Synopsis

• Effecting 14 Yrs in Information Technology and having 6 Yrs of global experience, have been an successful SME for Healthcare IT products development, Business consulting, Program management and Test management activities. Primarily worked with MBNA America, Blue Cross Blue Shield of Florida, BCBS Rhode Island, Cigna Healthcare, Humana, PNC Bank Medical Banking, Medi-Cal, Caremark CVS Pharmacy, Accumed Services, LabCorp and Missouri Medicaid. Have represented and successfully achieved Application portfolio assessment of Care Management products, Clinical applications and Patient monitoring systems.
• As a product consultant worked among the areas of Case management, First Pass Adjudication and Claims reengineering. Part pf CVS group for Application enhancements in Prescription drug plan programs and PBM implementations. As part of engagement group resposible for establishing a Test center of excellence for Missouri Medicaid.
• An expert communicator who can fluently speak the language of business and technology, blending technical knowledge and domain expertise while interacting with the cross-functional teams, project managers and steering committees.

Area of Expertise:

Domain Consulting Global Deliveries Product Enhancement/Development Requirements Management Test Management Program Management

TECHNICAL PROFICIENCY

• Products/Tools : Diamond , Vicura, Remedy, Orcas, Sam/Summit, Care Support, Metavance, Tibco Business studio, Test suite analyzer, TOAD, TSO/ISPF
• Database : Oracle 7.x/8.0, 9i, DB2 8.1
• Languages : Oracle Pl/SQL, CICS, Shell script, Cobol, Power Builder, JCL
• Domain : Healthcare, Credit Consumer Finance and Mortgages, EDI, Credit Card Banking
• Operating Systems : MVS, Unix, Windows NT

PROFESSIONAL EXPERIENCE AND ACCOMPLISHMENTS

Confidential

• Established Program Management for Testing center of excellence in Missouri Medicaid, increasing Testing productivity and reduce time in end-end System testing efforts across various projects. This included implementing Testing automation across different project engagements in MMIS systems.
• Steered project execution for the B2B migration project in APS Healthcare during HIPAA 5010 changes.
• Successfully managed the product development programs for developing a platform independent Testing solution for HIPAA 5010 and ICD10 changes. The engagement involved Testing 5010 migration program in Cigna healthcare solutions and developing a robust test data solution for the Trading Partner world and Test automation for the ICD10 migration program.
• Pivotal in consulting across Healthcare engagements. Specific large engagements were of SC Medicaid, UHG, LabCorp, Cigna Healthcare, Kaiser Permanente and Coventry health insurance.
• Effectively trained teams on user workflows and Model Based Testing for end-end Testing implementations.

Confidential

• Steered project execution and Test management for the NextGen product implementation in Medi-Cal program. The project was aimed towards implementing NextGen product to align with the MITA framework with an implementation in SOA maturity model and BPM Workflows.
• As a product expert responsible for management of test strategy and Test plan process with the engagement Testing group and defining the various business scenarios for product testing.

Confidential

• Defined and managed the program for the implementation of a Medical Banking solution revolutionizing the Hospital Revenue cycle. In the role of subject SME, pivotal in responsible for providing the solution of EDI exchange, value added services such as Real time claim adjudication, e- prescription, Business Rules implementation and Member services.
• Established training programs on healthcare business processes, user workflows and upcoming healthcare market segments with specific's towards Care Management, Long Term Care programs, Mail order pharmacy applications, claims adjudication improvements and latest Health Plans offerings.
• For a leading Healthcare product services client developed a complete migration roadmap of their existing Medical coding rules into automated Business rule driven application. This work included completing a pilot project, changing sample of few existing medical policies into Boolean statements to be driven by rules engine. Based on success of the pilot, there was a detailed proposal for the migration of entire 5000 rules policies. Responsible for providing the approach of policies migration defined within the project scope.

Confidential

• Created value proposition and spearheaded business as business specialist in an Application Portfolio assessment of different Home healthcare, Long Term Care products in Accumed/Omnicare. The project included developing a complete proposal charter for the enhancements of Long Term care applications phased over a period of 2 Yrs. The APA turned into successful start of two new engagements for the enhancement of 3 different products in Long term Care services.
• In the role of product consultant, worked for the product enhancements of Patient monitoring systems and clinical decision support systems for Long Term Care and Home health applications.
• Senior consultant responsible for pre-sales engagements in Healthcare group.
• In the role of a domain consultant within CVS CareMark Mail order pharmacy group, facilitated sessions for mapping user requirements, current processes system landscape. This involves PBM and Conflict management upgrades within one of the largest PBM implementations supporting Prescription Drug Plan programs.

Confidential

• In the role of product SME, supported program management framework for critical activities like business and knowledge transitions in LRSP migrating upgrade projects in Blue Cross Rhode Island. This involved working as product SME with the different migration teams for the Mainframe to Java migration and being also a technical consultant to project teams for verifying and validating each delivery projects wrt to product migration.
• Technical Lead in LRSP Blueline project, involving migration of Mainframe Claims transaction to Java applications. Defined Diamond framework for critical activities like Claims and Provider management. Leading the entire development efforts for migrating 12 different Mainframe transactions to Web based Java transactions. Completely handled the release management and verification validation for each transaction.
• Development and enhancement for claims payment processing module in Diamond. Responsible for leading the Capitation project and Implementing HIPAA transaction set compliance in these applications.
• In Bristol West UK, part of the development team to understand the current mortgage system developed in SAM/Summit application with the help of B W business analysts and develop Technical specs for the migration requirements. Model and prepare design specs for SAM enhancements, develop ERD's and interfaces to implement new and modified mortgage application transactions. Engaged with the maintenance team of existing SAM/Summit application executing BIM testing. As a developer responsible for the development of Oracle stored procedures in SAM application and enhancement of existing Shell scripts which are communicating with Mainframes.
• Responsible for programming new Sales Partner for America and Canada in MBNA America bank. Part of production support team, for enhancement of existing sales partners of the bank. Support and enhancement of CFIM mortgage systems developed in PowerBuilder and Oracle systems. Part of implementation in Canada credit online project, which involves development and testing of CFIM Java/Oracle programs and developing a Unix Interface for their integration with Credit middleware existing in C/C environment with Unix
• As part of development team responsible for developing a billing application for the mobile billing in a Roaming scenario. This was implemented for a leading Telecom provider in UK. The project involved studying the existing TAP formats of the client and developing the application using Oracle stored procedures and Java/ Inner script based GUI interface integrated with the UNIX environment.