SUMMARY

• Dynamic project leader with an expertise in project management, strategic planning, systems analysis and test management.
• Excel in liaising between business and technical areas to achieve on - time, on-budget and on-spec project completions.
• Exhibit strong leadership, problem-solving, relationship building and communication skills.
• Cultivates trusted relationships with key stakeholders, leverages innovative thinking in solving complex problems and managing conflict, and develops and inspires cross-functional teams to success.
• Thrives on responsibility and challenge and is committed to customer service excellence.
• 10+ years of experience working in multiple roles in Healthcare domain with good understanding of Project management, business requirements elicitation, analysis and quality assurance and experience in envisioning, representing and translating the product vision from business area to software development by making critical contribution in varied domains.
• Experience with Project Planning, reporting, resource planning and execution. Strong Project Management skills like product planning with LOE, test estimation and resource plans.
• Solid understanding in all phases of the Software Development Life Cycle (SDLC) including requirements gathering, analysis, design, implementation, testing and deployment.
• Hands on experience with Vendor management, Contracting and vendor assessment processes.
• Well versed with software engineering methods like Rational Unified Process (RUP), RAD, Waterfall, Agile and broad cross functional experiences leveraging multiple frameworks.
• Have extensive knowledge in Insurance products like HMO, PPO, POS, Managed Care, Life and Individual & Family.
• Well versed with application integration tasks and data migration projects.
• Ability to lead security vulnerability remediation projects along with vulnerability assessment.
• Experienced with extensive knowledge of the Open enrollment process for Affordable Care Act (ACA) along with knowledge on State and Federal Exchanges.
• Extensive knowledge and experience on Eligibility, Claims Billing, Claims Payment Processing, Rx Claims, Retail Rx Networks and Mail order Pharmacies.
• Firm ability to research, analyze and translate complex business and technical information to stakeholders, SME’s and developers at all levels of the organization
• Strong facilitation and managing skills to negotiate priorities, escalate and resolve conflicts among project stakeholders, coordinate with cross functional teams, and conduct status and checkpoint calls.
• Excellent verbal and written communication skills, strong analytical skills, desire and ability to research and formulate appropriate analytical technology and resolve complex problem situations and document results.

TECHNICAL SKILLS

Methodologies: Agile, RUP, Waterfall, and various hybrid implementations

Languages: C/C++, HTML, VBScript, Java, XML, SQL, .NET Platform

Tools: JIRA, Confluence, Rational Suite, Caliber RM, Version One, Clarity PPM

Testing Software: HP Quality Center and HP ALM

Software Packages: MS Office, MS Visio, MS Project, SmartSheet, SharePoint

Healthcare: EDI, Affordable Care Act, ICD 10, Medical Management, CM, Claims Processing, Benefit Configuration, Plan Filings, Home Health Care Agency Management, Payor, Medicaid, Medicare, Commercial Medical Plans, Employer Groups, Exchanges/State Marketplaces, EMR/EHR.

PROFESSIONAL EXPERIENCE

Confidential, Southborough, MA

Project Manager

Responsibilities:

• Responsible for managing, directing and planning multiple third-party integration projects for Medicare Advantage products.
• Worked with Business Owners, Analysts, Product Managers, and technical teams to define requirements and identify dependencies.
• Create daily dashboards and reports for tracking project updates and status for visibility across the enterprise.
• Reviewed, evaluated and formulated project plans, schedules and delivery milestones.
• Worked closely with IT teams, Operations, vendors and other client departments to co-ordinate systems testing, application deployment, training and support activities.
• Demonstrated value based decision making and implemented Agile principles across teams.
• Actively track metrics during sprints and shared results with scrum team to measure progress and plan for upcoming projects.
• Collaborate with team members to properly estimate project tasks; ensure accountability for delivery and execution of project milestones.
• Identified project resource needs, obtain necessary resources, define project team roles, and ensure effective team dynamics.

Confidential, Louisville, KY

Project Manager

Responsibilities:

• Analyze business use cases and understanding the business impacts of the migration activities by conducting sessions and meetings with all stakeholders.
• Gather application dependencies and understand multiple application interfaces and Work with CVS project managers to identify SMEs and ownership of multiple activities
• Create Project Charters, BRDs, FRDs, SRP, RTM, Architecture Design Document, Solution Design documents, assist in writing test cases and other artifacts which are crucial in successfully migrating applications.
• Engage 3rd party vendors for contract renewals, MSA and SLA and license agreements to adhere with CVS standards by working directly with vendor assessment team and senior management.
• Work with vendors to upgrade their products to latest industry standards, allowing customizations and move to API based interfaces and connections to other components.
• Understand the infrastructure requirements and ensuring that the right components are delivered at the CVS data center.
• Replicate certain server configurations and IIS settings to ensure that business activities are least impacted post migration.
• Work with the testing resources and business owners to formulate test scenarios and user acceptance test cases.
• Working with CVS configuration management to setup multiple environments and engaging with vendors to create the right configurations for the applications installation.
• Create disaster recovery and rollback contingencies for pre-deployment readiness.
• Analyze application security vulnerabilities and work with vendors to address and remediate the gaps.
• Work with Risk management, Security risk advisory boards and enterprise architects to analyze overall impacts to other applications in the datacenter.

Confidential, Louisville, KY

Project Manager

Responsibilities:

• Work with multiple teams and project managers to evaluate impacts on incoming development and enhancements.
• Participating in TAB, ERM Meetings, providingprojectestimates, getting Business approvals for the projects, providingprojectestimates and planning theprojectwith the approved budget and schedule.
• Work with Scrum Masters from various teams to align the delivery of projects in line with our release schedule.
• Report the development, design, testing and migration status to IT managers and Project managers.
• Projecttracking and reporting using MPP, Clarity, Version One, Weekly Status reports, Excel Pie charts, Pivot tables,ProjectPresentations using Microsoft Power Point, SharePoint etc.
• Facilitate discussions with business partners and technical PO’s to understand requirements and make sure the Requirements are tracked properly and converted to stories and assigned to appropriate teams.
• Maintain impacts tracker and update RTMs with the corresponding stories from VersionOne And trackingProjectStatus using Version one, Clarity, MicrosoftProjectPlan etc.
• Work with testing teams to make sure the projects are being tested as and when the sprints end.
• Facilitating meetings with the Development team, Business users, SMEs etc.
• Help the release manager to migrate the multiple stories to other environments.
• Facilitate the scrum master in prioritizing the backlog and future work and work with them in understanding the resource requirements and report that to the IT managers.
• Provide overall forecasts for the area in terms of project impacts and resource planning.

Confidential, Louisville, KY

Product Owner/Scrum Master

Responsibilities:

• Facilitate scrum ceremonies (grooming, sprint planning, retrospectives, daily stand-ups, etc.)
• Empowered teams to self-organize and grow cross-functionality.
• Protected teams from over-commitment, managed backlog, prioritized resolution of defects/bugs.
• Manage the lifecycle of code development, from ideation to sprints to deployment by working diligently with Release Managers, Project managers and IT managers.
• Coordinate and manage code releases and shared APIs with other IT groups and Sharing and maintaining contracts with third party vendors.
• Communicate with other management, Application Engineers and Production Support teams on product issues and work on rapid resolution of issues/defects.
• Track and communicate team velocity and sprint/release progress to IT managers.
• Involved in multiple projects and handling teams that develop and support the UI and Backend processes for HumanaOne’s tools that are used by Direct Consumers, Agents and Call Center Reps.
• Worked closely with IT managers for Resource and Budget planning for multiple teams and projects and future work.
• Supported Open Enrollment Period 2014 by making sure there is quick resolution of any issues in production environment by working with internal team members in a Kanban Fashion.
• Worked on onboarding and training of internal systems and processes for new team members.
• Worked on multiple major projects for improvements which eventually resulted in a system to support the ever growing new users post Health Care Reform.
• Extensively worked with Testing teams with Performance testing using HP Loadrunner and aligned with UI and Backend teams to monitor systems using tools like Dynatrace and Ignite.

Confidential, Louisville, KY

Sr. Business Analyst

Responsibilities:

• Analyzing clients’ current systems, processes and reporting requirements.
• Interview clients and associates to understand business rules and include them in the requirements document and generate use cases and scenarios.
• Create workflows, data diagrams, data mapping documents, user interfaces and other industry standard documents to represent the clients’ processes.
• Analyze requirements from stakeholders of existing business applications and understanding the impacts of the new project and performing GAP analysis.
• Identify potential solutions and assess them for both technical and business sustainability.
• Work closely with the application development and design team onsite and offshore to resolve technical issues and interact with them to ensure overall quality of the project.
• Participate in design review meetings and translate the requirements to the developers and guide the team when issues related to business requirements occur.
• Use tools like MS office, MS Visio, MS SQL, Apache Subversion, Erwin, MS Project and MS SharePoint to create and maintain project related requirements and documentation, and, to also increase the overall quality of the project.
• Responsible for identifying changes to different Development, Integration and User Acceptance Testing regions, and addressing User Acceptance Testing defects and supporting the system in Production and help the technical team in fixing Production defects.

Confidential, Owings Mills, MD

Lead Business Analyst

Responsibilities:

• Acted as the primary liaison between Business Partners and IT teams to mentor and share their specialized knowledge base on a daily basis.
• Conducted JAD sessions with business users and development team to drive out detailed business requirements and prepared the BRD (Business Requirement document), UCN (Use case narrative) and Project document for the project. Designed and developed Use Cases, Activity Diagrams and Sequence Diagrams using UML.
• Implemented the RUP methodology to help analyze the problem, understand user’s needs, and manage requirements. Have good experience of using Rational Requisite Pro, Rational ClearQuest and Rational ClearCase.
• Interacted closely with End users from Underwriting & Claims teams and SMEs to understand and gather the business needs and requirements. Facilitated and managed meeting sessions with users and SMEs to review business requirement capture
• Analyzed and designed the workflow to show users and client how the system would realize in the implementation phase.
• Worked with the users to prioritize and schedule the enhancement requests with the business needs.
• Analyzed data and created class diagrams and ER diagrams for designing the application.
• Closely interacted with technical team and development to ensure they understood the application’s functionality and navigational flow.
• Prepared and analyzed the Test plans and Test cases to successful perform the system integration testing, functional testing.
• Gathered requirements for upgrading the online POS system and created UML diagrams for the POS system.

Confidential, Chicago, IL

Business Analyst

Responsibilities:

• Analyzed existing Business units, Business process, System/ Application and their Interfaces through open-ended discussions, brainstorming sessions, and prototyping, prioritizing them and converting them as system requirements that must be included while developing the software.
• Managed project and was involved in resource management.
• Co-ordinated with documenting processes used agile methodology to write the Business Requirements documents and designed Functional specifications.
• Served as a liaison between the internal/external business community and the IT organization in order to provide technical solutions to meet user needs.
• Participated in design review meetings and translated the requirements to the developers and guided the team when issues related to business requirements arose.
• Worked with Associates and understood the business rules, systems and integrated them into the requirements document and assisted in generation of test cases and test data.
• Created workflows, data diagrams, and other industry standard documents to represent client’s business processes.
• Conducted JAD sessions between the business users, Developers, testers & Subject Matter Experts to resolve bottlenecks.
• Used HL7 guidelines and dictionary for defining business rules associated with pre-defined workflows according to business requirements.

Confidential, Long Beach, CA

Business Analyst

Responsibilities:

• Gathered Business Requirements and managed them using Requisite Pro.
• Interacted with the Users, Designers and Developers, SMEs, Project Manager to get a better understanding of the Business Processes.
• Designed the project development plan based on Agile methodology of SDLC.
• Helped Project Manager in Project Management Documentation and got MS Project experience.
• Used Excel to create the Data Mapping documents which is used by the Development & Testing team. Worked very closely with the latter in order to make sure the correct Data Element is being passed from one system to another
• Experience with documenting Claims processing lifecycle and got good exposure of X12 837 transactions for HIPAA 4010.
• Responsible to meet the information demands of our business users by delivering timely, accurate, meaningful and standardized data and reporting.
• Performed a complete GAP analysis to identify problems and inconsistencies with business requirements specification and the existing system and reported and escalated key issues requiring approval to the appropriate authorities.
• Attended daily SCRUM and guided QA and Developer meeting, regarding the Technical Specification Documents, defects and Mapping Documents.

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Thoroughly studied the incumbent systems to get an understanding of the processes and the functional workflow in order to analyze and initiate the project.
• Defined vision and scope of the project and transformed them into documents to better analyze and understand the rationale for the application.
• Facilitated Gap analysis to get a hold of the new business model and to extract additional functionalities that would be incorporated into the module.
• Worked closely with claim system processing to in corporate claim approval/denial and claim reimbursement and evaluated the claim system with which the data would be interfaced for the user.
• Conducted JAD sessions for clarity and gathered requirements through brainstorming sessions with the
• Participated in the design process along with the architect in attaining technical requirements to provide technical expertise to the developers for the development phase of the application.
• Dealt with ICD 9 encryption to verify and confirm the validity of the incoming claims and documented them by saving it in the database.
• Worked closely with the EDI 835 transaction to overlook both claim payments and remittance advice as they are incoming documents from the payer.
• Facilitated SCRUM methodology as the project's major workflow process and supported the QA and the developer regarding any functionality gaps, defects, change and mapping documents.
• Assisted QA team by reviewing test cases and test protocols for verifying the requirements to ensure complete coverage of all functional and technical requirements. Used Requirement Traceability Matrix to conduct thorough testing and verification.
• Provided training to the end users, conducted Regression testing and User acceptance testing sessions to gain user approval and feedback.