Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Naiserg Vakharia

Albany,NY

Summary

Certified Project Manager (PMP) and Technology Strategist with over 22 years of diversified experience leading complex programs across healthcare, insurance, financial, and mortgage sectors. Expertise includes program and project management, enterprise PMOs, IT management, change management, DevOps, and business analysis, with a strong focus on integrating Artificial Intelligence and machine learning solutions to drive digital transformation, operational efficiency, and data-driven decision-making. Skilled in designing scalable AI architectures, implementing predictive analytics, natural language processing, and intelligent automation, while leading cross-functional teams of data scientists, AI engineers, and IT professionals. Proven ability to develop strategic roadmaps, optimize business processes, and execute application development, infrastructure, and cloud migration initiatives within agile, waterfall, and SDLC frameworks. Adept at stakeholder engagement, vendor management, and fostering innovation, with extensive experience working in federal healthcare programs, private insurance, and financial services—leveraging emerging technologies to deliver impactful, future-ready solutions.

Experienced with overseeing and managing multi-faceted IT programs. Utilizes project management methodologies to streamline processes and enhance productivity. Strong understanding of stakeholder management and risk assessment.

Overview

23
23
years of professional experience
1
1
Certification

Work History

Enterprise IT Program Manager

New York State Medicaid Data Warehouse
03.2024 - Current
  • Led the CMS-64 reconciliation process in partnership with the Project Management Office (PMO), ensuring precise financial reporting, adherence to deadlines, and prompt resolution of discrepancies.
  • Acted as the PMO Lead for all quarterly project initiatives, overseeing project planning, execution, and delivery. Identified opportunities to optimize the Software Development Life Cycle (SDLC), resulting in reduced cycle times and enhanced quality standards.
  • Managed the Medicaid Disproportionate Share Hospital (DSH) program in collaboration with KPMG and the Division of Finance and Rate Setting (DFRS), ensuring compliance, data accuracy, and optimal utilization of federal and state funding.
  • Developed and implemented a standardized process alongside the Program Manager to monitor and control the Medicaid Data Warehouse (MDW) budget exceeding $75 million annually, promoting fiscal accountability and strategic resource management.
  • Spearheaded efforts to modernize Medicaid data warehousing by integrating cloud services, APIs, and emerging technologies, including the deployment of Generative AI solutions to enhance data accessibility, analysis, and reporting.
  • Coordinated with multiple vendors to draft, review, and finalize Service Delivery Infrastructure (SDI) documentation for Enterprise Data Warehouse, the Office of Health Insurance Program (OHIP), ensuring comprehensive coverage of program requirements and vendor responsibilities.
  • Provided continuous guidance for the Design Development Integration (DDI) processes, resulting in improvements in data accuracy, timeliness, and operational efficiency across healthcare and financial systems.
  • Assisted in reviewing critical SDI documentation, including the MDW Data Model, Metadata, ETL processes, Reference Data, Security & Privacy protocols, and Data Delivery specifications, ensuring compliance with standards and best practices.
  • Collaborated with CIO and CTO and program manager to draft and review procurement documents such as amendments, Requests for Proposals (RFPs), and Standard Operating Procedures (SOPs), supporting procurement planning and vendor engagement.
  • Led the successful delivery of the MOSAIC INSIGHTS project with a budget exceeding $10 million, overseeing project planning, execution, and stakeholder coordination to meet strategic objectives.
  • Managed the MOSAIC AI Chatbot initiative by defining comprehensive technical requirements and ensuring alignment with emerging technologies to enhance system capabilities.
  • Assisted the Project Manager in overseeing complex CMS deliverables, including the T-MSIS initiative, by coordinating efforts to ensure timely and accurate completion. Facilitated issue resolution related to the transition of Encounter data from EIS to OSDS and supported the implementation of the pharmacy rebate program, ensuring compliance with project requirements and regulatory standards.
  • Assisted the PMO in preparing the Advanced Planning Document (APD) with comprehensive guidance for submission and approval by CMS.
  • Maintained strong stakeholder relationships with University of Rochester, SUNY Buffalo, OMIG, OMH, NYSOH, eMedNY, and DDSA, facilitating the development of use cases for RFP processes aligned with organizational goals.
  • Directed the Medicaid DSH program in partnership with KPMG and DFRS to ensure compliance and maximize program performance.
  • Coordinated the CMS-64 reconciliation process with the PMO, ensuring accurate reporting and timely submissions.
  • Led process improvement initiatives within the SDLC to enhance project efficiency and effectiveness.
  • Developed a fiscal management process with the Program Manager to oversee the MDW budget, ensuring accountability and strategic resource allocation.
  • Drafted, reviewed, and finalized SDI documentation for the EDW OHIP program, working closely with multiple vendors to ensure clarity and compliance.
  • Provided ongoing leadership to optimize the Design Development Integration (DDI) workflows, improving data integration and operational performance.
  • Maintained comprehensive reviews of SDI documentation, including data models, metadata, ETL processes, reference data, and security protocols, maintaining high standards of quality and compliance.
  • Collaborated with the Quality Assurance team to streamline processes such as the HELIX attestation and vendor employee matrix, enhancing compliance tracking and audit readiness.
  • Partnered with the Division of Data Services and Analytics to optimize Tableau reporting processes, improving data visualization and decision-making efficiency.
  • Supported the CIO and CTO in drafting procurement strategies, including amendments, RFPs, and SOPs, ensuring alignment with organizational standards and regulatory requirements.
  • Facilitated cross-functional communication among internal teams, external vendors, and regulatory agencies to ensure seamless project execution and compliance.
  • Monitored industry best practices and emerging regulations, recommending process enhancements to maintain alignment with healthcare policies.
  • Drafted detailed scope and requirements documentation for the Health Home Tracking System transition, ensuring a comprehensive and effective transfer of responsibilities.
  • Streamlined the Leave and Accrual Tracking System (LATs) process for improved accuracy and efficiency in financial management.
  • Supported the DOH contracts team by providing necessary information and assistance for contract renewals and ongoing vendor management activities.

IT Project Manager

New York State Medicaid Data Warehouse
02.2018 - 02.2024
  • Managed daily/weekly operational support tickets and over 30 change requests, preparing project plans, status reports, and maintaining the EPMO change register, project register, and SharePoint updates.
  • Led complex implementation projects utilizing Agile and waterfall methodologies, defining business requirements with multiple vendors and stakeholders, and supporting stakeholder engagement during procurement processes.
  • Participated in weekly CAB meetings, supporting data profiling, data modeling, health plan reviews, HL7 implementations, budget planning, and prioritizing new requirements, changes, ad-hoc reports, and project schedules.
  • Extensively utilized Smartsheet for project planning, tracking, and collaboration, creating and maintaining complex project schedules, Gantt charts, and dashboards.
  • Established and maintained project charters, monitored project schedules, budgets, KPIs, risks, defects, and ROI throughout the SDLC process.
  • Led vendor, provider, and auditor collaborations for office relocations, ID management, EDI supplement modifications, and transaction backfill to data warehouses.
  • Collaborated with data architects, project managers, and analysts to identify requirement gaps and implement complex data warehouse projects such as MEDA, HL7, Rest API, T-MSIS, and Tableau reporting.
  • Supported QA teams and data analysts by reviewing functional/technical design documents, preparing cross-system mappings, and drafting RFPs; generated reports and data analyses using Smartsheet.
  • Organized and led daily stand-ups, weekly project meetings, and lessons learned sessions with vendors and stakeholders.
  • Delivered end-user reports via Tableau, supported Tableau server deployment, and managed the entire project lifecycle for software development.
  • Managed over 20 change requests, tracking progress, and ensuring project stability; prepared business design documents, daily status reports, and maintained change and project registers.
  • Provided insights and analyses to stakeholders on projects such as T-MSIS, pharmacy rebates, VBP, DSRIP, health plans, and office relocations, leading a team of 20+ members.
  • Organized project documentation, spreadsheets, and reports within Smartsheet workspaces; participated in federal/state meetings with CMS and OHIP to ensure compliance with CMS timelines.
  • Developed workflows to establish lean environments, supporting API implementation, HL7 guidelines, and deployment processes.
  • Identified gaps, resolved issues, and managed project schedules to address budget constraints and ensure timely delivery.
  • Collaborated on Business Design Documents (BDD), verifying all requirements aligned with stakeholder needs and project objectives.

IT Project Manager

New York State of Health-Affordable Care Act
06.2012 - 01.2018
  • Results-oriented Senior Project Manager with extensive expertise in leading large-scale healthcare IT initiatives, including the NY State of Health and Affordable Care Act (ACA) programs. Demonstrates a strong track record of managing complex projects, driving stakeholder engagement, and delivering innovative, high-quality solutions within scope, budget, and schedule. Adept at aligning technology strategies with organizational goals, optimizing processes, and ensuring compliance with industry standards and regulatory requirements.
  • Directed over 150 major project releases, overseeing planning, requirements gathering, risk management, and SDLC execution using Agile and waterfall methodologies, with a total project budget exceeding $50M.
  • Developed and maintained detailed project plans, including scope, WBS, risk assessments, vendor contracts, SOPs, and quality assurance processes, utilizing tools such as Rational RRC, RTC, RQM, and SharePoint.
  • Led the development and implementation of core eligibility and enrollment systems using Java, Webservices via Drupal, HL7 interfaces, and API integrations, ensuring compliance with ACA, HIPAA, and security standards.
  • Managed cross-functional teams of 25–60 members, including stakeholders, vendors, and federal/state agencies, providing mentorship, technical guidance, and process improvements.
  • Established and operationalized the DITI process, significantly reducing production issues and improving release quality.
  • Coordinated end-to-end testing, regression, and validation efforts, including HL7, EDI, and API testing, ensuring seamless deployment across systems.
  • Conducted gap and risk analyses to identify performance bottlenecks and scope modifications, recommending strategic improvements and technical solutions.
  • Led stakeholder communications, prepared status reports, interface matrices, and project documentation to ensure alignment and compliance.
  • Facilitated lessons learned sessions post-release, driving continuous process improvements and best practices.
  • Supported federal and state compliance (HIPAA, ACA, CMS) through rigorous artifact development, testing, and audits.
  • Led the development of ACA-specific functionalities, including:
  • O Enrollment & Eligibility: Managed end-to-end processes for ACA enrollment and eligibility verification.
  • O Interface (EDI) Development: Oversaw over 10 federal and state interfaces supporting Medicaid, CHIP, IRS, CMS, and other agencies, with budgets over $25M.
  • O Back Office Customer Service: Led development of customer support portals, ensuring compliance with ACA standards and improving user experience.
  • O Small Business (SHOP): Managed the SHOP application development, coordinating with distributed teams and stakeholders, and ensuring timely delivery within a $20M annual budget.
  • Conducted gap and risk analyses to identify performance bottlenecks and scope modifications, recommending strategic improvements and technical solutions.

IT Project Manager

First Niagara Financial Corporation
12.2011 - 05.2012
  • Led the consolidation and streamlining of business practices following the merger of First Niagara and HSBC acquisitions, ensuring seamless integration and operational efficiency.
  • Conducted comprehensive analysis, evaluation, and documentation of technical requirements; developed and managed Work Breakdown Structures (WBS) and project plans across various project lifecycle phases.
  • Collaborated with application stakeholders and developers to design and build data models aligned with project initiation documents and business needs.
  • Managed a cross-functional team of over 70 professionals, including DBAs, Data Architects, Business Analysts, QA teams, stakeholders, and vendors; acted as a liaison between development and architecture teams to facilitate data model development.
  • Drafted and negotiated Statements of Work (SOW) with vendors, overseeing contract performance throughout all project phases. Developed and maintained risk management, quality assurance, and development plans; identified resource requirements, scheduled testing efforts, and updated project schedules based on evolving requirements.
  • Led daily Scrum meetings with vendors to address core issues, coordinate resolution strategies, and ensure timely delivery of schema development; tested and validated new database schemas against existing schemas to ensure compatibility and performance.

IT Project Manager

Health Care Group
03.2011 - 11.2011
  • Developed and maintained complex project plan. Managed project team including subcontractors. Reviewed and approved all project documentations. Prepared, reviewed, and modified WBS with the help of functional managers according to resource availability.
  • Successfully implemented EDI/ecommerce transactions including 830 schedule agreements, security standards like HIPPA and Cisco, Payor, 850 purchase order and 810 invoices on time within budget.
  • Coordinated with SMEs for smooth implementation of the project at client location. Extended post implementation, application maintenance and technical support to clients.
  • Involved in extracting information, manipulate, format, and automatically publish customized business documents across multiple media formats. Lead both release and O&M support projects and delivered CR’s and issues on time to productions. Managed HL7 test strategy for developing and executing test cases in SIT and RIT environment.
  • Arranged daily status meeting and weekly build meeting with functional managers and stakeholders to document all stakeholders concerns and requirements for further implementations.
  • Reviewed conceptual and physical data model (Oracle) changes with stakeholders before implementations. Designed and developed of software applications and team members to provide proper communication channels.

IT Project Manager

HEALTHATION, CA
04.2010 - 02.2011
  • Develop ROI Model
  • Responsible for cost, estimation, and planning project change requests. Managed project budget over $25 M.
  • Restructured and established an improved process for claims budgeting. Tracked and reviewed activity against detailed Project plans including CMS and state identified scenarios.
  • Conducted QA audit of computerized systems as part of inspection readiness program to ensure compliance with regulatory and Mylan internal policies. Expertise in building web applications using ASP.NET MVC, including creating controllers and views, handling user input, and managing application flow.
  • Used XML to represent pieces of standard text that occurs in Documents, Review industrial standards against developments.
  • Prepared HIPAA EDI Transactions (837/835/834/Payor) technical Project plan. Wrote SQL queried to retrieval, insertion, updating, and deletion of data, HL7 defect logs, and performing management and administrative functions. Support test manager to identify test scripts using VB script. Reviewed all production data report exported through Informatica and discuss require changes in data structure with the help of data architect.
  • Supported SMEs to conduct QA audits using a SOAPUI tool, HL7, Rest API, SharePoint tracking, and custom code using rational tool and JAVA. In depth knowledge of smart identification feature on .NET.

Sr. IT Project Manager

Henry Ford Health System
08.2008 - 04.2010
  • Developed and maintained comprehensive project plans, including Integrated Project Teams (IPTs), budgets, and forecasts, ensuring alignment with project objectives and timelines.
  • Reviewed business, functional, and system requirement specifications, high-level design documents, detailed designs, and requirement matrices; created Work Breakdown Structures (WBS) to facilitate project execution within waterfall methodologies.
  • Designed and implemented vendor management SOPs and design procedures that increased operational efficiency, enhanced customer satisfaction, and reduced error rates.
  • Prepared and presented project overviews and status reports during executive committee meetings utilizing BI and reporting tools such as BIRT and Cognos, ensuring clear communication of project progress and risks.
  • Demonstrated strong expertise in the ASP.NET MVC framework, including controllers, views, models, and routing, supporting application development and enhancements.
  • Provided effort estimations and coordinated with development and testing teams to plan and execute schedules using Agile methodologies, ensuring high-quality deliverables within UAT and production phases.
  • Collaborated with program managers to identify impacts of scope changes, prepare scope documents, and effectively control project risks and budgets associated with new requirements and environment adjustments.

Instrument Product Control Engineer

Techno Product Industries
02.2006 - 07.2007
  • Defined and formulated system scope and objectives aligned with user requirements, leveraging industry standards and technologies such as Java, VB scripting, and JavaScript to ensure system compliance and performance.
  • Collaborated with project managers and team members to develop detailed project plans, successfully defining scope and executing tasks to meet project milestones and deliverables.
  • Developed complex SQL queries and executed database validation procedures against Oracle databases to verify data integrity and production accuracy.
  • Facilitated communication with team members and stakeholders to enhance the quality assurance (QA) process and perform qualitative risk analyses, ensuring project quality and risk mitigation.
  • Created detailed quality process workflow diagrams using Rational Rose, establishing requirement traceability and process clarity.
  • Monitored and controlled project schedules, proactively identifying new risks, updating risk registers, and integrating risk management into the overall project quality plan.
  • Engaged in strategic data modeling activities to support information system architecture and development, aligning technical solutions with business objectives.

IT Specialist – IT System Manager

Ravi Engineering
01.2003 - 02.2006
  • Participated in daily team meetings and developed comprehensive risk mitigation plans to proactively address potential project challenges.
  • Prepared detailed unit project plans for production phases and reviewed daily execution reports to monitor ongoing activity and ensure project adherence to milestones.
  • Generated and presented progress reports to product owners and cross-functional team members, utilizing QuickBooks and VB scripting to enhance reporting accuracy and efficiency.
  • Restructured the support team workflow based on waterfall methodology, integrating change management processes, training protocols, and performance monitoring to improve support operations.
  • Designed standardized templates for production reports, issue tracking, and daily maintenance documentation, aligning with Technical Inspection Association (TIA), IBR, and ISO standards to ensure compliance and quality consistency.

Education

Master of Science - Information Technology

University of Virginia
Charlottesville, VA
12-2009

Master of Science - Technology Mangement

University of Bridgeport
Bridgeport, CT
12-2007

Bachelor of Science - Instrumentation And Control Engineering

Saurashtra University
INDIA
06-2006

Skills

  • Project Management/Program Management
  • Artificial Intelligence (AI) & Machine Learning (ML) Imp
  • Enterprise Project Implementations/Data scientist
  • System Migrations/Program Transition
  • Requirement Definition & Analysis
  • Data profiling /Data Architect
  • Data Governance and Security
  • Project Budgeting & vendor management
  • Quality Assurance/Change management
  • Team Building & Leadership

Certification

PMP, PMI-RMP, CAPM, PgMP, ACP, Six Sigma, Waterfall, ITIL, CMMI, Lean Methodology, OCM Methodology, Waterfall, Tableau, Big Query, GCP, Python.

Timeline

Enterprise IT Program Manager

New York State Medicaid Data Warehouse
03.2024 - Current

IT Project Manager

New York State Medicaid Data Warehouse
02.2018 - 02.2024

IT Project Manager

New York State of Health-Affordable Care Act
06.2012 - 01.2018

IT Project Manager

First Niagara Financial Corporation
12.2011 - 05.2012

IT Project Manager

Health Care Group
03.2011 - 11.2011

IT Project Manager

HEALTHATION, CA
04.2010 - 02.2011

Sr. IT Project Manager

Henry Ford Health System
08.2008 - 04.2010

Instrument Product Control Engineer

Techno Product Industries
02.2006 - 07.2007

IT Specialist – IT System Manager

Ravi Engineering
01.2003 - 02.2006

Master of Science - Information Technology

University of Virginia

Master of Science - Technology Mangement

University of Bridgeport

Bachelor of Science - Instrumentation And Control Engineering

Saurashtra University

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Naiserg Vakharia