SUMMARY:

• Experienced Project/Program/Portfolio Management and Business (Analysis) Architect leader with wide - ranging progressive experience in Financial Services, Healthcare, and Regulatory Compliance industry sectors in planning, developing, and implementing state-of-the art business processes and complex cross functional solutions facilitating corporate growth.
• I have led the entire life cycle process of delivery engagements from RFP and Proposals, project planning and initiation, requirements gathering through systems implementation and delivery; provided guidance to business stakeholders, steering committee, and end-user community setting goals and objectives; evaluated and resolved complex technical, business, and operational issues and problems; developed and tracked budgets, resources, business risks, and mitigation planning; and managed relationships with internal, commercial off-the-shelf (COTS), and external software vendors / partners.
• Medicaid, Medicare, Healthcare Information Exchange (HIX), MITA 3.0 SSA, IES (Integrated Eligibility System - MAGI /Non-MAGI rules) and MMIS (Medicaid Management Information Systems)

EXPERTISE:

• Scrum Agile Principles Sprint Planning and Iterations Meetings
• Sprint Reviews and Retrospectives Communication and Conflict Resolution
• User Story-based development Project Planning and Management
• Product backlog and roadmap Relative velocity and effort based estimation
• Create and maintain the Product backlog Get detail level of requirement from stakeholders
• Help Scrum Master organize Sprint Review Meetings Clearly communicate requirements to the Team
• Build and maintain a relationship with the Stakeholders
• Fidelity FSDM, IBM RUP Rational Unified Process, UML Use Case, Joint Application Design (JAD), Scrum AGILE Methodology, User Stories, Storyboard, UML Use cases, Wireframes, Functional Design
• Business Process Re-engineering, Sequencing diagrams, Workflow analysis, Data Mapping and Conversions / Migrations, Data Modeling, ER (Entity Relationship) Modeling, Kimball Dimensional Modeling, Data Warehousing
• IBM DB2, SQL, Sybase 12, Sybase 15, Oracle 9-11g, MS SQL Server, Decision Support / Data Warehouse systems

SOFTWARE / TOOLS:

• MS Project (MS Project Server), MS Visio, MS Office Suite, Microsoft SharePoint
• Informatica ETL, XML, Teradata, SQL SaaS (Software as a Service) model, APIs and Web Services
• HP Quality Center ALM - Software Quality Application Lifecycle Management
• IBM RRC Rational Requirements Composer, RTC Rational Team Concert, JAZZ Agile tool, Clear Case, Clear Quest Defect Management, Requisite Pro.
• ITG Mercury Resource Planning & Budgeting, HP Quality Center ALM, JIRA, Clarity, Sales Force.
• Clinical and Physicians Workflow, Clinical Vitals Data, Clinical Analytics Data Warehouse

PROFESSIONAL EXPERIENCE:

Confidential

Project Manager and Business Consultant

Responsibilities:

• Led cross-functional Mass Health, Connector Care ( Confidential ) State Agencies to conduct information needs analysis and JAD sessions to document IES Integrated Eligibility Requirements and GAP analysis for HIX and MMIS (Medicaid Management Information System). Assisted and led team to elicit, challenge, and prioritize requirements, translate into functional design and use case models.
• Provided technical leadership in HIX and IES domains. Served in a cross-program role to ensure quality of the deliverables, innovation, and strategic solutions within mission-critical, large-scale programs.
• Managed the project scope, objectives, constraints and assumptions and provided guidance in development of the technical design, test plans, and user documentation. Led implementation/conversion strategy planning and implementation. Managed scope and changes throughout the initiative and requirements traceability.
• Gathered and analyzed information and provided recommendations to address strategic business reporting requirements. Presented business reporting indicators and dashboard to Mass Health and Confidential Steering Committee for OE2016 (Open Enrollment 2016).
• Implemented Enrollments (EDI 834) for the electronic exchange of member enrollment information, including benefits, plan subscription and employee demographic information. Identified and resolved reconciliation of members’ enrollments and payments discrepancies between Exchange and QHP records.
• Worked with Mass Health and Confidential agencies coordinating efforts with hCentive and OPTUM to ensure the successful implementation (scope, quality, business value, and business risks) of short term tactical solution goals for Confidential and long term strategic reporting and Data Warehouse and analytics BI solution.

Confidential

Principal Delivery Manager

Responsibilities:

• Federal Risk Adjustment and Reinsurance (Claims Encounter Data Submission for Medicaid, Medicare, and Dual for Unify Product to State and Federal CMS agencies) under Confidential - Affordable Care Act programs.
• Enhanced healthcare performance by extracting Clinical Data from Claims Encounter records for Critical Care Patients from Professional and Hospital Claims into Data Mart / Data Warehouse to make better decisions, deliver better patient care, and improve Confidential Quality Improvement Process (QIP) Measurement and Rating by effectively managing: Staying Healthy (Screenings, Tests and Vaccines), Managing Chronic Patient Conditions, and improving Member and Customer Service Experience related to Drug Plan and Patient Safety.
• Led planning, design reviews, requirements gathering to document IES / Medicaid Eligibility business and technical requirements, use cases, data, process, and workflow diagrams using Joint Applications Design (JAD) Scrum Agile methodology.
• Established configuration of Benefit Plans, Benefit Categories, Rules, and Provider Contracts.
• Coordinated with iHealth Technologies (iHT - Analytics vendor) to establish payment policies and guidelines to configure Benefit Categories and Rules and re-engineered Claims processes, procedures, and systems.
• Led data Integration to automate processes that supported ongoing interoperation, periodic settlement with iHT vendor. Worked with Product Pricing, Claims Research to support and provide timely, accurate Payers and Clinical relevant data and conduct Claims Audit and Reconcile payments based on Payment Fee Schedules.
• Supervised User Acceptance Test (UAT) planning, test execution, testing objectives, and certification.
• Acted as interface between business and technology regarding deliverables and status. Managed logistical support, operational administration, and execution of tasks to ensure operations are prioritized. Provided management and escalation point support to ensure successful delivery of critical components within established time frame.

Confidential

Responsibilities:

• Led planning, design reviews, requirements gathering to document business and technical requirements, use cases, data, process, and workflow diagrams.
• Established configuration of Benefit Plans, Benefit Categories, Rules, and Provider Contracts.
• Led implementation and delivery Claims (EDI 837) and outbound interfaces to DST, PBM / Argus Pharmacy, Dental delivery systems partners.
• Acted as interface between business and technology regarding deliverables, and status. Managed logistical support, operational administration, and execution of tasks to ensure operations are prioritized.
• Managed relationships with internal, commercial off-the-shelf (COTS), and external software vendors.
• Provided management and escalation point support to ensure successful delivery of critical components within established time frame.

Confidential

Senior Project Manager and Business Architect

Responsibilities:

• Formulated and defined program scope and objectives for the work streams with thorough understanding of business processes.
• Collaborated with cross-functional (Bank of America) Columbia Management and Confidential Marketing, Finance, Investment Management, Compliance, and Legal Business Stakeholders to document Business-level Application and Functional Requirements ( Confidential ), UML Use Cases, Data and Process flow diagrams for SEC Compliance requirements.
• Led systems integration of Ameriprise Fixed Income System with Confidential ’s Aladdin Fixed Income platform. Developed integration-point-analysis of (Golden Source) Security Master with Ameriprise’ GIM, PACE, Bloomberg, CPS Pricing, Fixed Income, and Investment Compliance systems.
• Worked with technology Data Hub teams to convert and consolidate data originating from multiple sources into Golden Source Data Warehouse system to provide an accurate and consolidated database. Reviewed the client's business rules, file layouts, and data conversion structures to develop automated routines using Informatica ETL for ongoing integrity of data transformation processes to ensure the consistent conversion of data into SEC statistical regulatory compliance reporting, and risk management systems.
• Supervised User Acceptance Test (UAT) planning, test execution, testing objectives, and certification.
• Obtained necessary approvals, and implemented technology projects to ensure goals are accomplished within prescribed time frame and cost. Worked closely with management to understand and prioritize business goals and information needs to develop and align project initiatives in concurrence with business.

Confidential

Clinical Product Lead

Responsibilities:

• Interacted at all levels of the Patient Keeper, Memorial Hospitals Physicians, Clinical & Nursing Staff, Confidential Healthcare Account & Technical teams, and State’s Medicare & Medicaid office.
• Facilitated Clinical Vitals Workflow sessions with business owners and end-users to elicit, create, and verify current state workflows of Clinical Vitals. Defined future To-be state of Clinical Workflows using Joint Application Design (JAD); Scrum AGILE Methodology to document Business-level Application and Functional Requirements, Use Cases, Data and Process flow diagrams.
• Led commercial off-the-shelf (COTS) Motorola Handheld Devices and Confidential ’s IDX Care Cast / Care-Fusion products integration and vendor management. Worked with cross-functional teams and departments to improve software and business processes, deployed Clinical products, developed necessary documentation with the goal of increased scalability, supportability and availability.

Confidential

Vice President

Responsibilities:

• Led planning and execution of strategic and operational Systems Integration, Re-Engineering of Data, and Interfaces across multiple initiatives and processes. Developed and presented business cases to Senior Management and Executive Committee supporting ROI, cost-benefit analysis and strategy.
• Assisted business operations defining, preparing, and guiding, the development of systems implementation strategy for the cutover and conversion activities for multiple release cycles. Led Joint Application Design (JAD) using IBM RUP Rational Unified Process Methodology to document Business-level Application (BRD) and Functional Requirements ( Confidential ), Systems Design Specifications (SDS), UML Use Cases, Data and Process flow diagrams. Led release planning and change management process initiatives, facilitated the delivery of change requests and functional enhancements in release cycles. Acted as primary interface with the Business client regarding deliverables, changes, and sign-off on status and specifications.
• Managed logistical support, operational administration, and execution tasks to ensure operations are prioritized and resourced. Managed relationships with internal, external commercial off-the-shelf (COTS), and offshore vendor.

Confidential

Senior Project Manager

Responsibilities:

• Managed staff and project deliverables. Led the overall planning and execution of activities, resources to ensure that cost, time and quality goals are met, and .accountable for successful health (scope, quality, schedule, resources, business value, and business risks) and delivery of projects.
• Led Joint Application Design (JAD) using Fidelity FSDM Methodology to document Business-level Application (PPI) and Functional Requirements ( Confidential ), Architecture Planning (AIP), Systems Design Specifications (SDS) Technical Systems Design (TSD), Data and Process Flow diagrams. Provided leadership and expertise in implementation (SEI/ CMMI) best practices and standards and ensured that the Best Practices are effectively implemented and adhered.
• Managed cross program conflict and interdependencies. Managed program risks, proposing appropriate mitigation and contingency plans. Proposed workable solutions to problems by analyzing business and technical trade-offs among alternatives, and used objective judgment and influence to formulate and drive consensus on recommendations.
• Managed relationships with internal, external commercial off-the-shelf (COTS), and Infosys Indian vendor. Managed logistical support, project operational administration, and execution tasks to ensure operations are prioritized and resourced. Established team dynamics, fostering teamwork and collaboration.

Confidential

Manager - Services Delivery Manager

Responsibilities:

• Led multi-million dollar OSS (Operations Support Systems) 271 Testing and Certification on-behalf of Confidential (Federal Communications Corporations) and Public Utility Commissions ( Confidential ) for States of New-Jersey, Florida, and Georgia to certify Verizon and Bellsouth’s entry into Long Distance market.
• The system included both Two-Factor Two-Way Authentication to protect the front (i.e. log-in) and the back-end financial transaction. The application allowed the user to set up secure system users, groups, entitlements, organizations, specify organizational relationships, and grant access privileges.
• Led Joint Application Design (JAD) sessions to identify business and system requirements. Evaluated RFP and Vendor selection for Data Rating Engine and 2.5G / GPRS solutions for Wireless Mobile Devices. Provided complex cross-functional engagement leadership and expertise in implementation and enterprise-wide testing of Wireless Mobile Devices and 2.5 / GPRS solutions with Admocs client/server Customer Care and Billing system; Supervised Systems Integration (SIT) and User Acceptance Test (UAT) planning, test execution, testing objectives, and certification.
• Provided Quality Assurance initiatives to meet Confidential ’s Requirements (CFR 21 Part 11) at major Manufacturer, Distributor, and Supplier of Home Medical Equipment and Products. Helped client to ensure that IT department’s software verification and validation processes and standards meet the Confidential ’s Compliance and Regulatory Requirements . As a member of Quality SWAT team, conducted GAP analysis to assess the state of current procedures v/s ideal QA processes and Confidential ’s compliance requirements. Participated in the QA program to install the Project Tracking System to ensure that all IT projects are documented and tracked. Implemented Software Security and Authentication Policy to meet per Confidential ’s Compliance Requirement. Developed written software quality assurance standards and procedures for every phase of the SDLC project life cycle. Created checklists to validate QA standards are met. Defined and documented package selection criteria to ensure that off-the-shelve third party software vendor products meet the Confidential software requirements.