Project Manager

VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

SUMMARY

Thorough knowledge of Software Development Life Cycle (SDLC) including Iterative

Rational Unified Process and Agile (Sprint) and Software Product Life Cycle Management

(PLM)

Adept at analyzing the current and future business processes.

Experienced in project management, working with various internal teams and clients in tracking

project progress and maintaining Change Request and Requirements logs

Skilled at gathering business requirements, functional requirements, non-functional using

Rational Requisite Pro.

Experienced in using different methods including conducting meetings, passing questionnaires

and interviewing stakeholders to gather requirements.

Astute understanding of value created by AS-IS and TO-BE analysis and experienced in

conducting process evaluations and writing recommendations based on the analysis.

Experienced in working with Project Management teams in various stages of the project to

identify high level requirements, and resource needs for the project.

Experienced working with remotely located teams, off shore development model.

Experienced in creating Unified Modeling Language (UML) diagrams including, use cases,

activity diagrams, using MS Visio and Rational Rose.

Excellent understanding and hands on experience with Trizetto FACETS, HL7 Messaging

Standards and EDI transactions.

Expert level skills in MS Office products and other tolls including MS Project, MS Word, MS

Power Point, MS Visio, MS FrontPage, MS Excel and IRise Studio.

Supervising the progress and mentoring team members’ within the Project Team and

Configuration Management Team for build releases.

Adept at understanding new applications and conducting manual testing on the applications.

Experienced in creating Test Plans and Test Cases based on user requirements and functional

specifications.

Strong Subject Matter expertise(SME) in ARMS Medical Billing Information System,

Market Research, Risk Management, Product Development, Banking, Risk Analysis, Asset

Management- risks and returns.

Experience in conducting UAT and writing test cases for business users for multiple scenarios.

Experience in working on Data Dictionaries with explanation of concepts in the form of use

cases.

Strong functional expertise in the Healthcare Payer Area - Membership claims, benefits,

eligibility check, ICD10, HIPAA, CMS HCPCS Exposure to Health Care Industry standards

like HIPAA / PHI.

Working Knowledge of Claims Processing, Insurance Workflow, HMP, PPO, HIPAA,

COBRA

Experience with all modules on Quality Center. Worked in the capacity of Project Admin for

QC, also managed requirements and test cases and created various custom reports.

Experienced documenting XML reference documents for data sharing.

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

Expert in Creating and executing test plans, test cases and data sets on the basis of

requirement Documents.

Experienced in documenting User acceptance test plan and training users for working with the

application.

Expert in conducting GAP analysis, User Acceptance Testing (UAT), SWOT analysis, Cost

benefit analysis and ROI analysis.

Trainings & Certifications

CSPO – Certified Scrum Product Owner

Six Sigma White Belt Program

Developing User Requirements: The Key to Project Success

Technical Expertise

RUP, Waterfall, UML, Six Sigma, Business Modeling, Process

Methodologies

Modeling

Facets, Plexis, Atlantes, Axiom, Mainframe, Oracle

Environment

Discoverer, MS Visio, Innotas, Sharepoint, C++, VB, Windows

Office Suite, ARMS Medical Billing Information System,

Meditech, Invision. Snagit, FileMaker Pro, Vista Plus

Win 95/98/NT/2000/XP, OS-390, ZOS, MAC

Operating Systems:

Rational Clear Quest, Test Director.

Change Management Tools

Rational Rose, Microsoft Visio.

Business Modeling Tools

Rational Clear Case.

Version Control Systems

Microsoft Project, Microsoft Office.

Project Management

Oracle, SQL Server

Data Bases

Rational Suite, Test Director

Testing Tools

RUP, Waterfall, UML, Six Sigma, Business Modeling, Process

Methodologies

Modeling

Professional Experience

Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

Role: Business Analyst

Duration: September‘13 – Present

BCBS New Jersey is currently in the process of revamping the user interface of the existing Online

Provider Directory application for the Horizon NJ Health network in providing more of an

interactive search and impacting the front end user. The organization is also implementing

Premium Billing transactions through a Third Party Vendor for Horizon Members subscribing

through Federal Exchange Plan (Affordable Care Act).

Roles & Responsibilities:

Conducted initial analysis on business requirement and need for revamping the user

interface of existing Online Provider Directory.

Developed Business use cases based off of analysis and presented to business for sign off

Developed flow diagrams to reflect appropriate workflow sequence.

Created and updated Requirement Traceability matrix to tie in the business use cases to

user stories and test cases

Developed Test cases for all UAT testing and performed UAT testing on behalf of

business.

Logged and Tracked testing defects on ClearQuest

SPOC and Lead for two projects (Online Provider Directory and Premium Billing

Transaction) for both communication as well as project updates.

Identified gaps in understanding of business need and portrayal of business requirements

and restructured the writing of business requirements to capture requirements as per

business need.

Communicated with Third Party vendors on assigning testing tasks and accountability of

work.

Estimated level of Effort on Change Requests made by Business from time to time.

Technologies: ASP.NET, JavaScript, Visio, IBM Rational ClearQuest, Lotus Notes, Microsoft

Office Suite, SharePoint, MS Project

ALFA CLOUD EMR New York, NY

Role: Business Analyst

Duration: June ‘13 – September ‘13

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

ALFA Cloud EMR is an end to end Cloud HIM product to enable accelerated adoption for all the

HIM needs of a typical Healthcare provider with negligible IT Investment and no IT Maintenance.

The system streamlines the access and procedural processing of Healthcare Information from

Patient Admission to archiving the Chart for the Medical Care provided with adherence to

standards and compliances and offers seamless integration between hospitals and clinics and

effectuates effective communication between physicians and patients.

Roles & Responsibilities:

Developed business requirements and facilitated JAD sessions to build product to support

new sales of ALFA Cloud EMR.

Conducted feasibility analysis for procurement of new cloud service solution to be used as

a platform in the development of the EMR product.

Responsible for On-shore and Off-shore coordination during requirements gathering and

development phases.

Designed workflows per recommendations of physicians and performed requirement

mapping during development.

Prepared evaluation forms and survey orders for various physician groups using currently

available EMR products in order to document pain points and identify solutions.

Performed AS-IS and TO-BE analysis based on current products and expectations of users

and stakeholders.

Used Requirements Traceability Matrix (RTM) to trace the relationship between business

and functional requirements to test cases.

Created Use Case diagrams and Story Boards to best express to the technical team, user

scenarios from a business perspective and created documents with use case scenarios for

developers from a system perspective.

Coordinated UAT (User Acceptance Testing), created UAT Plan, Test Cases and UAT

summary report as part of the standard Project deliverables documentation and involved in

the project release implementation process.

Technologies: ASP.NET, C#, SQL Server, SOA, Microsoft Azure, HL7, Javascript, CSS, HTML, ExtJS,

Agile, UML, MS Project, VISIO, Rational Rose, HP Quality Center, Mainframe

VNSNY (Visiting Nurse Service of New York) New York, NY

Role: Business Analyst

Duration: July '11 – June `13

VNSNY has PLEXIS as their billing system and has migrated to Trizetto FACETS through a Third

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

Party Administrator (TMG Health), which uses FACETS and administrates billing on VNSNY’s

behalf. I have worked as a Business Analyst on the migration project to enable VNSNY to focus

on patient care and better administration of billing and am currently working on analysis of various

system generated reports and building tech spec documents based on modifications.

Roles & Responsibilities:

As a Business Analyst I gather requirements from end users of various systems and prepare

the Business Requirements Document (BRD).

Responsible for providing overall system and operational support to the VNSNY CHOICE

Operations and Implementation Department in order to assist with departmental and plan-

wide operational projects and initiatives

Schedule and coordinate meetings, Facilitate JAD sessions for developers to understand the

requirements and for issues with migration to be discussed. Document all agreements and

resolutions for future reference.

Record data sources both at front and back end for numerous parameters/metrics of the

system& derive actively used fields

Perform UAT on various system applications with updated reports.

Compare& analyze if the business requirements have been met according to the required

suggestions/changes

Actively communicate with cross-functional teams and other internal divisions to ensure

that research and resolution opportunities are appropriately identified, pursued and

reported to senior management

Identify and document system problems. Escalate system defects with a sense of urgency

to avoid member data disruption, assist in meeting provider guarantees, and to promote

provider and member satisfaction.

Analyzed PLEXIS and FACETS as separate systems and conducted gap analysis between

the two systems in tandem with TMG Health and prepared VNSNY-TMG Health BRD

GAP Analysis Document.

Created a Migration Action Item List for PLEXIS to keep track of developments in the

project.

Prepared the Managed Long Term Care (MLTC) Benefit Grid

Ran Ad-hoc and Production reports on MOOP Reconciliation.

Assisted in Provider communication on process changes in PLEXIS and TMG billing

Worked on training providers on changes in billing and transitioning to a new system

Validated, researched, and analyzed claim and authorization processing problems and

trends referred by health plan, providers, system, bringing issues to resolution.

Observed and shared notes on Operations changes for Migration and Testing a system

application with updated reports.

Facilitated and assisted in Provider communication on process changes in PLEXIS and

TMG Health billing.

Updated and worked with training providers on moving to a new system in VNS through

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

EOS portal and the changes on billing to TMG Health vs. VNSNY.

Prepared Training Documentation for Providers on billing changes with screen shots on

system rules and details with the support of the IT group and Provider Communication.

Technologies: Facets, Plexis, Atlantes, Axiom, Mainframe, Oracle Discoverer, MS Visio,

Innotas, SharePoint, Windows Office Suite, Snagit, FileMaker Pro, Vista Plus

MBA Consulting Projects: Glendale, AZ

MBA- Change Consulting Project

The Next Step M3dia & Sanders Sports Marketing

Role: Change Consultant

Duration: January 2011 – April 2011

Worked as change consultant for The Next Step M3dia & Sanders Sports Marketing on

their current change initiative.

Used the Kotter’s 8 step model to induce change and initiate necessary steps to bring

positive outcome

Examined and Analyzed Market and Competitive realities and identified crisis, potential

crisis, or major opportunities. Documented evidence as per analysis to support the need for

change.

Assembled a group of key change leaders with enough power using the help of resource

mapping to lead the change effort. Encouraged the group to work together as a team.

Created a vision to help direct the change effort and developed strategies to achieve that

vision.

Build alignment and engagement through storybo ards and used innovative vehicles to

communicate the new vision and strategies.

Operations Management

Arizona Public Service (APS)

Role: Analyst

Duration: October 2010 – December 2010

Project: Streamlining of Procurement Card

The process that was to be value stream mapped was one which lay within the supply chain

management group (specifically in procurement), and involved the procurement card (P-card).

APS has many field employees who are scheduled to manage the electricity lines all over the

valley to ensure that customers have power. Those field operators who work more than 100 miles

away from their home base are registered with the company to receive per diem procurement

cards. These cards enable the company to pay them $85 per day for their services and are to be

used for meals and hotels (but can be used for anything if the employees choose to spend on

anything else). These cards have eliminated the use of traditional forms of payment for these field

employees, including purchase orders and requisitions, while allow for a paper-less system.

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

Mapped the business process by value stream and consolidated business processes for a

paperless system.

Documented issues and recommendations to mitigate the same along with steps for

standardization.

Business Intelligence

GE Health Care

Role: Analyst

Duration: September 2010 – December 2010

Project: Assessment of Industry Trends and Identification of Value Segments

GE healthcare is a huge player in the Medical Devices market in the US and other countries. They

needed Business Intelligence Research and reports on whether it would be a good idea to enter the

value segment with a low priced ultrasound device.

The organization needed to know in particular whether it would affect their brand image and create

conflict when competing in the mid and high range markets for medical devices.

Researched on competitors in the Ultrasound device segment in six d ifferent countries.

Analyzed and documented trends on the ultrasound devices used best by providers based on

demographics.

Analyzed the Value segment and drew up reports on competition and advised on the decision

to join value segment as compared to mid and high range.

VV Airen Construction Private Limited Indore, India

Role: Project Manager

Duration: Jul ’07-Apr ‘09

Planned, organized and managed $8 MM projects in railway flyover constructions, resulting

in completion on time within budget.

Managed 2 projects simultaneously and focused on detailed planning of all stages of

construction by resolving labor relations issues and coordinating material flow.

Conducted make/buy analysis for purchasing machinery, collaborated with team members to

conduct efficient budget review, contributing to reduced cost and market stability of

organization.

Inspected hoists, scaffolding, and equipment, ensuring all documents and test certificates

were in place.

Negotiated all purchases, managed vendor relationships, and scheduled inspections.

Apollo Health Street New York, NY

Role: Business Analyst

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

Duration: May ’05- May ’07

Project: Apollo Health Street Pvt Ltd is a Business Process Outsourcing organization which is

focused on revenue cycle management and EMR implementations. As part of the EMR projects,

we worked with MISYS (now ALLSCRIPTS) for their claims processing integration and

implementation of TIGER PMS with PayerPath. On the Revenue Cycle Management end we

worked with Raritan Bay, CIGNA and Greenwich for Accounts Receivable.

Worked with the Lead BA on preparing Functional Requirement Documentation (FRD) for

Clients in order to customize the MISYS PAYERPATH (now ALLSCRIPTS) per provider

specialty practice.

Hands on knowledge of Claims Processing and Resolution along with understanding of the

implementation of HL7 Interface.

Liaised with Client staff and the development team for better coordinating and creating a

conducive atmosphere for the project.

Handled Clients with regards to questions on EMR Capabilities and Customizations.

Conducted JAD Sessions to resolve issues and increase productivity of the Design team and

Clients

Conducted sessions, Video conferencing and coordinated offshore operations with

developers to meet deadlines.

Acted as a liaison between systems software development staff, management and application

end-users

Developed clear and concise ad-hoc reports utilizing the current analytical and reporting

environment.

Conducted User Acceptance testing on behalf of the Client and reported to the Lead BA.

Hospital Billing Projects:

Worked as an Accounts Receivables executive on Raritan Bay Medical Center and

Greenwich hospital billing accounts to resolve P,I,D, Worker’s Comp and Medic aid Claims.

Part of the team working on Resolution of denials and delays in third party payment

processing, ensuring the best A/R metrics possible.

Resolved outstanding medical claims to the tune of $4 MM at the grass-root level by

networking with medical insurance companies on behalf of hospitals, resulting in speedy

resolution of medical claims.

Trained and mentored associates on various processes related to USA healthcare system

including legal aspects of health insurance claims and functioning of client relationship

management system, helping trainees to get acquainted with the software used for claim and

patient information.

Used Meditech, Invision and ARMS Systems to access, check claim status and resolve

claims.

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VINIT MODI Email: ****@*********.***

New York, NY 10128 Ph no: 928-***-****

Planned a strategy, road map and allocation pattern for claims processing, effectively

resolving accounts receivable claims.

Maintained record of correspondence with insurance companies through mails and fax of

important documents and verified information with clients if further action was needed on

denials.

Developed the ‘Process Change Notification’ for an internal reference and ensured

agreement was reached by all team members, resulting in increased efficiency for speedy

resolution of claims.

For specific clients revised work patterns according to the needs and ensured resource were

aligned as per business need.

Pioneered an initiative for multiple claim resolution on a single call with the payers which

resulted in increased achievement of targets and productivity.

Worked on a TPA claims dump Pilot project for claims processing and gained new business.

Environment: ASP.NET 2.0, C# 2.0, ADO.NET 2.0, XML,HL7,SQL Server 2005,VSS

2003,Nunit, JavaScript,Windows XP, Share Point

Educational Background

MBA International Business Management, Thunderbird School of Global Management, Glendale,

AZ

Post Graduate Diploma Computer Application (PGDCA)

Bachelor of Commerce (Honors)

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