Health Edi
Resume:
Asim Ilyas
adfa0n@r.postjobfree.com
PROFILE
Dedicated Healthcare Executive with over 15 years of experience in the Healthcare, Banking and Finance sectors. Excellent analytical and problem solving skills in designing, developing and implementing innovative business processes. Proven ability to provide system solutions using new approaches, technologies through excellent oral and written communication skills. High level of knowledge in the Healthcare Sector, including EDI processes involving both conversions, integrations and implementations. Developed multiple IT teams that successfully transitioned into independent departments that served critical functions. Leveraging healthcare experience and applying it to the Digital Healthcare space. BACKGROUND SUMMARY
Extensive experience in gathering user requirements, analyzing and preparing project deliverables including: Business Requirements Documents, Functional Requirement Documents, Vision and Scope Documents and Feasibility Studies.
Adept in coordinating with stakeholders, Subject Matter Experts (SMEs), and end users to understand, analyze, communicate and validate requirements through the use of user interviews, Joint Application Design (JAD), Joint Application Review sessions (JAR), and Requirements Workshops.
Skilled in transforming business requirements into functional specifications that focus on workflow analysis and design, user interface design, business process reengineering and process flow modeling.
Proficient in Object Oriented Analysis and Design with experience in creating Use Cases, Activity Diagrams, Class Diagrams, Task Diagrams, Sequence Diagrams and State Diagrams using MS Visio and Rational Rose.
Demonstrated ability to work efficiently in various phases of the Software Development Life Cycle (SDLC) using varied methodologies including: Waterfall, Agile/Scrum, Spiral, Rational Unified Process (RUP) as well as Unified Modeling Language (UML).
Expertise in performing GAP analysis, managing Requirements Traceability Matrix (RTM) and Data Analysis.
Ability to create Test Cases, Test Plans, Test Reports and defect tracking as required.
Extensive knowledge in all current HIPAA rules and regulations pertaining to software development and medical coding and extremely well versed in all types of HIPAA 4010 and 5010 EDI X12 ANSI transactions.
Well versed in implementing many HL7 standards such as CCD, CCR, MDM, ADT, SIU and ORM among others as well working with FHIR APIs.
Implemented and managed the MIRTH Connect application which was developed into a client’s integration engine. TECHNICAL EXPERTISE
SDLC Methodologies Waterfall, Spiral, Agile/Scrum, Rational Unified Process (RUP) Programming Languages HTML, XML, UML, EMERALD, RUBY Databases Oracle, IBM DB2, Sybase, SQL Server
Modeling and Design Tools MS Visio, IBM Rational Rose, IBM Rational Requisite Pro Testing Tools Win Runner, Load Runner 11.0, Quick Test Pro Defect Tracking IBM Rational Clear Quest, Bugzilla Operating Systems MS Windows X, Mac OS X, Linux, Sun Solaris Other Tools MS Project, MS FrontPage, MS Office, ERWIN, TOAD, Adobe Photoshop, Pivotal Tracker, Cyberduck, Filezilla, UltraEdi, MiniTranslator, MIRTH Healthcare Transactional Sets 834, 837P, 997,835,270 and 271 – HL7 including CCD, MDM, ADT, SIU and FHIR APIs
Asim Ilyas
adfa0n@r.postjobfree.com
2
WORK EXPERIENCE
Company: MDLIVE January 2015 - Current
Location: Sunrise, Florida
Title: Director of EDI
MDLIVE is a leading telemedicine company providing virtual healthcare to individuals and employers. They provide acute healthcare, mental health and wellness services through a web and mobile based platform that serves over 25 million members. MDLIVE caters to individuals without insurance, employer groups, health plans and health systems across the USA. Responsibilities included developing the entire EDI team at MDLIVE and created the policies and procedures that should be adhered to when exchanging any healthcare data between MDLIVE and outside vendors, TPAs or clients. Managed a staff of 15 including EDI developers, EDI analysts, Health Integration Architects, Health Integrations Analysts, QA Analysts and Scrum Masters. Implemented all the EDI processes that MDLIVE uses when implementing a client or integrating a health plan or health system from a membership data and health history/encounters standpoint.
Responsibilities:
Managed a team of over 15 employees which developed and maintained the EDI processes for MDLIVE. These included eligibility, claims, health integrations, and effected the external processes such as membership registration, health history, claims revenue, and database integrity.
Implemented and managed the MIRTH application within the MDLIVE eligibility and health integration processes which automated many of the eligibility processes and allowed us to expand our integration capabilities by serving as the company’s integration engine. Integrations included bi-directional scheduling, encounter summary exchanges, patient health history.
Created the policies and procedures on how MDLIVE ingested eligibility data for our membership, determined member costs shares based on the insurance benefits, exchanged health history with health plans and health systems and stored membership data in MDLIVE’s servers.
Implemented a new clearinghouse which handled connectivity with various healthcare payers for both membership eligibility and claims processing.
Helped develop an in-house claims application that generated the 837 claims files and processed the returning acknowledgements and 835 remittance files.
Developed an EDI Dashboard which gave the EDI Department and Senior Management a clean view of the transactional history of all the data that was being exchanged between MDLIVE and external vendors.
Participated in client acquisition meetings as the main IT resource, presenting many of our processes which described the end to end lifecycle of an individual registering and conducting a consultation.
Created the processes which integrated health systems and health plans with the MDLIVE platform so we could exchange health history information from/to various EMR’s and data warehouses.
Implemented a Hybrid Agile methodology that primarily used KANBAN boards to help maintain projects associated to the EDI department.
Part of the departmental initiative to restructure the MDLIVE database and cleanup the bad data that accumulated over the years. This included eliminating redundant data, maintaining data integrity and providing access to the data in useful ways.
Lead the initiative in determining how to interpret the 270/271 transactions to calculate the member cost share when using health insurance. Created the standards for MDLIVE and worked with various health plans such as Humana, Cigna, HCSC and BCBS to solidify their standards in how to develop their telemedicine benefit using the 270/271 transactions.
Created all the standard forms used to intake implementation data for eligibility, claims and HL7 integrations. Environment: MS PowerPoint, MS Visio, MS Excel, JIRA, SQL, Hybrid Agile Asim Ilyas
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Company: MCNA Systems September 2013 – December 2014 Location: Fort Lauderdale, Florida
Title: EDI Manager
MCNA Systems is a leading IT solutions company focusing on the Managed Health Care sector. They provide various high quality services to State Medicaid agencies, Managed Healthcare Organizations and Health Plan Organizations for their Medicaid and Medicare members. MCNA Systems has helped organizations like these streamline their processes all across the country. Responsible in creating a plan to implement a dedicated staff to handle the EDI solutions provided by MCNA systems. Hired and trained both EDI Developers and EDI analyst to handle the workload of various state and private agencies who contracted with MCNA Systems. Implemented all the processes needed to run MCNA System’s EDI department efficiently, increasing the staff from 4 to 15 individuals.
Responsibilities:
Provided day to day supervision and implemented processes for the entire EDI Department.
Identify deficiencies in the newly created EDI Department and assessed what changes were needed to address those inefficient or missing processes.
Created Policies and Procedures that the EDI Department was mandated to follow when implementing solutions for our clients.
Participated in the design and development of system enhancements and tools critical to the proper execution when implementing EDI solutions.
Implemented a hybrid SCRUM methodology to initiate, assess, and develop the necessary changes needed for the existing EDI solutions in place as well as future enhancements.
Developed and complied monthly tracking metrics for senior management.
Main liaison between trading partners nationwide as well as state Medicaid organizations on all EDI related issues or conversions.
Lead EDI projects converting and implementing X12 transactions involving but not limited to 834,835,837,277,997 and 999. Environment: MS PowerPoint, MS Visio, MS Excel, MS Access, Pivotal Tracker, Agile SDLC, Acceptance Test Driven Development Company: Managed Care North America October 2012 – September 2013 Location: Fort Lauderdale, Florida
Title: Senior Business Analyst/EDI Business Analyst MCNA Dental (Managed Care of North America) is a leading dental benefit management company committed to providing high quality services to state Medicaid agencies and managed care organizations for their Medicaid, Children's Health Insurance Program
(CHIP), and Medicare members. MCNA serves approximately 3 million children and adults as well as offering dental plans for private employers, individuals and families.
Worked on several projects involving enhancements to the company’s proprietary software as well as leading EDI projects involved with adding new health plans to company trading partner list. Responsibilities:
Using Acceptance Test Driven sessions created Business Requirement Documents for features requested by various business units within the company.
Tracked lifecycle of the project using Pivotal Tracker software where detailed requirements were housed and refinements were discussed amongst Business Analysts, Development and QA team.
Set priorities of feature requests, defined software requirements and communicated with software development staff on regular basis to obtain updates and identify any gaps the requests did not address..
Worked with Subject Matter Experts to ensure requirements were defined and documented properly and also lead User Acceptance Test sessions prior to deployment.
Asim Ilyas
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Lead project to enhance the electronic claims submission portal used for healthcare providers to submit and track claims submissions.
Project Manager on initiative to augment the company's current Mailroom processes in conjunction with RICOH Production Print Services and a total conversion budget of $400,000.
Defined and documented EDI business processes and was responsible for documenting any requirements needed per project basis.
Lead EDI projects converting and implementing X12 transactions involving but not limited to 834,835,837,277,997 and 999.
Main liaison between trading partners nationwide as well as state Medicaid organizations on all EDI related issues or conversions.
Converted existing proprietary software to handle new 2013 CDT codes and prepare for the upcoming 2014 changes. Environment: MS PowerPoint, MS Visio, MS Excel, MS Access, Pivotal Tracker, Agile SDLC, Acceptance Test Driven Development Company: Metlife Insurance April 2011 - June 2012
Location: San Francisco, California
Title: Business Analyst
Metropolitan Life Insurance Company is one of the largest and most recognized insurance companies in the United States. It not only provides personalized customer service but also has fast claims services. MetLife Insurance offers various insurance policies to customers such as health, life and Auto Insurance. Worked on multiple projects. Contributed in designing a prototype for future system claim processing by developing a web-based service application to streamline office workflow processes involved in Electronic Data Interchange (EDI) transactions and benefits in claims management cycle based on HIPAA Guidelines (ICD 9 – ICD 10). Responsibilities:
Performed requirement analysis and documented the Business Requirements Document and Functional Specifications Document using Rational Requisite Pro.
Prioritized deliverables, identified gaps, tracked defects, defined software requirements and created artifacts for development and testing.
Collaborated with technical staff and subject matter experts to establish technical vision of the product and analyze constraint tradeoffs.
Created UML diagrams: Use Case, Activity and Sequence diagrams in MS Visio.
Created a Traceability Requirements Matrix to track Use Cases and the requirements related to them.
Assisted in the development of the UAT cycle test scripts and reviewed User Acceptance Test Plan.
Gathered knowledge on HL7 and various HIPAA rules and regulations for development of the proposed system.
Mapped HIPAA compliant EDI transactions for Healthcare Claims (837) and Payment Advice Transactions (835).
Advised on changes for the system design, methods, procedures, workflows and policies that effected the Medicare/Medicaid claims processing in compliance to government procedures such as HIPAA and EDI formats as well as ANSI.
Maintained and updated the FAQ knowledge base in SharePoint for better data accuracy and timely data availability. Environment: MS PowerPoint, Requisite Pro, MS Visio, MS Excel, MS Access, Oracle, Clear Quest, Waterfall SDLC. Company: Citibank February 2010 – March 2011
Location: Fort Lauderdale, Florida
Title: Business Analyst
Citibank is one of the leading banks providing an array of financial services to its retail clients, small and big businesses as well as corporate clients.
Asim Ilyas
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5
This project involved enhancing the payment gateway by using a technology-driven approach with upgraded security measures for online banking. The key features included in this project were the secured authorization processing and enhancement of automatic bill pay options. I was also engaged in creating interfaces for Citibank, World Wallet Project involving FOREX Module (CitiFX Pro). Responsibilities:
Created Business Requirements Document, Functional Specifications Document and Use Case Specifications based on information gathered through requirements workshop sessions with end users, SME’s and other stakeholders.
Conducted design sessions with key technical team members to create scope of work documents for prototypes using Rational Requisite Pro.
Used UML and Object Oriented methods to gather and document business and functional requirements. Prepared entity relationship diagrams, class diagrams and activity diagrams to help facilitate written documentation.
Utilized reporting tools such as SQL and ACCESS for querying underlying database tables and resolve data issues.
Worked constantly with the development and testing team to improve the quality of the application by conducting regression analysis and User Acceptance Testing.
Tracked and reported major project milestones by presenting status reports to senior management using MS Project.
Used Cognos and Crystal Reporting to enhance reporting capabilities.
Managed outsourced development team, on site development team and testing team to ensure project met all it's requirements and that the budget was maintained and the project was delivered on time. Environment: Rational Requisite Pro, MS Project, MS Visio, Oracle, Cognos, Crystal Reporting and SQL. Company: Medco Health Solutions Inc. December 2008 – January 2010 Location: Oakland, California
Title: Business Analyst
Medco Health Solutions provides Express Scripts to registered clients that help streamline previously tedious processes to communicate prescribe and dispense drugs for patients. This project required development of Clinical management products application to lower the plan costs and improve quality of care by engaging physicians and pharmacists in addressing inappropriate prescribing, dispensing of drugs. The major features to be included in the project were Coverage Authorization, Coverage Review/Prior Authorization, and Drug Utilization Review (DUR) Responsibilities:
Gathered business and functional requirements based on the Waterfall SDLC methodology..
Conducted JAR and JAD sessions and created status reports, oral presentations as well as interviewing end users, technical team members, non-technical team members and physicians to elicitate requirements.
Created Use Case Diagrams, Use Case Narratives, Activity Diagrams, Class Diagrams and Collaboration Diagrams using UML Modeling tools in MS Visio.
Created work breakdown structures, project timelines and guidelines using MS Project.
Developed and executed overall strategy for User Acceptance Testing and Operational Acceptance Testing.
Performed data mining using SAS and INSIGHT to detect relevant patterns in the Medco databases, both current and historical.
Performed data analysis by evaluating: Age, Gender, SSN, DOB and Procedural Codes including all financial representations, ie: deductibles, co-pay, reimbursements.
Environment: MS Project, MS Visio, Rational Requisite Pro, SQL, Oracle, INSIGHT, TOAD, MS Excel, MACROS, UAT and Waterfall. Company: APS Healthcare February 2008 – November 2008 Location: White Plains, New York
Title: Business Analyst
APS Healthcare is one of the largest healthcare service companies in the public programs area, serving nearly 40 percent of the US Medicaid population through 40 different programs in 20 states. Asim Ilyas
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This project involved creating a multi client care connection platform system with modules configured to support utilization management and clinical management for multiple clients in a single, scalable application for Medicaid programs in Florida, Oklahoma, New Jersey, Arkansas, Ohio, Nevada, Georgia and West Virginia. Responsibilities:
Assisted in preparing project plan, time line, stakeholders and resource identification.
Conducted JAD sessions with various stakeholders to gather business requirements and create Functional Requirement Document for the development team.
Using the Agile Scrum Methodology, sprints were conducted within 70% of the estimated time, which resulted in 2 beta releases within 6 months.
Tacked project progress and provided status reports to senior management using MS Project.
Performed Unit and Integration testing with the development team as well as User Acceptance Testing and Regression Testing of the application using QTP, Quality Center and Jira.
Involved in the issue assessment, risk analysis and change management processes to confirm that the solution met the business need.
Worked with the business stakeholders in creating the user acceptance criteria and coordinated the User Acceptance Testing process.
Environment: MS Project, MS Excel, SQL, Rational Rose, Business Objects, Bugzilla, Jira and Agile Scrum Methodology. Company: Waitsup.com January 2005 – January 2008
Location: Fort Lauderdale, Florida
Title: Vice President of Business and Technology Development Responsibilities:
Helped create and develop initial design, marketing and sales strategies for WAITSUP.com, a patient portal to help book doctor appointments and manage your own patient health record..
Developed strategies to create awareness of Waitsup’s benefits for physician practices and how it can help with increased office efficiency.
Created marketing campaigns to reach out to patients actively looking for physicians in their areas and promoting the benefits for using Waitsup to better their own health
Assembled and trained a sales/marketing team in various U.S. markets that helped increased users, both physicians and patients, making Waitsup a credible source in the healthcare sector.
Responsible for developing key sales implementation projects to increase clients in the Sanitas Medical Transcription Division. The resulting projects increased client base from 10 to 60 participating doctors by the end of 2010 and increased sales from $35k to $125k yearly.
Supervised the software and hardware implementations for all clients transferred from previous vendors for Sanitas Medical Transcription.
Created and managed a sales team in FL, NJ, NY and OH responsible in developing sales markets for Sanitas Health System and Lexis Health Products.
Created team to handle all future implementations for Sanitas Health Systems suite of products including Sanitas Medical Transcription and CURA.
Put together all educational & training material needed to maintain and implement CURA and Sanitas Medical Transcription.
Member of team that created key ideas including company names, slogans, website design and marketing information for all Sanitas Health System Websites: Sanitasmt.com, Lexishealth.com & CuraMD.com EDUCATION & CERTIFICATIONS
Economics Rutgers, the State University of New Jersey Project Management Professional (PMP) Project Management Institute Digital Healthcare Certificate UC San Diego
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