A Pragmatic and result oriented individual with over 16 years of experience in US Healthcare and Pharmacy industry that includes Problem solving, Process Improvement, Go to market strategies and optimizing systems to address dynamic needs.
Overview
17
17
years of professional experience
3
3
Certificates
Work History
System Analyst Advisor
Elevance Health
Norfolk, VA
06.2017 - Current
Manage product backlog for feature work, while planning for GROWTH strategy to support Enterprise Goals
Enhance project management skills by defining and presenting system solutions and timelines for business needs or technical problems
Assess data modeling and statistics to integrate high-level business processes with data rules.
Implemented solution for automating member LIS refunds through Facets product bringing down complete manual intervention by Billing/Cash operation teams resulting in quicker refunds and FTE cost reduction.
Led migration of Member Billing and Finance area from legacy system to Facets product for Employer group Retiree Line of business
Gathered requirements and performed gap analysis through design workshops with users.
Review technical design from technical team and ensure conformance to defined solution and business requirements for all Finance process which include Cash Journals (Journal entries to PeopleSoft General Ledger) and Sub Ledger reports(Account level reports used to verify variance against journal entries posted to General Ledger)
Analysis of Cash Journals posted to PSGL and Sub Ledger reports generated each month to identify discrepancies between PSGL system values and payments posted in Facets (source system). Lead execution of partner testing/internal testing and review results with business and Vendor.
Coordinate with DBA and development team to design tables and semantic views to meet end user performance needs.
Develop and own documentation to include work flows, functional and technical requirements and user stories
Mentored and coached new hires to grow their talent to next level
Sr. Consultant
CVS HEALTH CORPORATION
Solon, OH
06.2013 - 05.2017
Maintained service level agreements for 50+ large Health Plan clients to avoid service warranty pay-outs
Managed team of 12-14 employees performing testing and quality assurance of health plan prescription drug benefits for Medicare, Commercial and Exchange lines of business
Developed standardized reporting and dashboards to monitor key performance indicators(KPI) metrics and trends
Performed the root cause analysis for all the production correction cases and set up action plans for not occurring again
To drive process and consistency across board, lead team to create regression suite for MOB cases which helped to reduce production corrections.
Responsible for reducing Performance Guarantee penalties year on year by client
Determined areas for improvement and implemented processes to alleviate problems.
Lead all UAT tasks for End to End projects where systems are involved from Interrogation through Fulfillment
Involved in creation and analysis of Business Requirements, Functional design and technical design documents for enterprise level project RxEnroll
Identified business issues through careful collaboration with key stakeholders.
Prioritized projects and project tasks depending upon key milestones and deadline dates.
Monitored and managed staff performance to attain target metrics both individually and team unit.
Worked with different teams to see the need of trainings for the resources in Health Benefits team so that they perform well.
Configured data in FACETS application and prepared Knowledge repositories.
Associate Projects
Cognizant Technologies Solutions
College Station, TX
07.2006 - 05.2013
Worked in various roles like QA Lead, UAT Lead and Business/System Analyst.
Worked on EDI transactions like 270/271, 276/277, 837 and 835, Benefits testing, Agreement/Pricing Testing and member enrollment.
Lead the UAT tasks for Provider agreements, Price calculations and Product/Plan benefits
Creating and managing high performing engineering teams, Mentoring, and coaching to grow talent to next level
Developed detailed project plan with emphasis on deliverables.
Created solutions for customers to satisfy specific needs, quality and budget.
Prepared Daily status reports to be shared with Project PMO team
Used Microsoft tools to create correspondence, edit spreadsheets and develop presentations.
Education
Bachelor of Science - Computer Science
Andhra University
India
05.2001 -
Skills
Project Management
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Certification
Professional, Academy for Healthcare Management (PAHM) by AHIP Certified.