SUMMARY:

Over 9 years of progressive experience in Project Management, Business Analysis, scrum master with excellent understanding of industries like Healthcare, Insurance and Pharmaceuticals to contribute in continuous delivery capabilities and growth of client. Quality experience in working with clients to understand and implement requirements and in providing team leadership for development support teams comprising company as well as client and third party contract staff. Hands - on Project management experience developed and established through a variety of project management and work cross-functionally to solve problems and implement changes. Strong work ethics and analytical skills coupled with good communication and interpersonal skills describing a committed team player.

EXPERTISE:

• Managed highly complex strategic programs that significantly advanced client’s strategic objectives.
• Prepared Business Requirement Documents (BRD), analyzing Business Requirements, working with Requirements Traceability Matrices (RTM), re-engineering business processes.
• Extensive experience within the field of project management, business analysis, Business process design, application systems analysis, object oriented analysis, system analysis & design.
• Excellent knowledge of Medicare Part A, Part B, Part C and Part D.
• Experience with conducting assessments and impact/gap analysis concerning State Medical Management Information System (MMIS).
• Experience and knowledge on CPT/ HCPCS, HIPPA standards, EDI (Electronic data interchange), Implementation of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Used HIPAA 4010 transactions to support the analysisof current business processes and work with management to improve and implement enterprise solutions to ensure complianceand got involved in designing future state processes forHIPAA 5010 transaction processing EDI's 837, 835, 820, 271/272, 276/277, 278 and 834 andICD-10 Code sets. Experienced in Healthcare payer/ provider services.
• Experienced in Conversion of HIPAA X12 4010 codes to X12 5010 codes.
• Experienced in Conversion of Procedural and Diagnostic codes, ICD 9 to ICD 10.
• Expertise in Software Development Life Cycle (SDLC) including Waterfall, Agile/SCRUM, RAD, Rational Unified Process (RUP) methodology.
• Experienced in implementing complex claims platform migration project.
• Experienced in Formulary Management, Utilization Management, and Claims Adjudication.
• Experience implementing CMS (Content Management system) related projects.
• Experienced in leading daily standup daily meetings with the SCRUM team and sprint timeline.
• Created and updated data mapping document(s).
• Experienced in conducting GAP Analysis, interviews with the Subject Matter Experts (SMEs), Cost Benefit Analysis, SWOT Analysis and Return of Interest (ROI) Analysis.
• Handled multiple projects involving multiple team sizes, involved in Clinical Trial using SCRUM development methodology, establishment of recommendation of new firm wide coding and testing standards.
• Experienced in creating Data Flow Diagrams (DFD), Use Cases, Class Diagram, Activity Diagrams, Sequence Diagram, and UML Modeling.
• Extensive experience on Excel, Word, PowerPoint, MS Project, MS Visio, Rational ReqPro and SQL.
• Experience in White Box, Black Box, Unit, Functional, Integration, User Acceptance Testing (UAT), Back End and System Level Load and Stress Testing for many types of applications including web and client server applications.
• Ability to apply a mature and diplomatic approach to prioritization of tasks and conflict resolution.

TECHNICAL SKILLS:

Packages: MS Office, MS Visio, MS Project

MS Office Tools: MS (Word, Outlook, Excel, Access, PowerPoint), 2003/07, MS SharePoint

Tools: Rational TestManager, Rational Rose, Requisite Pro, HP Quality Center, Clear case, Clear Quest, Clarity, PPM tool, JIRA, Confluence.

Methodologies: Joint Application Development (JAD), Rapid Action Development (RAD), Rational Unified Process (RUP), Unified Modeling Language (UML), System Development Life Cycle (SDLC), Waterfall Model, Agile model, SCRUM.

Business Documentation Skills: Documented Business Requirement, Use Case Specifications, Functional and Non-functional Specification, System Requirement Specification, UML Diagrams (Use case, Class and Sequence), Traceability Matrix, Project Estimate, Change request, Change- Training and User Manuals, Master Test Plan Review (Integration, System and Acceptance).

PROJECT MANAGER SKILLS: Financial Forecast, Developing Budgets, Coaching, Supervision, Staffing, Project Management, Management Proficiency, Process Improvement, Tracking Budget, Planning, Performance Management, Dashboard, Business Process Improvement, Verbal/written Communications, Quality Control Processes, Negotiation, Proficient Communicator, Collaborative leader, Confident Decision Maker, SOWs & RFPs, Contract Management.

WORK EXPERIENCE:

Confidential, NYC, NY

Technical Project Manager

Responsibilities:

• Plan, monitor, track, communicate, and measure the status of Health information Exchange (HIE) projects.
• Serve as a liaison between the client, subcontractors, and other stakeholders.
• Manage client relationships and expectations.
• Ensure project progress and results are visible to leadership and other stakeholders as appropriate.
• Directly contribute to - and share responsibility for - project performance.
• Develop client deliverables in accordance with project requirements and company documentation standards.
• Provide recommendations on critical business and project decisions.
• Contribute to the resolution of any conflicts that arise and minimize potential risks.
• Perform contract and vendor management as required.
• Ensure the project is in continuous compliance with the contract and performance requirements.
• Maintain an understanding of the HIE as well as those applications with which it interfaces.
• Communicate priorities, monitor and escalate issues as appropriate.
• Provide regular status and other reports to management as required.
• Monitor project implementations for accuracy and timeliness to ensure the focus on successfully achieving project goals - including compliance with grant reporting requirements;
• Oversee vendor relationships to ensure success of technology implementations;
• Apply knowledge and skills related to current healthcare interoperability standards, activities, issues, and trends;
• Anticipate and respond to customer needs and continually ensure customer satisfaction;
• Identify opportunities for new projects and/or “add on” work with existing clients;
• Comply with HIPAA and other state and federal regulations.
• Work hands on the systems e.g. Intersystems’ Health share, Clinical Viewer, etc. and transactions e.g. ADTs, CCDAs, PIX, XACML.
• Experience with health information technology and HIE standards (e.g. IHE, HL7 V2/V3, FHIR, NCPDP, etc.).
• Experience implementing EHRs such as Cerner, Epic, Meditech, nextgen, etc.
• Provide ideas and best practices that can benefit the team to help improve the current business process and procedures.

Confidential, NYC, NY

Project Manager/Scrum Master

Responsibilities:

• Implemented a new Care Management model (geo-pod) for Medicaid, Medicare & Commercial Lines of Businesses (LOBs), including continuous improvement of existing care model until new model is launched on current platform (MaxMc on Legacy) and new platform (Clinical Care Advance, TriZetto module on FACETS platform).
• Also, coordinated and aligned the implementation of the Geo-Pod care model on Clinical Care Advance with migration efforts/timeline of Legacy to FACETS strategic migration initiative.
• Initiates the project from beginning and building the framework that aligns with the business need & stood up project team.
• Coached on-site and offshore team in Agile to abide by the methodology and to help team focus.
• Helped the team to maintain their Scrum tools (Story board, burn down chart, backlog etc.) with the help of JIRA tool.
• As a Scrum master lead team to implement projects successfully.
• Work closely with the team to identify impediments as early as possible and resolve quickly to help scrum team increase velocity.
• Helped team improve velocity by facilitating improvements and implementing changes per retrospective and day-to-day observation.
• Prepares Communication project plan with the co-ordination of the SMEs.
• Works closely with stakeholders to identify the tasks owners, helping them establish due date; identify roadblocks, critical path to deliver the tasks on time.
• Prepares & communicate weekly status to the stakeholders.
• Conducts the Executive Steering Committee.
• Co-ordinates with the on-shore and the offshore teams to make sure work is delivered on time as planned.
• Manages the product development lifecycle across multiple product teams in multiple global locations while maintaining legacy systems.
• Managed complex claim adjudication project to accommodate special Plan Benefit Configurations..
• Facilitates alignment of product initiatives to company goals and profitable solutions through short and long range roadmap planning paired with detailed user story definition, grooming and prioritization.
• Proven success managing the execution and delivery of high impact enterprise level projects
• Demonstrated ability to work effectively in cross-functional teams and matrix environments in fast-paced entrepreneurial settings
• Skilled at learning new concepts quickly, working well under pressure and communicating ideas clearly and effectively to both internal and external customers
• Flexibility to pivot between product management, business analyst and project management responsibilities as needed resulting in comprehensive hands on experience in the complete SDLC.
• Works with the senior leadership to resolve project related issues.
• Provide consulting advice on process improvement to help the business in day-to-day activities.
• Works with the stakeholders to establish the Operational readiness project plan to make sure right contacts are assigned/engaged & educated to complete the operation tasks on time.
• Provide SME support in regards to the Language Accessibility & Non-Discrimination mandate from the regulation standpoint.
• Mentors & provide oversight to the newly hired and Junior Project Managers.
• Co-ordinates and strategize implementation of the Care Management implementation for the Organization to bring huge ROI in calendar year 2017.
• Facilitates working sessions to stand up the Emergency room program for Case Management.
• Implements training programs for Nurses and related clinical staff as well as non-clinical to support Care Management Implementation.
• Coordinates and managed the day-to-day activitiesto plan, track status, brainstorm workflow for the Acute, Complex care & Disease Management Pillars.
• Co-ordinate with Analytics team to generate Clinical Analytics reports e.g. operational reports, Outcome reports & Leading indicator reports.
• Helps clinical operation business area to improvise existing reports in co-ordination with Clinical analytics team.
• Coordinates with stakeholders to ensure timely deliveries
• Implemented project related to claims processing and encounters.
• Helps project sponsor to create Business case and related documentation to get the initiative or idea into an approved project.
• Responsible for overall project scope management, client satisfaction, project schedule, budget, resources, overall tracking of issues, risks and deliverables.
• Manage inflight and intake projects utilizing Project Portfolio Management (PPM) system & utilized JIRA for Agile projects.
• Facilitate and participates weekly PMO forum and contributes to improve PMO best practices (PMBOK).

Confidential, Philadelphia, PA

Project Manager

Responsibilities:

• IRS 6055/6056 Regulation (implementation Social Security Number Elicitation/1095 & 4B Forms)
• CMS Machine Readable Mandate & Health Insurance Exchange (HIX)- Qualified health plan (QHP) issuers to post Provider Network Formulary and Plan content in a machine readable format on issuers’ public website & send to the CMS to publish on HIX. And, to the Department of Health and Human Services (HHS). The new standards will lead to greater transparency for consumers, including by allowing software developers to access formulary and provider stat to create innovative and informational tool. In order to increase and enhance transparency of QHP formulary information, issuers must publish an up-to-date, accurate, and complete list of all covered drugs beginning of the plan year. This information will help software developers and CMS to access this information to create tools to help enrollees better understand the availability of the drugs and providers in a specific plan on-exchange.
• Taglines in Non-English & Non-Discrimination in Health Program (Utilized Sitecore)
• Implemented multiple complex project related to IBC’s claims platform migration to Highmark (OSCAR).
• Also, migration to HealthEdge’sHealthRules with its natural language and rules-based engine to help enable lightning-fast configurations and reconfigurations which became the anchor of AmeriHealth Administrator’s LEAP Technology.
• Implemented complex project requiring claims adjudication (Medical and/or drug i.e. RxClaim & PBM)/encounter processing, etc.
• Established the Project Plan for the project, including Milestones, Project work streams and Release dates utilizing Clarity tool.
• On-boarded resources to the project per the Resource Management process. Led the project team to implement project successfully.
• Expert in agile and waterfall project management methodologies.Able to manage large project teams and known for high-quality deliverables that meet or exceed timeline and budgetary targets.
• Assessed the current capabilities of the organization in terms of the business processes, applications, data, technology, and change enablement.
• Coordinated the project related activities throughout the lifecycle of the project.
• The ability to take direction, work independently, and perform detailed work in a high paced, dynamic environment; handle multiple projects simultaneously; and ensure tasks are completed and deadlines are met as required.
• Defined processes and tools best suited to each project. Moved between agile and waterfall approaches depending on project specifics and client goals, creating detailed project road maps, plans, schedules and work breakdown structures.
• Ability to work and facilitate dialogue with Third Party Vendor.
• Ability to work effectively with all levels of management and other colleagues, and demonstrate initiative, mature judgment, superior customer service orientation, and the ability to anticipate the needs of the organization.
• Demonstrated the ability to adapt to changing business requirements and develop/execute tactical & strategic plans to meet business needs.
• Worked with the stakeholders on process improvements projects designed to improve results. Gathered and analyzed information and provide recommendations to address and resolve root causes.
• Evaluated/researched business problems and their relationship for technology.
• Added value to leading business process re-engineering efforts and demonstrates Business process improvements.
• Led the team thorough all the phases of the project and helped write quality User stories.
• Organized and presented ideas in a convincing and compelling manner.
• Participated & Contributed to the ongoing improvement of PMO bests (PMBOK), tools, and templates
• Identified process, technology and organizational role changes necessary to support business goals and objectives.
• Tackled complex business/system problems and conveys this information to stakeholders (includes technical teams for translation into solution design).
• Achieved operational objectives by contributing information and recommendations to strategic plans and reviews; preparing and competing action plans; resolving problems; completing audits; identifying trends determining systems improvements; implementing change.
• Collaborated with finance in generating purchase orders and payments; tracking annual spends, revenue and cost savings.
• Acted as a single point of contact for vendors and internal users of their services for escalations and new engagements

Confidential, NJ

Project Manager

Responsibilities:

• Assessed business need to document scope for the project to implement.
• Co-ordinated with on-shore offshore & offshore technical team to implement the project successfully.
• Used extensively Rational TestManager for planning tests, designing tests, implementing tests, executing tests and evaluating tests.
• Used Requisite Pro for the Requirement Document Preparation and Prepared Business Process Models (BPM) that includes modeling of all the activities of the business from the conceptual to procedural level.
• Managed Project Risk and issues to communicate to the stakeholders and team member as well as to put mitigation plan in place.
• Produced Gap Analysis documents for HIPAA 5010 and ICD-10.
• Identified gaps and performed gap analysis, cost analysis with respect to CMS requirements.
• Worked on HIPAA EDI transactions such as 835, 837, 276, 277, 278, 270, 271, 834, 820
• Performed Impact analysis for readiness of ICD-10 conversion.
• Authored Companion Guide to support all the information needed to process HIPPA transactions with United Healthcare.
• Created use case models, analysis models, implementation models, authored use cases, use case diagram, behavior diagrams (sequence diagrams, activity diagrams) based on UML methodology using Rational Software Modeler and MS Visio.
• Interacted with various HMO, PPO, Medicaid/Medicare Representatives discussing benefits of contracts on behalf of facilities or appeals from denials and compliance issues.
• Acted as User Acceptance Testing (UAT) coordinator and monitored business testing and interface with the development team regarding defect status and fixes on a daily basis.

Confidential, Farmington, CT

Project Manager

Responsibilities:

• Managed overall delivery Planning, Execution &Delivery of the project.
• Communicate & mitigate the bottlenecks, risk/issues while executing the project plan.
• Interacted withstakeholdersto get a better understanding of client’sneed.
• Implemented SDLC, which included requirements specifications, design, analysis and testing. Followed RUP methodology with Agile/SCRUM.
• Wrote/documented User stories utilizing JIRA.
• Organized daily scrum calls to keep the team on track and the stakeholders updated.
• Requirements Management Plan (RMP)
• Assist Project Manager with Work Breakdown Structures (WBS) to
• Comply with the triple constraint: time, cost and scope
• Business process and system Impact assessment
• Requirements solicitation
• Regulations interpretation
• Business Requirements Document (BRD) and Use case Preparation
• Business Process Modeling (BPM) - Data Flow, Work Flow, Process.
• Flow, and Entity Relationship Diagrams in MS Visio
• Documented Traceability Matrix (RTM).
• Stakeholder management
• JAD session facilitation with the required stakeholders
• Analyzed the test results from QA teams
• Assist business with user acceptance testing experience (UAT)
• Provide necessary training material.
• Evaluate alternative solutions and recommend solution that best meets the need of the business