SUMMARY:

• Experienced leader with strong business and technical skills that enable me to effectively manage cross - functional teams.
• More than 12 years of experience delivering high-impact solutions in the areas of Healthcare Payer and Provider industry in enterprise planning, business intelligence, TriZetto Facets Product and their Eco systems.
• Certified Scrum Master from Scrum Alliance
• Track record of establishing credibility with customers and delivering successful projects.

AREAS OF EXPERTISE:

• Enterprise planning, business intelligence
• Project management, scoping, and requirements
• Solution and Financial planning and analysis
• AHIP Certified Professional in AHM
• Agile project Management and SCRUM
• Business application implementation
• Pre-sales and recruiting
• Enterprise Content Management
• Service Oriented Architecture solution and design
• TriZetto Facets 4.51 to 5.20 Implementation and upgrade
• TriZetto Facets core Batch processes and its functionalities
• Facets Eco Systems and its integration with Core Facets in various clients.
• EDI 4010 & 5010 Transactions 834, 270, 271, 837 (P, I, D), 835, 276, 277, 278(I/O)
• Facets Workflow process, FXI and XC/XMS staging DB knowledge.

TECHNICAL SKILLS:

Applications: TriZetto Facets 4.51 to 5.20, MEET, EDIFECS, Mainframes TSO/ISPF.

Healthcare Domains: Membership, Billing, Claims, Provider, Care Management, Utilization Management, Sales & underwriting, Plan/Product Configuration, Customer service, Workers Compensation Insurance, Pharmacy Benefit Management (PBM), Shared Accumulators, ITS Claim Processing

Databases: VSAM, DB2, Oracle, Sybase, Microsoft SQL Server and MS Access

Tools: SQL, PL/SQL, TOAD, Clear Case, Clear Quest, MS Project, Rally, ALM, Selenium IDE & Web Driver, QTP, SOAP UI Pro, File Net, Gitolite, Jenkins, Kettle, Quartz, Tidal, Control-M

Languages: COBOL, JCL, Java, C++

Enterprise Planning, ECM & BI: Informatica, DataStage, Cognos, HP Extreme system, Caligo, Client Letters, thunderhead

Operating Systems: MS Windows, UNIX, Z/ OS390

PROFESSIONAL EXPERIENCE:

Confidential

Facets Solution Architect/ Healthcare Solution Architect

Responsibilities:

• Performed Facets kernelized migration feasibility analysis, Deep dive, SME interview.
• Developed approach, technical implementation solution, estimation and planning models for Facets migration.
• Reviewed the solution with Source and target system SME’s/Architect’s and received sign-off.
• Provided technical solutions for development and project management expertise to various workstreams in Modernized migration project.
• Created solution architecture and planned the development effort.
• Provided Healthcare solutions for off-cycle migration
• Performed / Supported Fit-Gap analysis done by healthcare consultants and finalized the Gaps.
• Provided healthcare solutions for the Gaps and written/supported Technical requirement.
• Providing continuous Healthcare and solution support to EBC, Claims, Provider, ITS Host, Correspondence, Finance work stream Business, functional and pre-functional team

Confidential, Atlanta, GA

Facets Solution Architect

Responsibilities:

• Facets kernelized Migration - Feasibility Analysis, Deep dive, Approach and solution
• Facets Traditional Migration - Feasibility Analysis, Deep dive, Approach and solution
• Claims Downstream/Finance Work stream for Modernized and Tradition Migration

Confidential

Program Manager/ Senior Solution Architect/ Solution Architect

Responsibilities:

• Responded to various RFPs and conducted oral presentations for potential clients.
• Developed estimation and planning models for Facets implementation and upgrade projects.
• Developed methodologies for Packaged Solution and Business Transformation projects.
• Participated in recruiting, resource management, and project staffing activities.
• Performed as a career counselor.
• Provided technical, solution development, and project management expertise to various projects throughout the firm.
• Created solution architecture and planned the development effort.
• Researched and analyzed competitor offerings and identified core solution differentiators to gain market share.
• Led and mentored the project team from both technical and functional perspectives including database development, data architecture, integration development, requirements identifications, testing, and project management.
• Responsible for qualifying opportunities, pre-sales support, deal pricing, contract negotiation, and implementation management of outsourcing contracts being delivered.
• Managed the successful pursuit activities for the messaging portion of large comprehensive outsourcing deals.
• Presented the solution to the prospective clients and responded to various RFPs.
• Developed solution architecture to support Core Healthcare Business Processes and Technology Transformation Program
• Analyzed current state technology environment and developed future state architecture.
• Led an effort to create transformation program road map.
• Adopted agile methodology to client environment and participated in methodology rollout and training activities.
• Analyzed current projects portfolio and provided recommended actions for the in-flight and future planned projects as part of the transformation program planning.

Confidential, Portland, OR

Senior Solution Architect/ Project Manager

Responsibilities:

• Data Transformation for Enrollment
• Health Equity Integration for HSA.
• ASO Chargeback
• D2F post Claim processing
• Shared Accumulator for PBM
• Regence on Exchange mobility testing
• SSRS report development
• Claim Xten UAT - Proposal
• Claim ITS Blue card ADM - Proposal

Confidential, Denver, CO

Solution Architect/Project Manager

Responsibilities:

• Facets Upgrade Due diligence and proposal
• Facets ADM Assessment and proposal
• Facets CoE Assets and accelerators development
• (Training Materials, Healthcare Facets Quiz, Facets Test Factory, Facets Impact Analyzer, Data Validation tool)

Confidential

Solution Consultant / Test Manager / Project Lead

Responsibilities:

• Responsible for managing the implementation of TriZetto Facets from legacy and version upgrade, collaboration solutions, and many other custom outsourcing engagements.
• Provided technical solutions to customer deployment issues in the field.
• Oversaw product-testing requirements to obtain customer certification for field deployment.
• Managed the coordination between customer, engineering various field teams and third party venders during major deployment activities.
• Managed and maintain customer relationships.
• Developed new procedures and processes to modify existing system to ensure stability, reproducibility of the upgrade process.
• Planned, and executed detailed service upgrade plan and procedures to ensure seamless transition and minimum customer service interruptions.
• Preparing ‘Capacity Plan’ every week, to make sure all team members has 100% allocation with the available planned delivery date from Design and Development team.
• Created and maintained “Master Inventory” Excel sheet, which listed all the WI’s and Planned Schedule, Actual Schedule & Status for the entire project activities daily basis.
• Mentored the team to automate the feasible reusable test scenarios and Development steps.

Confidential, Tampa, FL

Test Manager

Responsibilities:

• Workers compensation CIME QA
• NT24 QA
• First Script QA
• FS Prod Support QA
• File net QA

Confidential, San Francisco, CA

Project Lead

Responsibilities:

• EDI Production Support
• Shield Advance - IFP (Facets Upgrade)

Confidential, Rochester, NY

Project Lead

Responsibilities:

• Transformation Release 1 & 2 (Membership and Billing, Customer service, Care Management, Marketing and sales).
• Transformation Release 3 Medicare (Customer service, Care Management, Marketing and sales).
• Transformation Facets Upgrade 4.51 to 4.71.
• KLA Project.
• 2011 Product Conversion Regression.

Confidential, Nashville, TN

Team Lead

Responsibilities:

• Real Time Claim.
• Batch Claim process and handling 837 (P/ I/ D) and 835

Confidential, Basking Ridge, NJ

Team Lead/Team Member

Responsibilities:

• Consolidated Eligibility System ADM as Developer, Tester, Production support Analyst