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Neha Tiwari - Sr. Project Manager | Healthcare & Federal Programs | Product Owner

[email protected]

Location: Plano, Texas, USA

Relocation: Open

Visa: Green Card

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NEHA TIWARI Sr. Project Manager | Healthcare & Federal Programs | Product Owner 609-356-6219 [email protected] linkedin.com/in/neha-tiwari-432a95117 Green Card Holder PROFESSIONAL SUMMARY Senior Project Manager and Product Owner with 17+ years of experience across federal healthcare, Medicaid, enterprise IT, and business transformation initiatives. Certified Scrum Master with hands-on leadership in project planning, scheduling, stakeholder management, risk and impact analysis, budgeting, Agile delivery, UAT, release coordination, vendor oversight, and change management. Experienced translating business and regulatory requirements into executable delivery plans while coordinating business, engineering, QA, architecture, compliance, and data teams. Deep domain exposure includes VA healthcare, CMS/HIPAA, MMIS, claims, pharmacy, Snowflake, Power BI, PEGA, and Dynamics 365. CORE COMPETENCIES Project Management: Project Planning Scheduling Delivery Management Risk & Impact Analysis Budget / Cost Tracking Resource Allocation Change Management Vendor Management Agile & Product: Scrum Master Agile / Scrum Product Ownership Backlog Prioritization User Stories Acceptance Criteria Sprint Planning Release Coordination Healthcare & Federal: VA Healthcare Medicaid MMIS Plexis Claim Management Trizetto Facets IVR HIPAA CMS PASRR EDI 834, 835, 837 (P, I, D), 270/271 Data & Technical: SQL Server Oracle Snowflake Data Warehousing Power BI SSRS Source-to-Target Mapping PEGA App Studio Twilio Studio & Voice APIs XML Tools: Jira Confluence VersionOne SharePoint Portal Server MS Project MS Office Visio Visual UML ITIL HP Quality Center Rational Requirements Composer Salesforce CRM Dynamics 365 CRM PROFESSIONAL EXPERIENCE Sr. Project Manager & Product Owner Oct. 2024 April 2026 Veterans Affairs Austin, TX OUTPATIENT PHARMACY APPLICATION (ONEVA PHARMACY) The OneVA Pharmacy software enabled the Veterans Health Administration (VHA) to allow veterans traveling across the United States to refill or partial-fill their active VA non-controlled substance prescriptions at any VA pharmacy location, regardless of prescription origination. Defined and communicated the Product Goal, establishing overall objectives and targets for the product. Gathered and documented business and functional requirements to support nationwide prescription refill and partial-fill capabilities for veterans across all VA pharmacy locations. Conducted impact analysis and gap assessments for system changes, ensuring compliance with CMS guidelines and minimizing downstream risk. Broke down features into user stories with clear, testable acceptance criteria. Created detailed system interaction, process, and swim lane diagrams used in BRDs, FRDs, and stakeholder presentations. Created sequence diagrams documenting API interactions, system triggers, and message exchanges. Collaborated with VHA pharmacy operations, clinicians, compliance teams, and IT to ensure seamless prescription access regardless of origination site. Worked closely with developers, QA, and architects to clarify requirements and support solution design throughout the SDLC. Owned the product backlog in Jira and Confluence, prioritizing features by business value, regulatory deadlines, and stakeholder input. Facilitated Agile ceremonies including sprint planning, backlog grooming, daily standups, reviews, and retrospectives to ensure consistent delivery. Supported system workflows, user acceptance testing (UAT), and release coordination to ensure compliance with VA pharmacy policies and federal regulations. Ensured alignment of application functionality with patient safety, data integrity, and continuity-of-care objectives. Collaborated with data engineers and stakeholders to translate business reporting needs into Snowflake data models, ensuring performance, security, and data accuracy. Analyzed source-to-target data mappings and validated Snowflake data pipelines supporting enterprise reporting and decision-making. Supported cloud data warehouse initiatives in Snowflake, focusing on data governance, access controls, and performance optimization from a business requirements perspective. COMPACT ACT IMPLEMENTATION Led the implementation of Section 201 of the Veterans Comprehensive Prevention, Access to Care and Treatment (COMPACT) Act of 2020 at the Department of Veterans Affairs. The initiative mandated the VA to directly pay for or reimburse emergent suicide care for eligible individuals in acute suicidal crisis, significantly changing how that care is billed and how ongoing treatment is managed. Led business analysis and implementation activities for Section 201 of the COMPACT Act of 2020, translating federal legislative mandates into system and process requirements. Partnered with clinical, billing, finance, and policy stakeholders to redesign billing and reimbursement workflows for emergent suicide care. Defined eligibility rules, payment scenarios, and care management processes to support timely access to crisis services. Acted as primary liaison between business users and technical teams, resolving ambiguities and managing evolving requirements to prevent scope creep. Ensured compliance with healthcare and government regulations including HIPAA and FedRAMP where applicable. Created process flows, business rules, and data mapping documents to help technical teams understand current- and future-state workflows. Supported source-to-target data mapping, data validation, and reconciliation to ensure data accuracy, integrity, and audit readiness. Partnered with stakeholders to define reporting KPIs and dashboards leveraging Snowflake for population health, financial, and operational insights. Ensured Snowflake implementations aligned with data governance, security, and regulatory requirements (HIPAA, CMS, and state/federal guidelines). Supported UAT planning and execution by creating test scenarios, validating outcomes, and obtaining stakeholder sign-off before production releases. Identified gaps and impacts when requirements changed and communicated implications to stakeholders ahead of implementation. Delivered executive-ready documentation and status reporting to leadership, improving transparency, decision-making, and stakeholder alignment. Supported change management, documentation, and stakeholder communication to drive enterprise-wide adoption and regulatory compliance. STATE PRESCRIPTION MONITORING PROGRAM (SPMP) Headed the SPMP implementation to identify Schedule II V controlled substance prescriptions dispensed by VHA outpatient pharmacies and securely transmit that information to each state's Prescription Drug Monitoring Program (PDMP), enabling authorized providers to access controlled substance data at the state level and supporting safe and effective use of controlled substances inside and outside the VA healthcare system. Defined and communicated the Product Goal, establishing overall objectives and targets for the product. Led requirements gathering and implementation for SPMP to identify and report Schedule II V controlled substance prescriptions dispensed by VHA outpatient pharmacies. Engaged with SPMP and other business teams as the primary stakeholder contact. Created data mapping for each state's PDMP system. Broke down features into user stories and maintained a prioritized backlog. Created detailed system interaction, process, and swim lane diagrams used in BRDs, FRDs, and stakeholder presentations. Created sequence diagrams documenting API interactions, system triggers, and message exchanges. Ensured secure, compliant transmission of prescription data to state PDMPs. Coordinated with state agencies, VA compliance teams, and technical teams to support authorized data sharing and regulatory adherence. Strengthened controlled substance oversight by supporting monitoring, reporting accuracy, and patient safety across the VA healthcare system. Prioritized Snowflake-related data stories and enhancements supporting analytics, reporting, and compliance objectives. Translated stakeholder reporting needs into actionable Snowflake user stories and acceptance criteria. Designed and developed interactive Power BI dashboards and reports supporting executive decision-making and operational performance tracking. Translated business and functional requirements into Power BI data models, visualizations, and KPIs. Built reusable Power BI templates to standardize reporting across programs and stakeholders. Sr. Project Manager & Product Owner Sept. 2022 Oct. 2024 Veterans Affairs Austin, TX VENDOR ENROLLMENT SYSTEM (CUSTOMER ENGAGEMENT PORTAL) The Vendor Enrollment Processing System (CEP Customer Engagement Portal) is a PEGA-based application that automates processing of various vendor types for Veterans Affairs under 10091 guidelines. Performed requirement analysis and partnered with stakeholders and business teams to draft functional and technical specifications. Worked with business stakeholders to define business goals, process gaps, and case management requirements for large-scale PEGA implementations. Translated complex business needs into detailed PEGA functional requirements including case types, stages and steps, data pages, integrations, user interfaces, and decision rules. Led creation of user stories, acceptance criteria, and process models aligned with PEGA App Studio and DCO practices. Supported configuration of PEGA workflows, UI screens, service integrations, and data models. Created prototypes, mockups, and staging sites for stakeholder review and feedback. Created a clear visual representation of the end-to-end process showing interactions between systems, users, and data flows. Authored the Interface Control Document (ICD). Built and maintained reports and dashboards, analyzing data to produce vendor enrollment reporting. Designed and implemented management changes associated with business process redesign. Developed comprehensive training material to support and sustain the Customer Value Management programs. Integrated Twilio IVR with backend healthcare systems (eligibility, claims, and capitation modules) to streamline member interactions. Collaborated with stakeholders to define call flow logic, menu hierarchies, and escalation paths, improving customer experience and reducing manual call handling. Conducted end-to-end testing and UAT of IVR workflows to validate accuracy, routing, and compliance with accessibility and data privacy requirements. Worked with QA and end users to support test planning, defect resolution, and UAT execution. Conducted impact analysis, root-cause evaluation, and workflow optimization to increase automation and reduce manual touchpoints. Developed Power BI dashboards to track healthcare operations, program performance, and regulatory compliance. Supported federal and state reporting requirements through automated Power BI analytics and visualizations. Sr. Project Manager / Product Owner June 2021 Aug. 2022 Veterans Affairs Austin, TX SAM.GOV ENTITY VALIDATION INTERFACE Validated provider data against SAM.gov, creating services and APIs to verify provider Tax ID and NPI before allowing them to do business with the government. Played an active, leading role in gathering, analyzing, and writing business requirements. Facilitated several JAD sessions with stakeholders to identify requirements for a monthly feed table receiving data from SAM.gov. Managed requirements gathering and story tracking using the VersionOne agility tool. Created mockups and wireframes for the proposed solution. Created data flow, sequence, and swim lane diagrams. Contributed to creating APIs for callout services and data mapping to the database. Coordinated with and supported the testing team to validate SAM data. Imported data from the third-party SAM.gov system. Migrated forms and column data from SharePoint to Dynamics 365 CRM. Mapped all columns and column choice values from the data source file to D365 CRM columns and choice values. Worked through daily data imports from the source file into D365 CRM until all errors and failures were resolved and the import completed successfully. Managed security roles and users. Advised senior leaders on creating an annual validation process for providers and entities. Supported the development team during demos to the Product Owner and ensured requested changes were implemented. Coordinated with plan owners to update project plans for change request impacts and verified whether contingency plans would absorb resulting delays. Additional Responsibilities Assisted in developing the project schedule and status reports, attended project progress meetings, and worked with the Project Manager to develop estimates by identifying development and testing team tasks. Consistently managed and tracked project performance, resource allocation, and operating costs. Assisted in developing test strategy, test plans, test case objectives, and test cases based on business requirements, technical specifications, and product knowledge. Product Owner / Lead Business Analyst Dec. 2020 June 2021 Veterans Affairs Austin, TX BORDER PATROL CUSTODY REPORT (ICE) Served as Product Owner for the Border Patrol custody report delivered for ICE. Created SSRS reports. Created new columns and mapped all columns and column choice values from the data source file to D365 CRM columns and choice values. Managed security roles and user access for report distribution. Identified gaps and impacts when requirements changed and communicated implications to stakeholders before implementation. Developed UAT test scenarios, supported business users during testing, logged defects, and validated fixes prior to release. Product Owner March 2020 Dec. 2020 Veterans Affairs Austin, TX ECAMS PROVIDER PORTAL Delivered a new provider portal for non-government providers seeking to do business with the government, using the ID.me system for identity validation and claims payments. Collaborated with stakeholders and SMEs to define business, functional, and technical requirements for MMIS module procurements. Assisted in drafting RFPs, Statements of Work (SOWs), and evaluation criteria for vendor selection in alignment with CMS and state procurement guidelines. Participated in vendor evaluation, scoring, and selection processes, ensuring objective assessment of proposals. Conducted market analysis and developed comparison matrices to support informed procurement decisions. Ensured traceability of requirements from RFP through contract award and implementation. Supported contract negotiation efforts by providing data-driven insights and requirement clarifications. Sr. Business Analyst / Product Owner, UAT Tester Jan. 2018 Sept. 2019 Accenture Inc. Austin, TX DMAS VIRGINIA MEDICAID ENTERPRISE SYSTEM & MEMBER ELIGIBILITY INTERFACE Replaced the existing APHP asset-based product for the Virginia Department of Medical Assistance Services (DMAS) to implement member enrollment, open enrollment spans, and processing of member MCO change requests. Environment included SOAP UI, HIPAA transactions, Jira, and claims processing (request and response, claims status, prior authorization, claims vision, and claims payment). Worked as Business Analyst on the Accenture Population Health Platform (APHP), supporting the design and implementation of capitation and value-based payment models for VA DMAS providers. Led business and functional requirements gathering to inform content for MMIS modernization initiatives and healthcare IT procurements. Collaborated with state agencies and SMEs to draft RFP scopes, evaluation criteria, and technical specifications aligned with CMS modularity standards. Served as Product Owner within the Agile/Scrum process throughout the product life cycle, including backlog management. Partnered with product owners, actuaries, and data engineers to gather, analyze, and document business and data requirements for provider contracts, member attribution, payment calculation, and reconciliation processes. Defined end-to-end data mapping between source systems (claims, eligibility, provider, and reference data) and the APHP data warehouse. Authored functional requirement documents (FRDs), user stories, and data mapping specifications, maintaining traceability in Jira and Confluence. Supported design and implementation of capitation payment models, ensuring accurate per-member-per-month (PMPM) calculations. Analyzed provider reimbursement data and validated capitation rate calculations based on member risk profiles and utilization patterns. Collaborated with ETL and reporting teams to validate business logic for capitation rate calculation, retro adjustments, and payment distribution. Supported migration of capitation logic from legacy systems to FHIR-compliant APIs, ensuring data integrity and auditability. Developed data mapping documents and interface specifications for automated capitation file generation and provider payment reconciliation. Monitored capitation performance metrics including cost per member, utilization trends, and provider reconciliation reports. Supported Medicaid/MMIS and healthcare system enhancements by validating workflows across claims, eligibility, pharmacy, and provider modules. Supported the design, development, and implementation of MMIS to streamline provider enrollment, claims processing, and member management. Performed gap analysis comparing As-Is and To-Be states, along with BRD and user story review, development planning, and roadmap development. Managed PASRR Level I and II screenings and Medicaid LTC eligibility for nursing facility and HCBS admissions. Coordinated with state Medicaid agencies, TPAs, and care providers to authorize services and ensure smooth facility placements. Ensured compliance with CMS, HIPAA, and state LTC regulations, including documentation, reporting, and audits. Supported claims processing and care management workflows, tracking service approvals and outcomes. Designed and implemented end-to-end IVR solutions using Twilio Studio and Twilio Voice APIs, enabling automated call routing and self-service capabilities for healthcare applications. Conducted UAT planning and execution, defect triage, and validation of provider payment outputs against expected actuarial results. Participated in UAT and validation of capitation-related changes in claims adjudication systems. Prioritized metrics based on their impact on risk management and compliance efforts, escalating risks and issues affecting the project. Ensured data accuracy, integrity, and security in the collection and use of member-related data. Supported change requests and enhancements, helping optimize payment accuracy and reduce manual intervention. Managed the project to completion, ensuring timely delivery, adherence to budget, and sustained project ownership. PREVIOUS PROJECTS Business Analyst / Product Owner July 2017 Jan. 2018 Accenture Inc. Austin, TX ACCUMULATOR PERFORMANCE ISSUE & NEW MEMBER ENROLLMENT INTERFACE Redesigned the Accumulator module of the APHP system, which uses accumulators to place quantitative limits on the number of services and dollar amounts a claim will pay during adjudication. The project addressed accumulator performance issues under high-volume claim data. Owned requirements gathering and design, including process mapping and gap analysis, to fulfill application needs for the Facets implementation. Wrote use cases for the extended dashboard application and authored business rules based on 270/271 transactions and HIPAA standards. Created 837 (P, I, D) claims and maintained data mapping documents referencing HIPAA transactions 837 (P, I, D), 834, 835, 270, and 271. Coordinated JAD sessions with stakeholders to assess the impact of HIPAA 5010 on the existing system, identify business flows, and determine which current or proposed systems were affected by the EDI X12 transaction, code set, and identifier aspects of HIPAA. Gathered requirements for the front end and the core adjudication system through meetings and brainstorming sessions with end users and SMEs. Configured accumulators in the benefit plan and processed claims against them. Delivered conditional ruleset configuration, including the UI to add, delete, and configure conditional rulesets and the checks required to perform business rules validation within associated workflows. Created a K2 workflow containing the event responsible for executing conditional logic, and built workflows accessing smart objects and services exposed via the APHP adapter layer. Worked within the project team to identify and interpret state Medicaid policies applicable to customer-defined algorithm research and assisted with internal development of new healthcare analytics. Served as the conduit for managing system requirements between the business and the software development team. Prepared the Requirements Traceability Matrix (RTM) and test plans and test cases based on use cases identified during requirements gathering. Developed a SharePoint project dashboard to track progress of migration phases. Monitored vendor performance and deliverables for MMIS modernization initiatives, ensuring compliance with contractual obligations, SLAs, and CMS modularity standards. Partnered with procurement, legal, and program leadership to track contract milestones, review invoices, and verify completion of key deliverables. Conducted performance reviews and risk assessments to identify gaps in vendor execution and recommend corrective actions. Supported change request management and ensured timely updates to contract documentation and project schedules. Supported change management by tracking contract amendments, renewals, and performance improvement plans. Prepared status reports, audit documentation, and executive summaries for state and federal oversight agencies. Product Owner Sept. 2016 June 2017 Texas Department of Motor Vehicles (TX-DMV) Austin, TX APPLICATION MIGRATION & SERVER INFRASTRUCTURE TRANSFORMATION Served as Business Analyst for application and data migration from the Texas Department of Transportation (TxDOT) to TxDMV servers. Researched, identified, and documented application dependencies across the various TxDMV MS Access applications. Worked with all stakeholders to scope requirements and specifications for transferring MS Access and MS SQL applications from TxDOT to TxDMV servers. Used Visio to create infrastructure diagrams covering all applications and their database dependencies. Business Analyst Feb. 2015 May 2016 Cigna Healthcare Hartford, CT Led the end-to-end redesign of Cigna Healthcare consumer-facing web pages, improving usability, accessibility (WCAG), and alignment with brand and CMS standards. Collaborated with cross-functional teams including UX/UI designers, developers, compliance, marketing, and clinical teams to gather requirements and translate them into user stories and acceptance criteria. Conducted stakeholder workshops, user journey mapping, and gap analysis to optimize member experience for plan selection, benefits navigation, and provider information. Partnered with UX teams to validate wireframes, prototypes, and content strategy, ensuring compliance with healthcare regulations and Cigna branding guidelines. Managed the product backlog in Jira, prioritized features, and supported Agile sprint planning, demos, and releases for iterative webpage enhancements. Ensured HIPAA compliance, content accuracy, and accessibility standards across redesigned pages through coordinated reviews with legal and compliance teams. Analyzed website performance metrics and user feedback post-launch to drive continuous improvement in member engagement and conversion rates. Business Analyst June 2013 Jan. 2015 TJX Group of Companies Framingham, MA Analyzed business needs of customer service representatives and customer experience with the self-support portal, creating use cases, use case diagrams, data flow diagrams, and activity diagrams. Created use cases and assigned artifacts and features for traceability using Rational Requirements Composer (RRC). Designed a context diagram illustrating scope complexity, test data requirements, and time estimate justifications for the SIMS (new POS) end-to-end integration testing effort. Defined a detailed implementation strategy for testing inventory and customer data flowing from the POS UI into the Lawson Financial System (general and cash ledger). Documented test case scenarios with specific instructions for creating test data by general ledger, cash ledger, and inventory depreciation using Excel and HP Quality Center. Created and executed end-to-end and UAT test cases for the customer POS system, validating data across the POS user interface, Retail Management System, and Benefits Management System. Ensured all major problems and constraints in the existing business process were identified and that interdependencies were accurately documented and traceable back to business requirements. Created, tested, and demonstrated SharePoint sites including document libraries, lists, links, and web parts, and provisioned relevant user access. Prepared the Requirements Traceability Matrix (RTM) and test plans and test cases based on use cases identified during requirements gathering. Worked in the Salesforce CRM application supporting sales, marketing, and support departments. Business Analyst June 2010 Feb. 2012 Sony Electronics Park Ridge, NJ Created high-level user stories and tasks in Jira and managed the application support product backlog using Jira cards. Initiated implementation of the migration project, translating business requirements into user stories and tasks for agile BI projects. Gathered business requirements and analyzed data and workflows, defining scope and progressing from problem statement to well-documented design. Prepared RFP and RFI documents and conducted vendor evaluation through interviews and side-by-side comparison of all vendors. Created AS-IS and TO-BE business process flow diagrams and integrated them to show the end-to-end business model, including swim lane process mapping. Derived Functional Requirement Specifications (FRS) based on User Requirement Specifications (URS). Elicited and articulated business requirements from user interviews and converted them into technical specifications. Designed use case diagrams and wrote use case specification documents in Visio based on gathered requirements. Participated in data mapping of product and benefit systems, ensuring all data fields functioned correctly. Business Analyst Feb. 2008 May 2010 Nike Beaverton, OR Gathered business requirements, created the Functional Requirements Document (FRD), and analyzed data and workflows, defining scope, projections, and cost/benefit analysis from problem statement to documented design. Participated in the post-implementation phase of the first migration release, tracking bugs in Jira and re-prioritizing issues in daily scrum calls with the business. Worked with the Project Manager to finalize project plan documents in MS Project and prepared BRD and FSD deliverables. Prepared detailed use cases representing the various factors involved and their relationship with the system. Designed and developed use cases, activity diagrams, and sequence diagrams using UML and business process modeling. Created mockups and wireframes in Visio and presented them to the client business team, stakeholders, and design experts for approval. Performed gap analysis to identify the difference between optimized allocation and integration of inputs and the current level of allocation. Performed data mining and analysis using SQL queries, Microsoft Access, and Excel for data comparison, and carried out data validation by writing queries against the database. AWARDS & RECOGNITION Challenge Coin Above & Beyond Award, Department of Veterans Affairs Customer Satisfaction Award, Department of Veterans Affairs EDUCATION & CERTIFICATIONS Bachelor of Arts Pandit Ravishankar Shukla University Raipur, Chhattisgarh, India SAFe Agile 5.0 Scrum Master Certification Keywords: quality analyst user interface user experience business intelligence information technology hewlett packard microsoft mississippi Connecticut Idaho Massachusetts New Jersey Texas Virginia