Alok Mandal

Ellicott City, Maryland, United States Contact Info
4K followers 500+ connections

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About

Currently acting as Consulting Lead for Healthcare and Life Sciences. Solution Advisory…

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Experience & Education

  • Virtusa

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Licenses & Certifications

Volunteer Experience

  • American Red Cross Graphic

    Adult First Aid/CPR/AED

    American Red Cross

    - Present 7 years 9 months

    Social Services

    Alok Mandal has successfully completed requirements for Adult First Aid/CPR/AED: valid 2 Years
    Conducted by: American Red Cross

Publications

  • Digitize and accelerate healthcare payer Sales with data-driven Marketing

    Virtusa

    Digitize and accelerate healthcare payer Sales with data-driven Marketing

    Other authors
    See publication

  • Smart Care Management - Marching towards Value-Based Care

    Virtusa

    Future of healthcare is Value-Based Care. Providing the best care to improve patients’ lives is the goal of healthcare. To do this more effectively, payers and provider organizations must work in coherence to implement efficient care management (CM) initiatives to manage chronic health conditions better. Correct implementation of CM can help payers and provider organizations to reach the state of valuebased care. Before starting the CM journey, payers must implement a strong utilization…

    Future of healthcare is Value-Based Care. Providing the best care to improve patients’ lives is the goal of healthcare. To do this more effectively, payers and provider organizations must work in coherence to implement efficient care management (CM) initiatives to manage chronic health conditions better. Correct implementation of CM can help payers and provider organizations to reach the state of valuebased care. Before starting the CM journey, payers must implement a strong utilization management program, work with payers on care delivery, discharge planning, and post-discharge care transition. Performing the proper steps in these areas can prepare companies to implement and execute care management programs, better manage chronic health conditions, avoid negative health impacts for members, improve patient outcomes, and decreased long-term costs for payers. Technology can help payers launch their CM to ensure they are working seamlessly with providers to deliver the value-based care that patients need.

    Other authors
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  • Thrive beyond COVID-19 by transforming your claims

    Virtusa

    The current claims platform is not ready to handle the fast adoption of the latest codes and help the payers tackle the pandemic’s fiscal challenges now and later. It is difficult to quickly identify the relevant COVID-19 regulations and initiate the wave-off facility in the current legacy structure, subjecting payers to huge fines. The claims platform faces discrepancies in timeliness, process efficiency, and accuracy to understand the regulatory guidelines of COVID-19.

    This white paper…

    The current claims platform is not ready to handle the fast adoption of the latest codes and help the payers tackle the pandemic’s fiscal challenges now and later. It is difficult to quickly identify the relevant COVID-19 regulations and initiate the wave-off facility in the current legacy structure, subjecting payers to huge fines. The claims platform faces discrepancies in timeliness, process efficiency, and accuracy to understand the regulatory guidelines of COVID-19.

    This white paper delves into how claims modernization helps payers attain agility, faster time to market, drive innovation, and augment enterprise growth.

    Other authors
    See publication

  • Intelligent Digitization of Appeals & Grievances

    Virtusa - Whitepaper

    The Healthcare Appeals and Grievances (A&G) process is a vastly scrutinized back-office function in the healthcare domain. Healthcare payers deal with multiple challenges while managing A&G processing, including manual-intensive and non-standardized business processes, data fragmentation, and complex decision-making procedures.

    A comprehensive transformation strategy that comprises business process re-engineering, automation, and work effort savings is the key to improving efficiency…

    The Healthcare Appeals and Grievances (A&G) process is a vastly scrutinized back-office function in the healthcare domain. Healthcare payers deal with multiple challenges while managing A&G processing, including manual-intensive and non-standardized business processes, data fragmentation, and complex decision-making procedures.

    A comprehensive transformation strategy that comprises business process re-engineering, automation, and work effort savings is the key to improving efficiency. This white paper highlights the common business and operational challenges of healthcare payers and consolidates the learning from various intelligent technology implementations.

    Other authors
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  • Pega Collaborative Healthcare Summit 2017 - keynote

    PegaSystems

    See publication

  • PegaWorld 2017 - Presentation

    PegaSystems

    Other authors
    See publication

Patents

  • Artificial Intelligence based decision management system for appeals on healthcare claim denials

    Filed US 17/520,680

    Other inventors

Projects

  • CCCM Appeals & Grievances

    - Present

    Role: LSA, Cognizant Technology Solutions
    Client: Health Net Inc, USA
    Place: CA, USA

    Mitigate HN A&G current pain points and increase efficiency for all line of business (except HNFS) and geographies utilizing the BPM paradigm and its implementation in Pega leveraging the Case Management. Ensure sustainable compliant operations and performance of the Health Net Appeals and Grievance processes. Reduce operational and system costs. Exceed company’s customer expectations

    Other creators

  • OMNI - HN

    - Present

    Customer Call Center Modernization

    Other creators

  • Prior Authorization System

    -

    This project was driven by the needs to standardize; optimize and streamline their process for the Customer Service Group. The group primarily manages the prior authorization process for the members of the partner clients. The solution involved building of the core Prior authorization process using Pega CPM 5.2 HC to ensure a standard process across divisions adhering to the federal regulatory requirements. The solution includes complex business functionality which includes doing eligibility…

    This project was driven by the needs to standardize; optimize and streamline their process for the Customer Service Group. The group primarily manages the prior authorization process for the members of the partner clients. The solution involved building of the core Prior authorization process using Pega CPM 5.2 HC to ensure a standard process across divisions adhering to the federal regulatory requirements. The solution includes complex business functionality which includes doing eligibility checks against other enterprise systems; dynamic population of decision criteria; multiple level reviews; outbound call and correspondence transmission etc., It also supports taking in of request from multiple intake channels (Fax; Phone; Web) which required integration with enterprise fax and phone systems as well as providing the application on web (using IAC) to members and providers, within their respective enterprise portals

    Other creators

Honors & Awards

  • Technology Excellence Award 2023

    Virtusa

    Virtusa Spark Global Event - Technology Excellence Award 2023

  • Virtusa Winners Club - 2021

    Virtusa

    Virtusa Winners Club - Technology Excellence

  • Virtusa Winners Club - 2020

    Virtusa

    Virtusa Winners Club - Technology Excellence

  • Cognizant Delivery Excellence - 2014

    Cognizant

  • Cognizant Associate of the Year - 2004

    Cognizant

Languages

  • English

    Full professional proficiency

  • Hindi

    Native or bilingual proficiency

  • Bengali

    Native or bilingual proficiency

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