies the defined requirements & ensured the subject area is accurately represented prior to distribution to end-users for Radiology (CAC) iCode @GeBBS, DRG Inpatient (CAC) KPAI @KPMD• Payment Integrity & Revenue Integrity: Automated verification of healthcare claimsTraining:• Vice President and Education Officer – AAPC (Bangalore Local Chapter). Managing a member base of plus• Interventional Radiology Cardiovascular Coder (CIRCC), 1st Generation Trainer in India with 100% results• Trainer for Healthcare insurance domain, CPC, CPC-P, COC, CIRCC, ICD, HIPAAProject management:Initiating, planning, executing, liaison & closing the taskCompliance & Quality:Privacy Officer - HIPAAISO (QMS & ISMS) Auditor

Experience

1. Founder

   CoverSelf

   Jul 2021 — Present · Bengaluru, IN

   Building products with a mission to decrease ~1 trillion-dollar problem in US healthcare (Improper payments, Fraud, Waste & Abuse (FWA)) with latest technology and deep domain expertise, eventually bringing down healthcare cost and premiums.

Education

• Bangalore University

  Master's degree, Biochemistry

  2004 — 2006

• Bangalore University

  Bachelor of Science - BS, Industrial Microbiology, Chemistry and Botany

  2001 — 2004