SUMMARY:

• Senior IT leader with more than 19 years of experience in design, development and implementation of large - scale information technology (IT) projects based on Web and client server technologies.
• This includes more than 14 years of Medicaid Management Information System ( Confidential ) experience and more than 3 years working with Medicare Encounter Data Processing System.
• Recognized repeatedly throughout career for broad technical expertise, as well as uncommonly strong talents in the areas of client relationship management, leading teams, navigating project roadblocks, and being able to inspire diverse groups of project stakeholders to work hard toward a shared vision
• More than 12 years of experience as an architect and technical development manager for large multi-million-dollar projects
• More than 15 years of experience conducting joint application design (JAD) sessions and interacting with clients for requirement analysis and system design
• Strong technical experience in J2EE-based system architecture, design and development
• Developing and implementing solutions using methodologies that include Agile, SCRUM, and Waterfall
• More than 10 years of experience in proposals writing and demonstration for various Confidential, Health Information Exchange (HIE), and Electronic Health Records (EHR) projects.
• Substantial knowledge and experience with Confidential business processes includes claims processing, HIPAA transactions, third party liability, prior authorization, financials, reference datasets, decision support systems, risk analytics, accounts payable, and accounts receivable
• Supervised more than 90 developers, analysts, system administrators, database administrators, and architects
• Excellent presentation, communication and problem-solving abilities

PROFESSIONAL EXPERIENCE:

Confidential

Senior Director

Responsibilities:

• Designs and develops solution models based on internal and external best practices
• Project development oversight for the Confidential Medicaid Management Services (OMMS) offering
• Performed a key role in finalizing Financial Management Solution for OMMS.
• Performed a key role in defining core requirements for OMMS.
• Acted as Subject Matter Expert for Third Party Liability and Financials Management.
• Engages external partners in search of complimentary capabilities and partnership opportunities
• Assists in the development of market and sales strategies and value proposition
• Prioritizes multiple demands and ideas based on available resources
• Influences innovation across teams to ensure aligned, cohesive progress across multiple areas including technology, marketing, and service operations

Confidential

Director of Architecture/Program Manager

Responsibilities:

• Program oversight for Confidential and acted as System Architect
• For the Medicare Encounter Data Processing System ( Confidential ), interacted with the client for system requirements analysis and design.
• Recommended and executed solutions strategy for current operations and future business goals.
• Led the effort to make Confidential ICD-10 compliance.
• Let the effort to get Confidential CMMI Level 3 compliance.
• Let the effort to get Allow to Operate (ATO) clearance.
• Provided mentoring and guidance to the functional teams for business solutions and the technical teams for technical solutions.
• Improved stability and performance of the system, created architectural blueprints, and created and presented roadmaps.

Director of Architecture/Systems Architect

Confidential

Responsibilities:

• Worked with various project architects for translating business requirements into systems qualities like adaptability, scalability, availability, non-repudiation, reusability, etc.
• Responsible for enterprise application integration (EAI). This includes defining integration, selecting the tools, defining the interfaces and data-flows.
• Designed and implemented Web portal and Medicaid System integration.
• Provided technical as well as functional design solutions for various business areas which included Claims Adjudication/Reimbursement, HIPPA transactions, reference code sets (HCPCS, ICD9, CPT, etc.), Third Party Recovery, Drug Rebate, Rate Setting, Provider, Accounts Payable, Accounts Receivable, Recipient, Provider Audit, Managed Care, and Case Management.
• A key member of Implementation and Operational Readiness teams.
• Conducted strategic planning and created project schedules

Web System Architect

Confidential

Responsibilities:

• Reviewed system architecture, which is based on Oracle WebCenter 10G suite, and suggested architecture changes to improve system stability and performance.
• Reviewed implementation of Oracle WebCenter 10G suite components like Collaboration, Automation, Document Repository, Publisher, Custom portles and web services.
• Recommended enhancements for portal hardware and software components implementation.
• Fixed system configuration to improve performance and stability.
• Designed and Implemented a portal using WebCenter 11G features like Universal Content Management (UCM)

Functional Lead

Confidential

Responsibilities:

• Lead a team of proposal writers for functional sections which includes Claims Adjudication, Member Eligibility, Reference, HIPPA, Provider, Decision Support System, Data Warehouse, Program Integrity, Surveillance and Utilization Reviews (SURS) Management, Rate and Audit.
• Wrote proposal response to Technical Architecture and General Requirements sections.
• Conducted and participated in proposal response review processes.

Development Manager - Technical

Confidential

Responsibilities:

• Designed and implemented a centralized Accounts Payable and Accounts Receivable system for Confidential financials.
• Provided technical as well as functional design solutions for various business areas which included Claims Adjudication/Reimbursement, HIPPA transactions, reference code sets, Third Party Recovery, Drug Rebate, Rate Setting, Provider, Accounts Payable, Accounts Receivable, Recipient, Provider Audit, Managed Care, and Case Management.
• Prepared and monitored complex project plans and development schedules.
• Managed development resource allocations and communication across multiple teams.
• Performed Budget planning activities
• Created proposals and conducted demonstrations for various Confidential, HIE, HIX, 5010, ICD-10, and EHR projects.

Development Manager - Technical

Confidential

Responsibilities:

• Lead the design and implementation of Claims adjudication edits & pricing and integration with other business areas.
• Prepared and monitored complex project plans and development schedules.
• Managed development resource allocations and communication across multiple teams.
• Developed and implemented development processes using Agile and Waterfall methodology.
• Worked with functional teams to provide design solutions for various business areas which included Claims Adjudication/Reimbursement, HIPPA transactions, reference code sets, Third Party Recovery, Drug Rebate, Rate Setting, Payable, Accounts Receivable, and Recipient.
• Oversaw Integration and System testing
• Wrote project documentation: Design Specifications documents, Developer Guides, System Architecture and Implementation Plan.