ASHA KOLAGUNDA NAGAPPA SHETTY

Client: BCBS-Florida

• Serves as the SME for payer enrollment, billing, and financial processes, covering fully insured, ASO, individual (on/off exchange), Medicare, and Medicaid
• Leads integration efforts between ORMB and upstream/downstream departments, including sales, marketing, broker operations, claims, remittance, finance, and risk adjustment
• Analyzes & maps workflows across enrollment, billing, and associated teams to identify inefficiencies and recommend optimizations
• Ensures compliance with federal and state regulations in payer billing operations
• Oversees API integration for seamless data exchange across ORMB, premium billing, and claims processing systems
• Develops operational reports and dashboards to track premium payments, delinquency rates, and revenue reconciliation
• Provides strategic guidance on ORMB system enhancements and automation opportunities
• Facilitates release demos and post-release stabilization, ensuring smooth adoption
• Client: BCBS-Florida

Client: IBC – Individual Blue Cross

• Collaborated with stakeholders to align ORMB billing functions with payer-specific rules and compliance requirements
• Monitored payer KPIs to provide insights on enrollment, premium reconciliation, and collections
• Led automation testing strategies, ensuring compliance with revenue cycle standards
• Client: IBC – Individual Blue Cross

Client: Kaiser Permanente

• Led the design & implementation of ORMB solutions, increasing billing efficiency by 78%
• Developed process documentation for payer billing, claim adjudication, and financial reconciliation
• Automated payment processing & revenue tracking, reducing manual errors and improving reporting accuracy
• Client: Kaiser Permanente
• Developed and implemented functional solutions in ERP systems to streamline business processes.

Client: State of California

• Designed automation frameworks for payer billing workflows, leveraging TOSCA and Selenium.
• Conducted end-to-end validation testing, ensuring compliance, and seamless financial processing.
• Oversaw quality control to identify inconsistencies and malfunctions.

Client: Duke Energy

• Developed mitigation strategies for revenue cycle disruptions.
• Facilitated defect triage calls, and conducted RCA to improve ORMB system stability.
• Evaluated key data to develop effective strategies.

Client: Cisco Systems

• Monitored and reported on program financial performance, implementing cost-control measures to stay within budget constraints.
• Established KPIs to drive continuous improvements in payer and revenue cycle operations.
• Identified areas of improvement in existing processes, procedures and systems related to the program delivery cycle.