EXPERIENCE SUMMARY:

Software Professional with eighteen years of experience in information technology involving a wide range of applications and hardware, specializing in Telecom, Finance, Health Care Information Management Systems and Medicaid Management Information Systems (MMIS).

STRENGTHS:

• Excellent Project management skills
• Dedicated, hard working individual with the intercommunications skills to work at all levels of the organization
• Outstanding motivator and builder of teams. Works well in both team environments and individual assignments
• Successful in meeting new technical challenges and finding solutions to meet the needs of the customer
• Plan, execute, and finalize projects according to strict deadlines
• Strong written and oral communication skills
• Able to rapidly learn, understand, and apply new technologies
• Strong customer service orientation
• Ability to effectively prioritize and execute tasks in a high - pressure environment
• Ability to resolve highly complex technical issues, Coordinate and guide a project team of technical professionals
• Received the Performance Award (Multiple Times) and recognition for being a Team Player

TECHNOLOGY SKILLS SUMMARY:

Hardware: IBM ES9000, IBM 3090, IBM-4361, PC

Operating systems: MVS, OS390, WIN 98/2000/XP, WINDOWS NT, UNIX, DOS

Languages: COBOL, VS-COBOL-II, ADSO, JCL, EASYTRIEVE, CICS, MQ Series, VISUAL BASIC 6.0, C, C++, VBA, SQL, HTML, JAVA

Databases: IDMS, IDMS/R, DB2, ORACLE, MS-ACCESS

Tools: /Utilities TSO, ISPF, ROSCOE, VSAM, LIBRARIAN, OLQ, IDD, XPEDITER, DMLO, ADSALIVE, PANVALET, FILEAID, SPUFI, DUMPMASTER, ENDEVOR, TELNET, QMF, PLATINUM, ABENDAID

Applications: BUSINESS OBJECTS, MS WORD, EXCEL, POWERPOINT, VISIO, MS-PROJECT

EXPERIENCE SUMMARY:

Confidential

System Development Principal

Environment: COBOL, DB2, CICS, VSAM, JCL, TSO/ISPF, Endevor, Platinum, SPUFI, Expeditor, Inertest, Abend-Aid, Business Objects

Responsibilities:

• Analysis of claims subsystem
• Review Medicaid policy related to claims
• Participated in requirements gather meeting and design discussion meeting.
• Convert the business requirement in to technical requirements
• Create Statement Of Understanding
• Understand the business logic, user requirements, and test-objectives to develop test plan, test cases
• Create Test cases
• Perform system testing/Model Office Testing
• Involved in reviewing test results
• Problem Resolution
• Prepared system and user documentation and updated the same as and when the functionality changes
• Interact with different groups with in the internal and external customers
• Project Tracking and reporting the progress to all internal and external stake holders
• Advised client with solutions for Orthodontia claims.
• Advised client with solution to release Web stuck in-process voids
• Mass adjusted the claims to recoup payments from provider
• Created Utilization Review claim edits.
• Reviewed Reference subsystem for claim exception control and claim exception resolution.

Confidential

System Development Principal

Environment: COBOL, DB2, CICS, VSAM, JCL, TSO/ISPF, Endevor, Platinum, SPUFI, Expeditor, Abend-Aid, Business Objects

Responsibilities:

• Involved in analysis of claims subsystem
• Participated in requirements gather meeting and design discussion meeting.
• Created data mapping and business rule documentation
• Identified modules to be modified and upgraded them to make compliant with the new system
• Co-authored business requirements, user requirements, system/functional requirements.
• Convert the business requirement to technical requirements
• Involved in reviewing of programmers coding and test results
• Create Test cases
• Perform system testing / User Acceptance Testing
• Problem Resolution
• Prepared documentation and updated the same as and when the functionality changes
• Interact with different groups with in the organization

Confidential

Onsite Coordinator

Environment: COBOL, DB2, CICS, VSAM, JCL, TSO/ISPF, Endevor, Platinum, Spufi, Expeditor, AbendAid, Business Objects

Responsibilities:

• Created and Reviewed Edit Decision Tables
• Completed Customer Service Request (i.e. CSR) successfully and System Problem Assistance Request.
• Enhanced Modules and AVRS to allow EPSDT screening to be one of the services a caller can verify and to denote when last EPSDT screening was done for that recipient.
• Designed lower of logic between Medicare and Medicaid for all Crossover claims
• Completed Wholesale changes which is for applying Social Security & veteran s benefits Increases to recipient incomes and recalculating Eligibility and also applies changes in Federal Poverty level & Income Limits.
• Completed Reprocessing of claims due to system changes, Adjustments due to the rate changes and Voiding of wrongly paid claims
• Testing of UB92 Ver 5.0 and Testing of all Electronic claims which fiscal agent receive through WINASAP (New Software) and goes to the claims cycle for adjudication.
• Quality Assurance Responsibilities and ensuring bug free environment

Confidential

Sr. Consultant

Environment: COBOL, CICS. VSAM, DB2, JCL, Expeditor, AbendAid, TSO, ISPF, Panvalet

Responsibilities:

• I worked on maintaining timely and accurate MMIS claims adjudication subsystem, which accepts claims from Medicaid providers, billing agencies and Medicare intermediaries as well as enhancing and maintaining Missouri Medicaid drug prior Authorization process and other subsystems.
• I also took care of State Task Requests and System Problem Assistance Requests.
• I developed programs for adding age criteria to the drug prior authorization process of the pharmacy unit.
• Enhanced cost settlement summary for hospitals of the financial unit.
• Enhanced programs for adding new pricing indicators to the Confidential file, created new modules for generating recipient denial letters, developed new edit override reports, enhanced early refill reports etc for the claims adjudication subsystem and also various complicated reports for Confidential help desk.