Ranjit Kumar M

Advisor - Business Analyst (Product Owner)

About

• 10+ years as Product Owner/Business Analyst driving product solutions, design & implementation in both product and account portfolios. • Over 10+ years in supporting US Medicaid Health Insurance Payer portfolio accounts and products. • Healthcare experience revolves around MMIS (Medicaid Management Information System) with solid knowledge on Claims, Prior Auth, Eligibility, Provider Enrollment, Provider Management, Reference and Customer Self Service portals like Provider, Member and MCO. • Experience in Claims and Prior Auth adjudication – thorough understanding of the processing of claims and authorizations based on Benefit Plans, Provider Contracts, Service Information, Other Insurance, Fee info and adjudication rules. • Very good exposure to EDI ASC X12 implementation guides and implementing solutions based of standards such as 270/271, 278, 837I, 837P, 837D transactions. • Very good exposure to FHIR HL7 implementations for Claims and DAVINCI HL7 for Prior Authorizations. • In depth knowledge in coding business rules using InRule Business Rules Engine. • Very good experience in writing/analyzing complex SQL queries required in data analysis, fixing SQL issues and tuning queries for performance. • 5+ years in managing QA teams (functional, automation and performance) and assisting project management. • Experience driving a scrum team, conducting the agile scrum ceremonies and coordinating the nexus teams. • Experience working as a scrum master in the SAFe setup, conducting SAFe agile ceremonies and coordinating the scrum teams under ART. • Experience in collaborating with stakeholders, capturing and eliciting Requirements. • Experience in writing Business and System Requirement specifications, Business Design documents, leading and coordinating business as well as delivering technical solutions. • Experience in creating/reviewing test plans, test case specifications, reviewing performance specifications and mentoring the system integration, user acceptance and performance testing teams. • Experience in creating Project Charter, Project Initiation/Kickoff presentations, creating the WBS, timelines, assigning resources, tracking the progress using tools like PPMC, MS Project and coordinating the delivery with the leadership. • Good knowledge on the NCPDP pharmacy standards and the associated data elements/code values. • Good exposure to DDI interfacing modules such as OSB, OXI, .Net, Oracle, Content Manager, CRM, etc., • Good exposure to claims and prior auth mappings from X12 to legacy SOAP XMLs specs.

Country

Canada

City

Toronto

Industry

Information Technology & Services

Skill

Business Analysis, Project Management, Scrum Master, Quality Assurance Management, Business Process Mapping, Business Process Design, Test Automation, Banking, Healthcare, Manufacturing, Telecommunications, Quality Assurance, Visio, Business Systems Analysis, Performance Engineering

Experience

Advisor - Business Analyst (Product Owner)

Gainwell Technologies (Formerly known as Hewlett Packard Enterprise)

2011-1 - Present · 15 yrs 9 mos

Toronto, Ontario, Canada

* Developing product ideas for Prior Auth Automation Rules Engine and transforming the ideas into technical solution specifications. * Designing and implementing prototypes to assess the capabilities of products like Appian, InRule etc., * Collaborate with Enterprise Technology Stack, Business, Architecture groups to present and expand the product ideas. * Analysis of EDI ASC X12 standards such as 278, 837P, 837I and incorporate the findings into automation solutioning. * Analysis of current industry information exchange formats such as FHIR HL7 specifications for Claims and Prior Auth automation solutioning. * Estimate the scope for releases, sprints part of the release and build features, user stories and add technical implementation and testing requirements /acceptance criteria to the stories every sprint. * Assign the user stories to the resources, drive the implementation and resolve impediments every sprint. * Experience running the daily standup, sprint planning, review & retrospective sessions. * Design entities, inline tables/value lists and code the business logic as language rules/decision tables/java scripts using InRule Business Rules Engine for automating prior authorization adjudication process. * Assessing the capabilities of Appian by building prototypes using the expression rules, process models, interface and decision nodes. * Support the team with business and technical inputs, resolve the impediments, direct/engage the right resources to move swiftly with the incremental delivery. * Run the scaled agile ceremonies such as PO Sync, Iteration Planning, Inspect and Adapt Workshop in the SAFe environment for the transition from agile to SAFe. * Act as a liaison between business and the project team, use advanced tools & techniques to elicit, capture/document, analyze and validate business requirements. * Manage the QA teams in Selenium Automation, Load Runner Performance executions, 508 Compliance(WAVE, Axe Deque, NVDA) and Functional testing.

Senior JAVA/J2EE Developer

Motorola India Private Ltd.

2006-6 - 2010-10 · 4 yrs 5 mos

1. Analyze the new features specific to LMT/Provisioning/ELMT/Melody SSC Health-Check and DAP LMT modules. 2. Create High-Level and Low-Level System Design documents for Java related components and the interfacing modules (JNI, NMS & Scripting Components). 3. Lead the JAVA development team in effort estimation, design and implementation of the proposed features. 4. Develop/Code J2EE software applications using JSPs Servlets, EJB, Helper Classes etc., 5. Own supporting modules like Informix DB routines, LMT Core and Backup Server components. 6. Develop/Code Shell, PERL, PYTHON and EXPECT scripts on multiple flavors of Unix and Linux environments. 7. Develop Integration test suites and resolve impediments in component integration, system and box testing. 8. Support Software Configuration Management team in building and deploying applications/solutions. 9. Offer technical support to Field/Production Deployment activities and maintain Solaris and ATCA servers. 10. Analyze, recommend and implement solutions for field/production issues. 11. Involve in technical writing to create MOPs for Deployment.