SUMMARY:

• Lead Solution Architect/Certified Product Owner with 15+years of proven ability in leading and delivering enterprise strategic business process improvement, regulatory and merger programs for Healthcare/Pharma/other industries within consulting environment.
• Diverse Background - 12+yrs in healthcare and Pharma;12+yrs in Solution architecture; 10+yrs in Product and Project Management (Waterfall and agile scrum/Kanban/scaled agile framework; first hand working for a vendor and within customer organization.
• Adopt, Drive, Implement industry standards, best practices and been a change agent working with Clients to improve revenues, and workplace productivity.
• Product and Project Life cycle
• Requirements, Data and System Analysis
• Team Player and Self Starter
• Mergers and Acquisition Integration
• B2B, B2C,Cloud and EDI integration
• Problem Resolution and Leadership
• Business Process Management
• Claims, Enrollment, Billing and Clinical
• Customer Relationship Building
• Vendor Management and Estimation
• Application and Enterprise Architecture
• Stakeholder management
• Market & Competitor Research
• API Governance and Management
• Verbal and Presentation skills
• Insurance and Supply Chain
• COTS (Siebel, Alltel ALS-AF)
• Collaborate and Build Trust

TECHNICAL SKILLS:

Languages: Java, ILE / RPGIV/RPG/400,COBOL/400, VS-COBOLII, C, SQL, CICS and PL/SQL

Platform: OS/400, MVS/ESA, S390, WIN 95/NT/XP, LINUX and AIX UNIX

Databases: MS SQL Server 2000, 7.0, Oracle 9i, DB2/400, DB2 7V1, VSAM, BIG DATA, HADOOP/HDFS

Middleware/Application Servers: WBIMB5.0,ESB,WMQ5V3,MQWF,WBI Modeler, Sterling GIS 3.1,JCAPS5V1, eInsight, Talend, WAS Server,WTX8.4,ITX9.0, ESB, Axway CFT, Data Power, CDC, Kafka and API Gateway Layer7

Technologies: SOAP,REST API, Web services, SOA, SAX,DOM Parsers, XPATH, XSLT, XQuery, BPML,FTP, SFTP, SSL HTTP, HTTPS,PAAS, SAAS, JSON, API, OAUTH2.0,WADL and WSDL

Project Methodology: MS Project, MS PowerPoint, Office 2013, SharePoint 2013, Visio 2010, VLookups, Pivot Tables SDLC, Plan view, Agile/Scrum/Kanban, Scalable Agile Methodology, CA Rally, Clarity and ITILConfiguration ToolsVisual Source Safe, PVCS, CVS, Share point, HP Open view and Rational Clear caseEDI/HL7 transactions

Healthcare: 837I, 837P, 277CA, 835, 276/277, 270/271,278x216,278x217,278x215,274, 820,834, 271 Unsolicited, ORU, CCD, TA1,999 NCPDP5V1 and 271 Eligibility/Benefit Roster 4010x040Ocean Shipping:300,301,304,310,312,315,323,824,997/Supply Chain:810,812,820,850,855,856Code sets, Standards and Regulation

Code sets: ICD-9CM, ICD-10PCS, CPT-4, CPT-5, HCPCS, SNOMED, LO INC and NDC.

Data Standards: X12, MISMO, HL7V2.5/3.0, CDA, CCD, EDIFACT, CDISC, OAGIS, Canonical, B2MML/ ISA S95, DICOM, STARS PACS, NSF, UB92 and FHIR

Regulation: 21CFR PART 11, cGMP, HIPAA, PHI, GCP, GMP, GXP, GAMP and GLP

Tools: EDISIM, Xmlspy, UML, Alltel Als/AF, Siebel, HP ALM/Quality Center, Kibana, Logstash, elastic search, Splunk, Kafka, Claim Systems Trizetto, Diamond, Healthedge, Wonderbox, and Properitary systems Cloud architecture, Casewise Modeler

PROFESSIONAL EXPERIENCE:

Confidential, NJ

Lead Solution Architect/Product Owner/Consultant

Responsibilities:

• Conduct systems design, feasibility and cost studies and recommend cost-effective integration solutions for enterprise EDI systems.
• Advise software development teams on architecting and designing integration solutions that’s robust, scalable and industry standard.
• Created context diagrams, conceptual, logical data models, API road map and directions that powered management’s key initiatives.
• Translated business requirements into repeatable design strategies, patterns such as adaptability, scalability, availability and reusability.
• Lead implementation of POC on key technologies to produce design artifacts and documents following customer’s SDLC process.
• Identify and document business, technical, quality requirements, define, record, measure monitor and report business SLAs and KPI's.
• Collaborated with key stakeholders to define strategy, integration architecture principles, standards, framework and blueprints.
• Transform Legacy applications to cloud and assist in cloud migration activities like modernization, assessment and adoption.
• Worked with Application and Enterprise Architects to implement solutions consistent with the roadmap of the application/product.
• Led Optum’s B2B API strategy in Integration domains A2A, B2B, Data Integration (DI), ETL, ESB and MFT (Managed File Transfer).
• Created gap analysis and impact assessment artifacts to provide t-shirt sizing/budgetary/solution/design estimates.
• Designed integration patterns solutions using ESB, Cloud, Messaging, Event based and REST/SOAP JSON/XML services.
• Built healthcare product integrations between Medical/Speciality benefit providers, providers, clearinghouses and UHG systems.
• Conduct market research, evaluate technologies and make recommendation for cost effective solutions that fits customer’s needs.
• Drive buy/build analysis, perform feasibility reviews, vendor reviews and assist in development of RFIs, RFPs.
• Built scalable external facing B2B APIs and integration use case solutions for Batch, Real time and Message exchange patterns.
• Implementation environment was IBM WAS server, Message Broker, Transformation extender and CA API Management/Layer7.
• Enterprise B2B EDI application is a complex Java J2EE Custom application consisting of web and EJB applications.
• Prototyped solution using Talend for big data integration and advise business partners on fit-for-use and technical complexities.
• Architect, design and implement batch and real time data integrations between Initiate Provider MDM and source/target systems.
• Define vision, strategy, design, establish measurable outcomes for product delivery and set product priorities from user experience.
• Plan, Architect, Design, Build, Integrate, Deploy and Share API strategy linked to business strategy using API Management platform.
• Schedule releases/epics/features/stories of product increments based on value, risk, opportunities and constraint to maximize ROI.
• Liaison with business as Product Owner to manage backlog grooming, prioritization, refining requirements with the team.
• Collaborate with business, regulatory, cross functional and vendor teams to launch new services, create quality features/user stories.
• Led and supported Idea and process discovery activities, market needs, user interviews, surveys, data mapping and gap analysis.
• Consulted during PI, Sprint Planning, Daily Scrums/Standups, demos and Grooming sessions for projects of varying size/complexity.
• Generate feedback from user research, analyze competitive intelligence data for product lines and create lessons learnt.
• Manage end-to-end product lifecycle of complex app platforms from conception through market launch.
• Perform product demos to prospective customers and maintain matrix of key competitors.
• Realized 100% on time, budget and schedule for application releases over the last 8+yrs working on critical enterprise programs.
• Expert in API design using EDI/XML/JSON/Industry standard data interchange formats and interoperability in healthcare domain.
• Received numerous s and appreciation for architecture ideas, product and project management areas.
• Designed and released four new industry standard API and integration services in different healthcare domain areas.
• Specialist with Real time, event batch based architecture framework and HIPAA Custom Gateway.
• Optum rLink integration with CSP Facets Claims system restAPI and Cloud based integration.
• Optum Link PAAS is a digital secure platform that provides intuitive self-service tools to providers for administrative and clinical interactions with plan sponsors/Payers.
• Reduce administrative cost, standardize use of electronic transactions and reduced TAT from 2 days to 20secs.
• Increase provider satisfaction and ease through multi-payer self-service tools
• Various Platform Migrations| Migration project Standardization and Cost Saving - Acquisitions .
• Supported legacy platform migration impacting multiple lines of business including individual/small/public sector accounts
• Aided the successful attainment of business plan and execution of a leveraged buyout by facilitating alignment of strategy claims, clinical finance and operations.
• Confidential t Protection ACA EHB Plus | HCR EHB Accumulators - Regulatory
• Support EHB and PLUS Accumulator requirements outlined by ACA for each individual states and built Accumulator hub.
• Design, Develop, Implement healthcare exchange hub to receive and send enrollment, premium payment and reconciliation files with state exchanges.
• Create Accumulator hub to exchange, store, track deductibles and OOP accumulators between UHG-Medical Non-Medical, Non-UHG systems in Real time and Batch modes
• Implemented configuration based work flow manager to onboard state exchanges faster.
• ICD10 | EDI Transactions and Authorizations/ Notification /Referrals Remediation - Regulatory
• Provider Portal achieve ICD10 compliance by updating business logic changes to accept, transmit and retrieve both ICD9/ICD10 Diagnosis code sets
• Compliance with standard medical data code sets by compliance date 10/01/2015 for coding diagnoses and in Confidential t hospital procedures by adopting ICD10-CM/PCS.
• CSS| EDI Portal to CSS Integration (Notifications/Authorizations, and Referrals) - Medical Cost Saving Care Management
• Enhance Clinical Self Service experience for physicians, professionals and practice administrators by expanding capability of submitting pre-claim notifications, authorizations or referrals through provider web or EDI portals
• CSS program for providers to submit and check status of Notifications/prior-auth/referrals for in Confidential t admission/rad/card services thru uhconline portal and new clinical platform migration
• ECDI R2 | Enterprise Clinical Data Intake - ARRA HITECH Health care reform (HCR)
• Enable receipt of HL7 ORU and CDA R2 Level1 summarization of Episode clinical document confirming to CCD guide and unstructured document types to support programs like HEDIS/STAR/State/Federal/NCQA accreditation
• Industry standard data exchange of lab test results from Lab corp for ORU messages and added with new version of CCD and CDA level1 documents for state, federal regulatory and accreditation requirements.
• 5010|EDI X12 5010 Transactions and EDI Common Process Implementation-Regulatory
• Maintain 5010 HIPAA compliance and support CAHQ-CORE for eligibility transactions. 837, 834, 278 .
• Enhanced 837I/P Claim pre adjudication processing services like claim data edits, member, provider picks and eligibility check.
• Designed and implemented reporting application using elasticSearch, Logstash and Kibana ELK to report transaction errors.
• Implemented Compliance with the updated 5010 ASCX12 transaction Version standards.
• Updated claim validation edits as per business rule to improve error claim success rate by 30%.
• Implemented Kibana reporting and improved visibility on errors by 90% and created reports to share with internal and external partners.
• Tricare | EDI System Implementation-New Business
• EDI portal implementation to ensure that TRICARE partnership with M&V business segment will be successful. Design eligibility process to use DEERS.
• Requirements analysis, impacts, gap analysis solution blue print and estimation for new business

Confidential, NJ

Project Manager/Senior Validation Consultant

Responsibilities:

• Performed impact assessment of lab systems by interviewing system owners and vendors for remediation of GLP/GXP systems.
• Created Project Guide, Master Validation plan and conducted risk assessment for pilot to implement for Global R&D.

Confidential, Peapack, NJ

Project Manager/Integration Architect

Responsibilities:

• Managed multiple programs (budget of 500k-1000k) and (8 Senior/junior) resources onshore/offshore by creating detail plans.
• Drive, Design and Implement strategic global capabilities for SOA real time data exchange and batch based solutions.
• Partnered with regulatory, manufacturing, quality stakeholders to define scope of capabilities and defined product features.
• Delivered business process architecture, UML diagrams, capability and solution roadmap architectural artifacts for future state.
• Create GUI proposals, mockups / UI & usability design, data dictionaries and data flow diagrams.
• Consult business to create product backlogs, refinement, backlog adjustments, realization and feature set optimization
• Strong validation experience and assisted in creating IQ, OQ, PQ, UAT test plans/scripts/data for testing integrations.
• Led testing efforts to ensure system compliance of 21CFR PART 11 for core Global systems and relevant SOPs in GMP environment.
• Facilitated meetings between Confidential sites, Financial, Supply chain, Planning, Procurement, IT teams and Vendor to deliver projects.
• Product point of contact for Vendors, Confidential Global sites for project issues and post implementation support.
• Proactively managed dependencies, risks, change requests, communication across cross functional teams in agile scrum framework.
• Experienced in FDA regulations 21CFR PART 210, 211, SOX controls compliance and Product design/management process.
• Working knowledge of supply chain, quality, CAPA, operational and execution of laboratory processes/business scenarios.
• Deep knowledge in implementing industry standard best practices for Product data, BOM packaging and factory/plant automation
• Understanding of product artwork/label management, Customer/Product MDM, supply chain and Quality systems functional areas.
• Led and Designed SOA based Real time solution implementation for Material information exchange Lots and sub lots
• Solid knowledge of Pharma SOP’s and integrating manufacturing IT applications supporting cGMP practices like 21CFR Part11.
• Designed and Created SOA based product change interface web service between Documentum and PLM application.
• Presented Forecast/Purchase Order business documents to vendors, identified go live time and on-boarded 6 sites/12 vendors.
• Implemented data harmonization, standardization for product information management using ISA95/B2MML/OAGIS data exchange.
• Assess, blue print and implement batch and real time data integrations between Siperian Product MDM and source/target systems.