SUMMARY:

• Lead Solution/Integration Architect/Product Manager with 15+yrs 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 a customer organization.
• Adopt, Drive, Implement industry standards, best practices and been a change agent working with Clients to improve revenues, and workplace productivity.
• Product/Project Management & 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 and Change management
• Market & Competitor Research
• API Governance and Management
• Verbal and Presentation skills
• Insurance, Supply Chain, Logistics
• COTS (Siebel, Alltel ALS-AF)
• Collaborate, Build Trust, SWOT analysis
• Digital, Mobile and Data Analytics
• Consumer Insights, VOC and NPS
• Agile, Lean, Scrum and Waterfall

TECHNICAL SKILLS:

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

Platform: OS/400, MVS/ESA, S390, WIN 95/NT/XP, LINUX, YARN 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,ITXA 9.0, 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, WSSR, MQFTE, SAML 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, HPSA, 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 4010x040

Ocean Shipping:: 300,301,304,310,312,315,323,824,997/Supply Chain:810,812,820,850,855,856Code sets, Standards and RegulationCode sets: ICD-9CM, ICD-10PCS, CPT-4, CPT-5, HCPCS, SNOMED, LO INC, NPS and NDC.Data Standards: X12, MISMO, HL7V2.5/3.0, CDA, CCD, EDIFACT, CDISC, OAGIS, Canonical, B2MML/ ISA S95, DICOM, STARS, PACS, NSF, UB92, Encounters, EDIFACT and FHIRRegulation:21CFR PART11, cGMP, HIPAA, PHI, GCP, GMP, GXP, GAMP, NIST framework Manufacturing cyber profile security and GLP

Products/Tools: EDISIM, Xmlspy, UML, TOAD, 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, Mulesoft, Tableu, Zookeeper, Yarn, Apache Storm, Swagger tool, IBM Sterling Gateway, Sterling Integrator BPM, IBM Datapower, ITX, IIB, IBM Connect, ESB, RabbitMQ, Sterling File Gateway, AXWAY Gateway, web methods, Seeburger MFT, OSI PI Analytics, Maximo, Biovia LES, Waters SDMS, Antares Serialization, Waters Nugenesis, serviceNow, Empower 3, Wonderware, MES Syncade and DeltaV, Syntq, SAP, ESB, RAML,BPM, Tibco Spotfire, AXWAY gateway, ETL, Talend, KAFKA, Swagger and IBM control center

PROFESSIONAL EXPERIENCE:

Confidential - NJ

Lead Domain Manufacturing Architect

Responsibilities:

• Create technical artifacts including landscape, architecture diagram, remediation and roadmaps for digital transformation programs.
• Manage technical requirements, solution development, provide technical and process support for manufacturing-related IT projects.
• Capture, drive, manage resolution of technical issues and support manufacturing IT security program. based on NIST frame work.
• Performed options analysis, present recommendations, rationalize, harmonize enterprise Manufacturing MES and Lab IT systems.

Confidential -DC

Senior Solution Architect/Product Consultant

Responsibilities:

• Assessment, Impact analysis, road map, tool evaluation and create POC to support architecture decision for Sterling BPM.
• Created architecture approach, design, prototype, framework using IBM B2B Sterling Gateway and ITX using scalable and extensible.
• Architected and designed common EDI inbound flow using IBM Sterling integrator, ITXA for validation, transformation and routing.

Confidential- NJ

Lead Solution Architect/Senior Product Owner/Consultant

Responsibilities:

• Conduct feasibility, impact and cost analysis to recommend cost-effective integration solutions for enterprise EDI and digital systems.
• Advise development teams on architect and design of large enterprise integration solutions that’s robust, scalable and industry standard.
• Created context diagrams CCD, BACD, SAD, conceptual, logical, physical data models, API road map to powered 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.
• Architected and designed EDI to JSON transformation map using ITXA as a service for internal and external business units.
• Collaborated with key stakeholders to define strategy, integration architecture roadmap, standards, framework and blueprints.
• Transform Legacy applications to cloud and assist in cloud migration activities like modernization, assessment and adoption.
• Worked with Vendors/Development Application/Enterprise Architects to implement solutions align with the roadmap of the product.
• Led Optum’s B2B API strategy in Integration domains A2A, B2B, Data Integration (DI), ETL, ESB and MFT (Managed File Transfer).
• Design decoupled solutions, created gap analysis and impact assessment artifacts to provide t-shirt sizing/budgetary/solution estimates.
• Designed integration patterns solutions using ESB, Cloud, Messaging, Event based and REST/SOAP JSON/XML services.
• Built healthcare product integrations between Medical/Specialty 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, work flow analysis 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, WTX/ITXA 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.
• Led product implementations specialist of EDI 837, 835, 270/271/ 276/277, 278A/N/R, 834,271U for core admin business transactions.
• Lead discovery analysis, interviews, workshops, develop architecture roadmaps, identify architecture gaps and recommendations.
• Built integrations with Portals, Clinical, Claims/Encounters, Eligibility and Billing/Revenue Management and Financial applications.
• Implementation and integration of care management applications using message oriented middleware technologies and architectures.
• Partner with Platform Architects to define architecture strategy, system architecture, API analytics and reporting for Provider Portal.
• B2B application processes high volume of 7M real time transactions; 20 trading partners; 15 EDI and Non EDI transaction types.
• Proactively identify areas for growth, development of enterprise integration capabilities, micro services and implement industry trends.
• Led external API strategy/product roadmap for payment order, remittance advice, claims, eligibility, and Authorization products.
• Participate in application rationalization, developing multi-year application architecture roadmaps and remediating systems to digital.
• Reengineer and analyze existing APIs, legacy systems, prepare migration road maps integrations working with cross functional teams.
• Define vision, strategy, road map, 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 INVEST principle value, risk, opportunities to maximize ROI.
• Liaison with business as Product Owner to road map, backlog grooming, prioritization, refining requirements with development 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, demos 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 applications from conception through market launch, roll out strategy and ownership.
• Identify work, communicate, and resolve project issues and risks that interfere with project execution or success.
• Perform product demos to prospective customers, maintain matrix of key competitors, assist in development of marketing materials.
• Led and mentored team of 4 system analysts and translated business goals into strategy and tactics for innovating provider journey.
• Created user stories, functional, technical specifications and design options to meet business system and project requirements.
• Lead cross functional/matrix teams to deliver on time and on budget. Oversee and manage product roadmap and backlog.
• Coordinate activities required to complete project goals established by the program stakeholders with respect to scope/cost/time.
• Create project management artifacts as appropriate working with internal and external stakeholders for new program initiatives.
• Partner with technology for technical architecture, product roadmap and work with scrum teams to create common product backlog.
• Led adoption of integrated web Service framework for using Big Data Platform as a Service (BDPaaS) in a multi-tenant architecture.
• Developed new ideas, supported provider journey initiatives, data driven diagrams that improve the performance of the organization.
• Create prototypes and POCs to demonstrate new product development, enhancements, reliability, extensibility, usability and security.
• Define, manage risks, tradeoffs, implement roadmap items, translate business vision into roadmap items and technical solutions.
• Capture tactical and strategic enterprise goals that provide traceability through the organization.
• Worked with BA’s, SME’s and Architects to ensure requirements address business stakeholder digital capability requirements.
• Support the triage, resolution of critical issues, provide status and communicate mitigation plans.
• Ability to work directly with senior stakeholders, supported strategic and quantitative analysis.
• Create prototypes and POCs to demonstrate or validate new product development for CRF and EDC data processing and enhancements.
• 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 framework, EDI, ecommerce, CCD, integration and HIPAA Custom Gateway solutions.
• Worked across different lines of business like Commercial, Medicaid, CHIP, Medicare, Community and Military and Confidential .
• Operational knowledge of Constituent Services, Enrollment, Provider and Network, Claims, Clinical, Customer and Product areas.
• Strong knowledge of HCR, HIE, ACA, MACRA, CMS, CAQH (Phase I/II/III), HIPAA, HEDIS and Provider Performance programs.
• Deep knowledge in 5010, HL7, NCPDP, HITSP, IHE, FHIR, B2B, HEDIS, HIE, EDI system and application architectures.
• Guided business to onboard trading partners, create companion guides, user and procedures based on industry standard.
• Strong experience in SOA(SOAP/WSDL), Web API’s, Message/Queuing, Events and Notifications and File based integration.
• Understanding of CA API Management, Layer7 API gateway, IAAS, SAAS, DAAS and PAAS deployment patterns.
• Expert understanding of Medical, Pharmacy, Dental, Vision, Specialty Benefits ( LTD, STD, LTC), DSNP plans and domains.
• Sound knowledge of industry standard Big Data solution patterns, EDI, non EDI processing tools and best practice implementation.
• Strong knowledge of HL7 standards, interoperability, CCD, CDA, FHIR, CCDA, Clinical data, Lab results processing and mapping.
• Experience with HIPAA, PHI, HL7 PCI compliance models, DEVOPS productivity and frameworks ITIL, TOGAF, EABOK.
• Experienced in concepts of Authentication, Authorization (OAUTH, SSO, SAML integration, identity federation), ELK and RUP.
• Knowledge in CDASH, SDTM, SEND, ICH, & ADaM standards.
• 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. APIs and APPs-Administrative and Clinical
• 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.

Confidential

Responsibilities:

• 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 Visualization Tools 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 guided testing team to create 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 management, CAPA, operational and execution of laboratory processes/scenarios.
• Deep knowledge in implementing industry standard best practices for Product data, BOM packaging and factory/plant automation
• Understanding of product artwork/label/package management, Customer/Product MDM 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/GXP practices like 21CFR Part11.
• Designed and Created SOA based product change interface web service between Documentum and PLM application.
• 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 GXP systems.
• Presented design pitch of Supply chain integration to C level vendors, identified go live time and on-boarded 6 sites/12 vendors.
• Create User Requirement, Functional Specification, material, system guides and Standard Operating Procedures (SOP).
• Supported PGM standardization initiatives for MES, MRP, LIMS, DMS, PLM, OSI PI systems based on Plant and Market capabilities.
• Created architecture diagrams, roadmaps, business processes for various PGM One IT programs and update SOP’s.
• Plan, Execute, Deliver and Monitor deliverables, readiness assessment and communicate updates to project sponsor.
• Implemented appropriate integration topologies like Point-to-Point, Publish & Subscribe, Hub & Spoke and SOA.
• Create future state and roadmap architecture documents to present it to key stakeholder.
• : Florida Blue, Jacksonville, FL (Health Care) - Senior Integration Consultant
• Architect and design WMQI message X12 EDI flows for real time claim status and eligibility inquiries with Siebel CRM
• : JJILL, Concord, NH-(Retail)- Senior Integration Consultant
• Developed real time flows for price inquiry/Purchase order update to single global database for Retail & Websphere ecommerce channels.
• : American Honda Financial Services, Torrance, CA (CASS) - Senior Integration Consultant
• Migration of Shaw leman’s system to Alltel Advance Loan System-Consumer Lending Solutions. Designed and deployed integrations in a distributed environment for Insurance, Collections, Title and monetary functional areas. RMS, Polk, Western Union, Confidential
• : IBM, Raleigh, NC - Systems Integrator
• Design and Develop Siebel marketing interface to use a single business document for account maintenance, Marketing Contact and Correspondence Requests objects using OAGIS standard XML BOD and SIEBEL IOD data standard.