SUMMARY:

• Over 11 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 experience in Claims system applications, Claims, Membership & Provider and data models.
• Extensive experience in Healthcare - I/P/D EDI ANSI X12 Transaction data 837I/P/D, 835, 276, 277 and Claims processing system and extensively experienced on claims, benefits and back-end processing systems of NPS. Medicare & Medicaid claims processing.
• Developed web applications and web services in Microsoft Visual Studio .Net IDE using C#.Net 2.0, ASP.NET, ADO.NET and SQL Server.
• Experience in Scripting languages like Javascript, VB script, HTML.
• Experienced with J2EE technologies - Spring, Struts, Hibernate, Servlets, Java Server Pages (JSP), JDBC, XML, JBoss Application Server and Tomcat Web Server.
• Strong experience in online applications HIQK, HEHK, HSSK, HRBK, TPOL, GMIS, HZMK, HURK, ITSK etc.
• Extensive experience on OpenConnect Emulator architecture (Configure, Comprehend) and Attachmate emulator scripting.
• Experience in Application Design using Object Oriented Analysis and Design (OOAD), Rational Unified Process (RUP), Object Oriented Methodologies like UML.
• Experienced with Microsoft technologies - Visual Basic, VC++(COM, DCOM), C#, ASP.net
• Experience in PL/SQL scripts, functions & stored procedures for database queries in Oracle (SQL, PL/SQL) RDBMS, SQL Server 2000 / 2005 and MS Access databases.
• Experience in using Jbuilder, RationalRose, Eclipse, Dreamweaver.
• Self-Motivated and result-oriented professional with good work ethic.

PROFESSIONAL EXPERIENCE:

Confidential, San Francisco

Technical Lead

Responsibilities:

• Extensively worked on rootcause analysis, design and implemented enhancements to resolve various Facets Extensions related incidents.
• Analyzed and triaged incidents raised in Production environment to meet SLAs.
• Design and Implemented Facets Embedded and XCOM extensions.
• Lead the Thunderhead correspondence letter generation web application design and development of various enhancements based on the business needs. the application is developed using J2EE, Hibernate and spring framework.
• Lead the Common Data Model (CDM) web application design and development of various enhancements and implemented new modules for ITS project. The application is developed using J2EE, Hibernate and struts framework.
• Written Stored procedures, Functions and Queries in Oracle 11g.
• Deploying the codes to higher Environments using SVN, JIRA.
• Worked on Facets core Claims, Customer support & Billing applications.
• Facilitated meetings with Business for the critical issues and performed rootcause analysis.
• Provided offshore with subject matter expertise and responsible in delivering the solution within the tight timelines.
• Incident management (Failures/Missing or Invalid Data, Delayed data), Problem Management (Repeated incidences not permanently fixed) & Change management (Bug/Break Fixes; Enhancements)

Environment: Facets, Embedded/XCOM Extensions, Java, J2EE, Oracle11g

Confidential, Eagan

Technical/Development Lead

Responsibilities:

• Analyzed the technical requirements and developed technical design documents for 837 claims pre-processing logic and 27X (270/271 & 276/277) transactions process.
• Worked on FACETS Data tables and created audit reports using queries. Manually loaded data in FACETS and have good knowledge on FACETS business rules.
• Analyzed the functional details of various modules in mainframe and did the GAP analysis with the new TMG system.
• Conducted extensive analysis on migration and conversion of Provider and Member data, Group configurations, plan codes, benefit set-ups, fee schedules, provider pricing, capitation set-ups, etc from Legacy system (STAR) to TMG Facets.
• Facilitated work sessions with Architects to arrive at technical solutions and developed the components design for the technical requirements.
• Coordinated with the development & testing activities with multiple onsite & offshore teams. Reviewed and approved developers design, code and unit test results
• Implemented the Claims pre-Adjudication business logic using J2EE technologies.
• Used Agile methodology to develop the application
• Provided development vendor teams with subject matter expertise and responsible in delivering the solution within the tight timelines.
• Managed teams and oversee the coding activities to implement the Claims Migration project in WMB /WTX, MQ, EDIFECS and PEGA systems.
• Communicated development status, design and approach with management, business owners, IT managers and PMO
• Involved in design and implementation of Transaction routing determination service for the logic to route 837 & 27X transactions to Claim processing system.

Environment: Facets, Java, J2EE, Oracle11g, XML, XSLT, VISIO, buildforge

Confidential, Newark

Sr.Application Developer

Responsibilities:

• Architected and implemented web-based solution for automated claims adjudication.
• Used N-tier architecture for presentation layer, the Business and Data Access Layers and coded using C#.
• Interfaced with the claims Business teams from different lines of business (State Health Benefits Plan, Federal Employee Program, ITS,etc) and provided business process automation solutions.

Environment: C#, ASP.net, Configure, Open Connect, SQL Server, XML, VISIO, Tortoise SVN

Confidential

Responsibilities:

• Design and development of Radioiogy Vendor Delegation Model.
• Implemented the code to load the Inbound claims file linelevel details into database tables, trigger jobs automatically and generate response files and error notification emails
• Database design, RVD tables creation, writing queries and Stored procedures.

Environment: C#, ASP.net, Configure, Open Connect, SQL Server, XML, VISIO, Tortoise SVN

Confidential

Responsibilities:

• Prepared the Analysis & Technical design documents based on Business Requirements.
• 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.

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

Confidential

Responsibilities:

• Implemented the logic to call the IPD Webservice.
• Developed transactions in Openconnect’s Configure for B528 & B328 edits.
• 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.

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

Confidential, Southfield

Application Developer

Responsibilities:

• Analyzed the business requirements and created the technical requirements document for the enhancement of Portico - Facets Interface.
• Various conditions were analyzed and presented to business team to determine the use of Delete functionality on Facets Networks (NWPR) rows.
• Created new batch job for the date span sync up in Facets Provider Network & supporting tables.

Environment: Confidential Facets, C#, ASP.net, MS SQLServer, XML, VISIO, Microsoft Visual Sourcesafe

Confidential

Responsibilities:

• Some of the Edits that are automated include F001, F048, M222, F779-F780, R150, R269, M146-M148, 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, Configure, Open Connect, Oracle 9, XML, VISIO, Microsoft Visual Sourcesafe

Confidential

Responsibilities:

• Suspended Claims Adjudication logic has been coded for several NPI edits in VisualBasic.
• Several on-going enhancements were made and various modules were coded for NPI edits to process a set of claims with a customized logic

Confidential

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.

Environment: VisualBasic6.0, Attachmate, Oracle 9, WindowsXP

Confidential, Southfield

Systems Analyst

Responsibilities:

• Created the technical CSRs in PDM for the generation of outbound 837 data that needs to send to FUND.
• Prepared RTM, Test Strategy, Test Plan, Test case documents.
• Developed scripts in Visual Basic and Extra Macro editor to automate the adjudication.

Confidential

Responsibilities:

• Created the technical CSRs in PDM for match Logic to crosswalk the provider NPI to legacy provider number.
• 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.

Confidential

Software Engineer

Responsibilities:

• Involved in Design and Development of UI Screens using JSP, Struts, JavaScript and Html. Middle tier was implemented using Session Beans and Entity Beans.
• Designed the application on MVC (Model-View-Controller) pattern.

Environment: Java, J2EE, Struts, Jboss, MS Sqlserver2000.