PROFESSIONAL SUMMARY:

• 15+ Yrs. of IT experience as Facets Product Consultant/ Data Architect/Systems Integration Analyst involved in Design, Development, UAT and Implementation/Conversion of Legacy systems to Facets.
• Expertise in Core Facets Modules: Provider,, Accounting, Billing, Claims, Customer Service, and Workflow.
• Expertise in Facets configurations for Provider agreement Creation, Claims, Commissions and areas
• Solid Experience inFACETSbatchjobsand capabilities such as setting up Run books, error logs restarts etc.
• Expertise in Facets keyword files generation and their structures such as MMS () XPF0(Provider)
• Experienced in solving Complex problems related to Facets Configuration within Provider and Claims area during Facets Implementation.
• Experienced in Agile and waterfall Methodologies and Software Development Life Cycles

TECHNICAL SKILLS:

RDBMS: SQL Server, Oracle, Sybase

Languages: PL/SQL, T - SQL, C++, C, .Net (C#/VB), COBOL

IDE: Visual Studio, TOAD, SQL, PL/SQL Developer

Operating Systems: UNIX - Solaris/AIX/SCO/Linux, Android, Windows, Mac

Tools: SSIS, Project, Office, Pages, Notes, Rational Rose

Methodologies: Agile, Waterfall, combinations of methodologies

Software: Trizetto Facets 2., Trizetto MMS, XPF0, HIPAA Gateway, Erwin, RUBI

PROFESSIONAL EXPERIENCE:

Senior Facets Consultant

Confidential

Responsibilities:

• Participated in daily IT prioritization meetings for new Facets implementation and provided effective solutions.
• Developed and maintained custom processes to create keyword files for provider load (XPF0) and member load (MMS).
• Extensively used SQL queries to retrieve various reports for different departments.

Senior Facets Application Principal

Confidential

Responsibilities:

• Responsible for all aspects of the Trizetto Facets Windows based systems, Microsoft Windows security access controls, troubleshooting and problem resolution for the Windows environment. Installing and managing Trizetto Facets and security.
• Collaborates with the Application Services and other IT teams to provide a stable and secure Trizetto Facets infrastructure.

Senior Facets System Advisor/ Technical lead

Confidential, Los Angeles, CA

Responsibilities:

• Inside project is an ambitious initiative by CareMore and her parent company Anthem; to provide a host of services to the clients that would like to outsource the hosting of their business operations to a company which has a proven business model and is able to consistently deliver value to its customers and partners. This project has a host of products that are being integrated to deliver a common solution. These products include Access Express, NextGen, Facets and others. These products are integrated thru a common shared data layer architecture that involves, eligibility, billing, provider, claims, and utilization data both inbound and outbound to the shared data layer.
• I have been involved in creating the integration points of Facets with this data layer using Facets business model and integration points.
• Managed the effort for Facets upgrade . Successfully created and managed project plans to track scope, schedule, resource and budget effectively. Coordinated with stakeholders to track project changes in accordance with the EPMO processes. Organized regular meetings with project teams and business for project updates, risks, issues and action items. Implemented Agile project methodology practices across all projects.

Senior Technical Analyst

Confidential, CA

Responsibilities:

• Provided solution on Facets Post Implementation Issues and provided support for ongoing Production issues related to Facets and Provider Data.
• Implemented Three way recon solution to fix data Anomalies between three systems (Covered California, HPS and FACETS )
• Designed new tables in SAS Enterprise guide to performed data analysis.

Senior Technical Analyst

Confidential, NJ

Responsibilities:

• Interfaced with business users to prepare and update Business Requirement Document (BRD), High Level Design Documents (HLD), and TDD (Technical Design Document).
• Conducted Post migration analysts to prioritized outstanding defects and system problems, ensuring accuracy and deadlines were met.
• Validated technical designs created by IT developers against functional specifications.

Senior Technical Specialist

Confidential, NJ

Responsibilities:

• Lead architect of a new Provider Automation project to automate the provider loading process that will reduce significant manual effort and decrease XC claim fall out for No provider found and subsequently increasing auto-adjudication rate.
• Worked on redesigning and optimizing the Core EDI Process.

Senior System Analyst /Tech Lead

Confidential, NY

Responsibilities:

• Designed and developed AP Positive Pay Interface to extract/send Claims and Capitation check payment information from Facets to the bank, and receive/upload cleared check information into Facets from the bank.
• Lead EDI claims load-adjudication into Facets and developed a claims back-out process.
• Provide technical assistance in identifying production problems for Facets XC00 and CLMU jobs.
• Analyzed business requirements, prepared technical documentation for Provider and Subscriber selection logic in the Facets Gateway process.
• Developed an ad-hoc directory to comply with mandated state provider directory regulations.
• Redesigned Amisys Medicaid and Medicare claim routing logic and workflow.
• Responsible for day to day support of Facets Gateway application and managing of the offshore programming team.
• Managed reverse data mapping (Facets to Amisys) for a Web Portal project and created stored procedures to extract Facets data. Interfaced with vendor and internal system units to in corporate new Facets reverse engineered file into current Web Portal file upload process, minimizing both vendor application re-coding and Affinity’s overall dependency on vendor support.

Software Engineer

Confidential, NJ

Responsibilities:

• Requirements gathering and analysis for development of the BizTalk Billing interfaces to Facets providing input data to the application.

Software Engineer

Confidential, NY

Responsibilities:

• As a team member, performed troubleshooting and triage of problems reported by domestic and international users of a complex billing system for a global financial services company. Supported day to day operations and implemented system enhancements. Developed and enhanced business logic for pricing increases and charging plans on SYBASE, Transact-SQL stored procedures and C++ on Microsoft Windows platform. Performed support for Bill Monitor and the interface for PeopleSoft Feed.

Software Engineer

Confidential, NJ

Responsibilities:

• Enhanced, maintained and tested GUI applications and backend C++ application for Billing, Subscriber/Member and Provider on Windows 2000 server environment using Visual Studio.NET. Used PVCS for source code control management. Designed and developed C++ batches to meet new and existing clients’ requirements.
• Managed database objects update from design phase through coding and unit testing for three TriZetto- supported DBMS: Oracle, Sybase and SQL Server 2000. Objects included database tables, triggers, complex stored procedures and conversion scripts. Responsible for providing a team of seven developers with guidance for application support and maintenance, including converted Runbooks and Procbooks from Perl script to XML during system migration from UNIX to Windows 2000 server.
• Managed performance and fine-tuning of complex stored procedures and conversion scripts, defined and established programming standards. Interfaced with users to define functional specifications. As a key member of the policy team, created Graphical User Interface Standards resulting in creation of production programming templates and screens for final delivery to clients.