Summary
Overview
Work History
Education
Skills
Areas Of Interest
Career Overview
Certification
Timeline
Generic

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
India
06-2006

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
Abhishek .