Abhishek .
Sacramento
Summary
Dynamic Advisory Manager and Managing Consultant with extensive experience in Medicaid/MMIS Space, leading large teams in modernization projects. Expert in project management and stakeholder engagement, driving successful policy implementations and financial tracking. Proven ability to optimize processes and foster cross-functional collaboration, ensuring project success and innovation in complex environments.
· Helping Medicaid Clients understand their technical debt, build a modernization roadmap with them without compromising on stability.
· Provide a holistic, modernized hybrid, multi-cloud ecosystem in a cost-effective, flexible "Z platform as a Service" that delivers robust, security-rich, multi-tenant and single tenant solutions.
· Help maximize their mainframe investments and improve agility by providing Cloud-native development for z/OS applications, Real-time sharing between z/OS applications and AWS and Mainframe augmentation with new channels.
· Use the Co-create, Co-Execute, and Co-operate methodology to bring stakeholders together to prioritize, build, and scale data, process, and technology transformation projects.
· Implemented a Provider Management asset that can support modernizing of legacy MMIS systems by providing a one-stop Provider Portal as a solution that can scale and is vendor agnostic
· Utilized a repeatable, proven and disciplined methodology built over 15 years of transitioning key Medicaid and Commercial Clients.
· Implemented California MMIS projects like Data Center Migration, HIPAA 5010, ICD -10, ACA over the period of 14 years.
· Managed teams in capacity of 40 and executed projects in excess of $100 Million on the books.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Advisory Manager/Managing Consultant
IBM Corporation
Sacramento
01.2016 - Current
- Directed team of 50 on diverse enhancement and modernization projects, including cloud migration for Provider Portal and Mainframe applications.
- Analyzed market trends and competitor activities to shape business strategy.
- Managed annual budgeting and forecasting, optimizing resource allocation.
- Negotiated vendor contracts to achieve cost reductions.
- Developed customer service excellence program, enhancing overall customer satisfaction.
- Streamlined communication channels to improve information flow and decision-making efficiency.
- Ensured compliance with laws, regulations, and industry standards across all operations.
- Monitored financial performance and reported IBM contributions to executives.
Project Manager/Lead Consultant
Xerox
Sacramento
05.2014 - 04.2016
- Led successful implementation of Xerox’s System Replacement project through effective team management.
- Collaborated with functional groups to integrate legacy systems with new technologies.
- Consulted with Technical and Data Architecture teams during critical CAMMIS data mapping sessions.
- Assisted Business Analysts and development team in formulating business rules in accordance with CAMMIS policies.
- Tracked financial metrics and provided status updates to Xerox and IBM executives on project contributions.
Project Lead/SME
IBM
Sacramento
06.2013 - 10.2015
- Led team of 30 members in documenting, designing, developing, and supporting ICD-10 enhancement for CAMMIS.
- Documented existing workflows of business processes to ensure clarity and efficiency.
- Gathered, validated, and communicated business requirements to stakeholders, identifying critical gaps.
- Created functional design for baseline requirements and technical specifications for 350 impacted mainframe components.
- Served as SME to assess impact on claims processing and proposed necessary changes.
- Identified cross-project impacts within CAMMIS, advising stakeholders on resolutions and workarounds.
- Designed crosswalk approach to transition diagnosis codes from ICD-10 to ICD-9 for seamless claims processing.
- Oversaw development team in modifying 320 modules using COBOL, JCL, VSAM, and DYL280.
Operations Lead/ System Analyst/SME
IBM
Sacramento
07.2010 - 05.2013
- Served as Subject Matter Expert/Sr. Software Engineer for mainframe applications transition from HP to operations for Department of Health Care Services.
- Gathered business requirements and developed expansion project for Contingency Payments, ensuring Med-Cal providers received payments during CAMMIS processing failures.
- Configured CA-7, Endeavor, and Panvalet on FI Development, Test, and Production servers.
- Executed Claims Critical Path testing in sandbox environment to validate system performance.
- Participated in data migration from HP servers to IBM data center in Dallas.
- Led system testing efforts by configuring schedulers, customizing jobs, executing test cases, and analyzing defect data.
- Conducted parallel testing of claims adjudication processes between HP and IBM servers, achieving less than 1% deviation in results.
- Reduced inherited problem statements by 70% within six months while managing a repository of 380 issues.
Software Analyst
IBM & Lenovo
Bangalore
07.2006 - 06.2010
- Configured and implemented programs to separate accounts receivable processing for IBM, Lenovo.
- Developed JCLS and user reports for enhanced data management.
- Created client-side validations using CICS to improve system reliability.
- Contributed as Software Analyst on ZUMA project to facilitate financial processing separation.
Education
B.Tech - Mechanical Engineering
VIT University
India06-2006
Skills
- Mainframe
- Project management
- Technical consulting
- Process optimization
- Team leadership
- Risk assessment
- Stakeholder engagement
- Cross-functional collaboration
- Performance management
- Partnership development
- Change management
- Medicaid Management(MMIS)
- Staff development
- Conflict resolution
- Staff training and development
- Financial management
- Negotiation
- Innovation management
- Policy implementation
- Competitor research
- Decision-making
- Risk management
Areas Of Interest
- Medicaid Modernization
- Medicaid Interoperability
- Payer Systems
- Claims Processing
- Claim Financial Processing
- Data Management
- Client Management
- Operations Management
- Mainframe Systems
- Project Management
Career Overview
- Project Manager/SME/System Consultant, IBM India Pvt Limited, Bangalore, India, 07/07/06, 12/31/15
- Advisory Manager/Managing Consultant, IBM Corporation, Sacramento, CA, 01/03/16, Present
Certification
- MITA Certified Medicaid Practitioner
- Certified Scrum Master
Timeline
Advisory Manager/Managing Consultant
IBM Corporation
01.2016 - Current
Project Manager/Lead Consultant
Xerox
05.2014 - 04.2016
Project Lead/SME
IBM
06.2013 - 10.2015
Operations Lead/ System Analyst/SME
IBM
07.2010 - 05.2013
Software Analyst
IBM & Lenovo
07.2006 - 06.2010
B.Tech - Mechanical Engineering
VIT University
Similar Profiles
Ashish SrivastavaAshish Srivastava
Package Specialist at IBM CorporationPackage Specialist at IBM Corporation
Donnis C. ThomasDonnis C. Thomas
Bids and Proposal Pursuit Manager/Strategist at IBM CorporationBids and Proposal Pursuit Manager/Strategist at IBM Corporation
Scott CornellScott Cornell
Storage Solutions Specialist at IBM CorporationStorage Solutions Specialist at IBM Corporation
Britney TishchenkoBritney Tishchenko
Pathology Clerk at Kaiser PermanentePathology Clerk at Kaiser Permanente
Kelly OldhamKelly Oldham
Laboratory Assistant at Sutter Roseville Medical CenterLaboratory Assistant at Sutter Roseville Medical Center