SUMMARY:

• Project Manager utilizing education, credible private sector experience and demonstrated career progression. Seeking opportunities to sharpen my management capabilities and continue to excel in positions of Project Management.
• Good understanding of Software Development Life Cycle (SDLC), AGILE methodologies and implemented SCRUM and SPRINT techniques.
• Experience in enterprise, custom application and product development, maintenance and enhancement with in various roles in development, Project Management and Process engineering
• Proven track record of interacting with different members in the organization namely project managers, designers, testing team, subject matter experts, and customers to provide the best possible solutions
• Specializes in an interdependent environment where self - sufficiency and collaboration are extremely important to project deployment
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI … NCPDP and ICD9-ICD10.
• Medical Claims experience in Process Documentation, Analysis and Implementation in ANSI 837 P, 820, 835, 834, … … 999/TA1 (X12 Standards) processes of Medical Claims Industry from the Provider/Payer side
• Working Good Knowledge in HIE (Health Information Exchange)
• Adequate knowledge in Health Administration - Claims processing (auto adjudication), COB, EOB/ Drafts, Claims pricing and testing, HIPAA, enrolment, EDI, HER, HIX, Medicare, Medicaid, CDHP (consumer driven health plans).
• Strong knowledge of Use Cases, MITA and Activity Diagram and profound knowledge of EDI X12 standards in healthcare insurance.
• Designed and implemented basic SQL queries for testing and report/data validation
• Strong Knowledge and experience of EDI transactions, HIPAA, ASC X12 Transaction sets: 834 (Benefit Enrolment and Maintenance), 835 (Claim Payment/Advice, 837 (Claims and Encounters), 820 (Payroll Deducted and Other Group Premium Payment for Insurance Products) 270/271 (Explanation of Benefits (EOB) /Response to EOB), 276/277 (Claim Status/Claim Status Response).
• Excellent knowledge of Health Insurance Portability and Accountability Act (HIPAA) transaction, code set rules such as EDI 837, 835, 834, 270, 271, 277, 999, 997 and ICD9-ICD10.
• Well conversant with project management activities such as on Conduct meetings & prepare MOMs, Data analysis, Project Planning, Documentation, Business reports, Estimate team size & budget, Test strategy & Test Plan preparation, UAT Coordination, Defect management, Status reporting, Team size& Budget estimate, Environment& Tools estimate, Master Test Plan, Testing Dashboard, Testing Project Plan, issues &risk log register, Testing Assessment and Project Kick Off.
• Creative thinker and analytical problem-solver with demonstrated ability to manage projects from planning through execution/completion under the pressure of fast-paced, time-sensitive environments
• Excellent communicator leveraging technical, business and financial acumen to communicate effectively with client executives and their respective teams.

TECHNICAL SKILLS:

Methodologies: Agile, Scrum, Waterfall

Project Skills: Ethical Decision Making, Project management, Strategic Human Resource Management, Critical thinking, Problem solving, Effective business communication, Business presentation, Marketing Strategies, Market Analysis, Business Performance Management, Client Management and Retention, Organization Performance Management and Strategic Planning

Domain: Project Management, Healthcare Management, ICD 9-10 conversions, HIE

Risk Adjustment Error Remediation: Edifecs

Testing Tool: Jira, HP ALM, HP QC, Zendesk

Project Management Tools: MS Visio, MS Word, MS Excel, MS Access, MS Power Point, MS Share point

Database: SQL Server, MS Access, Oracle

PROFESSIONAL EXPERIENCE:

Confidential - Dallas, TX

Project Manager

Responsibilities:

• Worked directly with business leaders, application developers, subject matter experts and external affiliates to manage the delivery and programs and projects
• Facilitated and documented weekly project status meetings with project team and stakeholders to ensure alignment on project progress, resources management, scope management, cost management, effort, risk management, issues, and any necessary project change requests.
• Serves as the primary point of contact for project status and budget reporting and facilitating strong partnerships with stakeholders
• Managed the activities of project team resources on a day-to-day basis and create an atmosphere of collaboration and creative problem solving
• Understood the technical roadmap and larger project context to ensure adherence and escalate potential issues. Understand program dependencies and their implications for project planning
• Management and oversight of all Medicare Risk Adjustment data sent to a third party vendor (Edifecs) by the Plan.
• Maintained Project Dashboard, Project Performance Measurement against KPI's, and established SLA's
• Analyzed HIPAA 4010 and 5010 standards for 837P EDI X12 transactions, related to providers, payers, subscribers and other related entities.
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Resolved day to day EDI issues in ANSI X12 EDI Transaction sets and their file transfer.
• Reconcile outbound 837 EDI files against their corresponding state and CMS EDI response 999 & 277CA files
• Involved in developing/Migrating and implementing Steward Meditech system HL7 inbound and outbound interfaces with EMPI, HIE/DPH and downstream vendor systems across the hospital.
• While interfacing, utilized the healthcare industry standards- HL7, CCDA, XML, EDI, EDIFACT and IHE profiles.
• Kept abreast of advancements in Health Information Exchange (HIE), and Clinical Software and technologies
• Involved in HIE- HL7 requirements, Prepared workflow documents and building/developing the interfaces with HL7 and XML protocol.
• Involved in Requirement Analysis for EDIFECS implementations with SOA components.
• Involved in Design and Review meeting with Business, EDIFECS, Development and QA teams.
• Measured and monitored progress against plan at clearly defined points in the process to ensure that the project is delivered on time, within budget, and that it meets or exceeds expectations. Balance scope, schedule, budget, quality, and risks.
• Provided metrics about client/customer satisfaction rates using Zendesk.
• Ensured that all requirements, project plans, and resolved issues and changes are communicated to all affected team members
• Maintained testing requests/ test, Test Estimates, Test Strategy results using ZenDesk
• Executed UAT, test scripts, functional test scripts and regression testing of multiple line of business.
• Logged and tracked defects in HP ALM and reviewed stories in JIRA for new requirements or enhancements.
• UAT Coordination - UAT testing activities and the development of UAT test artifacts, UAT test documentation, UAT testing for change management and reporting.
• Conducted the UAT sessions with the business users and tracked/maintained and closed the critical defects for the migration efforts.

Confidential - Springfield, IL

Project Manager

Responsibilities:

• Met with clients to discuss and fine-tune project expectations Responsible and accountable for the coordinated management of multiple related projects directed toward strategic business and other organizational objectives.
• Used project management methodologies and documentation, which includes agile framework for Project stories, sprint planning product backlog and Sprint Backlog sessions to manage the project End to End.
• Gathered requirements, develop project scope, manage project plan in Microsoft Project, meet with principal stakeholders and assist the project team.
• Created a Mapping Documentation for generating EDIX12 formats of 834,835,837, etc.
• Analyzed HIPAA EDI 4010 and HIPAA EDI 5010 standards for 276/277 transactions and prepared gap analysis document for each X12 transaction.
• Performed Validation and QA on 837 (I, P) for claim submission files in EDIFECS.
• Worked with EDI concepts, standards, architectures (ANSI ASC X12, UN/EDIFACT).
• Distributed instructions, documentation, specifications, and questionnaires for EDI-related processes and procedures to client's personnel and/or external trading Partners.
• Interacted with trading partners and internal corporate and field units on a day-to-day basis to support and resolve issues relative to EDI transaction flow.
• Analyzed Data integration and electronic data interchange (EDI) requirements and perform logical mapping that includes field-to-field mapping, formatting rules, validation rules, and transformation rules.
• Streamlined Claims (837 EDI X12) Migration project by gathering functional specifications in Edifices.
• Coordinated the integration of clinical applications and electronic health record (EHR) systems to the HIE.
• Responsible for the support of existing HIE clients concurrent with the expansion to additional ambulatory offices.
• Worked in Health Information Exchange (HIE) implementation, Clinical hub, CCDA, Interface analysis, interoperability.
• Analyzed Audit and Change Files of 834, 835, 820, 837 PDI, 997, 999, 270 & 271HIPAA EDI Transactions using MS Word, MS Excel.
• Accountable for project communications, milestone tracking, resource planning, financials, risk assessment and contingency planning and escalation and conflict management. Develop a comprehensive project plan (Define critical path) incorporating deliverables, and Develop WBS, risk breakdown (RAID Log), resource plans (RACI Matrix) and base milestones.
• Tracked all issues and risks in the project scope utilizing Microsoft Project. Provided detailed analysis and scorecard reporting to senior management.
• Maintained, edited, and drove project scheduling of local and international conference sponsorships, internal/external stakeholder meetings, and high level international team travel and budgeting in Microsoft Project, SharePoint, Excel
• Supported functions include documenting issues and responding to customers, meeting with customers to resolve issues, remote analysis. Issue tracking via ZenDesk and JIRA, included detailed descriptions of issues and tracking of status.
• Managed bugs using Defect Tracking Tool JIRA, reviewed each defect and assigned development team to resolve problems.
• Prepared Test Estimates, Test Strategy/Scenarios/Summary report and Extract daily reports from HP ALM about the testing status.
• Developed all the necessary documents for UAT Testing including Test Strategies, Test Plan,

  Test Cases, and User Acceptance Documents.

• Conducted Functionality test, Performance test, and UAT with Product Test Group and report to Release Management.
• Responsible for UAT project planning like creating testing scenario, test plans, and test scripts
• Conducted User Acceptance Testing (UAT) of the application with the QA team.

Confidential, Minnetonka, MN

Project Manager

Responsibilities:

• Project stakeholders were identified in the beginning of the project and created communication plan for effective and timely communication on Project Progress, Escalation, Project Requirement approvals, Risk management, scope management and change management process.
• Apply project management principles and best practices throughout the lifecycle of each project, while working closely with stakeholders, to ensure project success relative to project plan, budget, schedule and defined deliverables.
• Conducted research on IT requirements and business requirements in UAT
• Created and delivered demonstrations, presentations and/or prototypes, which map features/benefits of Edifecs to prospects' specific needs in order to educate the prospect about the Edifecs environment.
• Responsible for ensuring the department is fully HIPAA-compliant on a daily basis by implementing departmental policies and procedures
• Worked closely on 834 transaction code for Benefit Enrollment and was involved in Validation of HIPAA for 837, 270/271, 276/277,835, 834 EDI transactions.
• Assisted in designing policies and procedures to protect the privacy of Electronic Protected Health Information to ensure data integrity as per HIPAA guidelines
• Created EDI documents for EDI maps to generate requirement documents and Project Charter, and logical design documents for EDI transactions and code sets.
• Established and maintained constructive working relationships with insurance carriers, clients, external business contacts and staff. Maintaining the highest level of confidentiality and comply with all HIPAA regulations and Business Associate Agreements with its clients.
• Verified, validated and routing the X12 834, 5010C enrollments, confirmation/effectuation, cancellation, and termination information from the enrollment systems to the exchanges in the format required by the recipient system.
• Responsible for Integration, Scope, Schedule, Cost, Quality, Human resources, Communication and Risk Management. Managing the End to End Project Lifecycle(SDLC)(Initiation, Planning, Execution, Control and closure), using Jira tool
• Worked with Technology and product management teams to develop and aggregate transactional reporting. And developed performance monitoring scoring and reporting including key risk indicators (KRI) and performance indicators (KPI)
• Used Microsoft Visio, Project, Excel, and PowerPoint to provide accurate, understandable, and useful metrics/reporting on performance.
• Defect Raising and Monitoring with HP ALM.
• Documented Epics and User stories in JIRA and assign them to the development team.
• Analyzed test results, identified issues and reported it to the developers and project manager through JIRA.
• Created UAT test cases that were further categorized into Requirement based test cases, Business process based test cases and data driven test cases.
• Gathered test data for UAT scenarios and conducting UAT testing as end users perspective.

Confidential - Washington, DC

Business Analyst

Responsibilities:

• Requirements gathering for new business requirements, writing BRD, FRD, Business process modeling and Use cases
• Elicited requirements through discussions with key stakeholders (Business Sponsors, Technical Teams, SMEs and Associate Teams) Defining project scope and deliverables.
• Conducted JAD session's workflow diagrams, UML diagrams, process models, activity diagrams, use cases, for incorporating design changes in the order creation/ management system.
• Prepared the Business Requirement Document (BRD) and functional requirement document (FRD) for the enhancement of the existing services.
• Analysis and Design of existing transaction sets, and modification of these transaction sets to ensure HIPAA compliance.
• Gap analysis for HIPAA P transactions and HIPAA P transactions.
• Managed the creation and submission of various test messages associated with the HIE interface build.
• Configured HIE API to allow user applications to communicate with the modules of the system.
• EDI file testing for checking the HIPAA 4010 compliance of the inbound 837 claims.
• Identified risks and reported on testing progress and results, log defects, facilitate defect resolution and document final test results in HP QC and project management teams.
• Conducted research on IT requirements and business requirements in UAT
• Responsible for UAT project planning like creating testing scenario, test plans, and test scripts
• Validated transaction records using SQL queries.
• Analyzed SQL data, identifying issues, and modifying the SQL scripts to fix the issues.
• Assisted QA Team in developing test cases and performed Functional testing of the various customers' fields and tested the message behavior functionality.
• Delivered Test Plan, Test Cases, Defect Reports. Coordinated and participated in UAT.
• Assisted Business Customer in UAT Testing to understand the features and how it meets with user requirements.