PROFESSIONAL SUMMARY:

• Driven technologist possessing 8+ years of diverse experience in project management, architecture and development of complex multi - platform Healthcare, real-time finance and medical applications.
• A dedicated, results-oriented PMP and PMI-ACP certified Project Manager
• Outstanding record of responsible, sound business judgment, expanding responsibility and achievement across multiple functions.
• Excellent knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing.
• Expertise in understanding HIPAA 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, and Medicaid.
• Strong hands-on knowledge of Object-Oriented Analysis & Design, full Software Development Life Cycle (SDLC), E-Commerce.
• Experience with Agile/RAD methodologies, best practices.
• Builds solid, highly motivated teams and bridges skills gaps where needed.
• Responsible for project integration management, coordination and completion of projects, web portal / database development and maintenance, workflow analysis, new systems development, implementation and major enhancements.
• Advanced communication and relationship management skills with stakeholders having Confidential, finance and medical backgrounds in a matrixed environment.
• Proven initiator and strategic thinker with effective leadership, excellent analytical, time management, organizational, and communication skills.

TECHNICAL SKILLS:

Platforms: Windows XP/2000/NT 4.0, WRQ Reflection for UNIX and Digital vs. 10.0, IBM 308X Series, IBM PC/XT/AT/PS2, IBM Mainframe, MS DOS, UNIX, OS/2, MVS/JCL, TSO/SPF

Front End / Back End Tools: MS Project, MS Visio, MS Excel, MS PowerPoint, MS Publisher, PowerBuilder 7/6.5/6/5/4, PFC, PVCS, PowerTool 3.1, LightShip, ReportSmith, Lotus Notes, Cognos, Powerplay, Doc-to-Help, QBE Vision, SQL Programmer, FOCUS, Basic, Unix shell scripts, Fortran, Pascal, Natural, Java, XML, XSLT, HTML, JavaScript, COBOL, CICS Command Level, ClearCase, PowerDesigner, InfoMaker, Autosys, DBArtisan, Erwin

Database: OLTP/OLAP/DW/BI on DB2, Sybase SQL Server, Oracle 7x, Informix 7.2, MySQL, SQL Anywhere 5.5, Lotus Notes, MS Access, ADABAS, ODBC

PROFESSIONAL EXPERIENCE:

Confidential, Novi, MI

Project Manager

Responsibilities:

• Responsible for project planning, scheduling, resource management.
• Responsible for successful delivery of multimillion dollar Confidential 10 projects.
• Worked on GEM translation files, process mapping templates.
• Managed 3 large projects PBM and Confidential projects, managed successful delivery and coordination of 3 projects and 6 teams, IT and Business team of each project.
• Develop and oversee implementation of project communication plan; champion the project to others in the organization.
• Ensure integration and coordination between facilities and community providers; establish integrating structures with medical staff and role model partnership; recommend changes to the governance structure to further stakeholder engagement, alignment, and integration; monitor activities of other projects with interdependencies with the Confidential -10 project.
• Identify and document business process re-engineering opportunities including current and future state process flows
• Managed workflow automation, Appeals, grievances, Billing and enrollment of claims for the client
• Customize frameworks such as CPM, Billing and Enrollment; Claims work station +, BIX, Appeals and Grievances, Billing and Enrollment.
• Worked on pilot for migration of existing data to Confidential 10 formats to meet CMS guidelines for OCT 2013 deadline from CMS.
• Worked on workflow automation and migration to Confidential 5010, testing Confidential 5010 codes for claims navigator project.

Confidential, NJ

Project manager

Responsibilities:

• Worked on phases such as Impact assessment, Overall Implementation strategy
• Worked on pilot for Confidential 10 assessment project and Confidential 9
• Worked on GEM files, process mapping templates
• Identifying and budgeting information systems changes,
• Create Confidential 10 awareness among the organization
• Case management, utilization, management, quality management, data analysts
• Asses status of payers and other related business entities towards Confidential 10 preparedness
• Compare structural changes to coding, terminology and functionality between Confidential 9 and Confidential 10
• Develop plan for Confidential 10 and preparation for changes including staff training needs
• Develop references to enable users to current on publication changes and delivery
• Identify strategies for training on coding/billing, Quality Assurance, Utilization Review, Compliance Staff, Information systems, Outside Vendors
• Identify software upgrades and develop plans for the same
• Used Project Management Framework in Pega for project planning, resource management, project plan documents, timeline planning, budget, project scoping
• Created Project forecasts and estimation using PMF
• Responsible for creating SCRUM Product backlog, Project forecasting, Project Estimation, creating Statement of Work for each Sprint for the project
• Worked on CPM framework, EDI transactions, HIPAA
• Analyze the communications, informational and programming requirements of the project.
• Coding impacts of changing Confidential systems

Confidential, NY

Business Analyst

Responsibilities:

• Conducted weekly meetings for deciding the Policies and Procedures to be followed while constructing new sites.
• Performed the requirement analysis, impact analysis and documented the requirements using Rational Requisite Pro.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets
• Documented the server farm requirements and requirements related to security within Share Point and using Windows Active Directory.
• Performed Gap Analysis to check the compatibility of the existing system infrastructure with the new business requirements.
• Designed High level design, for New process, integrating with legacy and Facets
• Used Query Analyzer, Execution Plan to optimize SQL Queries.
• Meticulously assessed data from various sources and generated conceptual and logical database designs using ERwin data modeling tool.
• Interacted with client and the Technical Team for requirement gathering and translation of Business Requirement to Technical specifications.
• Conducted interviews, meetings and JAD sessions during the process of Requirement Gathering.
• Planned and documented procedures for data processing and prepared data flow diagrams for the application.
• Analyzed and translated business requirements into system specifications utilizing UML and RUP methodology
• Expertise with supply chain strategies/vendor manufacturing process methods to determine level of procurement and strategic sourcing strategies/plans and worked with vendors/peers to determine lead times, schedules and cycle counts, established requirements needs.
• Interacted with line of business managers and coordinated the transition into the security database to assure business compliance with SOX.

Confidential, Carnegie, PA

Business Analyst

Responsibilities:

• Conducted the AS-IS and TO-BE analysis of the business process using GAP analysis. Coordinated closely with Business Users of both Script Med & PARS teams to gather/define Business Requirements, Business Use Cases, and Business Processes and finally documented them in Business Requirements Document (BRD).
• Created high level Business Process Scenarios, AS IS & TO BE Workflows and Business Process Flow diagrams for Primary PBM, Primary MM, Secondary PBM, Secondary MM etc.
• Created Functional Analysis Matrix and conducted Peer Review of Functional Analysis Matrix.
• Prepared activities for JAR sessions that included updates to High Level Process Flows, Functional Analysis Documents, and Meeting Minutes.
• Detailed knowledge about functionality of Confidential derivatives like equities, fixed income, credit derivatives, MM instruments, Interest Rate Derivatives, Swaps, ForEX etc.
• Confidential (credit conversion factor) add on refers to proportion of notional that goes into EAD calculation of a Confidential derivative transaction. Add on values are based on the risk type of a transaction and its tenor.
• Created various Data Mapping documents by looking into the schema and code by comparing the data elements of each record of both Source & Target File Layouts.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype and overall system.
• Performed as Confidential Functional lead in the Fit-Gap, Analysis, Design, Testing and Implementation of an Order to Cash Solution. Functional Areas: Order Management, Pricing, Inventory and Billing:
• Defined solutions such as Functional Requirements, Business Rules & Functional Level Use Cases (create Claims Processes, Billing & Payments), System Level Use Cases (Extract Load Process, Inbound Processing, Outbound Processing, Distribution Process, and Conversion Process) to business/systems problems and owned the integrity of the solution through customer acceptance.