# Pradeep Kalmat

Pradeep Kalmat is a remote worker on Himalayas, President/CEO, Healthcare Technology & Strategy at eSimplify Enterprises, based in United States.

Source: https://himalayas.app/@pradeepkalmat

```text
Healthcare strategy and operations leader at eSimplify Enterprises who achieved 3X ROI by pairing population health analytics with RCM automation.
```

| Detail | Value |
| --- | --- |
| Availability | Looking for a job |
| Location | United States |
| Authorized to work in | United States |
| Salary expectations | 150k+ USD |
| Job categories | Healthcare Operations Strategy, Healthcare Consultant, Revenue Cycle Director, Healthcare Technology Consultant |
| Skills | Healthcare Strategy, Healthcare Operations, Operational Redesign, Care Management, Care Navigation, Population Health, Revenue Cycle Management, Medicare Risk Adjustment, RAF HCC, Care Gaps, HEDIS, Value Based Care, Revenue Cycle Automation, Workflow Automation, Operational Assessment |

## About

```text
At eSimplify Enterprises, I advise health system executives and population health leaders on service and operating-model strategy. I lead Care & Case Management and navigation pilots, and achieved 3X ROI within 12 months across client initiatives by pairing population health analytics with RCM automation.

I designed analytical models combining population health risk data with EDI claims data to track total cost of care, identify patient leakage, and evaluate value-based contract performance. I also deployed a Medicare Risk calculator using the V28 HCC RAF model.

At Bill My Claims, I built and led a healthcare operations practice spanning billing, coding, contract auditing, and revenue strategy. Earlier, at Aon Hewitt (now Alight), I led enterprise implementations and managed a team of 50+ directly and indirectly, with a $10M+ team budget.
```

## Experience

### President/CEO, Healthcare Technology & Strategy (current)

eSimplify Enterprises. Oct 2021 - Present

```text
Advise health system executives on service and operating-model strategy, translating pain points into initiatives and roadmaps. Lead Care & Case Management operational testing and own business readouts for population health initiatives.
```

Skills: Healthcare-Strategy, Operating-Model-Design, Care-Management, Population-Health-Analytics, AI-Calling, Medicare-Risk-Adjustment, HCC-V28, Power-BI, Amazon-Quicksight, 835-837, RCM-Automation, KPI-Tracking, Executive-Dashboards

### Founder, Director of Strategy & Revenue Operations

Bill My Claims. Oct 2015 - Jun 2022

```text
Built and led an end-to-end healthcare operations practice delivering billing, coding, contract auditing, and revenue strategy. Managed a cross-functional team of 15 and streamlined operations through pre-submission audits and workflow automation.
```

Skills: Revenue-Cycle-Management, Billing, Coding, Contract-Auditor, Workflow-Automation, Claim-Scrubber-Rules, Operational-Deep-Dives, Business-Reviews, C-Level-Stakeholder-Management, Risk-Mitigation

### Technical Consulting & Enterprise Delivery Lead

[Aon Hewitt](https://himalayas.app/companies/aon). Sep 1997 - Jul 2015

```text
Led multi-disciplinary teams owning enterprise implementations end to end, managing scope, timelines, and risks on large-scale projects. Managed a team of 50+ and owned a $10M+ budget, delivering BPO implementations on time and within budget over 90% of the time.
```

Skills: Enterprise-Implementation, Project-Management, BPO, SLA-Management, Governance-Frameworks, Operational-KPIs, Team-Leadership, Budget-Management

## Education

### AAPC

Certified Professional Coder (CPC), Medical Coding. 2017 - 2021

```text
Certified Professional Coder (CPC) certification from AAPC, held from 2017 to 2021.
```

### AAPC

Certified Professional Biller (CPB), Medical Billing. 2016 - 2021

```text
Certified Professional Biller (CPB) certification from AAPC, held from 2016 to 2021.
```

### Bangalore University

Bachelor of Technology, Technology

```text
Bachelor of Technology degree from Bangalore University, India.
```

## Tech stack

- Amazon Quicksight
- Power BI

To contact Pradeep, message them from this profile with a Himalayas employer account: [Hire on Himalayas](https://himalayas.app/hire).

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