Vishesh Shah

Lead Business Analyst @Silicon Spectra

Austin, TX, US

Manage the end-to-end implementation of HealthEdge applications like HealthRules Payor, CareAdmin and HealthRules CareManager for a top-tier Healthcare organization to improve process efficiencies, increase profits and improve regulatory compliance• Assist in developing financial model and application inventory as part of the client proposal that would help the client avoid regulatory fines, penalties, and unnecessary interest on claims • Assist with Data Mapping and Data Load activities between Health Rules Payor (Claims) and CareManager• Create business intelligence reports for billing, claims, subscriptions using SQL that helped the management to make vital - business related decisions • Ensure workflows and system configurations adhere to healthcare compliance standards such as HIPAA, collaborating with legal teams to integrate regulatory requirements into updates• Configure key HealthRules modules, including COBRA, provider networks, pricing and benefits management. Oversaw data migration from GE Centricity, creating data flow diagrams and implementing validation to ensure data accuracy and continuity.• Validate if the claim adjudication process in the new system is working as the expected business process flow by configuring the service categories, creating member claims, member cost shares and DOFR• Validate Member Correspondence activities by testing integration with OnBase to ensure all activities and jobs run as expected• Collaborate with vendor to map out data fields for Member Enrollments at a Subscription and Account Level • Validate if data migrates as expected from HealthRules Payor to HealthRules Care Manager by creating test Claims, Members, Suppliers, Practitioners, Authorizations, Supplier Contracts and Practitioner Roles • Product integration and partnerships (eFax, MCG Cite AutoAuth Module) • Work on automating enrollment from incoming EDI files to HealthEdge using EDI management partners like CureIS

Harrisburg University of Science and Technology

Masters, Information Technology Project Management

University of Illinois Urbana-Champaign

Bachelors, Economics

The International School Bangalore

International Baccalaureate Diploma