SUMMARY

• Goal - oriented and self-motivated professional with a strong medical background and education. Project Management Professional (PMP) certified, clinical project leader who drives on-time, cost controlled programs in alignment with regulatory/budget restrictions. Extensive experience working in a fast-paced date driven environment, managing complex projects.
• Over 8 years of experience working as a Project Manager and Business Analyst on multiple domains like pharmaceutical and healthcare industries.
• Excellent in Project management methodologies, planning, scheduling methods, and tools.
• Well versed in Project Planning tools - Clarity and MS Project
• Managed various critical Enterprise Programs, packaged solutions and customized implementations from ground up and across cultures and time zones.
• In-depth understanding of Project Management Practices and Principles including Time Management,Budget Management, Resource Management, Risk Management and Change Management.
• Highly organized self-starter with strong process and leadership skills to bring business and technical teams together to effectively define and implement Enterprise wide programs.
• Worked on various service oriented, client/server and web based applications.
• Proficient in SCRUM, PMI, Waterfall, Iterative and Agile Methodologies. Ability to conduct daily scrum, sprint planning, sprint review meetings and creating SCRUM artifacts.
• Extensive knowledge and experience in the Health Insurance and HealthCare industry including expertise in Medicaid, Medicaid Information Technology Architecture, Medicare (Part A, B, C, D), Procedural and Diagnostic codes, Claims Process and Medicaid Management Information Systems (MMIS),ACO, PPO, HMO.
• Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction codes such as 270/271 (inquire/response health care benefits), 276/277 (claim status), 835 (payment or remittance advice), 837 I, P, D (health care claim) and 834 (benefit enrollment).
• Strong knowledge of HL7, HIE (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) and Facets.
• Experience with HEDIS (Healthcare Effectiveness Data and Information Set) for benchmarking managed care effectiveness and evaluating provider payer relationships.
• Extensive experience in creating As-Is and To-Be process models, conducting Gap Analysis to understand areas of improvement and analyzing the risks involved through SWOT, Value Stream Mapping, Cost-Benefit Analysis, Decision Tree analysis and Fish-Bone analysis.
• Experience in leading successful JAD session for performing gap analysis, deriving functional/non-functional requirements and document decisions on the future state of the systems and processes
• Excellent knowledge of Business Process Modeling and Process Re-engineering.
• Hands-on experience with process modeling using Unified Modeling Language (UML) including Use-Case diagrams, Sequence diagrams, Collaboration diagrams, Activity diagrams and Class diagrams.
• Strong experience in conducting User Acceptance Testing (UAT) and reviewing Test Procedures and creating Test Cases. Manual testing of GUI, Field Validation (Client-side, Server-side and database)
• Highly experienced in tracing requirements throughout the development process and verifying adherence to Requirement Traceability Matrix (RTM).
• Comprehensive experience and knowledge in using Data Modeling and Business Intelligence tools OBIEE, IBM Cognos, SAS 9.2, TABLEAU DESKTOP 8.2, MS Visio, UML, SQL (SSRS, SSIS, SSAS), and Data Warehousing.
• Extensive experience in using ALM tools (MSSharePoint2007, SharePoint 2010, SharePoint 2013, and Rational Suite).
• Ability to organize, document and track changes and defects using tools like MS Project, Rational Clear Quest and archive change request in Clear Case.
• Experience working with business users, SME’s, offshore teams and senior management.

TECHNICAL SKILLS

SDLC: Agile Scrum, Waterfall, RUP

Health Care: HL7, CMS Meaning Full use Stage 1 and 2, ASCII X12 EDI Transactions, HIPAA4010, HIPAA5010A, MMIS

Scripting Languages: SQL (SSRS, SSIS, SSAS), PL/SQL

Business Tools / Reporting Tools: MS Project, TABLEAU,MS Excel, MS Word, MS PowerPoint, MS Access

Modeling Tools: MS Visio, UML

PM Tools: SWOT, CBA, Impact, GAP, MS Project 2010, MS Office, MS PowerPoint, RAD, JAD, Requirement and Business Analysis, Quality Assurance

Supporting Tools: JIRA, Rational Requisite Pro, Door, Dashboards, Microsoft SharePoint 2007/2010/2013.

ETL Tools: Informatica 7, Informatica 9.0.1, IBM Cognos

Statistical Tools: SAS 9.2

Data Warehousing Concepts: Data Mart, OLAP, OLTP, Global, Independent and Interconnected Data Warehouses, MS Azure

PROFESSIONAL EXPERIENCE

Confidential - San Francisco, CA

Project Manager

Responsibilities:

• As the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program Manager for Confidential, managed 9 projects under the program and coordinated deliverables from Business Intelligence, Clinical teams, California Department of Health Care Services (DHCS) and California Health Care Safety Net Institute (SNI).
• Administer Audit Readiness, Monitoring and handle cross-functional client relations.
• Reported the performance baselines and successfully completed two demonstration year submissions after target setting, ensuring the reports produced by business intelligence met the specifications outlined by the State.
• Implement change management system related to data capture and accuracy: Building a formal policy/system wherein Medical Center, Business Intelligence and other Health System stakeholders are partofthe development and implementationofany large data capture changes (i.e. SOGI data Medical Center, Health Plan data, Financial data etc.)
• Worked with the Director of Performance Strategies and PRIME Clinical leads and successfully tracked PRIME metrics at an organizational level.
• Influential role in aligning all aspects of the project to meet or exceed State and County regulations.
• Recognized for maintaining project management standards, delivering executive status/risk reporting, and orchestrating team meetings that included cross-functional internal and external project members.
• Worked with Clinicians leading PRIME work at the Medical Center to increase data literacy, built policies to capture relevant data, support data exploration and supported clinicians to develop requests for additional quality improvement reports related to the PRIME work.

Confidential - San Francisco, CA

Project Manager

Responsibilities:

• Manage the in-house Customer Master and Alignment Master Applications and responsible for the overall steady state activities pertaining to the same.
• Managing onsite and offshore teams in a highly virtual matrix environment.
• Managed Executive level communications, Created Executive Dashboards, reports, Program, Newsletters and Project status updates on weekly basis for Senior Management and Projects teams.
• Delivery of strategic, high visibility projects within time, cost, scope, and quality defined boundaries in accordance with Client s life cycle methodologies and disciplines.
• Spear headed scoping, budgeting, resource planning for multiple ongoing projects.
• Create executive status report and present to steering committee
• Conduct weekly status meeting, ensured project is on budget and schedule using variance analysis.
• Support operation team in defect resolution process
• Effectively manage change by deploying change management techniques such as Change Assessment and Impact Analysis.
• Responsible for project staffing, project budget control, generating and monitoring the project plan and schedule, coordinating project activity between various project groups, and status reporting using MS Project.

Confidential, Melville, NY

Project Manager / Business Analyst

Responsibilities:

• Project Management including Transition Management (from development to Production Support), Communications, and Risk Management, Release Management, special projects planning & deployment activities. Scope the major milestones, timelines and overall business objectives of the project that must be achieved.
• Utilized agile scrum methodology for project delivery
• Assisted other Program Manager and developers in managing and developing AGILE process. Managed efficiently single as well as multiple related projects under the portfolio.
• Participated in the initial Impact Analysis for all the critical functional areas, i.e., Claims Processing, Utilization Management, Medical Policy, Health Care Management, Reporting, Vendor Management, etc.
• Facilitated Sprint release/standup/review/retrospect meetings efficiently and created a conducive work environment for the team self-organizing capabilities.
• Acted as a Scrum Master, documented sprint backlogs, organized and conducted sprint planning sessions, daily scrum meetings. Created sprint burn down charts and release backlogs for effective Project Management. Executed SQL queries to test the database for records that detect and submit functional acknowledgement and remittance advice in the claims application.
• Prepared test cases, test script and coordinated with the QA team for testing and interacted with the developers to report and track bugs using Test Manager.
• Involved in GUI Design sessions with Usability Team; Browser compatibility and navigation were tested manually.
• Managed the change request and analyzed the impact of the change request on the application in regards toProject Plan, Scope, and Schedule.

Confidential

Business Analyst

Responsibilities:

• Involved in the meeting with Business Process Owners and Subject Matter Experts (SME) for Requirement gathering in Definition Stage using Rational Requisite Pro.
• Conduct JAD and SCRUM work sessions to understand the working system impact.
• Createdwork scenarios and work sessions to come up to the most economical scenario of change.
• Createdlayout and mockup of the change to be made in form of the report.
• Worked on Impact analysis for each of the systems and their sub entities for both inbound and outbound systems.
• Created Various Business Requirement Documents (BRD) and Functional Requirement Specification (FRS) for the project using Rational Requisite Pro.
• Created Requirement Action Plan for various project deliverable.
• Created SQL queries (CRUD Operations) for extracting and updating data as required by the Dev team.
• Participated in user meetings to understand requirements for the Data Warehouse design.
• Created various Use Cases and workflow diagrams, using MS Visio.
• Maintained Traceability Matrix in Excel.
• Created Report Mockups and Sample Mapping documents for the Error Reporting.
• Extensively worked with SharePoint 2007 (MOSS) tool for document management and accessibility.

Confidential

Business Analyst

Responsibilities:

• Aided the project manager in developing a vision document for the project.
• Created the SRS document using existing artifacts and inputs from the SMEs, Sr. Architect and the Dev team.
• Performed Gap Analysis by identifying the shortcomings in the current systems and areas where compliance is a must.
• Utilized SharePoint for collaborating with the team on project artifacts and for communicating the project status and deadlines.
• Utilized Waterfall Methodology for the development of the application.
• Created UML and information flow diagrams using MS Visio.
• Assisted the Dev Team in unit testing and the product manager in end-user acceptance testing.

Confidential

Business Analyst

Responsibilities:

• Provided key project inputs by working with users in defining the project and system requirements.
• Reviewed business process, and functional requirements.
• Worked on hospital data processing for improving database for storing user files.
• Analyzed business needs, created and developed new functionality to meet real time data integration that facilitated decision.
• Involved in detailing project mission, data process flow diagrams, and timelines.
• Worked with SQL queries for data manipulations.
• Assisted in building a business analysis process model using Rational Rose, Requisite Pro and Visio.
• Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams.
• Assisted in process modeling; conducted and participated in JAD sessions with system users; helped with design walkthroughs with stakeholders for base lining architecture.
• Assisted Test Lead, Testers understanding business process and help them successful completion of Unit Testing, Integration Testing.