Ratheesh Harshavardhananan

About Ratheesh Harshavardhananan

Healthcare Product Principal Consultant with over 19 years of experience specializing in the implementation and optimization of Core Administrative Processing Systems (CAPS) such as TriZetto Facets and HealthRules® Payer, along with their associated solution suites.Possess 9 years of on-site customer engagement experience in the U.S, working with major healthcare organizations including Amerigroup, Elevance Health, Optum, and Blue Shield of California, across multiple states such as Illinois, Arizona, California, Michigan, and Virginia.Demonstrated expertise in U.S. healthcare domains, spanning Commercial, Medicare, and Medicaid lines of business. Recognized as a Subject Matter Expert (SME) on both Payer and Provider operations, with deep experience designing and delivering solutions for key functional areas including:Benefits Administration,Enrollment & Eligibility,Claims Processing,Provider & Network Management,Utilization Management & Clinical Services,Billing & Commissions,Regulatory Compliance Initiatives (e.g, ICD-10, ACA reforms)Proficient in building custom solutions for generating and processing HIPAA-compliant EDI transactions such as 834, 837, 835, 270, and 271.Led the migration of legacy platforms to Facets, and played a pivotal role in establishing the Facets Solution Group, contributing to multiple Facets versions.Hands-on experience with Facets batch processing configuration, including keyword file setup for key batches such as MMS, XPF, ABI0, UMI0, RCPT, XC00, CLMU, CKMM, and billing/commission modules.Key Roles & Strengths:Solution Architect: Translate complex business requirements into scalable, future-ready IT solutions by evaluating options and aligning cross-functional teams on strategic implementations.Design Specialist: Oversaw full delivery lifecycle, from requirements gathering through to Go-Live, ensuring high-quality outputs aligned with business goals.Technical Lead: Directed an onshore team interfacing with offshore developers. Reviewed designs and code with a focus on scalability, reusability, and long-term adaptability.Delivery & Stakeholder Manager: Led a portfolio of 125+ associates and contractors, including analysts, developers, and testers. Oversaw performance management, stakeholder communications, and delivery metrics reporting to internal and external partners.

Experience

1. Solution Architect - Enterprise Solutions

   UST HealthProof

   Oct 2024 — Present

   Enterprise Solution Architect responsible for end to end business and technical solution of various healthcare business processes for the healthplan around Core Administrative Processing System HealthEdge HealthRules Payer and HealthProof\'s product suite.Own end-to-end business and technical solution architecture for healthcare value chains (Enrollment, Claims, Payments, Correspondence), covering multi-stack integrations (Java, DB, Edifecs).Define and govern integration architecture, interface blueprints, and high-level designs (HLDs) ensuring scalability, performance, and zero-defect outcomes across SIT, UAT, and Production.Collaborate with Product, BA, and Engineering teams to define non-functional requirements (performance, scalability, monitoring, logging) and translate them into actionable deliverables.Oversee design reviews (LLD/TDD), deployment architecture, and DevOps readiness, ensuring quality, performance, and seamless environment promotions (DEV to PROD).Accountable for effort estimation, release governance, and proactive risk identification, ensuring adherence to timelines, cost, and quality objectives.

Education

• College of Engineering, Trivandrum

  Bachelor of Technology (B.Tech.), Computer Science and Engineering

  2002 — 2006

• Sree Narayana Central School, Kayamkulam Kerala.

  Senior Seconday School, Science

  1990 — 2001

Skills

• Agile & Waterfall Methodologies
• Business Analysis
• Performance Tuning
• Crystal Reports
• Facets
• Software Development Life Cycle (Sdlc)
• Sybase Sql Anywhere
• Software Development
• Consulting
• Management
• Pl/Sql
• Microsoft Sql Server
• Business Process Improvement
• Software Project Management
• Data Modeling
• Integration
• Onshore Offshore Model
• Process Improvement
• Business Intelligence
• Sdlc
• Microsoft Office
• Us Healthcare
• Requirements Analysis
• Technical Analysis
• Vb.net
• Xml