PROFESSIONAL SUMMARY:

• A results - oriented leader with 12+ years of TechnoFunctional Experience out of which 5+ years in Pega Based Solutions with proven track record of leading global teams in delivering complex, mission critical initiatives projects.
• Strength includes solving complex problems with innovating solutions, attention to detail and deliver projects On Time, within budget and with superior quality.
• Successfully deployed multiple business solutions in Healthcare domain working with/for fortune 500 companies.
• Academy for Healthcare Management (AHM) Certified Healthcare IT Professional.
• Pega Certified Business Architect (CPBA).
• Translating numbers into meaningful facts for businesses to help them make better business decisions.
• Subject Matter Expert (SME) in Health Management, Care Management, Utilization Management, Health Insurance Exchange Marketplace (HIX) and Healthcare Electronic Data Interchange (EDI).
• Demonstrated abilities to manage a project through its complete lifecycle viz. Initiation, Planning and Design, Execution, monitoring and controlling through Closing and support.
• Involved in Business Process Automation with PEGA systems Smart BPM suite - PEGA RULES Process Commander (PRPC).
• Great knowledge in workflow using Pega CPM (Customer Process Manger)
• Exceptional ability to work with world-class Subject Matter Experts in order to extract their domain knowledge, business rules, decisioning process, and expertise so it can be documented and digitized.
• Hands on experience using PEGA SCRUM and Smart BPM methodology PRPC Application Profile, Application Express, Document Wizard and Application Enablement Wizard, CPM.
• Experienced in facilitating Joint Requirement Planning (JRP), Joint Application Development (JAD) with Business User Groups, Subject Matter Experts, and IT to limit the change process and develop the design.
• Extensive experience in Release Management, Incident Management, Configuration Management, Business Process Modeling, Business Requirements, writing technical specifications, Use Case Modeling, VISIO Diagramming, Service Management and well versed with ITIL
• Knowledgeable of complete software development life cycle (SDLC) and well versed with the Software Engineering and Project Management methodologies like traditional Waterfall, Agile, Iterative and JAD.
• Extensive knowledge Qualified Health Plans (QHP), Health Insurance Exchange (HIX) and Affordable care Act (ACA).
• Excellent Team player having good communication and relationship with the customer and can Lead the team independently in both Onsite and Offshore driven projects.

SKILL:

• Program/Project Management
• Pega PRPC 7.2
• JIRA
• Payments
• Scrum Master
• SOAP UI
• Agile Based Delivery
• IT governance and compliance
• EDI ANSI X12 Transactions
• Onshore/Offshore Coordination
• Trizetto Care Advance
• Mainframes Applications
• Healthcare domain
• Change Management
• Rational Clear Quest

WORK HISTORY:

Confidential, Austin, TX

Lead Business Architect

Responsibilities:

• Collaborating with Product owner to conduct, drive, and document requirements in Rally and other tools.
• Used quantitative data gathered to develop an understanding of customer behavior, demographics and lifecycle.
• Leading and assisting the identification and definition of requirements, use cases, process flows, screen flows, and user interfaces.
• Interact and communicate product requirements to architects, engineers, development managers, product managers, testers, and a variety of other stakeholders.
• Working with Development Managers, Program Managers, and Architects in scoping and sizing of projects.
• Provide assistance and advice to business users as well as technical expertise and recommendations in assessing new IT software projects and initiatives to support and enhance existing legacy systems
• Gather and prioritize client requirements, make assessments (effort and feasibility) and clearly define project scope (relative to predetermined completion date)
• Constructing and maintaining an evolving list of processes and sub-process that is built into PRPC platform to retire legacy Customer Service applications.
• Constructing and maintaining an evolving list of capabilities that is built outside of our PRPC platform to retire legacy Customer Service applications. This inventory includes web service needs, enterprise platform needs, external integration needs, etc.
• Translate business needs and requirements into technology requirements.
• Conducting DCO sessions to set business process flows in PRPC and/or other tools.
• Elaborating requirements in the form of user stories to the level of clarity that is accepted by scrum teams as acceptable.
• Walkthrough Test Case with UAT team and help team with Unit Testing and Regression testing.
• Suggesting and creating ways to keep the business model in synch as requirements change or are added.
• Collaborating and creating the end-to-end business architecture.
• Leading the discussions with scrum team (Dev & CQ) to clarify/update requirements throughout the development lifecycle.
• Extensive knowledge in GITHUB to create pull request and deploy the code
• Coordinating with Business analysts to schedule JAD sessions and drive it up Until Technical Documentation.
• Participate in the business requirements review to elicit and document high level business requirement

Environment: Pega PRPC 7.2, PPPCM rules, Rally, TeraData Studio, Kibana, MS-Visio, Share Point 2010, XML, HTML, Microsoft Office Suite, REST POST MAN, Pindrop, SOAP UI,, SPLUNK, GITHUB, CAL(Sherlock), Tableu, Orion, Microstrategy.

Confidential, Norfolk, VA

Lead Business Consultant

Responsibilities:

• Coordinate with Business analysts to schedule JAD sessions and drive it up Until Technical Documentation.
• Participate in the business requirements review to elicit and document high level business requirement
• Facilitate the scrum events and manage Agile Lifecycle in JIRA from planning to sprint deployment.
• Lead Production support team for different phases of release.
• Lead the Architecture assessment planning for system retirements and migrations to new platforms
• Solid Architecture skills to assess vendor solutions from an overall Enterprise strategic perspective versus tactical perspectives
• Assess vendor solutions via Product Demonstrations and Proof of Concepts to determine their alignment with our stated goal.
• Organize, extrapolate, and disseminate data across departments to be used for drawing conclusions about the success of current module.
• Recommended solutions to effectively align the workflow based on CPM (Customer Process Manager) framework.
• Handle EDI 270/271 Authorization files and maintain healthy EDI format. Own complete maintenance of 270/271 transaction.
• Present detailed reports about the meaning of gathered data to members of management and help them identify scenarios utilizing modifications in the data.
• Responsible to maintain and track SLA progress and monitor support help desk functions.
• Helped Dev team to Implemented PRPC components like Decision tables and Decision Maps.
• Conducted DCO sessions with team members, SME, vendors, users and other stakeholders for open and pending issues.
• Lead and Facilitate Requirements Session with business user to hash of details and translate high level functional requirements into technical specification
• Created Mock-up forms, where appropriate, for better visualization and understanding of the proposed software solution.
• Worked on End to End migration of legacy Application WMDS (Wellpoint Medical Decision System) to Pega UM Intake solution.
• Assess the current methodology, identify / rationalize gaps vs. best practices, and continuously improve the process to support our aggressive deployment schedule.
• Interact with Member source systems such as FACETS, WGS, STAR, CS 90 and NASCO.
• Ensure that all upstream changes are visible to and approved as required
• Work with vendors and partner systems to ensure their processes are aligned
• Created Business Use Cases and corresponding Atomic Use Cases.
• Independently drive process discovery efforts with business and technical application owners
• Analyze and document the current processes of enterprise systems

Environment: Pega PRPC 7.1, CPMHC 7.4, MS-Visio, Share Point 2010, JIRA, XML, HTML, Microsoft Office Suite Clear Quest, Rational Req Pro, SOAP UI,, SPLUNK, Service Now, SQL 2008 and Max

Confidential, Hartford, CT

Lead Business Analyst

Responsibilities:

• Define and manage project and product management process. Schedule process improvement initiatives to implement best practices
• Responsible to maintain and track SLA progress, license management, escalations handling and monitor support help desk functions.
• Manage business analysis function, with oversight of plans auditing, state benefits coordination and process management.
• Conducted DCO sessions with team members, SME, vendors, users and other stakeholders for open and pending issues.
• Used PEGA Application Profiler to capture requirements and objectives into smartBPM and Document Wizard to automate creation and maintenance of documentation.
• Created Mock-up forms for better visualization and understanding of the software solution.
• Provide the point of accountability to the Business Owner - manage escalations. Executive / Leadership status reporting. Guide Jr. Project Manager with planning and scheduling of software releases.
• Optimize resource and capacity planning to support program (& project) goal
• Responsible for managing resources, stakeholder communication and management expectations within defined product road map
• Responsible bridging the gap between business requirements and technology implementation through working with technical team and industry experts. Experience in managing technical staff, and coordinating development activities with cross functional teams across multi locations.
• Lead effective program (& project) governance, stakeholder management, and communications ensuring that stakeholders have adequate understanding of timelines, resource needs, risks, contentions, and dependencies
• Responsible for maintaining PHI and HIPAA safeguards and procedures in align with federally defined healthcare standards and compliances
• Created High Level Class structure, Workflows and Rule sets in PEGA PRPC
• Understanding of rules, Properties, Embedded Pages and Correspondences.
• Prepared user guide and materials technical and user support to business groups.
• Lead and Mentor team members on Health Insurance Exchange plan filings.
• Drove various process improvements that reduced the number of releases by 50%, lowered risk and maintained quality, functionality and time to market.
• Implemented complex logic for provider information in corporation for QHP plan creation using HEDIS score for PPO organization and physicians.
• Lead teams for audits such as Data Integrity Testing Audit (DIT), Essential Community Provider (ECP) Audit, Cost Sharing Audit and Master Audit to ensure all plans are compliant per CMS regulations.
• Formulated easy process to create Schedule of Benefits (SoB) and Summary of Benefits and Coverage(SBC)

Environment: Pega PRPC V 6.7, MS-Visio, Share Point 2010, Quick base, Microsoft Office Suite (MS Word, Excel, PowerPoint), JAVA, Rational Requisitepro v7.0, HP Quality center

Confidential, Albany, NY

Sr. Business Analyst

Responsibilities:

• Creation and tracking of multi-year product strategy across 4 regions, managing dependencies within and outside program, creation of program organization.
• Implemented work flow processing for IT security governance using IBM Tivoli and CA Identity Minder.
• Implemented HEDIS measures for Disease Management programs.
• Followed up on backlog requirements in timely manner with corresponding owners in order to get closure on the product requirements.
• Created TO-BE Process Flows maps for review with the business team.
• Define and manage project and product management process. Schedule process improvement initiatives to implement best practices.
• Lead Production support for ECC(Empire Care Connect) application and monitoring Mailbox, fallouts tracking under Local and National Gains.
• Responsible for file loads (834) into ECC Application and WMDS applications, prepare 834 format and feed file to load.
• Had Proven track of expertise in resolving New Born Twins and Triplets claims issues.
• Lead and Maintain Client Sub System (CSS) to manage the new contracts entering into ECC plans.
• Worked on successful migration of Amerigroup accounts to ECC while at merger.
• Responsible to maintain and track SLA progress, license management, escalations handling and monitor support help desk functions.
• Was able to handle all types of CS-90 Claims and Member ships issues.
• Had great working knowledge in NASCO Enrollment issues.
• Along with standard project execution functions, responsible for service management functions like incident management (IM), problem management (PM), root cause analysis (RCA)
• Conducted UAT walkthrough sessions to updates participants on the expectation and the UAT process.
• Lead Defects Management team for different phases of release.
• Creation of detailed Project and Program schedules, allocation of resources, estimating budget, setup executive reporting, manage stakeholder communication, Risks/Issue management and formulation of necessary metrics
• Collaboration with other cross functional groups and work streams
• Inspected Change Order Requests, completing cost & effort estimates, planning and prioritizing the work for a suitable iteration

Environment: Pega PRPC V 6.7, MS-Visio, Confidential (ECC), Trizetto Care Advance(CCA), MS-Visio, Share Point 2010, Microsoft Office Suite, Clear Quest, Rational Req Pro, IBM Tivoli, Lotus Notes, CA Identity Manager, XML, JAVA.

Confidential, Cypress, CA

System Analyst

Responsibilities:

• Create work breakdown structure, project plan including schedule and resource planning, critical path analysis, business and technical analysis, coordination of work efforts between work packages.
• Derived mitigation and contingency plans based on the project risk and tracked effectively till the closure
• Facilitated sprint planning, release planning, daily stand-ups, product demos and sprint retrospectives
• Effectively worked with product owner in developing, maintaining and grooming Product Backlog
• Reviewed Business Requirements and analyzing the technical specifications.
• Supported existing EDI systems/subsystems and migration projects for new/existing partners
• Automated repetitive tasks and processes in order to maximize performance.
• Conducted walkthrough for all ICD-9 compliant codes.
• Overall accountability for the construction, quality and timely delivery of the project.
• Worked with end users to determine business needs for new or enhanced systems or applications.
• Established and maintained communication channels with senior managers, key team members and stakeholders.
• Running the Autosys / EMT Job when scheduled jobs fail.
• Performed applications enhancements, troubleshooting, and bug fixes as required.

Environment: IBM WTX, Mercator, MS-Visio, MS-Access, MS-Project, Share Point, Rational Clear Quest, Microsoft Office Suite (MS Word, Excel, PowerPoint) and JAVA