SUMMARY:

A highly skilled Health Insurance IT professional with more than 16 years of comprehensive Confidential Facets experience, seeking a position as a Consultant or SME where these skills will add similar or greater value.

TECHNICAL SKILLS:

Operating Systems: Windows, Sun Solaris, IBM AIX

Microsoft Skills: C#, VB.NET, VB 6, COM, DCOM, MDAC 2.6 - 2.7(ADO, OLE, ODBC), ASP (& .NET)

Java Skills: JAVA/J2EE - EJB, JSP, JDBC, Servlets, JNDI, JMS, RMI, JAXP, Tag Libraries

Relational Database: SQL Server 6.5 - 2014, Oracle 7-11g RAC, Sybase ASE 11-12, MySQL

Application Servers: BEA WebLogic 5.1.0 - 8.1, IBM WebSphere 5.02, iPlanet 6.0, MS Component Services

Web Servers: Apache Tomcat, iPlanet Web Server 4.x, IIS 5.0

Scripting Languages: XML, XPath, XSL, VBScript, JavaScript, Python, BASH, Z and Korn Shell

IDEs: Eclipse, JBuilder, Visual Studio 2017, XMLSpy, DB Artisan, Rapid SQL, Toad, SQL Server Mgmt. Studio

Java Adjuncts: ANT, STRUTS, J-Unit, Log4J, J-Integra

Reporting Tools: Microsoft SQL Server Reporting Services, Crystal Reports 8.0/9.0, Webtrends

HealthCare Applications: FACETS 2.961b - 5.3, Confidential Comm. Services, ePlan, Healthweb eBusiness Suite

Source Control: Visual SourceSafe, Perforce, Harvest, Team Foundation Server (TFS), SharePoint

Matching/Postal Formatting: Business Objects/Firstlogic IQ8, Informatica Data Quality

Scheduling and Batch Orchestration: Tidal, Autosys

Methodologies: Agile, Rational Unified Process

PROFESSIONAL EXPERIENCE:

Confidential, Bloomsburg, PA

Solutions Architect

Responsibilities:

• Played an instrumental role as a Facets SME in the Amisys to Facets 5.3 migration .
• Designed and integrated Provider related applications, Correspondences via Confidential Communications Services ( Confidential ), Mass Billing Rate load interfaces, remediating Medicare Secondary Payers (MSP) interface and Auto PCP Assignment ( Confidential ) among others.
• Mentored developers, testers and the business on Facets best practices and design approaches.

Confidential, Owings Mills, MD

Sr. Systems Analyst

Responsibilities:

• Provided technical support to the Benefits Configuration team, specifically on the Facets data tier. Also provided on-going Facets technical support related to Facets Batch, Extension, Data Model and Interactive Client approaches and best practices.
• Successfully developed and automated daily and weekly reports in Excel using Visual Basic for Applications programming. Ad-hoc queries were executed in Toad using Oracle PL-SQL.
• Managed and executed bulk dataloads to the Facets data tier in the plan domain.

Confidential, New York

Facets Architect

Responsibilities:

• Led a team of 10 technical consultants in the Facets 4.71 Upgrade (from version 4.41).
• Successfully led Impact and Gap Analysis for the Facets 4.71 Upgrade. Tasks included research and analysis of the 4.51 through 4.71 Enhancements and also the impact to the 150-plus custom surround applications that make up the Confidential business systems.
• Spearheaded the 4.71 Environments build. Confidential surround applications were incrementally added as information became available via interviews with individual application SME's.

Confidential, Denver, CO

Sr. Facets Consultant

Responsibilities:

• Blue Shield of California project - Involved in the custom design of Confidential 30-day letter project. Tasks included architecting a custom solution using the Facets Attachment/Letter, Facets Batch and Facets Letter Server frameworks to create claims delay letters to Confidential subscribers and providers.
• Confidential Health Plan of New Mexico project - Involved in the custom design of Medicare Secondary Payer (MSP) extract. Tasks included designing a custom interface for the mutual exchange of MSP data between Confidential ( Confidential hosted platform) and CMS.

Confidential, Owings Mills, MD

Technical Delivery Manager

Responsibilities:

• Involved in the implementation of the Model Office project that entailed activating the Medical Benefits domain in Facets 4.51 as Confidential moved to consolidate it’s various Medical Claims processing platforms.
• Successfully managed benefits configuration, bulk data loads to the various environments and technical concern related to Facets medical benefits.
• Provided on-going technical support to various Confidential IT units (Operational Data Store, Environments, Production Support etc.)

Confidential, Owings Mills, MD

Sr. Application Architect

Responsibilities:

• Acted as SME to the Confidential and Enrollment Workflow teams in mapping Facets sources to Confidential targets.
• Successfully designed Claims pricing system which re-prices Confidential Out-of-Network dental claims with business associate, Dental Network of America (DNoA). Solution included Provider Import Subsystem ( Confidential ), custom Informatica batch jobs and a Facets XCOM extension written in C#.
• Actively involved in the setup and configuration of Facet 4.51 systems such a Facets 4.51 Batch Architecture, Facets 4.51 Web Services Library and Letter Server.

Confidential, Owings Mills, MD

Sr. Application Integration Specialist

Responsibilities:

• Successfully setup, configured and managed Facets 4.31 Batch Application and Letter Servers across all environments on new batch architecture - Windows 2003, Visual Basic Script, XML and Oracle 10g.
• Reduced premium billing batch turn-around time by approximately 10 hours. Target achieved by maximizing the use of Batch Engines and Queues, understanding of Premium Billing system, cycles and data models and detailed analysis of the batch output logs (via dB capture functionality).
• Successfully fulfilled secondary responsibilities which included troubleshooting Facets Interactive client, Facets Extensions, Confidential (External Provider Load), Confidential (Membership Maintenance Subsystem), Mass Plan Batch Update, Batch Receipts and Dental Predetermination Claims batch issues and Electronic Dental Claims Adjudication batch configuration.
• Spearheaded Letter Server setup and configuration including custom Customer Service Appeal Letters from earlier version (Facets 2.961b).

Confidential, Denver, CO

Application Architect

Responsibilities:

• Designed and managed the implementation of Confidential Claims (Provider & Member) and Provider Confidential fuzzy matching system. System involved 3rd-party software (Business Objects/Firstlogic IQ8 - Match and Consolidate) which uses fuzzy algos to match Providers and members to the source of reference. Matching service was also designed to be part of corporate Enterprise Service Bus using TIBCO as the Web Service Layer.
• Designed and overlooked the implementation of Postal Formatting in Facets. Projects were transactional (via Facets XCOM extension using XEF Framework) and batch.

Confidential, Buffalo, NY

Sr. Facets Consultant

Responsibilities:

• Successfully enhanced several surround application that interfaced with core Facets suc has the Rate Quote System, Group Bills via RUBI Reports, Provider Portal (HealthEnet), and 4 Facets XWin Extensions. The Confidential Rate Quote System is an nth-tier architecture, which comprises of VB6, Crystal Reports 9, ASP 3.0 and Sybase (T-SQL). FACETS Extensions were developed in VB6 as XWin applications. The Provider Internet Portal is that of an multi-tier architecture whose layers include Websphere MQ 5.3, Java/J2EE, and Sybase on a Solaris 8 OS.
• Successfully reduced member Elig. Request (X12 270/271) turn-around time by 5 seconds via the implementation of database connection pooling using custom Java code and stored proc tuning.
• Served as a liaison between Confidential Sales, Marketing, Billing, Membership and Actuarial departments in an effort to improve the Rate Quoting System. The Rate Quoting System includes several use-cases, e.g. the creation of Benefits, Amendments, Riders, Products and the Quote functionality. Adjunct systems to Rate Quote include Group Change Manager, a 3-tier web application using ASP 3.0, IIS, Oracle 8 and Rate Manual Editor, a Visual Basic 6/T-SQL based PADE extension used to create and submit benefit rates/premiums to the NY state government.
• Reduced turn-around time for Commercial Billing batch by 9 hours by correcting inconsistent data in Facets, database optimization (Update Statistics, Forcing Indexes, refreshing Query Plans for Stored Procs etc.), purging Facets log tables and tuning Facets batch engines and queues.
• Developed custom reports in RUBI for Confidential PPO Bills, automated several month-end Finance Reports using UNIX shell scripting, and a web interface for HIPAA to Facets Benefit Codes crosswalk tables. Confidential PPO Group Bills were developed in Ms Access (includes custom VBA code). Finance Reports automation were written using Korn (Posix) shell scripts via KEA Telnet client, utilizing ISQL, BCP, FTP and CSV files as final reports. Finally, the HIPAA to Confidential Benefits Code Cross-walk interface was custom designed and developed using JSP, Servlets, Apache Tomcat, Custom Tag Libraries and Sybase (T-SQL).

Confidential, Virginia Beach, VA

Sr. Programmer Analyst

Responsibilities:

• Successfully setup, configured and deployed FACETS 4.01 Network Pricing Module (NetworX Pricer) on BEA Weblogic 7.0 & 8.1. Administrative tasks included creation of Domains (separate instances of the Weblogic App. Server) for the various environments, connection pools to the various databses, license key management etc. Also designed the network topology for a clustered, load balanced, fail-over capability coupled with security.
• Configured IBM Websphere MQ 5. Installation and Configuration of Queues, Channels and Distributed Communication with Clearing House, WebMD.
• Designed and developed POC’s for Facets Extension Architecture. Prototype was written in Java/J2EE, Session and Entity EJB (CMP), Web Services, Blaze Advisor and BEA Weblogic Application Server 8.1. Another Prototype was created using .NET C#. .NET components were exposed to classic COM objects (Facets objects) via CCW (COM-Callable Wrapper).
• Mentored and lead a team (comprised of COBOL and VB6 Programmers) on Object-Oriented Concepts using Java/J2EE and .NET (C# and VB.NET). Other tools included Informatica Power Center 6.0, Microsoft Reporting Svcs., PL-SQL, Oracle 9i Product Suite (SQL Plus, NetManager), BEA Weblogic 7-8.1, IBM Websphere 5.02 and IBM Websphere MQ 5.3. Also mentored Service and Financial Operations team on the Rational Unified Process to Software Design and Development.
• Designed and developed 4 Facets surround applications. These include the ANSI X12 837 Router, Controller and custom formats to feed to the Facets 4.11 system. Technologies used include Web Service (SOAP over HTTP) for the Claims Numbering Svc., ADO.NET, XML and Xpath for the Router and Controller.

Confidential, Irving, TX

Portal Administrator, Senior Software Engineer

Responsibilities:

• Successfully administered corporate Portal System, Network Provider Credentialing Mgmt. System (NCMS) and corporate Intranet on J2EE architecture, BEA Weblogic 5.1.0 & SQL Server 7.0.
• Migrated and managed new portal architecture to iPlanet/Sun Solaris. System comprised of Java/J2EE components, iPlanet App. Server 6.0, LDAP on Netscape Directory Server and Sun Solaris 220R (multi-server configuration).
• Implemented, custom coded and configured the Confidential ePlan 3.x/eFacets business-tier COM objects. Enhancements to the product included Web Services integration.
• Involved in the customization and development of an enrollment web application for Confidential of Kansas City and Confidential on Java/J2EE technology. The eEnroll application is a multi-tier Java/J2EE application designed to handle copius amounts of transactions which included member transactions such as new/open enrollment, family maintenance etc.