Professional summary:

• Driven technologist possessing 15 years of IT experience, consisting, Business Analysis, and Testing complex multi-platform projects in Healthcare Insurance, Medical and Telecom domains.
• Outstanding record of responsible, sound business judgment, expanding responsibility and achievement across multiple functions.
• Extensive experience in working on ICD 9 10 projects
• Excellent knowledge of HIPAA Compliance Lifecycle, HIPAA Insurance Regulations and Claims Processing.
• Expertise in understanding HIPAA 835, 834, 820, 270, 271, 276, 277, and 278, EDI, Privacy, Security, and Medicaid.
• Builds solid, highly motivated teams and bridges skills gaps where needed
• Responsible for project integration management, coordination and completion of projects, web portal / database development and maintenance, workflow analysis, new systems development, implementation and major enhancements.
• Advanced communication and relationship management skills with stakeholders having computer science, finance and medical backgrounds in a matrixed environment.

Technical Skills:

Professional Experience:

Confidential

Role: Project Manager

Responsibilities:

• Lead a team of over 10 members in ICD-10 conversion project.
• Work with architects, business owners to outline and document ICD10 remediation strategy for multiple departments, business functions. Participate in the Vendor assessment, product evaluation groups.
• Responsible for managing multiple project under ICD10 program. Created detailed project plan, schedules of multiple releases, template and methodologies of project deliverables. Performed cross functional coordination between multiple business departments, and IT for task dependencies per project plan.
• Recruit, mentor and manage project resources. Track and schedule delivery cycle, task, effort, and budget for each resources.
• Provide support in the delivery of the work products Test strategy, test plans, high level designs, requirements documents, use cases etc , participate in the review, facilitate users sign off.
• Provide different matrix reports monthly/weekly effort deviation, total effort, delivery milestone to senior leadership, Publish release updates about ICD10 program.
• Responsible for developing test plans, creating test scripts, converting test scripts to ALM format and uploading converted test scripts into ALM.
• Update daily, weekly and monthly status reporting.
• Ensure quality and functionality of all testing procedures.
• Analyze all test results and correct issues provide case execution status reviewing output and tracking defects
• Generate daily scorecard via VB scripting
• Review business requirement documents and functional specifications for assigned input
• Track validation of requirements and records test results and indicate pass/fail in defect resolution board meetings
• Drive daily and defect daily meetings

Confidential

Responsibilities:

• Drafted, reviewed, QA and finalized the ACA Project Schedule Management plan for execution and implementation through project life-cycle.
• Works with CADE ACA project and delivery managers and functional organizations to prepare project plans and estimates.
• Built, managed and controlled the CADE Integrated Master Plan from initiation through project closing and disposition phases.
• Works with CADE ACA project team to prepare project trends, maintains project trend log and incorporates trends into project forecast.
• Assist in developing policies procedures and analyzes techniques that will enable successful project controls management and enhance reporting of key scheduling information within a highly visible software development project.
• Responsible for assisting with various project related ad hoc analysis and reporting as required by the CADE ACA program.

Confidential

Role: IT Project Manager, EPMO

Responsibilities:

• Created structured governance to ICD-10 program as enterprise wide initiative and reported gaps in staffing and constraints to executive management and successfully procured additional resources for initiative
• Reported status of ICD-10 program to executive board and successfully redefined budget needs 25 Million using AHIP standards to more accurately reflect costs associated with ICD-10 remediation
• Worked with Application Development team and chief architect to identify backend systems and initiated triage assessment with IT steering committee to perform gap analysis and estimate IT effort for systems remediation
• Worked with business implementation lead to establish business side work streams and engage with P.O.Cs in each business area to establish roles responsibilities for ICD-10 involvement
• Worked with Vendor CoreLink which managed Claims Process Engine to provide updates on tested bundled codes and relayed to UAT/Mapping teams to identify logic errors debug issues
• Managed external partner relations for program and worked with firms to identify Business Domain Consulting firms, IT Systems remediation vendors, and Testing Services vendors
• Worked with cross-plan groups Wyoming Nebraska to identify common errors and reported to vendor to mitigate
• Lead managed implementation of CRM solution for Claims Operations Support team
• Worked with internal IT teams and vendor Power Objects to identify requirements and select suitable CRM solution for business needs and which is most compatible with internal system environment
• Lead IT teams to assess solution, formalize project plan, and to keep initiative on track under budget

Confidential

Role: ICD 10 Project Manager

Responsibilities:

• Responsible for project planning, scheduling, resource management.
• Responsible for successful delivery of multimillion dollar ICD 10 projects.
• Worked on GEM translation files, process mapping templates.
• Managed 3 large projects PBM and ICD projects, managed successful delivery and coordination of 3 projects and 6 teams, IT and Business team of each project.
• Develop and oversee implementation of project communication plan champion the project to others in the organization.
• Ensure integration and coordination between facilities and community providers establish integrating structures with medical staff and role model partnership recommend changes to the governance structure to further stakeholder engagement, alignment, and integration monitor activities of other projects with interdependencies with the ICD-10 project.
• Identify and document business process re-engineering opportunities including current and future state process flows
• Managed workflow automation, Appeals , grievances, Billing and enrollment of claims for the client
• Customize frameworks such as CPM, Billing and Enrollment Claims work station , BIX, Appeals and Grievances, Billing and Enrollment.
• Worked on pilot for migration of existing data to ICD 10 formats to meet CMS guidelines for OCT 2013 deadline from CMS.
• Worked on workflow automation and migration to ICD 5010, testing ICD 5010 codes for claims navigator project.

Confidential

Role: Project Manager

Responsibilities:

• OHM offers Medicare supplemental and Advantage plans to its customer along with Long term and life.
• This project was to study the current practice and business strategies of OHM.
• The outcome or end result was to submit a detail report on how to incorporate the best practices involving technologies and people.
• Deliverables included Visio diagrams of Process Flows and process designs, business requirement document for different functional areas Marketing, distribution channel, claims including implementation of HIPAA transaction X12 and ICD 9 10 , enrollment etc

Confidential

Role: Test Manager

Responsibilities:

• Worked with Department Medicaid stakeholders to gather requirements in JAD session identified the As Is and To Be processes. Identify and Create Test Cases and Scenarios.
• Perform requirements gathering for Medicaid claims, process and review Medicaid claims to identify the billing practices.
• Knowledgeable in healthcare terminology i.e. CPT codes, DRG manuals, ICD 9 10 codes and Hospital Reporting.
• Reviewed the requirements being gathered, created scenarios and created test cases against the test scenarios. Documented the results and follow through on necessary retests.
• Responsible for planning, development, execution and management reporting of end-to-end and External Trading Partner test scenarios for Department Medicaid business.
• Collaborate with Business Analysts and Development engineers to design test cases and provide test data that focus on business flows across integrated systems.
• Experience in Claims Member Billing and Provider Contracting systems using ICD 9 10, benefits processes through Medicaid claim processing application facet.
• Support testing for the Enterprise with specific focus on ICD-10 testing for the end to end testing of the department of Medicaid.
• Executed the sequences of test cases and performed Requirement Traceability Matrix against Test Scenarios and Test Cases using Mercury Quality Center/ALM.
• Develop HealthCare Transactions / EDI / X-12 related test cases and test data.
• Track validation of requirements and records test results and indicates pass/fail and involved in defect resolution board meeting.
• Troubleshoot defects which occurred during testing, determine root cause, resolution with the Testing Team SMEs.
• Develop automated test scripts for testing Regression testing and communicate with QA Leads and Developers.
• Developed test data using xml data format to validate the input data for negative test and integration testing. Created some SQL scripts.
• Assisted end users with the acceptance testing UAT by providing guidance where necessary to ensure correct execution of test scripts, and helped to resolve minor processing errors caused by users.

Confidential

Role: Sr Business Analyst / Project Manager

Responsibilites:

• Planned and controlled scope for complex, ambiguous and fluid projects, involving appropriate stakeholders to quickly and thoroughly in scope definitions
• Effectively managed project requirements such that final solution matches not only the written specification, but also the business need
• Installed/managed processes to ensure specific requirements are met and approved by users, where critical, to project results and timetable
• Developed and maintained a realistic project schedule that captured all the required work, ensured buy-in from project stakeholders and ensured required schedule changes are communicated and discussed as far in advance as possible. Managed critical path. Tracked and communicated progress and the right level of detail for the audience
• Ensured appropriate formal and informal communication of project status to the project core team, supported IT staff, actively involved business partners, and senior leadership
• Projected future needs and identified risks/issues, worked with resource managers to resolve ensured roles and responsibilities are clear for all team members
• Applied and tailored client's methods and PMI standards to define the appropriate Risk Management strategy including mitigation, acceptance, avoidance or transfer for a complex project
• Maintained an Issue tracking process that ensured team members can submit or review issues without going through the PM
• Anticipated complex cross function issues and facilitates resolution, escalated issues to executives with the proper balance of urgency and calm/composure.
• Daily status reports given to members of upper management regarding every project for each project manager regarding SIT and UAT testing Planned, directed, and controlled the resources and efforts of primary functional areas of the IT PMO
• Experience in leading all phases of testing quality control including functional performance testing
• Utilized Planview for Resource allocations and authorizations and timesheet entries.
• Accountable for budgets.
• Promotion of an environment of continuous improvement ensuring a QA process is applied through the project lifecycle
• Utilized MS Project for organizing resources and project tracking
• Scoped, defined, directed, and coordinated multiple concurrent IT projects related to the disposition of systems, software applications, and infrastructure across North America. Provided technical direction related to Information Technology Services strategies, business analysis, technical documentation, standards, and conventions.
• Provided project management direction for IT group in the form of scoping, planning, facilitating, and tracking IT initiatives. This includes project definition, identification of deliverables, milestones, phases, cost, and documentation as well as roll-up tracking and reporting.
• Aggregate input and sign-off from peer subject matter experts Server, Networking, Storage, Infrastructure, Database, Applications and drive collective decisions on core hardware/software/application implementation.
• Derived project tasks/sequence with these decisions.
• Communicated with differing business units and groups both IT internal and external to accurately track and gauge project progression against requirements.
• Ensured that projects meet business requirements and goals through diligent prioritization and synchronization.
• Reviewed and analyzed existing application effectiveness and efficiency, and developed strategies for improving or leveraging systems with input of peers.
• Developed and implemented business plans, goals, and objectives. Created business proposals and general or detailed implementation plans.
• Helped define, drive, and execute complex application hosting migration plans.
• Performed web-based testing separately for their e-commerce system.

Confidential

Role: Sr Business Analyst

Responsibilities:

• Elicited demands from the stakeholders and analyzed them for consistency, flexibility and completeness.
• Conducted JAD sessions with Subject Matter Experts to obtain domain level information.
• Developed a business vision plan that defined the primary goals and objectives of the project.
• Identified actors and use cases to create use case diagrams that described the behavior of the system.
• Used prototypes to demonstrate and verify the behavior of the system.
• Created use case diagrams and activity diagrams to view the system from different perspectives.
• Developed all operational and technical flows using MS Visio and created the Business Process.
• Created data, functional and quality requirements. Using traceability matrix to ensure that all business goals are reflected in requirements.
• Worked with User Interface interaction designers to conduct task analyses, usability tests, cognitive walkthroughs review , customer site visits and focus groups. Assisted the configuration team with design and testing efforts.

Confidential

Role: Manager for the HIV/AIDS Department

Responsibilities:

• Type correspondence, articles, reports, grants, budget, manuals and other related materials.
• Responsible for maintaining daily administrative operations for HIV/AIDS Program
• Maintaining client staff records and information in strict confidentiality.
• Communicate with other agencies for client's doctor appointment, referrals, follow-up, and other information.
• Data-Entry scheduling workshops training.
• Prepares Medicaid monthly billing department payroll

Confidential

Role: Substitute Supervisor/Computer Operator

Responsibilities:

• Data-entry Processing checks Customer Service supervises 4 employees.
• Operated a UNISYS DP 500 check encoding and sorting machine on the Check Processing Image System.
• Operated a Check Stripping Machine for preparing checks for encoding of Customers account numbers and dollar amounts.