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sanjay - Product owner

[email protected]

Location: Dallas, Texas, USA

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Sanjay Chowdhury Austin, Texas. Email Id [email protected] contact Number :(972)244-3178. Summary Experienced professional in the Information Technology domain working as a most ambitious and creative Product Owner to improve quality and efficiency by focusing on the products and its customers first and foremost. Experience Synopsis 7+ years of experience in the healthcare industry. Certified SAFE Product Owner. Certified Advanced Scrum Master. APEX IT professional award recipient HUMANA health. Embraced cross-functional leadership. Skilled at Product Analysis, Prototyping, and Value Proposition development. Business Savvy and best communication skills. Professional Experience Humana Health Care, Louisville, KY March 2020 June 2023 Product Owner Adopt standard practice to improve the EDI transaction workflow for Humana integrated downstream teams. Work on Humana's Administrative, Consolidated Clinical transactions, and Medical Records Management workflow. Involved in product development requirements that supported the structured/unstructured transaction flow. Work on the development side to enrich the clinical data for specific healthcare measures (gaps in care, Clinical insight, Clinical inference, Patient Safety). Reduce unwanted Product building delays by improving the process and practice in requirement gathering and Advocating delivery focus mindset with the ship-on-demand release orchestration. Participated in an Architectural session to discuss Interface Contract Document- ICD preparation. Participate in stakeholders' discussions to understand business change requirements. Managed New Vendor s connectivity establishment planning. Contributed to Humana's Agile Transformation journey by establishing the Safe Agile Framework guided practices. Worked as Mentor, Coach, Change Agent, and great facilitator for the development team. Involved in Backlog management and Prioritization, Sprint planning and execution, Epic and User Story creation, and Product Life Cycle management. Successfully implemented connectivity for the external vendor organization such as EPIC, MOXE, ALLSCRIPTS, ATHENA, INNOVACER, QHN, KPCA, DISPATCH heath, CAREHEALTH, CENTERWELL, Homecare Homebase, etc. Make good decisions that honor the team members for their hard work and dedication, recognized for Pioneering simplicity. Commit to upholding the quality of the development work and being able to shift quickly to build better products. Worked as team leader to learn and serve together, elevated the team s performance. Transform the team mindset into the Agile mindset, and strengthen the development excellence for creating, understanding, and building quality products. Communicated effectively with diverse stakeholders, from developers to executives Excellent knowledge of the .Net technology to implement solutions. Made sure product development work was in line with what the Customers were trying to accomplish. Anthem Health Insurance, Norfolk, VA February 2017 March 2020 Product Owner/ System Analyst Appointed as Scrum Master/Business Analyst resource to the Government Business Division's states Medicaid partner agency. Involved in Facility and Professional encounters related to Adjudication processes and Practices for Claims. Supported implementing the business rules in the new Rules Engine software for specific Medicaid and Medicare market claims information (PEGA claim engine). Played pivotal roles to meet the understandings of the state-specific business rules and edits for Medicaid/Medicare X12 formatted Facility and Professional claims (T837). Worked as the functional analyst to maintain the overall understanding of the Claims Adjudication process mechanisms in terms of Member Selection, Provider Selection, NDC rules, CLIA rules, HIPAA Check. Participated in the Process Improvement activities to discover and prioritize user-focused functionality, product-specific ASK, Identify technology shortcomings, and Quality improvement. Executed deliverables in Government Claims Intake Claims Repair (CICR) Application and Claims Intake Repair Tool (CIRT). Involved in front-end audit reconciliation with the Optum Transaction Validation Manager tool. Reviewed requirements specific goals by reviewing the data in the DATABASE to understand the business perspective. Worked in phases to understand the business requirements to maintain a commitment to excellence - Discovery the problems, developing new solutions, Implementing the solution, Monitoring the change impact, and Closing the requirements. Worked diligently to fully define the claims pre-adjudication process gaps and flaws in data to identify what works best for the existing process and review the improvements. Worked with Product Owners to review requirements documentation to understand the need for best solution information Consulted with the Subject Matter Experts to identify business rules compliance check and discussed transparency to clarify requirements objectives. Contributed in technical and in functional researched on the Encounter claims processing to mitigate downstream rejection Participated in requirements backlog grooming, design and Code review meetings, and Government business divisions Medicaid markets implementation meetings. Collaborated Sprint planning session as Scrum Master with the team to kick-offs the Sprint planning by identifying story requirements in terms of product development, defining the key requirements of the Sprint stories, and reviewed critical risks and remove any impediments. Created JIRA stories by providing the Acceptance Criteria and Description of the Change -describing the requirement in technical terms to help developers understand how to part better. Utilized the gathered requirements detail to carry out the Acceptance Test Driven Development activities before actual development work. Collaborated with business teams regarding change requests, identify the technical phases for 837P and 837I claims error issues, recommended proper resolutions. Prepared Test case scenarios and Test plan to ensure proposed solutions capture the functional and regression testing perspective for the given requirements. Prioritized code development activities in AGILE SCRUM methodology for the implementation and coordination for issue resolution. Supported Release Management Technical Activities to roll out Products in Production Environment after gathering necessary UAT sign-off approvals. Maintained the JIRA board and Confluence page for status reports and team activity summaries and relevant deliverable presentations and actionable items. Involved Anthem IngenioRX Pharmacy Benefit Configuration testing coordination - Drugs benefits; Tier 1-5 configuration details. Worked on Acceptance Test Driven Development framework to configure the Drug benefits for members and plans. Amerigroup, Virginia Beach, VA May 2016 February 2017 Business System Analyst Worked on the encountered batch processing system activities and inbound claims reconciliation system. Worked on the notification side monitoring T837 batch claims are loaded on the claims gateway systems. Monitored the inbound T837 claims loaded from the internal sources to the SFTP folder location. Extracted the report of the HIPAA compliance checked activities and shared that report in an email. Executed steps to load claims files from FACET to the EDIFecs Encounters Management user interface staging area per the Medicaid markets. Determined the Members have matched/Providers Data validated in the claims data per the market- specific requirements. Edit mode claims are correctly processed for acceptance or rejection in terms of CMS edits and specifics. Executed the scrubs run claims after the database update. Worked with the market-specific business teams for the proper configuration of the Edifecs identifiers for the claims edits. Worked on the Pend review claims after compliance check for the manual technical correction of Healthcare T837 Institutional and Professional claims. Conducted business-impact assessment and the results were compared with the new HIPAA 5010 standards to determine the current level of compliance. Performed System testing of the Front End Claims processing systems (NPI , Taxonomy check, State- specific match, Medical records number check, National Drug code check, Facility code check address check ). Proactively communicated with Subject Matter Experts to ensure expectations of the deliverable are kept in line with the requirements. Assumed ownership for mentoring the spirit of work together, skills sharing, and expectations focusing on the rewards and successful outcome. Participated in Medicare Specific Edits. Randolph Brooks Credit Union, San Antonio, TX September 2014 May 2015 Consultant Performed duties related to banking transactions related technical issues. Monitored software expected behavior working exactly as it intended. Networking troubleshooting to support the Management team. Worked with the team members to gather user experience information and overall efficiency. Reviewed user feedback and delivered the technical document to the configuration team. Performed required team coordination to understand the Credit Union objectives and expectations for the technical support. Attained valuable Product and People management formal training approved by Credit Union organization. Familiarized in reviewing the Client Service record protection workflow. Involved in new branch opening technical networking set up planning activities. Lead 4 Member technical support team. Wells Fargo Bank, Dallas, TX January 2012 September 2014 Business Analyst In Wells Fargo, a Scalable application enabled simplification, standardization of Auto Loans processes, increased visibility of information, reduced risk and better integration, and created an efficient software product for auto loan customers. Gained insight about the As-Is business process in Auto Loans portfolio to determine future opportunities for new To-Be value Stream with high-level collaborative workshops. Worked on the successful configuration of the SAP Finance - Asset Accounting and General Ledger module. Created business process designs (BPD) and business system designs (BSD) that meet the business needs, adhering to Auto Loan departmental documentation standards. Responsible for the long-term vision of product category as well as short-term implementation. Gained knowledge on auto loan-related functionality such as loan cycle time and automating the manual paper-intensive processes within the loan operation division. Adhere to departmental quality assurance and quality control standards during testing and implementation activities. Worked in Scum Framework. Completed the entire project from the inception to the implementation in the Production region. Supported Acceptance Test Driven Development work strategy. Woodforest National Bank, Denison , TX August 2008 November 2011 Internal Auditor Participated in auditing internally the accuracy and timely processing of payroll timing and other bank account-related reconciliation activities at the retail bank level in Dallas region branches. Reconciled and analyzed various branch Loan projects, and their related payments disbursement. Actively involved in researching discrepancies in paper works. Ensured account opening documents are created within prescribed timetables and using proper procedures and internal controls. Education Bachelor of Science Accounting Control System 2008 University of North Texas, Dallas, TX Certifications Certified Scrum Master Certified Advanced Scrum Master Certified SAFE Product Owner Azure Cloud fundamental Certified In-depth understanding of the HL7 FHIR standard Technical Skills Microsoft Products Azure DevOP ADO JIRA; Version One Gherkin (Acceptance Criteria), Balsamiq Altova XML SPY .net framework SOAP UI/POSTMAN Confluence MS Visio EDIFECS Claim Validation, FACET Keyword Claims Generator, Pega Claim Engine System; CICR application, CIRT Application; OTVM CICD Pipeline MS SQL Database RxClaims HL7/FHIR/X12 ServiceNow Keywords: user interface information technology microsoft Idaho Kentucky Texas Virginia