Tech Lead Resume Englewood CO - Hire IT People

SUMMARY:

Software engineer with 10+ years experience developing web and client server applications through all phases of software development lifecycle in Healthcare .
Manufacturing, Insurance, Retail (Supply Chain Management - SCM), and project management methodologies, including estimation, cost analysis and resourcing.
Extensive experience in FACETS implementation and in-depth understanding of Trizetto/FACETS data model. Strong analytical, technical and problem resolution skills;

TECHNICAL SKILLS:

Software: Trizetto Facets 4.31 to 4.81, HIPAA Gateway, Ping Federate (STS), PortalTransaction Services (PTS), Cruise Control.NET, Knowledge of EC MAP

Technical: SQL Server 2000/2005/2008, ASP.Net, JQuery, Java Script, VB.NET, C#.NET,ASP.NET web services, WCF 4, LINQ, HTML, XML, SAML 1.1, SSIS, Crystal Reports XI;

PROFESSIONAL EXPERIENCE:

Confidential, Englewood CO

Tech Lead

Responsibilities:

Developed an XCOM extension in C#.NET and XML LINQ to extract claims data during claims adjudication process and pass it to PEGA systems via MQ Series to facilitate the functionality of duplicate check on the claim.
Developed an XCOM extension in C#.NET and XML LINQ to the alternate funding (AFAI) batch process that will apply an adjustment during the billing cycle.
Developed an interface in C#.NET, LINQ and Sql Server 2008 that creates Member Reconciliation Reports to send the newly identified exceptions to the state of OH and KY and to read the response back from the state and store it in the database. Developed a sub application under the Subscriber module that acts as a User Interface to the reconciliation and exception data.
Reengineered an existing interface written in C#.NET that provides claims data to Easy Group application that groups and prices DRG claims to support changes for 5010.
Developed an interface in C# and Sybase to feed Authorization and Referral data from an external system to Facets through the Facets Utilization Management (UMI) batch job.
Provided real time production support of existing Facets interfaces and extensions that are hosted in the hosting center.

Confidential, Bronx NY

Tech Lead / Sr. Programmer Analyst

Responsibilities:

Real time production support of existing FACETS interfaces, extensions and custom reporting. Responsible for such key applications as Claims 837 EDI load, Claims Payments, Remittance advices (EDI 835), Billing Reconciliation, sending members’ premiums data to NYS DOH as outbound 837 EDI, FACETS MMS interface loading NYS Roster files to Member Enrollment System, and Member Eligibility data feeds to vendors in EDI 834 format.
5010 Remediation of custom claims load interfaces from 4010 format to 5010 format. Reengineered 834 outbound member eligibility data feeds to vendors. Supported development of 835-compliant remittance advices to providers. Created stored procedures, .NET application and Sybase Maps.
Web Portal development for provider/member and plan administrator access, search and lookup of claims, eligibility, and benefits, ensuring proper authorization levels. Customized client specific business functionality as services using WCF on IIS server. Developed base framework to accommodate interaction of the portal with a ‘session enabled’ web service suite Portal Transaction Services provided by Trizetto running on the Web sphere server. (ASP.NET, VB.NET, JQuery).
Developed Member/Provider Roster interface (SSIS) to extract and email member data from core FACETS to providers in Excel format.
Developed Provider Network Adequacy Interface to provide NYS DOH with regulatory provider data.
Involved in development of Family extension to view / change member’s PCP, ID card and billing details.
Designed and developed Accounts Payable Positive Pay Interface between core FACETS and banking institution to extract/send Claims and Capitation check payment information and receive/upload cleared check information back.
Supported custom pre-adjudication (CLMU) interface to select provider and member data using client specific rules.

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Tech Lead Resume

Englewood, CO

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