SUMMARY

• Agile Product Owner and a Certified Scrum Master (CSM) with excellent product and project management and business analysis skills. Proven ability to lead cross - functional teams to coordinate efforts to develop software products and execute projects within scope and on time.
• Over thirteen years of US Healthcare Domain Experience on Payers, Third Party Administrators and Pharmacy Benefit Manager.
• Agile Product Owner experience, using JIRA and Confluence for backlog and defect management.
• Extensively used Scrum, Kanban and Watefall methodologies in different projects.
• Detail understanding of software development lifecycle and agile development processes.
• Experience on identifying features, creating epics, writing user stories, acceptance criteria, design documentation, process flows and wireframes.
• Strong business requirement analytical skills with the ability to produce clearly articulated requirements and documents.
• Experience with the development of SOA and SaaS based product, UX/UI Desgin, Web and mobile applications.
• Ability to work on multiple projects at the same time.
• Third Party Administrators (TPA) service experience on end to end lifecycle of claim processing, benefits setup and plan administration, finance and billing, portals and data exchange using EDI transactions.
• Pharmacy Benefits Manager (PBM) services experience including integrated accumulators, claim processing, enrollment, drug utilization, prior authorization and customer center applications.
• Leadership role of championing the implementation and application of health claim and enrollment data specifications, standards and documentation within and across departments.
• Knowledge of a variety of healthcare processes and data:
• Medical, Rx, Dental, Vision, and Disability claims.
• Capitation, Premium, Enrollment data (834), Claims data (837), Electronic Health Records (EHR).
• Wellness: Health Risk Assessments, Health/Biometric Screenings, Disease Management, Health Coaching.
• HIPAA and CMS guidelines.
• Good understanding of the current digital and automation trends in creating solution addressing the market needs.
• Responsible for ensuring project scope is managed & controlled, successful delivery of project - to time, quality, cost and outcome metrics, identify, track, manage and resolve project issues.
• Project Management of multiple client engagements and concurrent projects.
• Good in creating presentation slides and effective communication skills.
• Lead multiple pre-sales and new opportunity calls with the new prospects customers and converted this into a multi-year project.

TECHNICAL SKILLS

Product Management: Jira, Confluence, Trello, Team Foundation Server (TFS)Project management MS Office Project, Innotas

Web prototypes/specifications: Axure RP Pro 7.0, Pattern lab

Programming languages: AS/400, RPG, CL, Java, .Net, Pearl, Shell Script, Bash, Devexpress, C#

Tools: IBM Datastage V11.3, Tableau, X-RAY, Planning Poker, EDIFECS, Cozyroc, Turnover

Database: Oracle, DB2, SQL Server 2012

Methodologies: Visio, UML, DFD, ERD, Flowchart, Workflow, Mind map

Other: MS Office Word, Excel, Access, PowerPoint, Bugzilla, PBM Express/PharmScreens

PROFESSIONAL EXPERIENCE

Confidential, Twinsburg, OH

Agile Product Owner

Responsibilities:

• Senior Agile Business Analyst of two concurrent projects, including the organization’s first Client Portal. Wrote user stories and specified acceptance criteria. Refined product backlogs and managed release plans. Reviewed and approved test case designs. Directed user acceptance testing (UAT) efforts.
• Wrote business requirements for the organization’s first accumulator data exchange and automation process, including a reconciliation process, and designed supplementary reporting. Operationalized accumulator processes through devising protocols for transition to operations and business areas.
• Served as Scrum Master for the web portal implementations. Lead sprint planning. Facilitated Scrum events. Removed impediments for the development team.
• Lead and manage requirements gathering and analysis activities by working with stakeholders, developers, designers, QA analysts and internal/external customers.
• Collaborates closely with UX, Development and QA Teams.
• Manage requirement changes throughout the project lifecycle.
• Synthesizes complex information into concise, readable, unambiguous language.
• Balances business requirements with technical feasibility and sustainability.
• Defect Triaging.
• Work alongside product owner, business stakeholders and third party vendors.
• Help team remove impediments using standard techniques.
• Author tickets in JIRA and manage backlogs.
• Document application requirements in Confluence.
• Facilitate grooming sessions for development team and design review sessions for UX teams on each sprint.
• Collaborates with product owner, operations team and application testing team to test changes in functionality and ensure project alignment across teams.
• Identify use cases and conduct group meeting and one on one meeting with various cross functional team.
• Led stakeholder discovery meetings to determine requirements for effective software solutions.
• Write SQL queries to validate the output and match the results with the process and work flow of the application as per the business requirement.
• Prepare and present product demo to internal and external stakeholders at the end of each sprint.

Confidential, Lake Forest, IL

EDI Project Manager

Responsibilities:

• Delivery incharge of the project and executed this for almost 5 years using onsite and offshore delivery model.
• Primary goal of the project was to reengineer the EDI transactions from Legacy system to new ICE platform and then do the new client file creation and support.
• The file formats include EDI 834, 837, 835 and vendor proprietary files in .CSV, .TXT, .XLS and other standards layouts.
• Designed, Initiated, Planned, Executed and Implemented more than 900 inbound/outbound files for 350+ active customers.
• Understand the existing file creation process and field mapping using AS/400 legacy code and converted this into the design document and process flow diagrams to recreate using IBM Datastage V11.3 and SQL Server 2012.
• Created test bed using data masking techniques after scrambling production PHI and PII data to test the file creation process.
• As part of the Data Operations development team, created Datastage Workflows to streamline and standardize the medical claims ETL process using change date capture mechanism.
• As EDI Manager in the Data Operations group, accomplishments included developing and coordinating the implementation of frameworks for new data types, documenting database testing and new client implementation procedures, and coding enhancements to standard clinical data quality checking programs.
• Identified the redundant processes for multiple vendors and created a reusable framework and user interface to automate the existing process.
• Level 1 production support on the mission critical processes and most of them were related to the PBM vendors.
• Responsible for processing and validating several hundred data feeds per month, including trouble-shooting and determining solutions when data anomalies arose.
• Setup new customized imports and exports via a user friendly interface.
• Setup the import/export scheduling frequencies and file names. Make changes to the existing process (i.e., assign a new file format, apply decimal rules for numeric fields, move the process to new trading partner etc.).
• Communicate effectively with all levels of management and stakeholders (CIO, SVP, Global Healthcare Head, Delivery Head, Business Head and multiple level of decision takers).
• Estimation, Budgeting, Forecasting and end to end delivery planning and execution.
• Served as the IT point of contact for the Account Services department. Worked directly with clients and vendors to trouble-shoot and recommend solutions for a variety of file and process issues. Recovered projects, bringing them back on track and improving service to the client
• Identified the key performance indicator reports and document the requirement for the WebFocus development team.
• Engaged clients to share functional specifications for standardized reports that were to be generated by a monthly process. Identified errors and inconsistencies in client’s business requirements. Revised requirements through iterative discussion with the client. Recommended and implemented design solutions.
• Undertook the lead role in researching and documenting technical requirements for a Data warehouse software upgrade which was used as a data feed to multiple reports and dashboards.
• Responsible for managing complex datasets of healthcare claims and enrollments for large self-insured corporations and Health Plans. Duties entailed data management, creating and maintaining data sources, and generating custom client reports and extracts
• Leadership in conceptualizing and developing strategic solutions to capture real time data during the peak hours into the reports.
• Primary goal of the project was to do end to end development and maintenance of the Claim process, Plan Setup, Enrollment Maintenance processes, Accumulator Processing, EDI Transactions 834/835/837/272 , Billing, Reporting, Provider setup
• Fielded client questions and requests. Gathered business requirements. Utilized programming team resources. Provided project status updates to clients and senior management. Identified and communicated project risks to senior management
• Managed team of off-shore AS/400 programmers. Developed program sequences and QA reports, following business standards, to process healthcare data for input into predictive models. Directed team in performing analyses and process improvements
• Mentored staff to improve their AS/400 skills and to build their healthcare data analysis knowledge. Fostered an environment where questions were encouraged and where team members need not feel intimidated by revealing a lack of knowledge or in reporting mistakes
• Oversaw quality and accuracy of the product delivered to the client. Identified and corrected errors in RPGLE programming and data analysis. Trained staff to prevent repeat errors.
• Written multiple AS/400, RPGLE, CLLE, SQLRPGLE programs to support the primary applications.
• Worked extensively on subfiles and RLU reports.