SUMMARY

• Over 10+ years of experience in the IT field as a Certified Project Manager with a thorough knowledge of Software Development Life Cycle (SDLC) methodologies such RUP, Agile and Waterfall.
• Highly skilled in RequisitePro and HP Application Lifecycle Management which is used in requirement capture, analysis, design and development.
• In - depth knowledge of business processes in Healthcare and Financial industries.
• Experienced in Business Requirements gathering, Risk Analysis, Gap Analysis, Feasibility Studies, and UML Modeling.
• A result oriented with highly developmental planning, analytical, technical communication, decision-making and leadership skills.
• Highly driven with the ability to multitask and deliver effectively in a fast paced environment.
• Filled great interpersonal skills, strong reasoning using both quantitative, analytical and organization skills to lead a project to its success.
• Managed several projects to ensure smooth porting of Claims data while maintaining existing functionality, business rules and Validated the Membership data transfer.
• Extensive experience in GAP analysis of conversion using implementation guides and companion guides.
• Worked on various Line of business PPO, HMO, FEP, HEDIS (Lab Claims) Medicare and Medicaid (CMS) claims and claims processing.
• Thoroughly analyzed EDI raw data for transactions (835/837) in the 5010 format to verify the changes as per the 5010 format.
• Strong experience on HL7, HIX (Health Insurance Exchange), EMR/EHR, Health Care Reform and Patient Protection and Affordable Care Act (PPACA) on Facets and Mainframe systems.
• Experience in impact analysis of migrating to ICD 10 on the key business process of health insurance and key application systems like claims processing, claim payments, reporting and business applications.
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets, ICD-9, ICD-10 coding and HL7.
• Extensive experience with Cloud (Public & Private), SaaS, PaaS, IaaS: 24x7x365 operations, high-volume transactions, 4 data centers
• Strong organizational, communication, leadership, planning and vendor management skills
• Private cloud (SaaS, PaaS, IaaS) - ground-up architecture, Agile development, and ITIL 24x7x365 operations.
• Solution included custom applications using Microsoft and non-Microsoft technologies, carrier-class private fiber network, broadband wireless, two data centers, and petabytes of storage.
• Great expertise in Insurance, Healthcare processes, health insurance exchange HIX, meeting federal compliance and regulation, understanding client requirements and providing scalable infrastructure.
• Extensive knowledge of DRG codes and Medicare/Medicaid Services.
• Experience in conducting User Acceptance Testing (UAT) on several projects.
• Performed several levels of testing of the conversion from which included syntax verification, balancing of the segments, situational cases and verification of the loops as per the guidelines of the implementation guides and companion guides.
• Involved in JAD, walkthroughs and various meetings with the stakeholders of the project including technical users in order to design complete and detailed documents such as Business Requirement Documents, Financial Requirement Documents, Use Case Diagrams and Activity Diagrams.
• Experience of MMIS, HIX, EMR (Electronic Medical Record), EHR (Electronic Health Record) and (PPACA), Emergency Medical Treatment and Active Labor Act (EMTALA)
• Thoroughly analyzed EDI raw data for transactions (835/837) in the 5010 format to verify the changes as per the 5010 format.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI) in 4010 and 5010 formats.
• Expertise in creating complex SQL Queries using Joins (inner and outer) and sub-queries.
• Experience in using requirement management tools, such as IBM Requisite Pro and HP Quality Center
• Expert on Business intelligence and Business process improvement using informatica
• Experience is gathering, analyzing and documenting requirement for LOS.
• Extensive knowledge in content management with tools such as Documentum
• Extensive know knowledge in PAS, DTI, LTV and CLTV

PROFESSIONAL EXPERIENCE

Confidential, New York, New York

Snr project Manager

Responsibilities:

• As a Project Manager, effectively communicated the project goals, requirements and deliverables through clear, concise and comprehensive presentation to the key project stakeholders.
• Schedule and facilitate daily stand up meeting at same time and same location each day in accord with the scrum fundamentals.
• Prepared weekly status report and provided to the upper level management for review.
• Analyzed operating procedures and policies on an ongoing basis and recommended and implemented improvement plans where appropriate.
• Organized and facilitated meetings with the management and the development team to better understand the Business Requirement.
• Managing the financial of the project and Calculating NPV, ROI.
• Organized weekly and daily meeting with project team to address issues, concerns and progress of the project.
• Demanded updates from the project team and escalated risks and issues to the appropriate persons.
• Organized stakeholder meeting at every phase of the project.
• Used business process re-engineering to update, modify systems flow and improve business processes and update financial planning.
• Identified the scope, business objective and documented the functional requirements for each release.
• Involved with the developers and the stakeholders in conducting walkthroughs
• Lead the business process analysis and development using SOA.
• Organized and gathered requirement for business intelligent for rational and profitable use of business data.
• Trained team members on using software tools for big data analytics such as Natezza
• Facilitated and took meeting minutes and sharing with all attendees and posting it on sharepoint
• Managing project schedule and updating accordingly.
• Used Jira, PPM and plan view for tracking and reporting project status

Confidential, Pittsburgh, PA

Snr Project Manager/ Snr Business Analyst

Responsibilities:

• Communicated the project goals, requirements, deliverables through clear, concise and comprehensive presentation to the key project stakeholders.
• Schedule and facilitate daily stand up meeting with project team members.
• Prepared weekly status report and presented to the EPMO.
• Monitored the project using Ms. Project and RAID log
• Organized and facilitated meetings with the management and the development team to better understand the Business Requirement.
• Mentored the business and analyst to use data mapping and data modelling to analyze data for the migration projects.
• Managing the financial of the project and Calculating NPV, ROI.
• Organized weekly and daily meeting with project team to address issues, concerns and progress of the project.
• Demanded updates from the project team and escalated risks and issues to the appropriate persons.
• Organized stakeholder meeting at every phase of the project.
• Identified the shortfall and old business logic using business process re-engineering.
• Identified the scope, business objective and documented the functional requirements for each release.
• Involved with the developers and the stakeholders in conducting walkthroughs.
• Functioned as the primary liaison between the business, operations.
• Created the discussion platform for business data usage and its profitability.
• Train team members on using big data tools
• Organized meetings both online and onsite for stakeholders.
• Shared meeting minutes through outlook and on sharepoint.
• Manage project timeline and updated accordingly.
• Used Jira, Clarity and other tools for tracking and reporting project status
• Used Jira in an agile environment for reporting and tracking of project deliverables.

Confidential, Newark, NJ

Sr. Project Manager

Responsibilities:

• Project was to redesign Medicare Advantage (Medicare part C) Plans.
• The project also redesigned the Medicare Supplement plans.
• The project was responsible for properly structuring Medicare plans for HMO, PPO, PFFS base on the zip codes
• The project redesigned the formularies for the Medicare part D (Prescription plans).
• The budget for the entire project was about $ 6 million.
• Prepares CIO and SVP report to the upper level management.
• Worked with various vendors and participated in vendor selection during bidding.
• Analyzed operating procedures and policies on an ongoing basis and recommended and implemented improvement plans where appropriate.
• Organized and facilitated meetings with the management and the development team to better understand the Business Requirement.
• Worked and mentored business analyst to identify data flow short falls using process and re-engineering.
• Managing the financial of the project and Calculating variance using actuals and budgeted
• Organized weekly and daily meeting with project team to address issues, concerns and progress of the project.
• Demanded updates from the project team and escalated risks and issues to the appropriate persons.
• Organized stakeholder meeting at every phase of the project.
• Identified the scope, business objective and documented the functional requirements for each release.
• Involved with the developers and the stakeholders in conducting walkthroughs.
• Functioned as the primary liaison between the business, operations, and the technical teams throughout the project cycle.
• Identified, tracked, researched and assisted in the resolution of system problems and testing.
• Created different Traceability views to maintain the Traceability of the requirements.
• Updated the requirement and defect status as per the current status of the testing project in the ClearQuest.
• Used Jira in an agile environment for reporting and tracking of project deliverables.

Environment: XML, EDI: ANSI ACI X 12 40105010 , HIPAA, PMBOK, UML, ETL, SQL, MS Visio, Web App(HTML, CSS, JavaScript), MS Visio, SAAS/Cloud, Rational Suite, MS Office Suite, ALM

Confidential, Oakland CA

Project Manager

Responsibilities:

• As a Project Manager, effectively communicated the project goals, requirements and deliverables through clear, concise and comprehensive presentation to the key project stakeholders.
• Schedule and facilitate daily stand up meeting at same time and same location each day in accord with the scrum fundamentals.
• Analyzed operating procedures and policies on an ongoing basis and recommended and implemented improvement plans where appropriate.
• The project is about enrollment of ADAP, MTM and RCA for people with low level income. A web based application for enrollment into a PBM and 340B prescription program.
• Worked with IT teams regarding EDI transaction such as X12 835/837, 850,855,810,832, X12 270, X12 271, X12 275 codes and many more for claims processing.
• Worked on various Line of business PPO, HMO, FEP, HEDIS (Lab Claims) Medicare and Medicaid (CMS) claims and claims processing.
• Followed a hybrid of strategic planning of budget forecasting and proposed enhancements Waterfall, RUP and Agile approach of development throughout the project
• Schedule and facilitate daily stand up meeting at same time and same location each day in accord with the scrum fundamentals.
• Prepared weekly status report and provided to the upper level management.
• Presented CIO and SVP reports to the senior vice presented.
• Worked with various vendors and participated in vendor selection during bidding.
• Analyzed operating procedures and policies on an ongoing basis and recommended and implemented improvement plans where appropriate.
• Organized and facilitated meetings with the management and the development team to better understand the Business Requirement.
• Created innovated process for identify risk and financial improvement using business process re-engineering.
• Managing the financial of the project and Calculating NPV, ROI.
• Organized weekly and daily meeting with project team to address issues, concerns and progress of the project.
• Gathered and managed requirement and deliverables for mobile app such android, IOS and windows.
• Organized stakeholder meeting at every phase of the project.
• Identified the scope, business objective and documented the functional requirements for each release.
• Involved with the developers and the stakeholders in conducting walkthroughs.
• Functioned as the primary liaison between the business, operations, and the technical teams throughout the project cycle.
• Identified, tracked, researched and assisted in the resolution of system problems and testing.
• Created different Traceability views to maintain the Traceability of the requirements.
• Used Jira in an agile environment for reporting and tracking of project deliverables.

Confidential, New York, NY

Project Manager

Responsibilities:

• Schedule and facilitate daily stand up meeting at same time and same location each day in accord with the scrum fundamentals.
• Prepared weekly status report and provided to the upper level management.
• Prepares CIO and SVP report to the upper level management on monthly and quarterly basis respectively.
• Worked with various vendors and participated in vendor selection during bidding.
• Analyzed operating procedures and policies on an ongoing basis and recommended and implemented improvement plans where appropriate.
• Organized and facilitated meetings with the management and the development team to better understand the Business Requirement.
• Managing the financial of the project and Calculating NPV, ROI.
• Organized weekly and daily meeting with project team to address issues, concerns and progress of the project.
• Managed information and data on cloud computing.
• Track derivable on mobile apps such as IOS, android and windows applications.
• Organized stakeholder meeting at every phase of the project.
• Identified the scope, business objective and documented the functional requirements for each release.
• Involved with the developers and the stakeholders in conducting walkthroughs.
• Functioned as the primary liaison between the business, operations, and the technical teams throughout the project cycle.
• Identified, tracked, researched and assisted in the resolution of system problems and testing.
• Created different Traceability views to maintain the Traceability of the requirements.
• Updated the requirement and defect status as per the current status of the testing project in the ClearQuest.
• Updated the requirement and defect status as per the current status of the testing project in the ClearQuest.

Environment: Window, UNIX, Oracle, SQL, Quality Center, ETL- Informatica, HIPAA Standards, SAAS, MS Visio, MS Project, Requisite Pro, Agile

Confidential, Louisville, KY

Project Manager

Responsibilities:

• Thoroughly analyzed EDI raw data for transactions (835/837) in the 5010 format to verify the changes as per the 5010 format.
• Understand rules and regulations of HIPAA as imposed during Electronic Data Interchange (EDI) in 4010 and 5010 formats.
• Schedule and facilitate daily stand up meeting at same time and same location each day in accord with the scrum fundamentals.
• Prepared weekly status report and provided to the upper level management.
• Prepares CIO and SVP report to the upper level management.
• Worked with various vendors and participated in vendor selection during bidding.
• Analyzed operating procedures and policies on an ongoing basis and recommended and implemented improvement plans where appropriate.
• Organized and facilitated meetings with the management and the development team to better understand the Business Requirement.
• Managing the financial of the project and Calculating NPV, ROI.
• Organized weekly and daily meeting with project team to address issues, concerns and progress of the project.
• Prepared Lesson leaned document during the project for future use.
• Organized stakeholder meeting at every phase of the project.
• Identified the scope, business objective and documented the functional requirements for each release.
• Involved with the developers and the stakeholders in conducting walkthroughs.
• Functioned as the primary liaison between the business, operations, and the technical teams throughout the project cycle.
• Identified, tracked, researched and assisted in the resolution of system problems and testing.
• Created different Traceability views to maintain the Traceability of the requirements.
• Updated the requirement and defect status as per the current status of the testing project in the ClearQuest Developed Project Status metrics for weekly evaluation of Project Status.
• Used Jira in an agile environment for reporting and tracking of project deliverables.

Environment: Windows, DB2, Rational Unified Process, EDI, HIPAA, Mercury Quality Center, Quick Test Professional, Microsoft Visio, SQL Server, UNIX, Java, Mercator, MS Office, Load Runner, EHR System

Confidential, Oklahoma City, OK

Business Analyst/Project Manager

Responsibilities:

• Extensively worked withSMEto better understand the existingclaimprocessing at Confidential Health.
• Performed GAP Analysis ofEDI 837 and 835 transactionsfrom ANSI 12 StandardHIPAA focusing on how current transaction would affect the new Federal compliance.
• Also, develop cross-walk for understanding major changes fromICD-9 to ICD-10version.
• Performed and analyzedGAP AnalysisofEDI 837 transactionfrom .
• Organized and facilitated meetings with the management and the development team to better understand the Business Requirement.
• Worked on a business application for Service request management using SaaS.
• Gather requirements afterJAD sessionswith the purpose of defining the functional business and system requirements.
• Identified the scope, business objective and documented the functional requirements for each release.
• Followed a hybrid of strategic planning of budget forecasting and proposed enhancements Waterfall, RUP and Agile approach of development throughout the project
• Determined how the changes inHIPAA-5010impact current business operations to define and develop business and technical requirements within and across transactions.
• Directly involved in process improvement Plans and implementing business change, creating and managingProject templates,Use Case project templates,requirement typesandtraceability relationshipsinRequisite Pro.
• UsedMS-Visioto createData Flow Diagramsas aStructured Analysistool.
• Wrote clear, concise and detailedsystem requirements specification (SRS)documents and user documentation in accordance to guidelines and standards of a level where developers can interpret and design and develop the application with minimum guidance.
• Facilitated UAT (User Acceptance Testing) with the stakeholders and the business users, and the errors discovered were fixed and then verified via Regression Testing.
• Conducted Alpha and Beta testing along with the end users and the QA team.
• DevelopedBusiness flow diagrams, Activity/State diagramsandSequence diagramsso that the development team and other stake holders can understand the business process.
• Worked closely withQA team and Developer to establish traceability matrixto ensure the completeness of the enrollment procedure.
• Guided QA team to writetest cases and test scriptsto confirm the displayed information and also tested to print the image in the paper.
• Performedfunctional testingof the application as per the5010changes.
• Documented andanalyzed all defects usingQuality Centerand tracked them to completion by communicating with the team every day.

Environment: XML, EDI: ANSI ACI X 12, HIPAA, Oracle, MS Office Suite, Facets, ALM

Confidential, Phoenix, AZ

Business Analyst/PM

Responsibilities:

• Utilized RUP (Rational Unified Process) Methodology to configure and develop process, standards and procedures in all phases of SDLC (Software Development Life Cycle)
• Acted as a department SME (Subject Matter Expert) while attending requirements gathering meetings with business owners and assist project managers with the development of complete business requirement documents and departmental projects.
• Conducted sessions with the stakeholders for gathering business need to understand the business process.
• Used SQL for Claims Data Analysis.
• Documented and published Functional and Non-Functional Specifications as well as the Business Requirement Document.
• Conducted Gap analysis and Impact analysis of the “To-Be” model and generated scope documents.
• Involved with the developers and the stakeholders in conducting walkthroughs.
• Functioned as the primary liaison between the business, operations, and the technical teams throughout the project cycle.
• Analyze business functional requirements and segregate them into Use Case Specifications and create Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using MS Visio according to UML methodology.
• Identified, tracked, researched and assisted in the resolution of system problems and testing.
• Created data flow diagrams/ activity diagrams displaying all major actors in the claim management system regarding HIPAA, EDI provider claim transactions.
• Interacted with the Quality Assurance team for designing and developing test plans and test cases.
• Charted out Project Plan and ensured the compliance of the following EDI transactions: 277 - Healthcare claim status response.
• Designed the Test Plans, creating and running the Manual Test Cases, identifying the defects for EDI transactions.
• Experience in GUI, functional and web testing with manual testing using tools as Quality Center.
• Provided weekly status updates to project stakeholders on the progress of project development activities.
• Facilitated UAT (User Acceptance Testing) with the stakeholders and the business users, and the errors discovered were fixed and then verified via Regression Testing.

Environment: XML, EDI: ANSI ACI X 12, HIPAA, SQL, MS Visio, Rational Suite, MS Office Suite, ALM

Confidential, Woodland Hills, CA

Business Analyst

Responsibilities:

• Assisted Project Manager in creation of Implementation Plan identifying the action steps for developing the system, describing tasks, primary responsibilities, deliverables, and completion dates.
• Extract and Gather requirements from the stakeholders, and develop Use Cases and Document it for the development team.
• Validated various HL7 messages, encounters and EMR (Emergency) records and workflows.
• Tested and Validated the EHR Data and EMR Data in Ambulatory EHR.
• Involved in testing of the Registration, Appointments, Patient Summary, Prescription Medication, Lab Orders, Clinical Summary, Chart Search, Results, EMR and EHR modules
• Extensive knowledge of the HIPAA standards and EDI transaction syntax.
• Worked on the HIPAA transactions and ANSI X12N Code Set 837 (I/P/D), 835, 270 and 271.
• Coordinated with the offshore team for development of the code.
• Actively participated in the pre-testing that included review of the requirement documents, studying the use cases for developing test plans and collection of test data.
• Apply strong analytical skills and use techniques like brainstorming, focus groups and questionnaires to ensure that the software engineering and the business engineering community communicate properly with each other.
• Analyze business functional requirements and segregate them into Use Case Specifications and create Use Case Diagrams, Activity Diagrams, and Sequence Diagrams using MS Visio according to UML methodology.
• Interview the Subject Matter Experts (SME) and carefully record the requirements by asking detailed questions and document all the requirements so that both business and technical teams could understand them.
• Manage requirements in Microsoft Excel and make them available to all team members.
• Participate in JAD sessions to develop an architectural solution and ensure that the application meets the business requirements, resolve open issues, and change requests.
• Performed walkthrough with the development team and system analyst and incorporated modifications in the original test plan before proceeding with automated testing.
• Performed User Acceptance Testing (UAT) of the application by creating and running demo versions of the application with the prospective users.

Environment: EHR System, MS Project, MS Visio, Rational Suite (RequisitePro, ClearQuest, Clearcase), and EDI ANSI X12/HIPAA.

Confidential, Grand Junction, CO

Business Analyst

Responsibilities:

• Helped in defining Change Management Process for Release Management Team
• Mapped process flow; assess as-is a process through user interviews, data collection and analysis, design and evaluation of to-be process solutions.
• Researched and identified new system, process to replace existing intake system while also considering their integration with the letter generation system.
• Assisted JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Responsible for architecting integrated HIPAA, Medicare solutions, Facets.
• Work with Compliance and Regulatory operations to follow and monitor different IT process bound by CMS Regulations.
• Utilized Rational Requisite Pro as a user to analyze the business requirements.