- 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.
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
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
Confidential, Novi, MI
- 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.
- 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
- 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
- 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.