SUMMARY:

• 18 years of professional IT experience in Business Analysis, System Design, Development, Testing, Implementation, Maintenance, and Quality assurance as Delivery Manager, Architect, Technical/Project Lead, Developer and Systems Analyst.
• 11 years of experience in Healthcare domain specializing in Payer space.
• 11 years of experience in Trizetto Facets™, a leading health plan administration product, with strong working knowledge in Membership, Products, Claims, Billing and Provider modules.
• Possess expert knowledge in Trizetto Facets™, Online, data model and Batches
• Expert knowledge of HIPAA X12 EDI transactions such as 837 and 835.
• Strong knowledge of Facets configuration relating to Member eligibility, Benefit configuration, Billing, Group - Class-Plan-Product, Claims, Workflow, PCA, Application Support.
• Expert knowledge in developing and configuring Facets Extensions (Embedded, XCOM, XSQL) using C#, VB .NET, SQL, and VB
• Expert knowledge in design and implementation of custom Interfaces, Extensions, Data Extracts on Facets platform.
• Extensive experience in Facets version upgrades projects.
• Strong knowledge of Claims In and processing flow within Facets platform.
• Possess strong knowledge in ITS Home & Host implementation on Facets platform
• Strong expertise in designing and developing Data Warehousing & Business Intelligence solutions involving Operational Data Store (ODS), Data Acquisition (DA), Data Marts, Tactical Data Stores, Enterprise Dimension model, Decision Support Systems using ETL tools such as Informatica PowerCenter 9.x/8.x, Informatica PowerExchange, Informatica B2B Data Transformation, Microsoft SQL Server Integration Service (SSIS).
• Strong experience in developing ETL solutions with near real-time data capture using Informatica PowerExchange Change Data Capture (CDC) process, interfacing with Oracle database.
• Strong knowledge in Data Warehousing aspects & concepts such as Data modeling, Enterprise Dimension model, Star Schema, Snowflake schema, Slowly Changing Dimensions, Logical and Physical data models.
• Strong experience and knowledge in Microsoft technologies such as C#, .NET Framework 3.5/3.0/2.0/1.1, VB .NET, ASP .NET, ADO .NET, Web Forms, Win Forms, Windows Communication Foundation (WCF), Web Services, VB 6.0, ASP, VC++ 5.0, MS SQL Server, SSIS, SSRS, COM, DCOM/ Active-X, MTS, XML, XSL.
• Strong experience and skills in generating reports using tools such as Microsoft SQL Server Reporting Service (SSRS), Seagate Crystal Reports and Ramco Report Writer.
• Strong Data profiling experience to derive statistical assessment of data values, evaluate structure and quality of data and identifying data anomalies & business rules exceptions.
• Experienced in data extraction, transformation and loading the data involving different heterogeneous data sources like flat files, HL7, XML Files, Oracle, and SQL Server.
• Strong knowledge in programming Shell scripts on UNIX platform.
• Proficient in RDBMS such as Oracle and MS SQL Server with strong experience in writing SQL queries, stored procedures, functions, triggers, Indexes, Views.
• Strong experience in preparing Technical design documents, Business process flow, Data Flow and Program flow diagrams.
• Expert knowledge in performance optimization of applications developed in MS SQL Server and Oracle.
• Extensive experience and skills in Project Management and co-ordination complying with PMI standards and using project management tools like MS-Project and in-house Project Management Utilities
• Strong knowledge of SDLC methodologies such as Waterfall and Agile.
• Basic knowledge of creating JCLs in Mainframe, programming in Perl
• Basic knowledge of Big Data Hadoop architecture and concepts such as HDFS, HIVE, MapReduce
• Strong knowledge of core Java J2EE programming concepts and implementation
• Possess strong analytical and problem-solving skills
• Possess excellent leadership skills and proven ability to motivate, guide and mentor team members to derive results in dynamic environments.
• Strong team player with excellent communication, interpersonal and customer facing skills
• Thorough understanding of technologies & concepts such as OOPS, OOAD, UML modeling, N-Tier, Client/Server Architecture, Reusable Components and Security.
• Good experience in Project and Account Management activities viz. preparation of Project charter, Project Plan, project proposal preparation, Statement of Work preparation, Revenue and profitability forecast, Strategic Account plan preparation, effort estimation, Resource Planning and client interfacing for the upcoming projects
• Extensive experience and skills in efficiently managing project control & execution for multiple concurrent projects
• Over 5.5 years of experience in ERP product development - SCM, Financials

TECHNICAL SKILLS:

ETL Tool: Informatica PowerCenter 9.6.1/9.5.1 /8.6.1/8.1.1, Informatica PowerExchange 9.6.1/9.5.1, Informatica B2B Data Transformation 9.5., MS SQL Server Integration Services (SSIS)

Languages/Packages: C#, VB .Net, NET Framework 1.1/2.0/3.0/3.5, Visual Basic 6.0, VC++ 5.0, ActiveX, ADO.NET, WCF, XML, XSL,XSLT,SOAP, COM, DCOM, C, C++,JAVA, Python

Databases & Tools: Oracle 12c / 11i/ 10g, MS SQL Server 2012/2008/2005/2000/7.0, MS-Access, Sybase

Products: Trizetto Facets 5.3/ 5.2/5.1/5.01/4.81 /4.71/4.61/4.51/4.31/4.11, RAMCO MARSHAL 3.x, RAMCO 4.0

Scripting Languages: Korn Shell, Perl, VBScript

Reporting Tools: MS SQL Reporting Services (SSRS), Crystals Reports 9, RAMCO Report Writer

Modeling Tools: ERwin Data Modeler, E/R Studio, Embarcadero Team Server, IBM Rational Software Modeler, Rational Rose, MS Visio

Internet Technologies: ASP .NET,ASP 2.0, JavaScript, VBScript, AJAX,CSS, IIS 7.0/6.0/4.0, MTS, HTML, DHTML

Project Management: MS Project 2003, Cognizant Prolite

RAD Tools: Visual Studio 2008/2005/2003/97, MS Visual Interdev, Eclipse

Enterprise Scheduler: CA7, TIDAL, AutoSys

Version Control Tools: SVN, PVCS, Serena Dimensions, MS Visual Source Safe (VSS) 6.0

Defect/Issue/Incident Tracking: HP ALM, JIRA, Merant Tracker

Operating systems: Windows, Unix, Linux

Other Utilities: MS BUILD,MS Front Page 2000,RAMCO Virtual Works

PROFESSIONAL EXPERIENCE:

Confidential, San Francisco, CA

Sr. Facets /EDI Systems Analyst

Responsibilities:

• Developed System Use Case (SUC) specification explaining High level design, Use cases, Main/Alternate/Exception flows, Business rules, design & test considerations.
• Prepared process flow and detailed flow diagrams to depict the as-is and to-be state of the systems.
• Performed impact analysis of Facets version upgrade changes.
• Performed data analysis and data profiling to analyze the data and understand data patterns and anomalies.
• Generated various ad-hoc reports to help business team to review data identify requirements.
• Gathered and validated business requirements for new enhancements.
• Provided Facets system solution and technical design, for business problems.
• Analyzed HIPAA EDI X12 implementation guides for 837 & 835 transition sets.
• Designed the Trizetto HIPAA Gateway (THG) XSLT mapping changes for 837 inbound transactions.
• Analyzed the Facets billing configuration and designed the Refund letters process for Consumer billing project.
• Worked on Rendering provider details mapping on the 837 outbound based on the SF record from Host plan for ITS Home professional claims.
• Reviewed Informatica code mappings/workflows to design the changes required for new enhancements.
• Designed the job dependencies for custom Interfaces in TIDAL

Environment: Trizetto Facets™ 5 .3, Trizetto HIPAA Gateway (THG), HIPAA EDI Transaction sets: 837 & 835, Informatica PowerCenter 9 .5 .1, Oracle 12c, Oracle SQL Developer, Trizetto HIPAA Gateway (THG), XSLT, XML, Microsoft Visio, TIDAL Enterprise scheduler, SVN, JIRA, SVN.

Confidential, Washington, DC

ETL Lead & Facets Expert

Responsibilities:

• Version upgrade from Facets 4.71 to Facets 5.01.009, 5.01.011, 5.01.013, 5.01.015, 5.01.017, 5.2.001
• Remediation of the Facets Data Acquisition (DA) layer for tables which have changed due to the upgrade.
• Remediation of all ODS projects which source data from the DA layer.
• Capture and subsequent storage of FACETS 5.01, 5.2 tables data which are new as a part of upgrade from the FACETS, FACETS XC, CFS, CFI, CFX schema in the DA layer.
• Developed the FACETS DA tables load mappings for all the new tables added as a part of Facets version update.
• Designed and developed Dental provider data mart load process by sourcing data from FACETS and PORTICO systems.
• Developed Membership, Claims, Revenue and data mart based on data from FACET and NASCO systems.
• Designed a process to performance optimize FACETS DA layer data refresh of 1400+ tables.
• Designed & developed ETL processes using Informatica 9.6.1/9.5.1 /8.6 to extract and load data to Operational Data Store, Tactical Data store and Enterprise Dimensional Model data stores.
• Developed Informatica mappings, reusable Mapplets, workflows, for processing data from disparate sources such as PWX Condense files, Flat files (Fixed length & Delimited), HL7 unstructured file, HL7 XML file, Relational database tables from Oracle and SQL Server.
• Designed and developed Korn shell scripts (KSH) for UNIX to perform pre and post processing steps such as parameter file generation, ftp process, file validations, archiving files, email notifications and invoked them from Informatica.
• Set up Informatica PowerExchange process to implement Change Data Capture (CDC) to load data on a near real-time basis from OLTP to ODS DA acquisition layer. This DA layer has over 1,400+ tables that are captured near real-time from OLTP tables. Developed PowerCenter mappings to consume data from Informatica PWX condense files and load them to Oracle relational tables.
• Developed Perl program to convert Microsoft Excel spreadsheet (.xls) to csv file format so that it can be consumed via Informatica. Spreadsheet::ParceExcel library from CPAN was used to parse the excel file.
• Developed Java transformations to parse Rx benefit strings from manual spreadsheets, to derive data values and loaded them as separate data elements in the Data Acquisition tables.
• Developed PowerExchange CDC registrations using Informatica PWX Navigator.
• Developed Oracle Supplemental log scripts to enable logging for the tables registered as a part of PowerExchange CDC.
• Designed the PowerExchange restart activities such as Cold start vs Warm start of the condense process depending on the data requirements.
• Designed the data model for Data Acquisition layer, Data mart layer, and Tactical Data store layer and stage tables.
• Designed & Developed ETL solution to capture history of data changes in SCD Type 2 methodology.
• Developed Informatica error handling solutions to validate, capture, report & reprocess error records coming in through the vendor feeds from CVS.
• Prepared Oracle SQL DDL scripts for altered and new tables (including indexes, constraints, triggers, sequences) for ODS DA layer.
• Worked with Informatica Analyst tool for setting up Reference table manager for capturing business input for reference lookup tables.
• Developed ETL processes using SSIS and SQL scripts to load data from Business Intelligence layer to the Reporting layer.
• Developed several reports using SSRS that are rendered as pdf output and also stored procedure based In-line reports. These reports were developed as a part of Account SearchLight project and were rendered via Provider, Employer and Broker portals.
• Performed impact analysis of the downstream applications and remediated the code.
• Performed reverse engineering of existing SQL code components to extract business logic and converted the ETL solution to Informatica.
• Prepared Capacity planning, Solution design, Source to Target mappings, Unit test cases & results, Production support documents.
• Prepared Deployment plans and coordinated the end to end development & deployment of ETL solutions with different teams such as Enterprise Data Architects, Data Governance & Stewardship, Informatica Admin, DBA, Business Intelligence Administration, External Vendors, Software configuration management, PMO, Downstream consumers, Upstream source systems, Audit Balance & Control (ABC).
• Worked on designing and developing Informaitca B2B Data transformation processes using Serializer & Mapper components to consume HL7 Continuity of Care (CCD) XML files as a part of CVS MinuteClinic project. These XML files follow HL7 Clinical Data Architecture (CDA) standard and are extended by Healthcare Information Technology Standards Panel (HITSP).
• Worked on project planning, execution, monitoring & control tasks for ODS development for Pharmacy initiatives projects.
• As a development lead, coordinated the end-to-end development tasks with the team.
• Participated and contributed to JAD sessions and Technical discussions with CareFirst internal teams and External vendors ( Confidential ) to drive solution designs.
• Developed Mainframe JCLs to set up jobs in CA7 scheduler.
• Implemented Audit and Balancing functionalities for the ETL processes using CareFirst ODS ABC (Audit, Balancing & Control) framework.

Environment: Informatica PowerCenter 9.6.1/9.5/8.6, Informatica PowerExchange (CDC), Informatica B2B Data Transformation, Informatica Analyst Tool, Trizetto Facets™ 5.2/5.1/5.01/4.81 , SQL Server Integration Services ( SSIS ), SQL Server Reporting Services ( SSRS ), ERwin Data Modeler, E/R Studio, Visual Studio 2008, Oracle 10g, UNIX, Perl, Oracle SQL Developer, HL7 Version 3 XML, Microsoft Visio, Serena Dimensions, SVN, CA7 Scheduler, Mainframe JCLs

Confidential, Solon, OH

Sr. Business Systems Analyst

Responsibilities:

• As a Trizetto Facets solution expert, created the end-to-end solution design for Medicare COB process
• Created Source to Target data mapping between COB MARx Daily/Annual files to Facets tables
• Created BRD for COB data in Facets and ECRS Inquiry & Response implementation
• Involved as a core team member of the BRD review and approval committee
• Involved in data modelling of new tables to support custom interfaces and extracts.
• Created AS-IS and To-Be state data flow diagrams and process flow diagrams for conversion from Legacy platform to new platform.
• Performed data profiling and data validation, writing complex SQL queries to reconcile data between Source and Target systems .
• Involved in the business requirement gathering and analysis relating to the modification of custom built TRR engine as a part of TRR phase 5 Automation project relating to LIS TRC codes
• Reviewed and approved UAT test cases & design, closely coordinated with the testing team in tracking testing progress and implementation to production
• Trained the team members on Facets, SQL and Oracle SQL developer

Environment: Trizetto Facets™ 4.81, MMS batch, Facets METR Batch, Facets Imbe batch, Facets Bil0 billing batch, Facets ISL, Oracle SQL Developer, Oracle 10g, ERwin Data Modeler, RxClaim, FAZAL, Pega, MS Access, Microsoft Visio, JIRA, SVN, Autosys Enterprise scheduler

Confidential, San Francisco, CA

Extensions Lead/Senior Systems Analyst

Responsibilities:

• This Facets Embedded Extension provides the functionality for the Claims processors and Customer service reps to view the images of Paper and EDI claims that come through HOV and stored in DocDNA repository. The extension has been developed in C# .NET and Microsoft Enterprise library using Facets FXI capabilities and is integrated as a part of Claims Inquiry application.
• This Extension generates messages for Subscriber and Provider EOBs, that are consumed from downstream applications/streams such as Outputs, Interfaces to web portal, Reports and Letters. The extension has been developed using technologies such as Informatica, Java, Oracle and has been scheduled as a batch job in TIDAL enterprise scheduler.
• This Extension provides the functionality of pending claims in Facets that have the rendering provider that has been set for review. The extension has been developed using technologies such as Informatica, Oracle and has been scheduled as a batch job in TIDAL enterprise scheduler.
• This project involved the conversion of Group, Membership, Billing balances, Provider, Claims and Accumulator data from legacy systems into Facets.
• This project involves the implementation of ITS host functionality on Facets platform, migrating the functionality from the NASCO platform. The effort involved development of many new Interfaces and Extensions and also the remediation of various applications developed as a part of Release 1 implementation.
• This Custom extension enriches the Facets 835 keyword file with HIPAA remark codes based the claim EXCD codes, Payment reduction details on the PLB section and send the same to HIPAA gateway for processing.
• Developed Facets Embedded Extensions using C# .NET, ADO .NET, User Controls, MS Enterprise Library and Oracle.
• Designed and developed business logic layer and Data Access Layer using C#, ADO .NET
• Created Facets table/column mappings to fields on Subscriber and Provider EOB message processing logic
• Developed stored procedure to retrieve claims image attachments records from the Database accessing Facets Claims and Attachment tables.
• Leveraged MS Enterprise Library features such as Logging and Exception handling by calling the APIs from C# code.
• Designed the high level solution design, process flow, architecture and key test scenarios
• Created various structural and behavioral diagrams such as Use case diagram, Class Diagram, Sequence Diagram, Component view, Deployment diagram, Data Flow Diagram representing the systems in an end-to-end fashion.
• Prepared the deployment instructions explaining the steps to configure the Extensions in Facets System Administration (SA) module.
• Designed the Java application for applying EOB business rules and generating EOB messages.
• Designed Informatica mapping, sessions and Workflow for the EOB and Rendering provider custom code components.
• Created the Data model and DDL scripts for Extension custom tables.
• Prepared System Use case and Boundary specification documents for the Extensions using Rational Software Modeler
• Executed Batch jobs in Development environment via TIDAL scheduler and analyzed output logs for troubleshooting batch job errors.
• Prepared the ITS host matrix that provides the inventory of components that are needed for ITS host implementation on Facets platform.
• As a Facets Systems Analyst, participated in BRD review and Solution workbook sessions for Interfaces and Facets Extension components
• Created High level solution architecture for new Interfaces and Facets Extension components
• Guided the batch team in setting up ITS claims specific Facets batches such as ITSE, ITPP, CLSF, CLUD
• Involved in business requirement gathering, analysis and validation, working closely with the business SMEs and participating in JAD sessions.
• Review & approve of project deliverables such as source code, design documents before sharing them for stakeholder approvals
• As the project lead, Responsible for the delivery of the Facets Extensions & custom development components meeting the business requirements and project timelines.
• Responsible for effort & cost estimation and allocation/releases of resources
• Coordinated the project delivery by working closely with different stakeholders/teams such as Business architects, PMO, QA test analysts, UAT testers and SCRM.
• Managed scope and identified new requirements as Change requests where applicable, following the Change management process.
• Lead and managed project throughout all project stages in the areas of communication, schedule, budget, resources, scope, risk, and issues
• Supervised and allocated task to team members and tracked tasks to closure.
• Led and mentored the team by providing technical and Healthcare/Facets domain related guidance to the team members.
• Worked closely with project managers and leads of different streams such as Reports, Letters etc. in collating effort estimation and resources names for every component, which formed the input for the project plan and task assignment.
• Involved in ITS host project plan preparation and baseline.

Environment: C#, .NET Framework 2.0/3.5, ADO .NET, Trizetto Facets™ 4.61/4.81, MMS batch, XPF batch, ATD0 attachment batch job, Microsoft Enterprise library 3.1, Oracle 10g, Oracle SQL Developer, Informatica 8.1.1,SQL Server 2005, Java, ANT, MS BUILD, XML, Microsoft Visio, Rational Software Modeler, TIDAL Enterprise scheduler, PVCS, Merant Tracker, JIRA, SVN, Windows XP

Confidential, Seattle, WA

ETL Technical Lead

Responsibilities:

• Faces Dimensions Core Apps & Extensions
• Faces Dimensions Interfaces & Output
• Created custom batch jobs and interfaces using SSIS, T-SQL, C# .net to produce Membership, Claims, Commission Entities data extracts from FACETS to external vendors/systems.
• Developed new SSIS packages to convert the existing Medco claims interface from Mercator
• Developed Billing & Finance reports using SSRS
• Data modeled the new tables for billing and Finance reports using Erwin
• Created new Facets XCOM, XSQL extensions using C# .NET & T-SQL and integrated with Facets Application using SA module in Facets.
• Converted existing VB 6.0 Extensions to VB .NET
• Involved in the Database Analysis, Design & Implementation
• Implemented business logic through SQL stored procedures and functions
• Developed a custom logging component for the applications to log errors and debug statements during run time
• Used IBM DB2 Data Provider for .NET with C# to retrieve data from DB2 database
• Involved in Facets 4.51 impact analysis and remediation of custom code components as a part of Facets version upgrade
• Preparation of Technical design document, Unit Test cases & logs
• Prepared logical object model and data model using Microsoft Visio
• Performance tuned SQL Queries and Indexes for tables in SQL Server for faster retrieval of data.
• Gathered and analyzed requirements, defining the architecture, technical design, task estimation and implementation of all work requests in SSIS, C# .NET, SQL Server 2005 and SQL Reporting Services.

Environment: C#, VB .NET,.NET Framework 2.0/3.5, ADO.NET, SSIS, SSRS, Web Services, Visual Studio 2005/2008, SQL Server 2000/2005, Trizetto Facets™ 4.31/4.51/4.71, XML, MS BUILD, Microsoft Visio, Autosys Enterprise scheduler, PVCS, Windows XP

Confidential

System Analyst

Environment: Trizetto Facets™ 4.31, Facets FXI, C#, .NET Framework 1.1/2.0, SQL Server 2000/2005, SSIS, SSRS, ASP .NET, Web Services, XML, NUnit, Microsoft Enterprise library, Master Pages, XML, XSLT, XML, XSD, Microsoft Visio, Log4Net, VSS, Windows XP