SUMMARY

• Over 8 years of professional experience in software development life cycle (SDLC) involving analysis, design development, testing, documentation, implementation & maintenance of application software in Web - based and Client/Server environment.
• Extensive Experienced in Healthcare - I/P/D EDI ANSI X12 Transaction data 837I/P/D, 835, 276, 277 and ANSI conversion and ICD9 to ICD10 conversion.
• Knowledge in NASCO Claims processing system and extensively experienced on edits, claims, benefits, back-end processing systems of NPS, Strong experience on NASCO online applications HIQK, HEHK, HSSK, HRBK, TPOL, GMIS, HZMK, HURK, ITSK etc.
• Extensive experience on Mainframe emulators, Open Connect Emulator architecture (Configure, Comprehend) and Extra ATTACHMATE Scripting
• Experienced in Application Design using Object Oriented Analysis and Design (OOAD), Rational Unified Process (RUP), Object Oriented Methodologies like UML.
• Experienced with Microsoft technologies - C#, ASP.net, Visual Basic, VC++(COM, DCOM)
• Experienced with J2EE technologies - Servlets, Java Server Pages (JSP), Struts, JDBC, JNDI, JBoss Application Server and Tomcat Web Server.
• Experienced in Scripting languages like Java script, VB script, HTML.
• Experienced in PL/SQL scripts, triggers & stored procedures for database queries in SQL Server /2008, Oracle and MS Access databases.
• Java, J2EE and MVC design patterns, Web Services were used and implemented in web applications.
• Experienced in using RationalRose, Eclipse, Dreamweaver and tools like XMLspy, Toad, FileAid & TSO/ISPF.
• Experienced in using Tortoise SVN, Visual Sourcesafe and PVCS version control tools.
• Self-Motivated and result-oriented professional with good work ethic.
• Efficient interpersonal and written communication skills.
• Proven ability to handle multiple projects under tight deadlines
• Good team spirit and abilities to manage teams within projects and Interfaced with different teams within the company & Intra companies.
• Responsible, pro active and solution oriented thinking.

PROFESSIONAL EXPERIENCE

Confidential

Systems Analyst

Responsibilities:

• Various plan & system specific condition codes are automated include E253, E287, U302, F042, E708, R269 (ITS & Non-ITS), etc.
• ITS10.3 implementation for Bluecard ITS claims processing and automated the Claims Adjustments.
• Automation scripts are developed on Open Connect’s Configure and deployed as a web service to automate the Claims Adjudication in Nasco.
• Modules are developed in C# for various edits that interacts with multiple external systems and NASCO to process the claims.
• Developed transactions to perform updates like Me-Too indicator in GEM, COB indicator, Mneomonic code updates for various benefits in HRBK etc.
• Impletemeted transactions to update/add the benefit file coding for several benefit strings/Particulars.
• Impletemeted various Membership file transactions like 401,402, 418, 428, 420, 458 etc
• Automated Nasco customer worksheet creation and process the image documents in FAF application.
• Implemeted group Load / Pacakge code update project by loading all group details from SARS reports and by switching between two sessions (ModelOffice & Production).
• Gap & impact analysis was performed for conversion and developed mapping documents. Involved in ICD9 to ICD10 conversion.

Environment: C#, ASP.net, Open Connect (Configure), Sql Server 2008, XML, XSLT, HTML, VISIO

Confidential

Sr. Application Developer

Responsibilities:

• Design and development of Radioiogy Vendor Delegation Model.
• Prepared the Technical design document based on Technical requirements.
• Multiple transactions were created in configure tool to process the claim as per the Confidential needs.
• Implemented the code to load the Inbound claims file linelevel details into database tables, trigger jobs automatically and generate the outbound response file.
• Implemented the logic to transfer the file to Confidential FTP Server.
• Implemented the logic to process 5 files at regular interval and generate the reponse files and CnB reports for CarCore.
• Implemented the logic at frontend to validate the inbound file and generate error notification emails for any errors.
• Created stored procedure to distribute the high volume claims to multiple threads to process on-time & claim skipped logic.
• Created and used Domain Objects for intermediate storage and Data Access Objects for the transfer of data from the Database to the front end and vice versa. performed the database design, RVD tables creation, writing queries and Stored Procedures.

Environment: C#, ASP.net, Open Connect(Configure), MySQL, XML, XSLT, HTML, VISIO

Confidential

Sr. Application Developer

Responsibilities:

• Prepared the Analysis & Technical design documents based on Business Requirements.
• User Interface Pages were designed and developed both for real-time Job scheduling and reporting processes using ASP.net.
• Several additional features were provided for customers to generate reports and claim & line level and other analysis reports.
• Implemented the logic to upload the history claims by customer thru the UI webpage and run the jobs.
• Developed the User-Interface webpages and created authentication to login, upload claims, and run the job on-demand.
• Created and used Domain Objects for intermediate storage and Data Access Objects (DAOs) for the transfer of data from the Database to the front end and vice versa.
• Performed the database design, tables creation, writing queries and Stored Procedures.

Environment: C#, ASP.net, Open Connect(Configure), MySQL, XML, XSLT, HTML,VISIO

Confidential

Sr. Application Developer

Responsibilities:

• Involved in design and prepared the technical design document, Test strategy, Test plan and Test case documents for Magellan tool.
• User Interface Pages were designed and developed both for real-time Job scheduling and reporting processes using ASP.net
• Implemented the logic to call the Magellan’s IPD Webservice and get the Provider Participation indicator, allowed amount & action (deny / reprice) information for each service line of the claim.
• Developed the multiple transactions in Openconnect’s Configure to return the required claim line details from the claim in EEC and to adjudicate the claim as per the details provided by the Magellan’s IPD webservice in 3 step fashion.
• Automation scripts have been developed in Open Connect’s Configure for both B528 & B328 edits.
• Email notification with Attachment logic was coded for Magellan to review the results reports.
• Developed the User-Interface webpages and created authentication to monitor only the B528 edit Job run by Magellan and performed Client-Side validations.
• Created and used Domain Objects for intermediate storage and Data Access Objects (DAOs) for the transfer of data from the Database to the front end and vice versa.
• Involved in the database design and writing queries and Stored Procedures pertaining the Magellan’s Job runs.

Environment: C#, ASP.net, Open Connect(Configure), MySQL, XML, XSLT, HTML, VISIO

Confidential

Sr. Application Developer

Responsibilities:

• Some of the Edits that are automated include F001, F048, M222, F 0, R150, R269, M 8, F001, NPI R Edits, etc.
• Claims Adjudication transactions were developed on Open Connect’s Configure and deployed the webservice on Open Connect’s SliConnect Web Server.
• The claims adjudication business logic for different edits was developed using C#.

Environment: C#, ASP.net, Open Connect(Configure), Oracle 10g, XML, XSLT, HTML, UML

Confidential

Sr. Application Developer

Responsibilities:

• Suspended Claims Adjudication logic has been coded for several NPI edits in VisualBasic.
• Design & development of various NPI edits and other edits related to NPI to process the suspended claims.
• Several on-going enhancements were made and various modules were coded for NPI edits to process a set of claims with a customized logic.
• Few transactions were developed in configure to process the claims using Openconnect.
• Openconnect transactions were developed, deployed and scheduled the jobs to run daily.

Environment: VisualBasic, Oracle 10g, Extra Attachmate

Confidential

Sr. Application Developer

Responsibilities:

• Automation scripts were developed for each membership transaction using the Attachmate’s Emulator library.
• Involved in the database design and writing queries to format and upload the data sent by different groups.
• GUI was developed to load, validate the membership data for all the ANM transactions sent by groups.
• Involved in Production support and ran all the membership transactions many time to perform the updates in the NASCO Membership file.

Environment: Visual Basic, Oracle 10g, MS Access, Extra Attachmate, Visual Source safe.

Confidential

Systems Analyst

Responsibilities:

• Created the technical CSRs in PDM for the generation of outbound 837 data that needs to send to FUND.
• Developed the Sequence diagrams for several sub systems of NASCO from the Confidential solution’s perspective.
• Prepared RTM, Test Strategy, Test Plan, Test case documents for testing outbound 837 data that is generated with payment calculations and other deductibles.
• Involved in tracking the defects and add them in the Clear Quest.
• Involved in writing the scripts in Extra Macro editor to automate the test data creation and generate reports for the dollar amounts (ATP, Secondary allowed, OIDOL, Deductibles, prorate, Copay).
• Developed the scripts in Visual Basic to automate the adjudication of Confidential COB claims in production EEC during the Post implementation of the Project.

Environment: Visual Basic, Oracle 10g,, HIQK, HEHK, HSSK, TSO, Rational Rose

Confidential

Systems Analyst

Responsibilities:

• Created the technical CSRs in PDM for match Logic to crosswalk the provider NPI to legacy provider number.
• Developed the Sequence diagrams for several sub systems of NASCO from the NPI solution’s perspective.
• Prepared RTM, Test Strategy, Test Plan, Test case documents for TRLOG Conversion from Version 5 to Enhanced version 6 to accommodate NPI fields for all the providers (professional, facility, referring, service, service referring, attending physician).
• Performed the Test Data Validations & mapping from ANSI 837 format to TRLOG format.
• Prepared the Test plan, Test cases and performed the test data validations for Match Logic criteria.
• Involved in tracking the defects and add them in the Clear Quest.
• Involved in writing the scripts in Extra Macro editor to automate the test data creation and generate reports with the screenshots of HIQK screens.

Environment: Visual Basic, Oracle 10g,, HIQK, HEHK, HSSK, TSO, Rational Rose

Confidential

Sr. Developer / Functional Consultant

Responsibilities:

• Involved in the design and development of KnoahsARK Tool / Applications.
• Involved in designing the system based on UML concepts including Data Flow Diagram, class diagram, sequence diagram, Rational Rose Enterprise Edition.
• Involved in Design and Development of UI Screens using JSP, Struts, JavaScript and Html.
• Designed the application on MVC (Model-View-Controller) pattern.
• Implemented Stored Procedures using PL/SQL.
• Built the application using Ant.

Environment: Java, J2EE, Servlets, JSP, EJB, JDBC, JNDI, Struts, SQL Server 2000, HTML JavaScript, XML, UML with Rational Rose,JBoss

Confidential

Software Developer

Responsibilities:

• Involved in the design and development of the call recorder.
• Involved in designing the system based on UML concepts including Data Flow Diagram, class diagram, sequence diagram, Rational Rose Enterprise Edition.
• Configuring the Ethereal Sniffer tool to sniff RTP, SCCP, RTCP packets and implemented a module to segregate the required packets to be processed by the call recorder.
• Involved in the implementation Multi-Threaded application to process each sniffed packet by one thread each based on the application layer protocol.
• Involved in design and development of GUI build Setup for the clients to install the Call recorder.
• Did Performance analysis and programmed high-performance parts of TCP/IP Recorder server application on Windows.
• Involved in version control of the Call Recorder using Microsoft Visual Sourcesafe.

Environment: C++, VC++, UML with Rational Rose, BSD Sockets, Windows 2000, SQL Server 2000, Microsoft Visual SourceSafe.

Confidential

Software Developer

Responsibilities:

• Involved in the design and implementation of the screen capturing tool.
• Implemented a module which extracts the desktop screen picture data and store in a .jpeg file.
• Implemented a module which transmits the .jpeg file of desktop screen to a listening centralized-server thru HTTP protocol.
• Involved in design and development of GUI build Setup for the clients to install the screen capture tool on all the systems.
• Involved in converting the screen capture tool into an NTService in the later versions.

Environment: C++, VC++, UML with Rational Rose, Windows 2000, SQL Server 2000,, Microsoft Visual SourceSafe.