Project Manager

ESWAR SINGH

Cell: 508-***-****

***********@*****.***

Frisco, TX- 75035

Strong techno-management background … uniting business process with technology

Senior Business Systems Analyst/ Project Manager

Results driven and extremely motivated professional with 19 years of experience in software application analysis design, development and implementation, technical leadership and IT strategy. Successful track record in developing and managing initiatives within large Enterprise and leading cross functional teams in solution delivery.

Core Competencies:

Healthcare Payer Experience – Deep understanding of Healthcare business processes in Healthcare Payer settings in Medicare, Medicaid, Federal and State health insurance Exchanges and Blue Cross Blue Shield (e.g. claims, benefits, Membership and Account Implementation and Billing) and industry specific technologies in health care domain. Extensive experience with HIPAA/EDI and HL7 transactions.

Systems Analysis – realize information and data from multiple sources, apply analytical skills, and produce thoughtful and strategic recommendations that focus on business requirements and provide tailored solutions. Expertise in system integration with emphasis on reusability, performance, and scalability.

Business Process and Project Management – ability to think beyond the obvious and identify the real underlying business requirements and pros/cons of each solution – leading cross-functional teams, budgets, timelines, project implementations.

Summary

Nineteen years of intense software design, development and implementation experience in Web and client-server technologies.

Hands on Experience in Process Improvement using Six Sigma methodologies.

Hands on experience in Healthcare, HIPAA/ EDI and HL7 systems analysis, business analysis, requirements engineering, project management/co-ordination, Quality Assurance using proven Software engineering methodologies.

Seven years of experience in IT project management using proven methodologies like SDLC, RUP, Agile and PMBOK.

Twelve years of experience working on projects with Global Delivery Model.

Expert in communication, co-ordination with stakeholders to ensure project is delivered on time, with in scope, budget and quality.

Deep understanding of process management and hands on experience in using Six Sigma processes at enterprise level.

Extensively worked on EDI Applications in systems integration for HIPAA ANSI X12 transitions.

Proficient in HIPAA EDI TCS like 837I/P/D, 270/271, 835, 820, 276/277, UB-92, HCFA-1500, HL7, ICD-9, ICD-10, HCPCS, CPT-4

Extensively skilled in developing Internet and Intranet applications.

More than 10 years’ experience in Relational and Multi-Dimensional Databases.

Proficient with Object Oriented Analysis and Design using UML.

Well versed in Reporting tools like Crystal/Cognos Reports, Oracle Reports.

Proficient with UNIX, MainFrame and Microsoft platforms.

Quick learner, Good Communicator, Well-Organized, Team Player.

Ability to adapt to fast changing technology with new skills.

Ability to work in-groups as well as independently with minimal supervision.

Involved in the Full Life Cycle of the Project.

Certifications:

Certified SAFe® 5 Scrum Master ( Scaled Agile Certified Scrum Master)

Microsoft Certified Professional.

Brain Bench Certified HIPAA Professional

University of Connecticut – Healthcare IT Certification

PMP Certification in progress

Six Sigma

Public Profile:

https://www.linkedin.com/in/eswar-singh-2b44ba20/

Member Affiliations:

PMI – Member

Education:

Master of Science in Software Engineering – West Virginia University

Training:

Six Sigma

Horizon BCBSNJ Project Business Analysis

IBM Rational Requisite Pro

Certification of Appreciation/Excellence:

Business Analysts Center of Excellence - Horizon-BCBSNJ

Executive Office of Health and Human Resources – Commonwealth of Massachusetts (Medicaid MMIS Project)

West Virginia Department of Health and Human Resources – Medicaid MMIS Project

Project Management & analysis Skills

Design Methodologies: JAD (Joint Application Development), UML, OOAD, SPARX

Project Management: Microsoft Project, Microsoft Visio, RUP, PMBOK and SAFE Agile SCRUM, PMO operations, COTS products, RFR and RFP evaluation.

Technical Skills

EAI/EDI Tools: Sybase ECMAP, ECGateway, ECRTP, EDIFECS,Microsoft Biztalk, Biztalk Accelerator for HIPAA, Mercator and Data Junction (HIPAA Junction), Informatica B2B, Amisys

Web Technologies: Java, J2EE, .Net Framework, ASP. Net, VB.Net, ADO. Net,, ASP, HTML, DHTML, XML, XSL, JSP, Servlets and EJB etc

Scripting Languages: VB Script, Java Script, VBA

Web Servers: Apache, JWS, IIS web server

Application Servers: Web Logic, MTS

Database: Oracle, SQL Server

Languages: Java, SQL, PL/SQL

GUI/IDE: VB, PB, JFC

Defect/Issue Tracking: Rational Clear Quest

Operating Systems: UNIX, WINDOWS, MainFrames

Reporting Tools: Cognos, Excel

Project Tracking: JIRA, VersionOne

Data Modeling RDBMS, Multi-Dimensional (OLAP), Data warehousing, BI

Process Management: Six Sigma – Green Belt, BABOK and ITIL

Health Payer Systems: Amisys, Health Rules.

Work Experience and accomplishments

NTT Data ( formerly DELL Services Healthcare Payer Solutions) Plano, TX

Role: Business Analysis Senior Advisor – Systems Integration Healthcare Payer solutions. : Feb 2015 to till date

Clients: Massachusetts State Connector, Wellcare Health Plan, Healthcare New England, Avmed,FL, Bluecross Blueshield of FL.

Responsibilities:

Representing NTT Data Products as Scrum Master/Product BA to the Clients in project initiation to completion.

Identifying opportunities, pain points and improving the Product using Industry standard Process Improvement methodologies.

Responsible for process standardization, governance and controls.

Responsible for enhancements and new processes for Member Enrollment, Premium billing, HIPAA 5010 EDI Gateway and Member Portal etc.

Based on RFP and client’s requirements identifiying the gaps in the NTT Data Healthcare Payer products and to allocate resources to work on enhancements as per the NTT Data SDLC methodologies.

Identifying the client’s business objectives and tranforming them to requirements and materializing the solution delivery from inception to completion.

Processing and handling resource requests as per the Client/internal requirements.

Working with Clients, State and Federal regulatory agencies such Medicare and Medicaid, Healthcare Market place in identifying the future enhancements and working with sponsors in getting approvals to work on them.

Managing Globall resources ( DEV and QA) distributed On-shore and Off-shore in delivering solutions to the clients.

Working as Scrum Master in NTT Data Product enhancements and Client Engagments.

Working on Iteration/Sprint Planning, Daily Standups, Backlog grooming, Iteration/Sprint review/Retrosepective, PI planning etc

NTT Data Client Accounts:

Wellcare: Worked as Senior Business Analyst/Project Manager

Commonwealth Connector: worked as Tower lead Analyst/Scrum Master for the enrollment and premium solutions

Avmed: Business Analyst Team Lead/Scrum Master for transition and transformation.

Horizon Bluecross Blueshield of NJ

Role : Senior Business Systems Analyst and Project Manager( Business Analysts Center of Excellence and Business Solutions Group) working on multiple projects

Nov 2009 to Jan 2015

Responsibilities:

Process standardization and Governance

Leading Enterprise projects from inception to delivery

Mentoring and training BAs

Core Process governance Lead for multiple domains

Major Enterprise Projects:

Membership, Billing and Account Implementation project for PPACA (Healthcare Reform Act)

Objective: Initiative to revamp, build and implement the processes (Membership, Billing and Account implementation) to be able to participate in Health Insurance Exchange Market Place( Individual and SHOP Exchanges) by 10/1/13 as per PPACA to participate in Federally Facilitated Exchange(FFE).

Responsibilities:

Lead Requirements analysis, design and implementation

o HIPAA 5010 834 X12 EDI Enrollment Inbound/Outbound (SMEs and BAs) with impacted business areas and systems.

oHIPAA 820 X12 EDI Billing with impacted business owners (SMEs and BAs) areas and systems (IT owners).

oGroup/Account Implementation with new HIX products (QHP products) automation and work flow.

Worked with Development Teams as Business and IT Liaison Lead to ensure that all the business requirements are translated smoothly.

Worked as IT Lead with SIT and UAT team in testing effort.

Coordinating with key stakeholders Executive Management, Program/Project Management, Business and IT owners as per the enterprise established SDLC methodology.

Working with major business stakeholders such as Claims Adjudication Units, Benefit and Product Administration, Correspondence, Office of Healthcare Reform, Customer Service, Sales, Member Enrollment, Account implementation and Billing units etc.

Working with CCIIO, AHIP and BCBSA (BlueCross Blueshield Association), NASCO and various business units in getting the enterprise prepared of Healthcare Reform to be able to participate in Healthcare Insurance Exchange Market Place via FFE.

Worked on various PM tasks such as Project Planning, Scope Management, Scheduling, Issue/Risk Management, Communication Management, Change Management Project Estimates and Financial Planning etc,

Care Planner Web Replacement with CareRadius(Landacorp) for HCM:

Assessment of current CM / DM / UM programs and capabilities

Evaluation and selection of care management application software

UAT Test Lead for Workflow management for all modules for CM/DM/UM

EDI Gateway Modernization and HIPAA 5010 – Horizon BCBS NJ

Role : Team Lead ( Senior Business Systems Analyst)

The scope of EDI Gateway Modernization project is to migrate the current EDI Gateway environment to a new platform. This new platform/ environment will set up a good base for HIPAA 5010 & ICD 10. The current version of the mapping tool cannot support level 4 edits and higher. The current version of GENTRAN is not HIPAA 5010 compatible. To support the future strategic projects of Horizon BCBSNJ, there are requirements needed to change the business process flows and IT architecture.

All the HIPAA X12 transactions such as 837 I/P/D,835, 834,820,270/271, 276/277, 278 etc with various trading partners are converted from 4010 to 5010 from Legacy platform to Informatica EDI Gateway along with EDIFECS.

Medicaid Management of Information Systems (MMIS) - MassHealth

Executive Office of Health and Human Resources, Massachusetts

Role: NewMMIS Interfaces SME –Team Lead Nov 2004 to Nov 2009

Description:

Procurement and implementation of MassHealth’s (Massachusetts Medicaid Management Information System) 20+ years old Legacy system to advanced next generation system to render services to over 1.2 millions the citizens of Massachusetts. The total cost of building this project was over $150 million.

Role and Responsibilities:

SME and Team Lead for NewMMIS system interfaces.

Responsiblie for implementation of Enterprise level system to system interfaces with internal and external entities as per MITA architecture guidelines. The Enterprise MMIS consist of interfacing entities as below

o State Agencies: MA21, HCF, Enterprise Data warehouse, Connector, DMH, DYS, DMR, DPH, DTA, DPL Federal Agencies: CMS, SSA

oThird Party Administrators (ACS, DORAL, MASSPRO),

o Managed Care Partners (Fallon, Network Health, Neighborhood Health, BMCHP, Centene, HNE, SCO and PACE) and

o State Contractors (Perot, Maximus, HMS and UMASS) in implementing the system-to-system interfaces.

Certification of Massachusetts MMIS with CMS as per MITA guidelines.

Medicaid Management Information Systems,

West Virginia Department of Health and Human Resources,

State of West Virginia, Charleston, WV Mar 2003 to Oct 2004

Role: Sr. Business System Analyst

Description: Bureau for Medical Services manages MMIS of State of WV. They have MMIS System developed and run on Mainframe systems. This project is to transform the total legacy MMIS System into XML based. NewMMIS system running on Microsoft Platform with SQL Server 2000, BizTalk Server Architecture.

Responsibilities

Evaluated RFP and RFQ creation, responses to RFPs and RFQs.

Involved in GAP Analysis of HIPAA Compliance of WV MMIS.

Worked with HIPAA PMO(Project Management Office) regarding the tasks associated with the status of HIPAA Compliance activities of WV – DHHR

Blue Cross Blue shield of Tennessee Feb 2002 to Jan 2003

Sr. Business System Analyst

Description: Redesign and development of EDI transactions existing in legacy systems using COBOL, FILENET, UB92, and FACETS etc. to HIPAA compliant Transaction Code sets.

BlueCross had several Trade Partners like CIGNA, FEP (Federal Employees Program), TennCare (Tennessee State Medicare) and several Providers, Hospitals and several intermediaries etc running on legacy EDI transactions.

Responsibilities

Developed and tested EDI maps which are compliant to HIPAA transactions using ECMap and ECGateway of Sybase

Provided EDI Administration using ECGateway and ECRTP of Sybase

Implemented Business Edits using ECMap and routing it to database to develop Confirmation Reporting

Park Land Hospitals, Dallas, Texas Mar 2001 to Jan 2002

Business Analyst

Description: Implementing various related provisions of HIPAA (Health Insurance Portability and Accountability Act) to make the EDI Gateway HIPAA compliant.

Health Care Clearing House Project May 2000 to Feb 2001

Client: Health Integration Technologies, Dallas, TX

Role: EDI Analyst

Programmer Analyst, Citation Computer Consultants Apr '97 - April 2000

References:

On Request

Contact this candidate