PROFESSIONAL SUMMARY:

• Accomplished information management professional with more than 15 years of experience managing data - intensive projects. History of managing deliverables in all phases of the project lifecycle other data-conversion related projects. Responsibilities included to define and manage the system scope, elicit business requirement / documentation, and supervise user-acceptance testing while resolving end-user issues.
• Knowledgeable in using Process Improvement Techniques which contributes to better organizational performance, building effective teams, solving problems, improving implementation time frames, and lowering overall cost through aligning technical resources with project objectives.
• Ability to multitask for various projects, organize meetings, update project schedules and deadlines, and create work flow procedures. Build Relationship with business and other stakeholders for effective communications for risk and issues to monitor the progress of the project using Jira and Agile approach (Burndown chart, Velocity Chart, Sprint Report), Epic planning, Sprint Review and Planning
• Good knowledge of Health Insurance Plans, managed care concepts and experienced in determining the membership eligibility, Enrollment, Claims processing, Billing, Correspondence.
• Assisted in the development of business and programming specifications for the compliant implementation of the NCPDP 4 Part transaction sets (PAInitiationRequest, PAInitiationRequestResponses, PARequest,PAResponse)
• Highly skilled in client relationship, Test Data Management (TDM) for client organization and HEDIS to include identification, selection, manipulation, provisioning, and maintenance of data for testing.

TECHNICAL SKILLS:

Project Management: Custom Software Development, Database Design (RDBMS), Account Management, Change Strategy, Strategic Planning, System, Migrations/Integrations, Enterprise wide Implementations

IT Project Lifecycle: Requirements Analysis, ROI Analysis, Costing & Budgeting, Project Scheduling, Testing/QA/Rollout/Support, Six Sigma, Waterfall & Agile

Value-Added Leadership: Cross-Functional Supervision, Team Building & Mentoring, Client Relations & Presentations, Business & IT Planning, Contract Management, Vendor Management, Onsite Coordination

Domain Expertise: Health Insurance (Commercial, Medicaid, Medicare, Exchanges, Pharmacy), Clinics (ESRD, Dialysis, QIP Five Star Rating, Crownweb submission), Medical Record Data Registries

Skills: Project Management, Project Charter, Scope, Scheduling, QA/QC, Policy & Procedures, Six Sigma

Business Architecture: Analysis, Business Case, Business Requirements, Functional Requirements, Entity-Relationship, and Cost-Benefit Analysis

Technical Delivery: Business Requirement, Technical Design, Test Plan, Implementation Plan, Defect Tracking, Prioritizing, Root-cause analysis, Incident Management, SLA.

Databases: Oracle 11i, SQL Server 2016, MS Access, Db2

Operating Systems: UNIX, Windows 7

Process Flow: UML, Rational Rose, MS Visio

Tools: Red gate SQL Data Generator, Rational Suite - Clear Quest, Rose, Requisite Pro, Visual Source Safe, Microsoft SharePoint, Team Foundation Server, JIRA, Mercury Quality Center, CA - Service Center.

Productivity Software: Microsoft Project, Visio, MS Office, Jira

EXPERIENCE SUMMARY:

Confidential, Deerfield, FL

Data Conversion Project Manager / Business Analyst / Team Lead and Scrum Master

Responsibilities:

• Managed offshore, onshore and onsite team with different time zone. Managed client relationship as onsite coordinator.
• Participated and managed daily scrum meeting to report the status of various team located across the globe (India, Philippines and US-California)
• Assigned task and stories in Jira to team and coordinated their work according to project plan.
• Planned Sprints for Epics to allocate the project work to various teams
• Provided specifications to create Test data in volume using red gate SQL data generator for performance testing.
• Wrote specifications for ETL Processes for all the 32 entities including Member Demographics, Billing, CMS TRR, MMR, BEQ, PWR etc.
• Elicit requirements with client’s stakeholders for various ETL Load processes from Source to Destination
• Coordinated with Lead developers, developers and QA resources to perform the offshore testing using Jira.
• Provided status reports to management team of the project.
• Tracked assigned tasks of the development teams.
• Maintained Issue and /change Log to escalate the Issues and changes during the project

Environment: SQL Server 2016, Visual Studio 2012, SQL Data Generator, Microsoft Word, Excel, PowerPoint, MS project, SharePoint, Visio

Confidential, Washington, DC

Healthcare IT Consultant

Responsibilities:

• Led the effort to gather the requirements for the project from Business Stakeholders.
• Interacted and coordinated with various Business (Registry, Clinical, and Analytic).
• Performed the gap analysis to find the identified changes in the existing Business Rules and Algorithms to propose changes in the Outcome Report for the Participants(User)
• Wrote BRD/FSD to describe the requirements and functionality of the Data collection tool, Data Quality Processing, Data Extraction, Data Migration, Business Rule Development, Algorithm Modifications, Outcome Report Modification, Data Mapping and ETL Process for the EDW.
• Conducted requirements-gathering session to elicit complex requirements from SMEs and key stakeholders.
• Coordinated with QA to perform the offshore testing.
• Provided status reports to management team of the project.
• Tracked assigned tasks of the development teams.
• Resolved raised Issues in Jira

Environment: SQL Server, Microsoft Word, Excel, PowerPoint, MS project, SharePoint, Visio, MongoDB, CDA, HL7, XML

Confidential, Melbourne, FL

Project Manager /Sr Business Systems Analyst

Responsibilities:

• Coordinated with multiple stakeholders of the projects (ESI, HFHP and Technology Vendor (DST health solutions)) during implementation meetings and assigned work to development team
• Prepared Projects plan and defined the schedule of the project. Negotiated schedules adhered to the project deliverable and made sure the delivery dates were met.
• Prioritize change requests identified and make sure to adhere to the timelines promised.
• Managed project risks, issues/problems, and activity progress to ensure project goals are achieved. Assist with problem resolution or risk mitigation as needed.
• Provided status report on a weekly basis to the senior management on the project status and health.
• Developed and managed work breakdown structure (WBS).
• Conducted project status meeting to track the progress of the project.
• Project reporting - communicated project status to management and stakeholders.
• Conducted JAD sessions with business and elicited the
• Coordinated with Testing team to manage the Test cases
• Wrote BRD and Data Mapping documents for the Commercial, Medicare and Exchange data Eligibility files.
• Defined the Requirements for the Inbound and Outbound RX and Medical Accumulator and Group Structure / Benefits Plan Level (BPL) of the Member.
• Documented various Use Case scenarios , Process Flows and other diagrammatic representations in MS Visio.
• Wrote BRD for the Rx Claims in NCPDP format included gap analysis and HIPAA compliant crosswalk for the NCPDP transaction that include the claim, eligibility, and pre-authorization/predetermination elements.
• Assisted in the development of business and programming specifications for the compliant implementation of the NCPDP transaction sets

Environment: SQL Server, Microsoft Word, Excel, PowerPoint, MS project, SharePoint, Visio

Confidential, Boston MA

Project Manager / Sr Business Systems Analyst

Responsibilities:

• Managed and reviewed the existing process and prepared scope and vision document of the project.
• Prepared Projects plan and defined the schedule of the project.
• Conducted project status meeting to track the progress of the project.
• Project reporting - communicated project status to management and stakeholders.
• Risk, issue and resolution - mitigated risk, managed issues and provided resolutions to stakeholders.
• Conducted JAD sessions with business and elicited the requirements.
• Reviewed existing SAS code and prepared data flow diagrams to define the technical specifications.
• Wrote BRD and FSD to get sign off from stakeholders.
• Manage a variety of complex HEDIS ® and STAR projects and key initiatives from start to finish including but not limited to vendor related programs.
• Continuous field and office review of methods to improve network provider compliance to health plan QI Program policies and procedures, utilizing profiles/scorecards and efforts to i Confidential ease provider compliance to practice guidelines policies and procedures as it relates to HEDIS .
• Accurately performs yearly annual HEDIS data collection and analysis.

Environment: Oracle, SAS, Informatica, Microsoft Word, Excel, PowerPoint, MS project, SharePoint, Visio

Confidential, Tampa, FL

Sr Business Systems Analyst

Responsibilities:

• Led the effort to gather member data from the various IT departments (DMR, Appeals, and Enrollment).
• Performed the gap analysis to find the identified changes in the existing applications
• Wrote BRD/FSD to describe the requirements and functionality of the application
• Conducted requirements-gathering session to elicit complex requirements from SMEs and key stakeholders.
• Wrote technical design document for development team to use to write the code in SQL and SAS for backend.
• Coordinated with QA to perform the offshore testing.
• Provided status reports to management team of the project.
• Tracked assigned tasks of the development teams.
• Resolved conflicts during the multi-stakeholders scenarios.

Environment: ORACLE, SAS, MySQL, PLSQL, Cognos, Microsoft Word, Excel, PowerPoint, MS project, SharePoint, Visio

Confidential

Responsibilities:

• Wrote BRD/FSD/TDD to describe the requirements, functionality and design of the DER application changes.
• Conducted requirements gathering session to elicit complex requirements from the pharmacy technicians and key stakeholders.
• Coordinated with QA to perform the offshore testing.

Environment: ORACLE, SAS, MySQL, PLSQL, JAVA, JBPM, Spring

Confidential

Responsibilities:

• Managed production scheduled automated jobs to make sure member data was being correctly transmitted to vendors
• Supported application during break down
• Provided Confidential SME-support to development team
• Wrote BRD/FSD/TDD to describe the requirements, functionality and design of the changes in the Confidential application.
• Coordinated with QA to perform the offshore testing.
• Worked extensively on all the mandated first phase of provisions of Confidential .

Environment: Oracle, SAS, PLSQL

Confidential

Responsibilities:

• Responsible for managing outstanding risks, issues and defects and ensuring these were successfully addressed and closed.
• Managed complex multi-party relationships involving pharmacy business, Pharmacy IT, Enrollment IT, DELL and Accenture to ensure that the responsibility for resolving issues was correctly identified and action taken by the appropriate parties.
• Responsible for analyzing migration business requirements and devising appropriate solutions. This included technical requirements, member- experience issues, legal, regulatory and compliance requirements and operational-exception processes.
• Managed the successful integration of Confidential Pharmacy benefits-eligible membership to existing applications. This involved coordinating activities performed by DELL, Accenture and pharmacy business to ensure all regulatory requirements met before the integration
• Managed relationships with key stakeholders at all levels within Dell, Accenture, pharmacy business and third-party vendors (CVS, Catamaran).
• Ensured that all integration requirements were captured, risks and issues were identified and resolved and that key pre-integration activities were executed.
• Determined requirements for go live testing and provided troubleshooting support during the launch of the Confidential Integration project.
• Wrote Business / Functional / Technical requirements for the projects in the area of Pharmacy Benefit Management ( Confidential ).
• Studied SAS /SQL code to define the technical design specification
• Provided support to development team to coordinate with business, QA, infrastructure support team
• Led JAD session to define the complex requirements and suggested solutions
• Performed code verification for changes to existing application code
• Worked with QA and checked in the requirements in HP ALM
• Performed validation for business stakeholders during critical issues and deployment
• Provided support to development team during the code release by managing the pre-requisites and post-requisite activities during the planned and Sev 2 release windows.
• Suggested strategic initiatives to improve existing processes and resolve the ongoing issues
• Provided support to the management team during the project life cycle by providing the Visio diagram and other documentation.
• Suggested consolidating the various projects for Confidential into single request for faster delivery.