DEEPA

GOVINDARAJAN

****

JACQUELINE

DR,

APT

E62,

W ILMINGTON,

DE

19810

ab6rw9@r.postjobfree.com

978-

317-

3056

Product

Consultant

/

Manager

–

Solution

Delivery

End-

to-

End

Solution

Delivery

~

Technology

Leadership

~

Account

&

Team

Management

Accomplished

Product

Consultant

/

Project

Manager

with

13

years

of

experience

and

a

verifiable

track

record

of

leading

/

managing

complex

IT

engagements,

predominantly

in

the

Healthcare

Payer

space.

Experienced

in

managing

end

to

end

implementations,

performing

gap

analysis

between

goals

and

existing

procedures/skill

sets,

and

designing

process

and

system

improvements

to

increase

productivity

and

reduce

costs.

Experienced

in

managing

and

orchestrating

large

data

migration

projects,

defining

and

executing

Playbook

activities

for

successful

implementation.

Extensive

experience

in

solutioning,

effort

estimation,

ROI

calculation

and

responding

to

RFPs.

Good

interpersonal

skills,

adept

at

facilitating

discussions

and

negotiations

with

stake

holders.

Additional

areas

of

expertise

include:

Project

Management

&

Tracking

Project

Risk,

Scope

&

Cost

Solution

Architecture

Management

of

Cross-

Change

Control

Talent

Development

&

Functional

Teams

Management

Resource

Management

Education

Masters

in

Computer

Applications,

Bharathidasan

University,

INDIA

Bachelors

in

Mathematics,

University

of

Madras,

INDIA

Certifications

AHM

250

certified

–

An

Introduction

to

Healthcare

Management

AHM

510

certified

–

Governance

and

Regulation

Cognizant

Certified

Professional

in

Managed

Healthcare

Competencies

Management

Domain

/

Technology

Expertise

Solution

Delivery

&

Client

Management

Medicaid

–

On-

boarding

and

end-

to-

end

implementation

of

new

Project

Management

in

a

multi

vendor

LOBs

for

Medicaid

on

Facets

core

claims

processing

platform

environment

Medicare

–

Implementation

of

a

Medicare

Dual

Eligible

Special

Project

Management

across

multiple

horizontals

/

Needs

(D-

SNP)

program

on

Facets

and

Trizetto

suite

of

products

verticals

/

specialties

and

locations

(TMS)

Manage

stakeholder

expectations

Consolidation

–

Consolidation

of

several

Facets

product

Scope

and

Risk

Management

instances

Project

invoicing

&

Profitability

monitoring

Regulatory

Projects

–

Assessment

and

implementation

of

a

People

and

Performance

Management

solution

to

address

NPI

regulations

Recruitment

&

Retention

Product

Upgrades

–

End-

to-

end

assessment,

remediation

and

Business

development,

RFP

responses,

implementation

of

the

Facets

product

upgrade

and

change

packs

Opportunity

Identification

and

definition

of

Migration

–Migration

/

Conversion

from

Legacy

platforms

to

statements

of

work Facets

PROFESSIONAL

EXPERIENCE

Cognizant

Technology

Solutions

–

Sep

2000

to

Current

Led

globally

diverse

teams

consisting

of

Project

Managers

/

Leads,

functional

consultants

and

•

software

developers;

oversaw

multiple

projects

simultaneously.

Experience

in

functional,

techno-

functional

consultant

roles

for

various

healthcare

customers

such

•

as

United

Health

Group,

Blue

Cross

Blue

Shield

of

MI,

Claims

Sphere,

Dental

Benefit

Providers,

TMG

Health,

Fidelis

Care

NY,

WellPoint,

Blue

Cross

Blue

Shield

of

RI

and

AmeriHealth

Mercy

Family

of

Companies

(AmeriHealth

Caritas).

Managed

teams

of

size

35

(direct

reports)

and

budgets

of

10M.

•

Managed

complex

projects

in

a

multi-

vendor

environment

that

included

the

plan’s

employees

and

•

numerous

vendors

for

IT

solutions

and

specific

plan

functions.

Managed

cross-

functional

teams

across

multiple

locations.

•

Planned

and

oversaw

all

phases

of

software

development

life

cycle

(SDLC)

in

large,

complex

•

technical

environment,

including

assessment

and

feasibility

studies,

scheduling,

budgeting,

resource

allocation

and

status

reporting

to

higher

management.

Handled

multiple

projects,

requiring

extensive

IT

Healthcare

experience

using

TriZetto’s

Managed

•

Care

application

&

its

conversion

and

implementation.

Led

the

selection

of

3rd

party

software,

including

Healthplan

CRM

vs.

Salesforce.com

for

Medicare

•

implementation

meeting

CMS

requirements.

Led

Data

and

Application

design

and

architecture

aspects

to

seamlessly

fit

in

new

LOBs

into

the

•

existing

landscape.

Provided

product

configuration

recommendations

for

combining

working

models

across

LOBs.

•

Led

Data

Conversion

processes

for

migration

/

conversion

projects

and

Facets

product

upgrades.

•

Developed

solution

approaches

and

architecture,

guidelines

and

provide

IT

strategic

viewpoint

•

associated

with

the

Medicare

Implementation

solution

design

activities.

Executed

IT

strategies

and

objectives

to

maximize

short

term

impact

utilizing

existing

systems

and

•

positioning

systems

for

scalability.

Created

system

interaction

models,

addressing

business

and

technical

needs.

•

Supported

multiple

application

releases

in

parallel

utilizing

milestone

based

development

•

implementations.

Defined

and

developed

the

go

live

Playbook

that

includes

critical

line

of

path,

sequences

and

•

action

steps

for

successful

implementation.

Managed

end-

to-

end

go

live

planning

and

execution

ensuring

timely

delivery;

work

with

business

•

to

identify

cut-

over

windows

in

the

production

schedule

and

facilitate

conversion

loads.

Provided

subject

matter

expertise

associated

with

Medicare

and

the

customer’s

IT

environment

•

throughout

the

entire

project

development

life

cycle.

Worked

with

customers

to

define

business

and

processes

from

an

IT

perspective,

functional

•

requirements

and

data

element

requirements.

Devised

a

plan

and

successfully

managed

the

automation

of

the

PMO

reporting

processes.

•

Responsible

for

coaching

leads

on

the

various

projects

on

methods

and

means

to

improve

overall

•

performance

by

maximizing

the

contribution

of

individuals

and

teams.

Problem

resolution

recommendation

for

escalated

issues.

•

PROJECT

PROFILE

P ROJECT(S)

–

B CBSM

N EW

B USINESS

IMPLEMENTATION

C LIENT:

A MERIH EALTH

CARITAS

R OLE:

P ROJECT

M ANAGER

/

IS

IMPLEMENTATION

L EAD

D URATION:

FEB

2 01 3

–

CURRENT

Description

-

AMFC,

a

premier

Medicaid

company

in

the

US

healthcare

industry

currently

operates

its

lines

of

business

in

various

states

either

through

partnerships

or

as

TPAs.

BCBSM

acquired

Amerihealth

Mercy

in

April

2013

when

the

company

was

renamed

to

Amerihealth

Caritas.

AmeriHealth

Caritas

(formerly

Amerihealth

Mercy

Family

of

Companies)

is

a

majority-

owned

subsidiary

of

Independence

Blue

Cross;

Blue

Cross

Blue

Shield

of

Michigan

holds

a

minority

interest.

Prior

to

this

partnership,

BCBSM's

Medicaid

business

was

hosted

at

Trizetto.

With

this,

a

decision

was

made

to

maintain

BCBSM's

Medicaid

business

at

Amerihealth

Caritas,

which

led

to

BCBSM

being

implemented

as

a

new

line

of

business.

As

an

IS

Implementation

Lead

/

Project

Manager

on

the

BCBSM

Medicaid

New

Business

Implementation:

Implemented

a

new

line

of

business

offering

augmented

ability

to

claim

adjudication

and

claim

processing

-

Lead

the

IT

data

and

application

aspects

to

seamlessly

fit

in

Michigan

business

into

the

Amerihealth

Caritas

-

landscape

Lead

analysis

of

Michigan's

Facets

data

and

conversion

to

AMFC's

structure

for

data

and

maintenance

-

Lead

the

migration

of

Michigan's

data

on

Facets

4.71

into

the

Amerihealth

Caritas

instance

and

Facets

upgrade

to

-

5.01

Make

config

and

design

recommendations

combining

Michigan's

and

Caritas's

working

models

-

In

coordination

with

other

IT

teams,

define

and

execute

/

coordinate

execution

of

the

Playbook

activities

providing

-

critical

information,

sequences

and

action

steps

for

successful

implementation

Work

with

business,

Amerihealth

and

Michigan

batch

IT

teams

to

identify

cutover

windows

in

Facets

production

-

schedule

to

facilitate

conversion

loads

Go-

live

and

post

go-

live

planning

/

execution

and

timely

delivery

-

Project

Management

activities

including

managing

scope,

effort,

resources,

schedule,

risks,

issues

and

change

-

requests

Staff

management,

interviews

and

recruitments

-

P ROJECT(S)

–

M EDICARE

D -

SNP

IMPLEMENTATION

C LIENT:

A MERIH EALTH

M ERCY

F AMILY

OF

C OMPANIES

(AMFC)

R OLE:

P ROJECT

M ANAGER

/

IS

IMPLEMENTATION

L EAD

D URATION:

M AY

2 012

–

JAN

2 013

Description

-

Dual

eligible

D-

SNPs

are

a

high

cost

sub

population

within

Medicare,

representing

16%

of

the

Medicare

beneficiaries,

but

accounting

for

24%

of

the

total

Medicare

spending.

In

addressing

this

issue,

CMS

is

working

to

facilitate

integration

of

Medicare

and

Medicaid

services

(dual

eligible

population)

and

to

create

incentives

for

States

and

plans

to

work

together

to

produce

a

well-

coordinated

service

delivery

experience

for

dual

eligible

beneficiaries.

AMHP

is

planning

on

offering

Medicare

Advantage

Special

Needs

Program

for

dual

eligible

members

by

01/01/13

(D-

SNP).

As

an

IS

Implementation

Lead

/

Project

Manager

on

the

Medicare

D-

SNP

program:

Lead

the

implementation

of

the

program

on

Trizetto

Facets

and

TMS

suite

of

products

Provide

subject

matter

expertise

associated

with

Medicare

and

AMHP's

IT

environment

through

the

entire

project

development

life

cycle

Work

with

clients

to

define

business

and

processes

from

an

IT

perspective,

functional

requirements

and

data

element

requirements

Consistently

make

decision

recommendations

and

takes

actions

which

fully

support

targeted

strategic

changes

Develop

solution

approaches

and

architecture,

guidelines

and

provide

IT

strategic

viewpoint

associated

with

the

Medicare

Implementation

solution

design

activities

Identify,

design

and

facilitate

the

delivery

of

IT

based

solutions

to

meet

Medicare

business

needs

Creation

of

a

system

interaction

model,

addressing

the

needs

of

both

the

business

and

technical

teams

Participate

in

recruitment

efforts,

management

of

resources

and

performance

appraisals

Responsible

for

staff

development,

mentoring

and

supervision,

also

ensuring

timely

delivery

Create

and

manage

project

schedules,

effort

and

cost

estimates

Define

statements

of

work,

manage

change

control

and

change

requests

P ROJECT

–

B LUET RANSIT

C LIENT

-

B LUE

C ROSS

B LUE

S HIELD

OF

R HODE

ISLAND

R OLE:

P ROJECT

M ANAGER

D URATION:

A UGUST

2 010

–

M AY

2 012

Description

–

Rhode

Island’s

leading

health

insurer,

BCBSRI

covers

more

than

600,000

members.

BCBSRI

decided

to

migrate

to

a

new

operating

platform,

FACETS

as

the

existing

(legacy)

system

reached

its

functional

capacity.

BCBSRI

is

taking

a

phased

approach

over

a

span

of

three

years

to

ensure

that

the

new

system

can

appropriately

administer

the

required

functions.

As

a

BCBSRI

Project

Manager,

responsible

for:

Responsible

for

coaching

leads

on

the

various

projects

within

this

account

on

methods

and

means

to

improve

overall

performance

by

maximizing

the

contribution

of

individuals

and

teams

Problem

resolution

recommendation

for

escalated

issues

Project

delivery,

planning,

schedule

alignments

with

client’s

project

plans,

risk

management,

quality

assurance

and

other

aspects

involved

with

Release

4

of

this

large

program

Suggested

approaches

/

execution

methodologies

on

Medicare

Implementation,

generic

solution

for

Multi-

format

to

single-

format

conversion,

CM

data

migration

to

FACETS

Devised

a

plan

and

successfully

managed

the

automation

of

the

PMO

reporting

process

for

the

BlueTransIT

program

As

a

key

member

of

the

Cognizant

Leadership

team

at

the

muti-

vendor

BCBSRI

environment:

Identified

business

development

opportunities

and

provided

implementation

solutions

in

multiple

areas

Conceived,

built,

presented

and

drove

FACETS

initiatives

including

Medicare

Implementation,

FACETS

Config

proposals,

UM/CM

data

migration

to

FACETS

and

SRP

(Service

Related

Parameters)

claims

baseline

and

sync

Initiatives

on

FACETS

Configuration

were

perused

to

help

penetrate

an

area

that

constantly

has

been

high

on

demand

and

a

win

over

other

existing

vendors

Presented

the

Release3

AES

approach

to

the

client

CIO

that

re-

established

client’s

confidence

in

Cognizant

P ROJECT(S)

-

A MFC

U NIFIED

P LATFORM

C ONSOLIDATION

C LIENT:

A MERIH EALTH

M ERCY

F AMILY

OF

C OMPANIES

(AMFC)

R OLE:

DELIVERY

M ANAGER

D URATION:

N OVEMBER

2 008

–

JULY

2 010

Description

-

AMFC,

a

premier

Medicaid

company

in

the

US

healthcare

industry

currently

operates

its

lines

of

business

in

various

states

on

different

instances

of

FACETS.

Owing

to

the

high

level

of

similarity

between

the

business

processes

of

various

Lines

of

businesses

(LoBs),

AMFC

is

consolidated

the

different

instances

of

FACETS

across

the

LoBs.

Project

scope

included

an

Assessment

/

Feasibility

Study,

providing

recommendations

and

implementation

of

remediation

strategies.

As

a

Project

Manager,

was

responsible

for:

Managing

a

35

member

team

executing

in

multiple

locations

and

across

multiple

horizontals

/

verticals

/

specialties,

also

ensuring

timely

delivery

and

high

quality

Instrumental

in

the

ramp-

up

and

responsible

for

managing

the

induction

of

over

30

resources,

both

internal

and

external,

into

the

project

Directly

involved

in

interviews,

recruitment

and

project

on-

boarding

Project

Planning,

Scheduling

and

Estimation

Prioritize

requests

for

customized

work

plans

/

adhoc

requests

to

ensure

that

adequate

staffing

is

in

place

to

meet

anticipated

needs

Establish

the

work

plans

for

execution

and

ensure

that

appropriate

processes

in

support

are

derived

Determining

appropriate

revenue

recognition,

ensuring

timely

and

accurate

invoicing

Risk

Management

and

handling

Change

Requests

Status

Reporting

to

higher

management

Providing

Design

and

overall

architecture

recommendations

P ROJECT

-

S ENIOR

M A

F ACETS

C LIENT:

W ELLP OINT,

INC

R OLE:

P ROJECT

M ANAGER

/

L EAD

D URATION:

N OVEMBER

2 007

–

O CTOBER

2 008

Description

-

Client

is

a

leading

health

plan

in

the

U.S.

with

over

35

million

Medicare

members.

Senior

MA

FACETS

is

a

maintenance

project

with

the

Development

team

assisting

WellPoint

Wisconsin

on

several

work

requests

such

as

Operational

Reports,

Interface

Balancing

Reports

and

implementation

projects

including

NPI,

iHealth,

Provider

loads,

ITS.

This

project

involves

the

scrubbing

of

existing

providers

and

loading

of

new

providers

to

Senior

MA

FACETS

so

that

the

number

of

claims

pended

because

of

Provider

mismatch

is

reduced.

The

project

also

involves

developing

new

reports

using

Crystal

Reports

11,

developing

new

interfaces

and

solutions,

fixing

issues

faced

in

the

existing

applications

and

tuning

the

existing

applications

for

better

performance.

As

a

Project

Manager

/

Lead,

was

responsible

for:

Preparing

project

plans

and

monitoring

/

tracking

the

progress

of

the

as

per

the

project

plan

Managing

a

team

of

15

associates

and

ensuring

that

the

tasks

allocated

are

completed

and

delivered

within

the

scheduled

time

Develop

SOW

and

schedule

Management

of

staff,

recruitment,

performance

assessment

appraisals

and

feedback

Estimations

and

managing

change

control

process

Functional

requirement

Analysis,

Design

reviews,

estimation

reviews

Ensuring

that

laid

down

procedures

and

processes

are

followed

by

the

offshore

team

Involved

in

Business

development,

RFP

responses

and

Opportunity

Identification

P ROJECT

–

M VP

M EDCO

C LIENT:

M VP

R OLE:

P ROJECT

L EAD

D URATION:

JULY

2 007

–

O CTOBER

2 007

Description

-

To

build

a

system

to

automate

the

load

of

the

member

group’s

files

received

from

MEDCO.

As

a

Project

Lead

/

Manager,

was

responsible

for:

Review

of

project

scope

and

schedule

for

compliance

with

customer

specifications

Identified

non-

conforming

issues

to

the

client

and

assist

in

resolution

Drafting

and

implementing

the

functional

architecture

Requirements

gathering

and

final

review

of

project

deliverables

Sending

appropriate

and

timely

written

communications

to

all

project

team

members,

customers,

and

IT

management

throughout

the

life

of

the

project

P ROJECT

–

A MHP

N PI

C LIENT:

A MERIH EALTH

M ERCY

F AMILY

OF

C OMPANIES

(AMFC)

R OLE:

P ROJECT

L EAD

D URATION:

JANUARY

2 007

–

JUNE

2 007

Description

–

AMHP

has

been

operating

several

Medicaid

books

of

business

from

its

facilities,

on

FACETS

4.21

platform.

This

project

involves

providing

NPI

Remediation

services

on

the

current

IT

systems

supporting

the

different

Line

of

Businesses,

including

FACETS.

As

a

Project

Lead

/

Manager,

was

responsible

for:

Managing

a

team

of

15

associates

and

coordinating

activities

with

the

offshore

/

onsite

teams

Requirements

Gathering

and

Analysis

to

formalize

functional

specifications

Suggest

re-

engineering

approaches

and

provide

recommendations

in

determining

the

best

approach

Identify

performance

improvements

for

existing

production

applications

Ensure

on-

time

delivery

and

quality

of

deliverables

Received

accolades

“Associate

of

the

Quarter”

for

the

comprehensive

FACETS

knowledge

and

commitment

towards

successful

completion

of

the

project

P ROJECT

–

W ELLP OINT

M EMBERSHIP

C ONSOLIDATION

C LIENT:

W ELLP OINT,

INC

R OLE:

P ROJECT

L EAD

D URATION:

A PRIL

2 006

–

D ECEMBER

2 006

D escription

–

WellPoint

has

multiple

Operational

Systems

running

at

Mid-

West

(OH,

KY

and

IN),

Wisconsin

and

Missouri.

WellPoint

consolidated

the

Membership

and

Billing

information

in

FACETS

from

the

Wisconsin

(Mainframe)

and

Missouri

(FACETS)

systems

by

consolidating

them

with

Mid-

West

to

form

a

single

instance

of

FACETS.

As

a

Project

Lead,

responsible

for:

Handling

a

team

of

11

resources,

primarily

responsible

for

all

development

and

testing

activities

Project

Estimation,

planning

activities

and

work

management

Guiding

the

team

members

through

complex

technical

requirements

OTHER

HEALTHCARE

PROJECTS

Sierra

Health

Case

Tracking

and

Reporting

System

(CTRS)

–

Sierra

intends

to

automate

their

Case

Tracking

and

•

Reporting

Systems,

which

will

facilitate

the

users

to

work

with

their

Case

information

as

required.

Fidelis

Care

FACETS

Upgrade

Assessment

and

Remediation

–

The

project

involves

Impact

Assessment

at

the

•

functional

level

and

code

level

on

the

custom

objects

due

to

version

upgrade

from

FACETS

3.11

to

FACETS

4.11.

Fidelis

Care,

Claims

Mass

Adjudication

(CMA)

–

Claims

Mass

Re-

adjudication

project

involves

development

of

a

tool

•

to

support

re-

processing

of

“Paid”

ad

“Processed”

claims

using

FACETS.

TMG

Health

Care

Implementation

–

TMG

Health

Care

Implementation

project

(including

Medicare

and

Medicaid)

•

involved

developing

Operational,

analytical

and

Ad-

hoc

reports

using

FACETS.

The

project

also

involved

generating

extracts

in

Membership

and

Claims.

Trizetto

BCN

FACETS

Reporting

–

The

Project

involves

developing

Reports

out

of

the

FACETS

database,

creation

of

•

data

stores

and

Data

Migration

for

BCBS’

business

processes.

Specialized

Care

Services

–

UHG

–

For

reporting

purposes,

relevant

data

would

be

fetched

from

FACETS

and

•

populated

in

the

custom

R&I

database.

Cognos

would

then

use

the

data

to

generate

appropriate

reports.

IMS

European

Production

-

Territory

Planner

–

TP

application

consist

of

software

and

data

components

which

will

•

provide

timely

answers

to

the

specific

business

questions

each

customer

considers

important

to

drive

efficient

sales

force

(Sales

representative

and

regional/area

management)

activity.

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