PROFESSIONAL SUMMARY

Highly effective and efficient IT operations management professional with experience in delivering rapid and complex technical solutions to business problems. Demonstrated ability to learn and adopt new and innovative technologies to apply them to enterprise level solutions.
Intricate knowledge of the Health Insurance Industry with years of working experience with Payers, TPAs, CMS, IPAs, HMOs, PPOs and EDI clearinghouses. Experienced in healthcare EDI transaction implementations, Claims Systems, HIPAA compliance issues, process re-engineering, off-shore IT development and CMS data compliance regulations.

KEY QUALIFICATIONS

• Project Planning/Management
• Quality Improvement
• Customer Relations Management
• Project Integration
• Process Re-engineering
• Vendor Procurement
• Development Management
• Offshore IT Development
• Contract Negotiations
• Operations Management
• Systems Architecture
• Software Design
• Requirement Analysis
• Process Workflow Automation

EDUCATION

Candidate for Master of Business Administration To be awarded May 2011
Emphases in Corporate Finance and Investment Banking

Bachelor of Science in Computer Science May 2006
Bachelor of Arts in Math

Confidential
St. Paul, Minnesota
A leading provider of innovative cost cutting technology to the healthcare insurance industry by leveraging technology to provide effective and efficient high-quality claims processing solutions.

Senior Development Manager/Operations Manager October 2006 -present

Managed and lead onshore and offshore development and IT staff to support quarterly growth, assisted in pre-sales and RFP process, performed environmental business assessments, estimated costs and wrote Statement of Work, developed metrics to measure implementation and support costs, implemented a formal SDLC process. Implemented project management tools and documentation to enhance project delivery, tracking and metrics.

KEY ACHIEVEMENTS

• Upgraded all HealthCare EDI Transactions from X12 version 4010 to 5010 and developed products to manage customer upgrades per CMS compliance requirement.
• Scaled IT infrastructure to support the growth of clients from 8 to 120 clients in 6 years and revenues of $6 million/year.
• Exceeded the service demands of top-tier accounts including United Health, IBX-Philadelphia, BXBS-MN.
• Implemented load balancing web servers with Virtualization technology to support 1000+ users daily in India.
• Implemented standardized billing and quarterly audit procedures to reduce client billing errors.
• Outsourced daily technical production support and development to India reducing costs by 5 FTEs.
• Promoted based on excellent leadership, superior project management and business analysis skills and client recommendations.

Responsibilities:

• Managed pre-sales, environmental assessments and implementations of all new clients (TPAs, PPOs, HMOs).
• Assessed new vendors, inspect existing vendor operations and identify outsourcing opportunities in India.
• Developed new product strategy and designed new solutions working closely with sales and marketing.
• Managed SAS70 Audit and help achieve level II SAS70 compliance.

Senior Developer and Implementation Specialist September 2004 - October 2006
Lead a team of developers and design core system modules to scale to growing needs and customer base. Lead customer implementations and set implementation standards to enhance customer experience and delive faster implementations.

KEY ACHIEVEMENTS

• Successfully implemented Ingenix Clinical Editing System (ICES) as a core product to existing client base.
• Developed coding standards and design parameters to rapidly develop customized applications per customer need.
• Migrated all automated job processing from Windows 2000 to a Linux environment, reducing costs.
• Successfully implemented Virtualization using Vmware ESXi and reduced hardware costs.
• Automated job processing, streamlined operations and developed metrics to measure client to developer ratio.
• Developed QA requirements and successfully outsourced QA to India, achieving faster and higher quality results.
• Developed a standard new customer implementation process to increase customer satisfaction levels.
• Developed an automated EDI Routing module that allowed rapid implementation of Payer and PPO EDI connections.

Confidential
St. Paul, Minnesota
Junior Developer June 2003 - September 2004

KEY ACHIEVEMENTS

• Developed a learning table based AI system, which used data entry behavior to improve data entry and reduce errors, gaining a 20% productivity in the Quality Assurance system.
• Improved existing OCR systems to gain productivity on claims processed in OCR by 10%.
• Successfully implemented all new clients for the year increasing the customer base from 8 to 20 clients in 2004.

Responsibilities:

• Managed day to day customer support and implementation tasks as assigned by the Senior Developer.
• Database maintenance and backup monitoring.
• Install scanning software solution and OCR systems for new clients.

TECHNICAL SKILLS:

Management Tools UML, RUP, Microsoft Office Suite, Microsoft Project, Eclipse.
Tools MS Visio, Enterprise Architect, Rational Rose, Rational Requisite Pro.
Reporting Tools Test Director 8.0, Crystal Report, SQL Server Reporting Services, Actuate.
Languages Java, PL/SQL, .Net, Python, Visual Basic, C++, C#.
Platforms Mac OS X, Windows NT4.0 / XP/ 2000, MS-DOS, UNIX
Database MS-SQL Server, MS-Access, mySQL, MS Acces.
Web Technologies HTML, XML, PHP.
Other Technologies MVC Architecture (Turbine, Struts), Apache web servers, HealthCare EDI Transactions 837, 834, 835, 270/271, 276/277, 820, 278), SOA (Service Oriented Architecture), BPMS ( Business Process Management Suite), EAI ( Enterprise Application Integration), OCR ( Optical Character Recognition), Agile Development methodology
Claim Systems Eldorado, LuminX, BizTalk, IKA Systems.

LEADERSHIP:

• Member of Workgroup for Electronic Data Interchange (WEDI).