Avinash Mahajan
Summary
- Certified Project Manager that led and delivered various projects of different sizes and types, with 20 years of IT development and delivery professional experience.
- Versatile professional with 16 years of experience working in healthcare, Medicaid, and Medicare.
- SME on Medicaid Eligibility, Medicare Part A, B, C and D, Dual Eligibility, DSNP
- Created effective short- and long-term strategies and leveraged cross cultural Negotiation skills and a collaborative work ethic in enterprise to complete new initiatives and business as usual projects under tough deadlines and resource constraints.
- Experience with HIPAA X12 4010-5010 transaction sets; 270/271, 276/277, 278 transaction sets and 834, 835, 837 transactions, in Fee For Service, Managed Care, Mix Delivery Channel
- Subject Matter Expert in HealthCare domain in various functional areas – Claims adjudication, Pricing/Cost of Care, Provider Management, Member (Recipient), Prior/Service Authorization, Third Party Liability, Finance, Reference, MARS, T-MSIS,CMS Federal Reporting for Healthcare Effectiveness, Service Utilization
- Experienced and knowledgeable about Medicaid eligibility, Medicare Parts A, B, C, and D, dual eligibility, and DSNP.
- Technical background with project management expertise.
- Experience on various types of claims - Inpatient, Outpatient, DME, Pharmacy, Home Health/Home based care, LTSS, Nursing Home, Behavioral Health, Professional, Dental etc.
- Known for team management skills, managing projects with cross-functional teams.
- Strong experience from the pre-requirement phase through closure.
- Strong collaboration through joint application development sessions between architects, DBAs, the business development team, and other multiple stakeholders and sponsors.
- Excellent organizationalc,oordination skills and Time management skills.
- Expertise in Status Reporting, Deadline management and Roadmap Development
- Excel in Leadership, Problem Solving, Results Driven, Communication
Overview
21
21
years of professional experience
Work History
Healthcare Specialist, Project Manager
DMAS-State of VA
10.2020 - Current
- Provide direction, mentorship, close collaboration with project team
- Manage CMS Federal Reporting projects, brand new development of functionalities from Requirements through Closure
- Identify and mitigate project risks, build roadmaps, track milestones
- Provide SME level support on the various projects, Provide Design solutions
- Resource planning, execution plan, delivery management
- Coordinate, engage with multiple departments and divisions to ensure delivery
- Analyze various project work requests from various agencies and healthcare areas such as Dual eligibility, Waivers, Member Plan changes, Crossover, Healthcare performance
- Support New System changes, manage stakeholders
Project Manager,Healthcare Consultant
Anthem Inc
11.2018 - 10.2020
- Lead Program Increment (PI) planning sessions for Epic Implementation
- Gather requirements by meeting various stakeholders
- UAT Test Plan Development Participation and Mentorship
- Work with Scrum Master, Product Owner and team for prioritization, scheduling features
- Coordinate with other functional areas, Architects, SMEs, project owners
- Participate in all Agile ceremonies – Daily Stand ups, Sprint planning, refinement, Sprint retrospective, feature demo
- Develop, Maintain and Monitor feature development progress
- User Acceptance Support
Technology Specialist
State of North Carolina, Child Support Service
10.2017 - 10.2018
- Develop Program Specification document, Business Requirement document
- System wide impact analysis
- Perform Integration testing, Gap analysis
- Project Estimation, Effort coordination amongst all stakeholders during development
- Develop, Maintain and Monitor Project Schedule
- User Acceptance Test support
- Develop Test Plan, perform Unit and Integration testing
- Support UAT
- Coordinate test efforts
Medicaid Specialist
Missouri Medicaid
01.2017 - 09.2017
- Interaction with the Business and Development team on various requirements
- Development Team meeting, meetings with business team on various requirements
- Develop, Maintain and Monitor Project Schedule
- Coordinate, prioritize JIRA Issues
- End to End Impact Analysis
- System Conversion Support
- Develop Test Plans
Healthcare Analyst
Health Plan Services
06.2016 - 12.2016
- Design to customize the system as per the client’s requirements
- Coordinate and Participate in Agile Processes
- Extensive End to End analysis
- Issue Resolution, timely planning and coordination
- Develop various modules to receive various feeds and load those successfully into HPS system
Lead Analyst, Liaison
NC State MedicAid
09.2010 - 05.2016
- Plan phase wise merger of various IT application and set the targets for the team after carefully considering all the constraints
- Project Status Report, Coordination, Prioritization of different assignments
- Work with Release Management team on Monthly/Quarterly/Special release
- Manage logged defects, prioritize, schedule and plan the release to fix those
- Participate Joint Review Board meeting with State
- Prepare and monitor post implementation plan
- Defect Management – Prioritization, planning, coordination
- Database Design with Involvement from Architecture team
- Configuration Management
- Work Pre-Estimation, Analysis, Estimation and Monitoring the progress
- Co-ordinate Production Activities
- Meetings with Architecture and Development teams for implementation plan
- Work as Liaison for testing and other teams
Business System Analyst, Project Lead
Missouri MMIS, Infocrossing
06.2008 - 09.2010
- Meetings with State on Project Status
- Lead team on Provider & Operation Issue Resolutions, Work Estimation
- Monthly Project Production release coordination
- Guide and Mentor new members
- Work Prioritization, Coordination, Planning
- New Business Requirement meetings, discussions
- Coordination with other project teams
- Provide gap analysis and defined the scope of implementation
Project Lead, Architect
USAA
San Antonio, USA
06.2007 - 05.2008
- Gathered business requirement and converted to technical specs
- Lead Offshore – Onsite model
- Data Mapping
- Implemented Agile Methodology
- Automated Various Jobs using Scripting Languages
- Participated in all SDLC phases of Analysis, Design, Coding, Testing and Implementation
- Data extraction from different environments and databases
- Proposed various designs to meet the requirement
Onsite Project Coordinator
MetLife Auto and Home
12.2005 - 06.2007
- Lead Onsite-Offshore team
- Project Status reporting
- SOX Coordinator
- Application Optimization for cost saving
- Coordinate and Communicate between Business side and offshore technical team
- Core System Redesign for better Maintenance
- Project Deliverables Ownership
- Ensure that all the plans made, documents drafted have met the IT Quality standards after performing a quality assurance check and then went ahead for client’s approval
- Provide analytical support
Developer, Team Lead
MetLife Individual Life Insurance
05.2004 - 12.2005
- Co-ordination with onsite team for ongoing & forthcoming assignments – Delivery, schedule, identification of risks
- Developed 75+ new control cards and moved into the production
- Developed several new jobs/ JCLs for the application apart from modifying the existing
- Developed 45 new Cobol programs for the enhancement to the application
- Lead a team of 12 offshore resources on the Automation testing project
- Responsible to Product design
- Lead Conversion Process Activities
- Resource allocation
- Defined the scope, purpose and all the deliverables for the automation test effort
- Implemented the Test platform for a web based application at Verizon wireless and gave demos to the client at several stages
Education
Bachelor of Engineering -
Diploma in Business Management -
PMP Certified, 2017
Product Owner Product Manager Safe -5 Certified
ITIL V4 Certified, 2020
Agile CSM Certified
PMI-Agile Certified Practitioner, 2019
Skills
Initiating/ Planning
Resource planning, Kick off meetings, Project Charter, Project scoping, budget planning, strategic planning, implementation planning, Gap analysis, Risk Analysis, Cost-Benefit Analysis, , Communication plan
Execution
Business Requirement Documentation, Release Management; PMO; Business process re-engineering; Business process improvements; creating Business Requirements documents (BRD), Use-Case Specifications, System Requirements Specifications (SRS), Development of test plans
Monitoring/ Controlling
Status reports, Performance metrics, Quality metrics, Stake Holder Management, change management
Closure
UAT, lessons learned sessions, post-implementation meetings
Technical SKillset
Languages
COBOL, SQL, EASY TRIEVE PLUS, JCL, Java,SAS, C, C++,CICS
Scripting Language
HTML5, DHTML, XML, JavaScript, VBScript, Shell
Web Technologies
JSP,Java,J2EE,Servlets,EJB,Spring,Hibernate,WebServices, AJAX,JPA, Spring, Hibernate, Struts
Databases
DB2, SQL Server, Teradata, Oracle
Configuration Management
ENDEVOR, ChangeMan, IVMENU, VSS, JIRA
Tools
FILE–AID, Easy Plus, Xpeditor, TSO/ISPF, Visual Studio, MS Office, Smart Test, Librarian, EXTRA, Bluezone, Passport,REXX,VSAM, Teradata Studio, Tableau
Utilities
ISPF/PDF, TSO/E, SPUFI, QMF, DB2 Tool, OPC/ESA, BMC, QMF, SPUFI, SORT, FTP, Comparex, FTP, IBM Optim, Debug, Fault Analyzer, CNTL-M,SYNCSORT
Other Tools
MS office, MS Project, Sharepoint, Confluence,Visio, Adobe Acrobat, Silk Central
Timeline
Healthcare Specialist, Project Manager
DMAS-State of VA
10.2020 - Current
Project Manager,Healthcare Consultant
Anthem Inc
11.2018 - 10.2020
Technology Specialist
State of North Carolina, Child Support Service
10.2017 - 10.2018
Medicaid Specialist
Missouri Medicaid
01.2017 - 09.2017
Healthcare Analyst
Health Plan Services
06.2016 - 12.2016
Lead Analyst, Liaison
NC State MedicAid
09.2010 - 05.2016
Business System Analyst, Project Lead
Missouri MMIS, Infocrossing
06.2008 - 09.2010
Project Lead, Architect
USAA
06.2007 - 05.2008
Onsite Project Coordinator
MetLife Auto and Home
12.2005 - 06.2007
Developer, Team Lead
MetLife Individual Life Insurance
05.2004 - 12.2005
Bachelor of Engineering -
Diploma in Business Management -
PMP Certified, 2017
Product Owner Product Manager Safe -5 Certified
ITIL V4 Certified, 2020
Agile CSM Certified
PMI-Agile Certified Practitioner, 2019
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