- Over 19 years of IT experience and more than 11 years of Health project management experience.
- Provided program and project management support to high profile ICD - 10 projects.
- In depth knowledge of Project Management in ICD-10, EHR and Quality (HEDIS) analysis, assessment and implementations.
- Strong understanding of the full project management cycle of care/healthcare/insurance.
- Experienced in managing highly matrix aligned onshore and offshore project team and environment: Ancillary, Clinical, Revenue Cycle, physician services, & Information Technology.
- Excellent knowledge of Medicaid Management Information System (MMIS).
- Extensive experience in managing project related to Pharmacy Benefit Management (PBM) systems.
- Experienced in business practices and processes of Information Services and Healthcare Enterprise.
- Specialized in Healthcare, Insurance, Risk and Compliance, Document management.
- Strong experience in Claims Processing and Claims Scrubbing in HMO, PPO, Medicaid, Medicare and Business Intelligence tools.
- Worked on healthcare standards such as HIPPA 4010, 5010, DICOMM, CPT, ICD-9 and ICD-10.
- Solutions-oriented IT Professional who excels at managing projects, collaborating with project teams, interfacing with clients, and deploying technology to build successful solutions for clients.
- Exceptional abilities in project design, planning and management with the organizational and supervisory skills to assure success.
- Extensive experience in system and business analysis, requirements gathering, design, development, testing, data conversion, training, debugging and documentation (user manuals, functional and technical specifications) and pre-production unit test and regression test plan generation.
- Decisive, energetic, focused team leader/player who leads high-performing teams through implementing change and improvements.
- Acted effectively as point-of-contact on status of EDI transactions from internal and external customers.
- Solid management skills, demonstrated proficiency in leading and mentoring individuals to maximize levels of productivity, while forming cohesive team environments.
Project Management: MS Project, Planview Enterprise, JIRA
Methodologies: PMI Project Management, Scrum/Agile, Waterfall, System Development Life Cycle (SDLC), CMM, ISO Standards
Siebel: Configuration, Customization and Data Migration (EIM)
Programming Languages: C, C++, Java, Visual Basic, and XML
Scripting Languages: Perl
Databases: Oracle 8i/9i/10g, MySQL, SQL, PL/SQL Stored Procedures, and MS Access
Presentation/Frontend: MS Visio, HTML, Java Scripts, JSP, JavaBeans, Swing and Developer 2000
Application Server: BEA Web Logic App Server 7.x and 8.1, JBoss, and Tomcat
Operating Systems: UNIX, Windows NT/2000
Confidential, Detroit, MI
Sr. Project Manager
- Managing multiple projects of moderate size concurrently.
- Involve in the development of strategic plans for projects of high business complexity.
- Implemented process improvement efforts within the EDI structure including system interface, policy and procedure changes.
- Performed detailed design and mapping specification creation for translation between Legacy and EDI formats.
- Identified and recognized opportunities to resolve problems related to EDI transactions.
- Worked with the CRM and marketing departments to understand their requirements and provide relevant data for their analytics.
- Managing migration, data conversion, and data continuance of the different sets of Pharmacy Benefits Management (PBM) apps.
- Provided data for Contact Center, Campaign management and Lead Management processes according to the team’s requirement.
- Managing end to end delivery of multiple data warehouse-business intelligence projects.
- Work with the PMO project managers to ensure that project deliverables such as project tasks, activities, and issues, day- to -day execution of project plans, review & updates of the work plan are addressed and communicated to management & project teams.
- Attend project review sessions with PMO and team leaders for project scope change requirements, resource issues, risks, project document updates/changes, & daily communication with vendors & clients (hospital).
- Facilitate application assessment, crosswalk & GAP analysis sessions.
- Adheres to Project Management Office policies, procedures, and methodologies.
- Oversees client/customer relations to ensure that service expectations are developed and met.
- Analyzing business needs and working with cross functional (technical & non-technical) teams to deliver enterprise solutions.
- Leading a matrix onshore and offshore project team to define, establish, and ensure completion of all program milestones while adhering to timelines and budgets.
- Managing projects at various levels of complexity using different Project Management Methodologies and using JIRA to keep track of all the issues.
- Creating and managing detailed project plans for small to high complexity projects.
- Creates and executes project work plans and revises as appropriate to meet changing needs and requirements.
- Leading large and complex technology integration initiatives.
Confidential, Lansing, MI
Sr. Project Manager
- Developed project charter outlining project objectives, scopes and identifying all the key stakeholders.
- Ensure that the project is properly documented in terms of scope, functionality, and risk.
- Built a detailed project plan for the data warehouse icd10 project initiatives.
- Monitor and enforces that the project meets the overall objectives, business requirements, quality standards, performance criteria and user needs.
- Work with stakeholders to understand where they stand against their remediation efforts and where they are currently using ICD-9.
- Analyzed System Impact including MMIS tables, reports and interfaces to external entities.
- Remediated business intelligence tools used by state.
- Liaison between IT technical departments and external and internal customers to ensure error free EDI transactions
- Coordinated with PBM systems owners to remediate ICD-9 data to in corporate in data warehouse. Following the resolution of defects in the Medicaid MMIS System.
- Oversaw and coordinated projects with offshore components.
- Work with project teams to integrate change management activities into the overall project plan.
- Maintains overall accountability for the entire project including internal and external stakeholder relationship management, issue management, work effort, deliverables, and resources.
- Responsible for the Change Management and Resource Allocation.
- Created a solid communication plan to mitigate the risk of communication gap between each stakeholders and project team members.
Confidential, Bloomfield, CT
- Provide project leadership, development processes, and system expertise to the ICD-10 Steering committee and ICD-10 workgroup.
- Prepare project documentation, and project plan to ensure timely completion of project deliverables. Communicate project status to team and department throughout assignment.
- Perform organizational and process analysis and develop plans to improve quality, cycle time and cost.
- Work with key business partners, including Finance and Reporting, to identify significant cost drivers with upfront rigor and in-depth analysis.
- Coordinated with business owners to ensure business needs and EDI transaction format requirements were met and troubleshoot issues that arose.
- Planned and executed the process of remediating and testing PBM systems and operations workflow.
- Communicate issues to vendor, IT ICD-10 Steering Committee and ICD-10 workgroup as needed.
- Identifies necessary resources including personnel, hardware and software, and makes recommendations for inclusion into the project.
- Tracked actual performance against planned project performance and work with project team to understand variances.
- Acts as liaison and collaborates effectively with all matrix partners within the organization: Quality, Medical, Product, Benefits, Service Operations, and Contracting, Sales and Prepay.
- Document and/or review current and future workflows related to ICD-10 impacts and use in operations.
- Update existing documents for internal and external audience on changes and enhancements of the ICD-10 code set.
- Performed requirements analysis and created functional specifications to support the system for IC10.
- Duties include analyzing business practices and procedures and developing specifications for the applications to be used by various departments to perform functions such as enrolling subscribers, claim calculations (claim limits & deductibles), claim processing and premium calculations.
- Coordinate and guide the development team for code changes for ICD10 implementation.
Confidential, Novi, MI
- Responsible for project planning, scheduling, resource management.
- Responsible for successful delivery of multimillion dollar ICD 10 projects.
- Worked on GEM translation files, process mapping templates.
- Managed 3 large projects PBM (Pharmacy Benefit Management) and ICD 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 ICD-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 ICD 10 formats to meet CMS guidelines for OCT 2013 deadline from CMS.
- Worked on workflow automation and migration to ICD 5010, testing ICD 5010 codes for claims navigator project.
Environment: ICD 10, ICD 9 CM, ICD 10 PCS, Windows XP, MS-Visio, Correspondence Output Server, Test Management Framework, CPM, CMF, Appeals and Grievances Framework, Billing and Enrollment Framework.
Confidential, New Jersey
- Worked on phases such as Impact assessment, Overall Implementation strategy
- Worked on pilot for ICD 10 assessment project and ICD 9
- Worked on GEM files, process mapping templates
- Identifying and budgeting information systems changes
- Create ICD 10 awareness among the organization
- Case management, utilization, management, quality management, data analysts
- Asses status of payers and other related business entities towards ICD 10 preparedness
- Compare structural changes to coding, terminology and functionality between ICD 9 and ICD 10
- Impact analysis of ICD 10 to billing, coding, software processes
- Develop plan for ICD 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
- Scoping, Budgeting, Resource management, project plan creation using tools such as Pega Project Management framework
- Worked on CPM framework, EDI transactions, HIPAA
- Analyze the communications, informational and programming requirements of the project.
- Conduct research studies that may include collecting, analyzing, trending and presenting data and recommendations to management
- Perform project management duties including the creation of status reports, work plans, and presentations to client leadership
- Coding impacts of changing ICD systems
- Utilization review, Coding billing, Compliance staff
- Prepare plans for reengineering and documentation
- Work closely with payers to resolve payer issues, rejections, denials
Confidential, Honolulu, HI
- Managed the coordination and reporting of EDI 837 x12 files, 835 (EOB), and encounter claims of Hawaii into the main claims management application (Peradigm) while adhering to HIPAA policies, State, and Federal mandates when transferring data to other providers (via secured FTP) and/or state.
- Was responsible in creating communication plans, executive summaries, procedures, compliance summaries, and enrollment process to provide services to policy holders needing/requesting curb side pickup.
- Responsible for sending encounter files to the Confidential . Created adhoc reports using SAS while developing state reports by writing SQL queries.
- Worked with EDI clearinghouse in sending over the 837 files in order to have x12 SNIP (Strategic National Implementation Process) validation in order to have files imported into our DIAMOND system (for data loads and manipulation), for claim, member, provider, and association reports.
- Worked with Confidential (imaging partner) to validate imaged 837 claims that were rejected by data loads.
- Provided visibility for HIPAA compliance in validating claim numbers and ICD9 codes vendors.
- Coordinated the effort in generating various reports for the Confidential (as outlined in the RFP) by working with business analysts and IT in mapping the correct data elements from our schema to provide the State with the requested information.
- Installation and Customization of the Oracle BRM/Portal Infranet 7.0, MultiDatabase, PRE & Portal Telco products.
- In charge of Strategic Deliverables that included the Full Corporate Solutions and Ongoing deliverables.
- Implemented tracking and reporting procedures that provided sharing of test plans/results among team members reducing testing cycle duration
- Established standardized testing methodology and provided well defined test procedures.
- Performed UAT presentation to client.
- Worked on SRS, issues list, design documents and project management Plan.
- Providing operational Support for various business functionalities.
- Managed monthly bill run activities.
- Analysis and Design for the Java based Adapters for performing various tasks on the Corporate Hierarchy like purchasing aggregation discount and add it to sharing group. Add members to the group etc.
- Participated in analysis, designing, development, deployment and documentation of billing system.
- Key driver for getting the client sign-off on Confidential deliverables.
- Investigated interface points and data mapping between Oracle BRM/Portal Infranet and Siebel CRM.
- Involved with integration team to integrate Oracle BRM/Portal Infranet with Siebel CRM and EAI.
- Involved in testing, debugging, and troubleshooting during the system testing and deployment phase.
Environment: MS Project, Oracle BRM/Portal Infranet 7.0, Siebel, Confidential MQSeries, Perl, XML, C/C++, Java, Sun Solaris, Windows, SQL, PL/SQL, Oracle, Confidential Web Server.
Sr. Software Engineer
- Developed Accounts Receivable and Flexible Billing functionality for the Club Industry using Web Logic, XML, DHTML, and Java. Club staff can make formatting changes to the bill layout without requiring programming changes.
- Designed and implemented a flexible counter mechanism to keep track of required minimum purchases by club members using Counter Designs Pattern.
- Created browser-based user interface for the reservations module within the Confidential using Struts.
- Developed data migration procedures for customer and billing data. Involved in the data migration and implementation of 3 implementations of the product.
Confidential, CaliforniaSr. Software Engineer
- Developed integration with Siebel 2000 for Confidential to streamline Order Entry Process by retrieving User Profile data electronically based on Caller Id. Made changes to Order Entry Forms to extract data from an OLE Server.
- Performed Gap Analysis to identify enhancements needed for implementation. Performed data mapping from other systems in System Stack to Siebel Object Model. Worked with Business Analysts to perform Gap Resolution.
- Modification of Applets, Business Components using Siebel Tools. Added new attributes to Account and Order object to keep track of data received from Confidential ’s Call Center Product.
- Used Siebel’s workflow capability to forward accepted orders to Supervisor for Quality Control purposes.
- Created EIM Batch Jobs to import and export data retrieved from Siebel 2000 to flat files.
- Performed unit testing and integration testing on Siebel 2000 test instance to ensure compliance with marketing requirements.
Environment: Visual Basic 6.0, Siebel Basic, EIM, Siebel Configurator, OLE, Oracle 8i
- Designed and developed user interface and back-end for the billing system. The billing system managed client billings, payment processing, and the collections process.
- Created VBA procedures for loading data from Excel Spreadsheets to the centralized billing system allowing company personnel to initially enter timesheets into Excel Spreadsheets.
- Developed reports to manage the billability of staff, analysis of profitability by client, type of work done, and revenues by industry.
Environment: Visual Basic 6.0, Oracle 8.0.5, OLE, and COM.
- Developed the personnel system used to manage and maintain employee data, appraisal information, and salary & benefits information.
- Created various reports to assist Personnel Department with managing benefits, annual review process, extension of contracts, and extension of visas.
- Using OLE, Mail Merge Facility in MSWord, and personnel data stored in Oracle, generated customized documents for the Personnel Department. The generated document can then be reviewed by the user and updated.
Environment: Visual Basic 6.0, Oracle 8.0.5, Erwin, and ActiveX.