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Saurabh
DR.S.PATHAK@GMAIL.COM
424-239-9412
225 Kendal Way
Orlando, FL 32802
Physician
13 years experience W2
1
Recommendation
Average rating
140
Profile views
Summary

Experience
Physician
Banking/Financial
Mar 2021 - present
Provider Networking & Contracting Professional
  • Developed the provider network (physicians, pharmacies, ancillary groups & facilities, etc.) yielding a geographically competitive, broad access, stable network that achieves objectives for cost performance
  • Evaluated and negotiated contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls
  • Established and maintained solid business relationships with Physician, Pharmacy, or Ancillary providers, and ensures the network composition includes an appropriate distribution of provider specialties
  • Balance financial and operational impact of contracts to providers, members, and different customer groups when developing and/or negotiating contract terms
  • Evaluate market rates and provider performance (e.g., billing patterns, referral patterns, quality, and effectiveness) in order to establish provider rates and negotiation strategies
  • Explain the organization's direction and strategy to internal partners and providers in order to justify methodologies, processes, policies, and procedures
  • Identified and gathered information regarding provider issues in order to develop and/or implement a strategy to resolve the matter, keep the manager informed of progress, or escalate the issue to the appropriate internal business partner
  • Represent department in external meetings (e.g., ancillary providers physician groups facilities) to gather relevant information, recommend solutions, execute on deliverables as assigned, and explain results/decision/activities
  • Monitor and/or oversee provider financial performance to identify opportunities to improve performance and/or provider relationship
  • Educated providers on the organization's processes, policies, and procedures in order to ensure provider compliance and ease of administration
  • Monitor and/or oversee network performance and industry trends to identify opportunities to refine, develop, and/or implement market strategies
  • Manage the Vision Network (Optometry and Ophthalmology Practices for regions 1-8 in Florida) Systems used CAS2PIMS, CAS, SERVICE FUND, CIS, PAAG, CCP2, MTV (METAVANCE), MENTOR, IPAR, PMDM, MERLIN/ICERTIS, APEX, PFP, ADOBE SIGN, CRM, IPRG, PSSC, PICA PD REPORTS, COMPASS, PD AUDIT 2.1. Charity Work
  • Self-Financed Bangalore, KA, INDIA
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Healthcare Provider Network Contract Manager
Information Technology
Oct 2019 - Jul 2020
/ Optum / Ewings Healthcare Provider Network Contract Manager Developed the VACCN (Veterans Affairs Community Care Network) provider network yielding a geographically competitive broad access, stable network that achieves objectives for unit cost performance, trend management, and produced an affordable and predictable product for customers and business partners.
  • Evaluated and negotiated contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
  • Responsibilities also included establishing and maintaining relationships with providers ensuring the network composition includes an appropriate distribution of provider specialties.
  • Network management-related roles, such as contracting or provider services. Managed care work experience contracting on recruiting a range of healthcare providers including Physicians, Hospitals/Systems, Facilities, Specialists, and Ancillaries.
  • Applied my knowledge of reimbursement methodologies, i.e. Resource-Based Relative Value System (RBRVS).
  • Have an intermediate level of knowledge of claims processing systems and guidelines.
  • Reviewed, approved, processed, countersigned, executed, and sent via snail mail, +700 backlogged contracts for the backlog project. 2 2
  • Reviewed, approved, and countersigned ALL Contract Amendments for the VACCN Network. *
Compliance
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Oct 2019 - Oct 2019
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Medical Devices
Jan 2019 - Oct 2019
  • Rescued the FL Blue CDI program from termination by increasing group participation by 300%.
  • Converted several groups from Fee for Service to Full risk contracts.
  • High-level negotiations of contracts for FL Blue. Due to engagement activities revenue BCBS was increased by Multi-Million Dollars.
  • Assisted groups in increasing their risk score from 0.8 to 1.7 through the CDI program.
  • Engaged Performed in-person /WebEx presentations on the benefits of the CDI program to very large groups, attendees were CEO's, COO's, CFO's, VP's, Directors, and Head of the Quality Departments.
  • Provided direction to the CDI Department with 14 employees.
  • Applied thorough understanding of physician/facility practices and supported practice transformation through education and support to participating groups to improve documentation, ICD-10 coding, and overall value-based performance.
  • Engaged providers at various audience levels via electronic tools and face-to-face encounters (group and/or one-on-one sessions) to promote the concept and understanding of Risk Adjustment (Medicare, Commercial, and The Affordable Care Act lines of business) under various value-based arrangements.
  • Relied on as coding subject matter expert for the organization and will represent the organization in dealing with vendors, delegated entities, and Providers.
  • Assisted in the development of educational materials, policies and procedures, training programs, and educational tools for coding staff, Provider Relations, and outside physician offices.
  • Demonstrated analytical and problem-solving ability regarding barriers to improving the accuracy of HCC coding.
  • Performed and/or collaborated with internal business stakeholders on analysis of trend issues.
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Clinical Documentation Improvement Specialist, Traveler (CDI)
Medical Devices
Mar 2018 - Jan 2019
  • Inpatient (IP) ICD Coding i.e., ICD 9 & 10, HCPCS, CPT.
  • Clinical Documentation compliance Reviews.
  • Physician Liaison. Physician Education, Physician, and hospital presentation on benefits of CDI program.
  • Creating queries for Physicians to correct documentation errors for CMS review.
  • Traveling to all +47 hospitals (AL, CA, FL, GA, IN, KS, MI, MO, NV, NJ, OH, PA, RI, TX) Vascular Interventional Pavilion / Premier Vein Institute / Chiropractor's office
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Physician Liaison
Medical Devices
Nov 2016 - Mar 2018
  • Acquiring patients for Arterial, Vein, and Aesthetic procedures and services.
  • Managing the patient's care.
  • Communicating and addressing the concerns of the patients and Physicians. 3 3
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Manager of MRA Dept. (Medicare Risk Adjuster/Auditor)
Jul 2014 - Feb 2018
Tampa, FL
* ICD 9/10 Coding
• CPT Coding
• HCPCS LEVEL II Coding
• Advising Physicians on how to implement better coding practices
• Scheduling and performing office visits for patient chart Audits
• Scanning relevant documents
• Completing reports for CMS
• Performing File Reviews *
Project Management Medicare HCPCS CPT ICD-10 ICD-9 Audit
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References
Average Rating

1 recommendation
Physician Liaison (Central Florida)
Medical Devices
Jan 2014 - Nov 2016
  • Acquiring patients for home health services.
  • Managing the patient's care.
  • Communicating and addressing the concerns of the patient and Physician.
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Sales Executive
Jan 2013 - Jan 2013
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Provided Physician consultation via phone / Sales Executive (Central Florida)
Medical Devices
Dec 2010 - Nov 2011
to help assess the patient's needs this age management company.
  • Explained the therapies available to the patient.
  • (Company went out of Business, Due to internal conflicts).
  • Marketing and sales of various products to the Physician.
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Director of Outpatient Therapy (Central Florida)
Oct 2009 - Dec 2010
  • (Company went out of Business, Due to internal conflicts).
  • Directed ALL aspects of the EECP Therapy performed in all 4 offices.
  • Patient identification via chart review.
  • Training of technical personnel.
  • Supervising Technical personnel.
  • Ensuring proper billing protocol is followed as per CMS guidelines.
  • Maintaining proper patient charts.
  • Verified that all issues were compliant with CMS guidelines.
  • As this company was a startup, I identified, created, developed, organized, evaluated, planned, and executed all protocols and procedures. Freedom Health Insurance Corporation 4
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Edit Skills
Non-cloudteam Skill
Education
Bangalore, KA
Ramaiah Medical College of Bangalore University 2006
M.B.B.S
not provided
Biology
Temple University
Skills
HCPCS
2019
7
Audit
2018
6
ICD-9
2018
6
Medicare
2018
6
CPT
2019
5
ICD-10
2019
5
Compliance
2020
3
Project Management
2018
3
Pain Management
2009
2
Surgical Nursing
2009
2
ER
2019
1