SUMMARY:

IT Operations Manager / Certified Project Management Professional / Agile Certified Practitioner / Healthcare Business Systems Analyst with wide range of IT skills, proven ability to provide strong leadership and decisively manage diverse group of individuals and multiple projects.

SKILLS AND TOOLS:

OS, various MF technologies, UNIX, DB2/SQL, MQ Series, TWS/CA7, Java, JavaScript, VB, VBScript, WAS, DataStage, ETL, REST, JSON, SOAP, XML, WODM, Toad, Oracle, SQL Server, SSMS, SSIS, SSRS. SDLC, MS SharePoint, MS Project, CRM, TestDirector, HP QC/ALM/Service Manager, CA Optics/Clarity PPM and Rally, P6, ServiceNow, JIRA, QNXT.

PROFESSIONAL EXPERIENCE:

Program Manager

Confidential, Long Beach, CA

Responsibilities:

• Performing Project Manager tasks for Enrollment Membership Accounting (File Management) organization to support PR Medicaid, MMP (CA,IL,MI,OH,SC,TX) and MAPD Medicare LOBs. Managing 20+ small and medium size projects from immediate code break fixes and enhancements to mandatory CMS/State compliance regulatory initiatives (SSNRI, CARA, CY 2019 Medicare updates), vendors and regions procurement or decommissioning
• Collecting and defining Business Requirements, Data Mining and Analysis (QNXT, SQL Server, SSMS, SSRS)
• Using Agile methodology with large projects (JIRA, SP, Release vision, roadmap/ timelines, sprint panning, defining user stories/ acceptance criteria, backlog grooming, daily scrum meetings, demos, deployments, retrospectives)
• Working on EDI HIPAA Transactions (834, 820, 270/271), DTRR files, data mapping and validation
• Analyzing Inbound, Outbound files and data from: Molina Member Workflow (MMW) File Management, KPIs, Exceptions reporting, Vendor Extracts Dashboard, COB app, MemberMerge, PCP AA.
• Working with PMO, BA, IT/QA, Premium Billing recon, UM, Delegation Oversight, Compliance, HP Business Operations, Vendors (HMS, CMS, Wipro, CVS, Merrill, Delta Dental, Secure Transportation, A2C, MarchVision)
• Analyzing and resolving variety of ServiceNow tickets from Business and Operations

Confidential, Cypress, CA

IT Operations Manager

Responsibilities:

• Managing the team and different projects in Testing Environment and Infrastructure (TEI)
• Managing six Integrated e2e Test Environments for UNET/COSMOS/NICE/FACETS/Rx claims processing
• Ongoing Project Management for monthly ITE Release Upgrades and quarterly Production Data (CDB,TOPS, COSMOS,FACETS,NDB) refreshes using Six Sigma (DMAIC) and Agile Essentials (Scrum, LEAN, ATDD)
• Hands - on technical SME for e2e claims (NSF,837p,UB92,837i,835) testing in current MF software releases
• Continuing data mining and requirements analysis for various projects (CCT, PE, ICD10, HCR, OptumRx)
• Leading migration, code conversion and modernization of applications to newer platforms
• Ongoing critical defects/ incident tickets resolution and overseeing integrity of change control process
• Focusing on the team SOPs, RASCI matrix, RCA, gap analysis, process automation and self-services
• Monitoring and evaluating systems performance, and leading process quality improvements initiative
• Leading, Advising, Counseling, Coaching, Mentoring (personal development and business goals, training, performance evaluations, Vital Signs survey action plan)