Healthcare IT Professional Healthcare Lead Business Solution Architect/ Product Manager with 10+ years of experience in healthcare applications implementations, business requirement analysis, enterprise solution delivery, under budget, and at finest quality with minimal impact. Well-versed in process orientation and financial aspect toward cost reduction and enhancement. Key achievement: Partnered with various departments to ensure that all requirements goes through sprint process to avoid multiple code branches for different clients. Ultimately resulting in a single platform with all enhancements named MHK2.0 and help the organization to upgrade any client with ease.
Skills
Technical Skills:
Application Roadmap solution
Complex Problem solving
Critical Thinking
Gap Analysis
Troubleshooting
Business Process Improvement
Experience in Integrated Solution:
Care Management
Utilization Management
Population Health
Pharmacy Part D
Part B
Grievance & Provider Dispute
Medication Therapy Management (MTM)
Tools and Software:
MS Office Tools
Microsoft Visio
MySQL
Project Management Tools
Experience
Lead Business Solution Architect/ Product Manager, 09/2018 - Current MHK – City, STATE,
Extensively interacted with the stakeholders, compliance team, security and the IT Department in finalizing the requirements according to the CMS Compliances/Regulations and HIPAA Regulations
Worked with cross-functional teams through project lifecycle phases, including requirements gathering, design, and deployment
Implemented multiple million dollar projects including; CVS and Aetna merger, Scan LTSS project, Texas Medicaid implementation etc…
Implementing Integration solution including; CM, UM, Pharmacy Part D and Part B, Grievance, MTM, Provider Dispute, Provider and Member Portals
Working with multiple clients on Integration and Interface projects to support EDI 278 (Prior Auth), 837 (Claims), HL7 and real-time API or batch interface implementation
Used Soap UI and Postman to test API request & responses
Worked on requirements for Rules engine, UI interface, data mapping, workflow enhancements, auto-tasking, SSO and process improvements with automation
Develop clinical TO-BE workflows based on the client's AS-IS workflows.
Healthcare Sr. Business Analyst, 06/2018 - 09/2018 Adbakx – City, STATE,
Partnered with Emids and myNEXUS project team, developed a new home health services platform to deliver offline solution for nurses to conduct survey and provide care by making visitation
Elicit Healthcare requirements using various sources/techniques including interviews, brainstorming sessions, workshops, site visits, business process flows, scenarios task, system analysis and document analysis
Details User stories including User Interface prototype, attributed Domain Model, Business Rule specifications, Interface/Integration specifications and workflow diagrams.
Healthcare Business System Analyst, 04/2013 - 06/2018 ZeOmega – City, STATE,
Implemented Population Health System at various client location including; Florida Blue, AmeriHealth Caritas, Community Health Choice, Cardinal Innovations, Group Health Corporation (now Kaiser), MDwise & HealthSmart
Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle
Worked with modules of Care management such as; Utilization management, Case management and Disease management
This further stretches out to Medical Referrals, Intake, Authorizations, Appeals and Physician Reviews
Worked with EMR and ADT to HIE system integration to translate the HL7 and C-CDA feed into xml to display Lab Results, Problems, Allergies, Medication, Clinical Summary in Patient Portal and Provider Portals
Worked with Delivery Managers, Subject Matter Experts, IT professionals, and Software developers to define project scope and objectives
Worked with various tools including Extract, Transfer & Load (ETL), WSO2, Postman for Restful (Web-Services) testing and Single Sign-On (SSO) for Integration and Interface data load.
Healthcare Business System Analyst, 09/2011 - 04/2013 Tekenergy – City, STATE,
Involved in the development of Eligibility Integrity and Access Integrity suite to make revenue cycle management smarter, better and faster
It is designed to help a healthcare facility achieve "meaningful" outcomes in less time and at lower costs
Extensively worked on 270 & 271 EDI X12 5010 to improve the current Eligibility and Benefit application and launch a stand-alone Eligibility Application
Constantly working with development team on Object-Oriented Modeling and Relational Database to maps the properties and subsequent fields
Produce visual models for the application using MS Visio to create Sequence, Workflow Diagrams and Activity Diagrams.
Education and Training
Masters of Business Administration (MBA): Information Technology, Expected in 04/2012 - The University of Dallas - , Texas GPA:
Bachelor of Business Administration (BBA): , Expected in 06/2007 - Chaudhary Charan Singh University - , GPA:
Certifications
Leadership Development by Harvard Business Publication
HIPAA Certified
Pre-MBA Certification
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