Siva Kumar Yalamanchili

Cell: 904-***-****

adcibd@r.postjobfree.com

I am an Information Technology professional & experienced Project/Portfolio/IT Manager with 18 years of experience in the information technology industry with extensive experience in the software development life cycle (waterfall & Agile) & IT Service Delivery. I have expertise in the areas of Business analysis, Systems Analysis, QA, Proposal management, Technical writing, Training, Systems testing, UAT & System/Solution design. My expertise encompasses Project/Portfolio management, QA, Test Automation, staff training, Scope, Schedule and Budget management. I am also proficient and have SME knowledge in Healthcare Insurance payer solutions, Health care claims, Medicare, Medicaid, HEDIS, RAF, Healthcare Regulatory & Compliance requirements, EDI (837, 834, 27,271,276 & 834), Eligibility & benefits, Enrollment & Billing & Healthcare Analytics

Areas of Expertise

Program Management Medicare/Medicaid Vendor Management

Change Management HEDIS & RAF Proposai Management

Quality Assurance EDI Transactions Strategic Planning

Healthcare Claims HIPPA Act Software Development

Education

Master of Business Administration (MBA)

Concentration in Management of information technology (MIS), Schiller International University

Florida, USA

Master of Business Administration (MBA)

Concentration in International Business, Stamford University

Bangkok, Thailand

Bachelor of Engineering

Concentration in Electronics & Communication, Andhra University

AP, India

Certifications

Project Management Professional (PMP)

Certified Scrum Master (CSM)

Certified Test Engineer (CTFL)

Technical Skills

•Operating Systems – (Windows 2003 Servers/Unix, IBM AIX & Linux)

•IBM Sterling integrator, Diamond, DMT, SSPT, ITS

•Java/C#. Net, ASP.NET Knowledge

•Oracle 11g/SQL server 2008, T-SQL database Knowledge, HDFS, Hadoop, HIVE

•HP Quality center/ALM, QTP, UFT, Rally & Microsoft Team foundation server

•Microsoft Visio, Clarity, MS Project server 2010, MS SharePoint 2010, MSEPM

•Devops tools: Gitlab, Jenkins & OpenShift

Professional Experience

Florida Blue July 2019- Current

Senior IT Manager: Florida Blue Medicare

Providing leadership to the assigned team, provide direction to project and functional resources within and outside their reporting structure, gather, support and develop the resources needed to execute the plan, champion the tactical direction of work and remove barriers within their sphere of influence. Lead cross function initiatives, projects and discussions and is relied upon to anticipate and mitigate cross functional issues. Provide subject area expertise to the team

Set the strategic vision, direction, and standards for championing a best in class experience for Florida Blue Medicare line of business, in alignment with the changing needs of the business and its members

Work with executive leadership to provide insights regarding the Florida Blue applications and current performance metrics

Provide plans to remediate the applications based on the current needs.

Work with multiple IT teams for the project’s implementation

Update the executive leadership with the project status

Serves as the lead point of contact for all information technology related interactions at the executive management level and above.

Provide leadership and subject matter expertise for the execution and management of all IT projects

Leads cross-functional discussions with multiple teams to resolve issues and dependencies

Collaborate with business and provide strategic direction for creating business cases

Manage budget effectively and make sure projects are implemented within the allocated budget and timelines

Work with HEDIS vendors for annual and monthly prospective and retrospective runs

Provide direction to streamline HEDIS engine input data (CCDA & EMR) including supplemental data

Florida Blue Feb 2018—JULY 2019

IT Manager: Pharmacy, Health & Wellness: CARE Domain

Providing leadership to the assigned team, provide direction to project and functional resources within and outside their reporting structure, gather, support and develop the resources needed to execute the plan, champion the tactical direction of work and remove barriers within their sphere of influence. Lead cross function initiatives, projects and discussions and is relied upon to anticipate and mitigate cross functional issues. Provide subject area expertise to the team

Responsible with work with the vendors to implement IT solutions in CARE domain

Implemented Cafe well Health & Wellness platform for Medicare and Commercial markets.

Responsible for working with PBM vendors to implement pharmacy solutions

Responsible for resource allocation and budget approvals

Responsible for maintaining staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.

Managed vendors and negotiated contracts, tracked SLA’s and proposed performance improvements

Track vendor performance metrics and take necessary action to improve the KPI’s

Manage vendor implementations end to end in the role of a solutions lead

Propose alternative solutions to vendor implementation challenges

First in Florida Blue to implement projects in Devops framework, all the Health & Wellness micro services developed by my team are hosted in OpenShift. We do continuous integration and delivery using Devops oriented development pipeline

Florida Blue Mar 2017—Feb 2018

Sr IT Project Manager: CARE Domain

Plan, execute, and finalize projects within triple constraints of delivering on time, within budget and scope objectives, including acquiring resources and coordinating efforts of team members in order to deliver projects according to plan. Identify, effectively communicate, and resolve project issues and risks. Develop risk mitigation plans. Manage Projects, in CARE domain ranging from $3M to $5M. Scope of responsibilities includes vendor coordination, Risk management, Budget Management & issue management.

Manage CARE domain projects with multiple internal and external dependencies, complex or multiple scope, a higher level of risk requiring mitigation plans, multiple integration points with some external integration related to functional capabilities, medium cost, time sensitive work within multiple teams of resources

Oversee the development of CARE domain operations roadmap & operating model

Monitor major projects, budgets, priorities, standards, procedures, and overall IT performance

Coordinate priorities between the IT department and user departments

Determine project schedule, cost and Scope.

I am accountable for preparing project management plan; scope documents and gets them approved by the sponsor.

Responsible to acquire project team members from within the organization and outsourcing process.

Responsible for resource allocation and budget approvals

Maintain capability level work breakdown structure

Indiana University Health Plan AUG 2016—Feb 2017

Sr Manager (UST Global): IT Project Delivery

Manage Indiana University health plan Software's global portfolio of healthcare solutions. Responsibilities include vetting new solution ideas, planning strategies for new and existing solutions, ensuring the execution of plans for optimizing time to revenue of all solutions. Additional responsibilities include business plan influencing, alignment and performance tracking. Provide consulting & advisory services for Commercial, Exchange & Medicare line of business.

Accomplishes information technology staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and disciplining employees; initiating, coordinating, and enforcing systems, policies, and procedures.

Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.

Maintains organization's effectiveness and efficiency by defining, delivering, and supporting strategic plans for implementing information technologies.

Directs technological research by studying organization goals, strategies, practices, and user projects. Provide consulting & advisory services for Care, Medical cost management, Contact center and Claims processing systems.

Completes projects by coordinating resources and timetables with user departments and data center.

Verifies application results by conducting system audits of technologies implemented.

Preserves assets by implementing disaster recovery and back-up procedures and information security and control structures.

Recommends information technology strategies, policies, and procedures by evaluating organization outcomes, identifying problems; evaluating trends; anticipating requirements.

Accomplishes financial objectives by forecasting requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective action.

Maintains quality service by establishing and enforcing organization standards.

Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.

Contributes to team effort by accomplishing related results as needed

Blue cross Blue Shield Florida MAY 2014—JUL2016

IT Delivery Manager (UST Global)

Direct Management of organization that developed and tested and verified Healthcare claims processing system, Enrollment & Billing, ITS & PeopleSoft application. I implemented new processes and procedures. Built team of 16 QA Testers offshore and 12 Developers offshore and insured all quality metrics and deliverables were met.

Manage different projects from end to end and responsible for the overall delivery.

Personally, Trained the offshore resources in EDI Transactions (837, 835,270,271 &276) and Healthcare claims, Benefits and set up a claim testing team responsible for primarily testing the Diamond claims processing system

Provide technical guidance to the resources on day to day basis to resolve their issues and impediments

Managed multiple projects worth 2 million for 2014 & 2.5 million for 2015 and managed projects worth 2.5 million for 2016.

Improved software quality and reduced defects via strategic test planning and introduction of testing best practices, root cause analysis and via creation of standardized tools, processes and methodologies.

Introduced Key Performance Indicators (KPIs) related to quality in employee performance plans.

Managed vendors and negotiated contracts that saved the organization over 3.1M /year by appropriately maintaining offshore and onshore ratio

Meet the client on periodic basis to present them the status of the overall progress of the projects.

Responsible for raising invoices against the work completed on quarterly basis.

Planned and coordinated resources needed to implement new test strategies (Agile Scrum, Sanity Suite Regression, etc.), resulting in development of best practice models

Participate in RFP, pre bid meetings and SOW finalizations

Blue Cross Blue Shield Florida JAN 2013—APRIL 2014

Sr. IT Project Manager: Healthcare Exchange Affordable care act

Client Blue Cross and Blue Shield of Florida is a health insurance and health solutions company providing health insurance services to the citizens of Florida State

Responsibilities:

Plan, execute, and finalize projects within triple constraints of delivering on time, within budget and scope objectives, including acquiring resources and coordinating efforts of team members in order to deliver projects according to plan. Identify, effectively communicate, and resolve project issues and risks. Develop risk mitigation plans. Direct enrollment & Billing project portfolios ranging from $5M to $8M. Scope of responsibilities includes implementing stakeholder requirements for System design, development and validation.

Selected accomplishments:

Managed multiple software system development and integration projects related to Healthcare Claims, Enrollment & Billing, Medical cost management and pharmacy claims simultaneously through all phases of project life cycle - analysis, design, development, testing, implementation, and post-production support from End to End

Manage multiple ERP/WEB/COTS application development projects developed using .NET/Java/ platforms with multiple internal and external cross functional dependencies

Managed critical projects related to government mandates & security pertaining to HIPAA/CMS guidelines.

Worked with multiple external Rx vendors to integrate their systems with Florida blue internal systems claims processing, enrollment and billing etc.

Extensively worked in business to implement projects related to vendor integration and enrollment and billing

Blue Cross Blue Shield Florida FEB 2012 —JAN 2013

Sr QA Consultant – ICD10 Transition

Client Blue Cross Blue Shield is leading Health Care Insurance provider for individuals and groups. I had participated in different projects related to web applications and client server applications

Responsibilities

Provide training & Mentor the resources in the EDI, Healthcare claims, ICD 9 and ICD 10 Topics

Lead a team of testers responsible for testing ICD 10 remediation projects

Develop and establish quality assurance measures and testing standards for new applications, products, and/or enhancements to existing applications throughout their development/product lifecycles.

Prepare and deliver reports, recommendations, or alternatives that address existing and potential

Create and execute test plans and scripts that will determine optimal application performance according to specifications

Collaborate with software/systems personnel in application testing, such as system, unit, regression, load, and acceptance testing methods.

Communicate test progress, test results, and other relevant information to project stakeholders and management.

Worked on ICD10 Diamond claim system remediation projects and lead a team of UAT for final validations.

Projects handled:

ICD 9 to ICD 10 Transition

Blue Cross Blue Shield Florida AUG 2011 —FEB 2012

Sr QA Consultant – HIPAA 4010 to 5010 Transition

Blue Cross Blue Shield is leading Health Care Insurance provider for individuals and groups. I had participated in different projects related to web applications and client server applications

Responsibilities

Develop and establish quality assurance measures and testing standards and design strategic test planning for new applications, products, and/or enhancements to existing applications throughout their development/product lifecycles.

Prepare and deliver reports, recommendations, or alternatives that address existing and potential

Create and execute test plans and scripts that will determine optimal application performance according to specifications

Verify and revise quality assurance standards as needed.

Ensure that testing activities allow applications to meet business requirements and systems goals, fulfill end-user requirements, and identify existing or potential issues.

Collaborate with software/systems personnel in application testing, such as system, unit, regression, load, and acceptance testing methods.

Communicate test progress, test results, and other relevant information to project stakeholders and management.

Analyze formal test results in order to discover and report any defects, bugs, errors, configuration issues, and interoperability flaws.

UAT Tested Institutional and professional McKesson claim check project

Worked on HIPPA 4010 to 5010 remediation projects and lead a team of UAT for final validations.

Sreeeven Infocomm/ Multiple payers DEC 2005—July2010

Sr Project Manager/Offshore Delivery Manager:

I worked with multiple payers simultaneously as Sr project manager managing a group of junior project managers and project analysts. I worked for a managed service provider for healthcare payers

Responsibilities:

Manage multiple ERP/WEB/COTS application development projects developed using .NET/Java platforms with multiple internal and external dependencies, complex or multiple scope, a higher level of risk requiring mitigation plans, multiple integration points with some external integration related to functional capabilities, medium cost, time sensitive work within multiple teams of resources

Oversee the development and maintenance of the Medicare IT strategic plan.

Monitor major projects, budgets, priorities, standards, procedures, and overall IT performance

Coordinate priorities between the IT department and user departments

Determine project schedule, cost and Scope.

I am accountable for preparing project management plan; scope documents and gets them approved by the sponsor.

Responsible to acquire project team members from within the organization and outsourcing process.

Responsible for resource allocation and budget approvals

Maintain capability level work breakdown structure

Prepare the RFP/RFI proposals for procurement of software/hardware and facility management services and send out to the approved vendors.

Conduct pre bid meetings for the vendors to clarify the requirements and concerns.

Communicate project status to customers, project team, project offices, leadership

Seagate NOV 2003—OCT 2005

Business Systems Analyst

Seagate is a leading manufacturer of hard drives and storage solutions worldwide. Seagate implemented PeopleSoft to support its finance operations across the enterprise. The project scope is integration of enterprise applications developed in-house with the PeopleSoft system

Responsibilities:

Determines operational objectives by studying business functions; gathering information; evaluating output requirements and formats.

Designs new computer programs by analyzing requirements; constructing workflow charts and diagrams; studying system capabilities; writing specifications.

Improves systems by studying current practices; designing modifications.

Recommends controls by identifying problems; writing improved procedures.

Defines project requirements by identifying project milestones, phases, and elements; forming project team; establishing project budget.

Monitors project progress by tracking activity; resolving problems; publishing progress reports; recommending actions.

Maintains system protocols by writing and updating procedures.

Provides references for users by writing and maintaining user documentation; providing help desk support; training users.

Maintains user confidence and protects operations by keeping information confidential.

Prepares technical reports by collecting, analyzing, and summarizing information and trends.

Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies.

Contributes to team effort by accomplishing related results as needed.

Raasi Enterprise Solutions Ltd JUN 2000—Sep 2003

Software Engineer

Responsibilities:

Develop & establish quality assurance measures and testing standards;

Create, execute test plans and scripts;

Identify existing or potential issues;

Involve in system, unit, regression, load and acceptance testing;

Analyze test results and report any defects, bugs, errors, configuration issues and flaws;

Validate the backend table in database for DML processes

Perform UAT testing

Expert in planning, organizing, and managing resources to successfully complete project goals and objectives, while honoring predetermined constraints

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