SUMMARY:

• Over eight plus years of Solid functional knowledge on Main Frames applications in Health care and retail industry.
• Two years of experience in developing JAVA / JSP applications.
• Functional knowledge of Claims, Pricing, Products, Authorization and COB.
• Responsibilities included business analysis / resolution of various issues through interaction with Payers/Trading partners/Providers to accommodate mutually agreed practices.

TECHNICAL SKILLS

Operating System: MVS, Sun Solaris, HP - UX, AS/400, Windows NT/2000

Map Tools: Geneva 4.0 (IBM SAFR) - Data Warehouse - Eclipse IDE for JAVA, Gentran 6.0, GIS ON Unix, EC-Gateway, EC-Map, EC Gateway

Main Frame: TSO ISPF,EDI Control System, MVS Assembler, CA-7, CA-11, ENDEAVOR, AUTOFLOW, CONTROL M, XPEDITER, CICS and IBM Utilities, PLATINUM (CA) FOR DB2, FILE-AID, VSAM, Connect Direct, SAS, SPUFI, QMF, JCL, IMS, Intertest, Smartest

Health Care courses attended: Medicare Medi-cal Crossovers, CA-MMIS non technical account training, CMS 1500 (HCFA 1500) CLAIM FORM, Medical supplies claims processing. CHDP Program.

J2EE: Servlets, JSP, JDBC, JMS, Swing (Familiar with EJB*, Hibernate, multithreading, currently pursuing certification in JAVA )

EDI Transactions: 837, 835, 850, 810, 856, 820, 270, 271, 276, 277, 278

Testing Tools: Cyclone interchange, Remedy, Test Director, Win Runner

Languages: COBOL, REXX, C LIST, C, C++, VB 6.0, Java, Perl, Shell Scripting, XML

RDBMS: DB2, ORACLE, SQL Server ((PL/SQL, PRO*C, SQL*Plus)Hardware

PROFESSIONAL EXPERIENCE

Confidential - Bloomington, IL

Development & Productions support

Responsibilities

• Participated in all meetings with client to understand the requirements
• Debugged the CICS application (GENEVA 3.0 / 4.0)
• Worked on Geneva 3.0 to 4.0 conversion jobs, and tested the various passes.
• Analyzed Service requests for post production issues.
• Analysis of the requirements and designing / upgrading the model
• Generating the code as per the requirement using COBOL, DB2, JCL and SAS
• Designing Geneva views, LRs, FLD and Path for batch operations
• Implementing the changed module or new module into PROD through RMS
• Involved in unit testing and SIT testing
• Preparation of quality and process related documents

Environment: Main Frame, MVS, JCL (Patternised), COBOL, DB2, CICS, GENEVA (ETL TOOL ) VSAM, File Aid, Panvalet, Control M, AUTOFLOW, RMS, BMC DB2, QMF, CEMT, CEDF trace Facility, expediter, TSO/ISPF and MS Access/Excel/Word.

Confidential, Sacramento

Development & Productions support

Responsibilities:

• Worked on creating, spec definitions, and business rule changes to the driver programs.
• Extensively modified on new requirements that involved both batch and online programs in the Daily audit & Weekly edit cycles of the claims adjudication engine.
• Coded, enhanced and debugged (Calpos) standard online inquiry/update functions (CICS/COBOL/DB2 and VSAM) with attendant batch file-maintenance
• Project included some Assembler development as and when necessary, specific claims scenario was extracted using assembler features like fixed point, decimal, logical, macros and branching instructions.
• Researched on impacted modules, dependencies, module changes, pertaining to major upgrades like National Provider Id Change.
• Attended business meetings and policy discussions and created field definitions for file system includes, gap analysis and policy translation & their usage and impact
• Wrote many conversion and re-conversion programs after detailed research as to when the conversion should happen and impact on other entities and prepared a list of archive files that would likely need conversion.
• Analyzed and created gap document & the data requirements for the business setup and mapping
• Editing and preparing new batch jobs to route transactional data as per the requirements using Jcl and CA-7.

Environment: Main Frame, MVS assembler, JCL, COBOL, DB2, CICS, VSAM, File Aid Interest, CA-7, ENDEVOR, File Manager, QMF, CEMT, CEDF trace facility, Platinum tools for DB2, expediter, TSO/ISPF and MS Access/Excel/Word.

Confidential

Migration & Production Support

Responsibilities:

• Extensively worked on map editor & Gentran’s Map interface to Create both inbound / outbound for transactions (850 - orders, 856 - ship notice, 810 invoice, 852, 820, 832, 855, 864 ) and system extraction & partner specific maps from scratch in GIS map editor 3.1
• Created / modified Java Server Pages, servelets to their trading partner profile tracking subsystem which for the most part gave trading partners access to their profiles and current activities, which in turn would update the database and provide an XML file that would be ported to the GIS suite.
• Worked on Eclipse IDE to make modifications to existing Java Programs which was the application that fed most of the data to the web based trading partner tracking system.
• Worked on setting up Business processes using BPML. XML, file system adapter for inbound, outbound & archiving purposes of GIS (Gentran integration suite)
• Assisted in production support, trouble shooting in GIS using their logs and gentran
• Involved in business specific application analysis / changes to all the entities involved on the mainframe (COBOL / JCL / DB2 / X-Ref files )
• Wrote couple of stand alone programs in JAVA to read the EDI files in the UNIX box to identify data patterns for research and debugging process .
• Implemented Partner set up on transactional gateway (Cyclone interchange)
• Analyzed and created gap document & the data requirements for the business setup and mapping
• GENTRAN production support and troubleshooting including re-processing, re-sending raw data for business people, running demand-in-jobs
• Worked with partners to resolve files that failed to make it to their system by applying interim fixes and patches.
• Preparing new batch jobs to test / route transactional data.
• Worked on Connect direct Jobs (Modifications), File backup jobs, testing to productions migration procedures through audit trails, version control process for maintaining program modules.

Environment: Gentran 6.0 on MVS, GIS 3.1 EDI-ANSIX12 (850,856,810, 855,820, 824,832 & VICS Versions), JAVA, J2EE, JCL, COBOL, DB2, VSAM, File Aid XML, UNIX, BPML, Cyclone Interchange, Test Director 7.6, TSO/ISPF and MS Access/Excel/Word.

Confidential

Sr. Programmer Analyst /Business Analyst

Responsibilities:

• Interacted with different clients from the Health Care industry, which included Hospitals, large commercial & Blue cross Payers, TPAs, Pharmaceutical Company's etc, to study their existing limitations and workarounds that are mutually acceptable.
• Mapped ANSI X12 standard for EDI/HIPAA using EDI - GENTRAN for transactions 834, 837, 835, 276, 277 & 278.
• Performed gap analysis and data mapping. Created process flows and wrote system documentation. Developed processes using scripts and ECMaps.
• Worked on Payers proprietary file and specification to interpret and create an EDI/HIPAA file using Gentran.
• Review client ICs (Implementation Conventions) and Logical Maps prior to the creation of type trees and physical maps.
• Developed and created payer/provider transaction wise & data content wise analysis sheets & Co-coordinated Inbound and Outbound Transactions between Providers, Payers and Subscribers.
• Created business scenarios and implemented test cases based on these scenarios.
• Maintained the user testing system and developed test procedures. Reviewed peer programs, prepared test material for Documentation and auditing. Change management tools Endeavor, CA-7 were used.
• Developed / modified different COBOL / CICS interface applications and has created test & production JCLs to execute them.
• Extensively worked on production support (Restart of jobs, demand in jobs, monitored payer file schedule) production files in batch mode and reported / resolved errors with customers.

Environment: EDI, ANSIX12, UB92, HCFA, Gentran, MVS, JCL, COBOL, JCL, DB2, VSAM, File Aid, Test Director 7.6, TSO/ISPF and MS Access/Excel/Word.

Confidential

Sr. Programmer Analyst

Responsibilities:

• Prepared excel spreadsheets for gap analysis between the MMIS (Medicaid Management Information system) and HIPAA compliant file structures for transmittal purpose which includes the requirement analysis and detailed design of the software changes.
• Involved in the preparation of business cases to initiate dialogue and exchange information within HIPAA user groups like NMEH (National Medicaid HIPAA Group) to be further submitted to HCFA to resolve.
• Generated the final HIPAA EDI X12, 835(Claims Payment/Advice), Responsibilities included creation of test cases and end-to-end testing of various programs involved in the chain of Claims processing on the IBM after the Claims are adjudicated successfully by the Adjudication Engine.

Environment: OS/390, VSAM, DB2 (QMF, SPUFI), COBOL II, CICS, TELON, TSO/ISPF, OS/JCL, OS/MVS, HYPERSTATION, XPEDITER, FILEAID, SYNCSORT, EZ-TRIVE, IDMS/ADSO.

Confidential

Sr. Programmer Analyst

Responsibilities:

• Designed, Analyzed and Modified application programs for Welfare Reform system FACETS Family Assistance and Comprehensive Employment and Training System, which tracks most welfare programs including AFDC/TANF, FOOD STAMPS, MEDICAID/MMIS, and JOBS/WATS
• Responsibilities include re-engineering from VSAM to DB2 to accommodate the additional data elements required by HIPAA.
• Coded programs using COBOL, DB2 and CICS for revised claim upload to various DB2 databases after adjustments
• Wrote programs using structured techniques in COBOL and DB2 CALLS using ADSO.
• Involved in Web Enabling pilot project using MQSeries for the existing text system on the mainframe, allows user to run reports from anywhere.
• Contributed to develop new supplement system to MMIS Maintained and contributed in enhancements of sub system called JOBS/WATS (part of TANF) to monitor and report work to welfare activity to Fed.

Environment: OS/390, TELON, VS COBOL II, CICS, DB2, IMS, IDMS, VSAM, QMF, FILE-AID, ORACLE, MQSeries, XPEDITER, PANVALET, SYNCSORT, MVS, JCL, CA7, CA11, EZTRIVE, IDMS, ALMS & IBM supplied Utilities.

Confidential

Sr. Software Engineer

Responsibilities:

• Responsible in supporting the system integration, implementation, reporting for HIPAA compliance, Application development and deployment, after converting data to comply with HIPAA.
• Involved in creating test plans and scripts, also created detailed test cases to perform functional regression testing.
• Participated in the planning, scheduling and co-ordination of the Migration project. Develop Business/Technical Specifications that pass a walkthrough. Write programs of any complexity that pass walk through, for this initiative.

Environment: VS COBOL II, OS/390, CICS, IMS DB/DC, MVS, VSAM, JCL, Inter test, Expediter, CEDF, NDM, File Aid, BMS, IDCAMS & IBM supplied Utilities.

Confidential

Programmer Analyst

Responsibilities:

• Gentran Mapping Developed and upgraded EDI maps for transactions 810, 820, 824, 830, 850, 856, 860, and 866 using the X12 standard. Maps created were for both inbound and outbound trading partner relationships. The EDI subsystem and maps were upgraded to Gentran Server on the Unix platform
• Testing: Performed unit/system testing on all EDI transactions .Outbound testing involved the translation of the transaction set by Gentran, and the review and comparison of the generated EDI stream with the original Legacy layout. Testing of the inbound EDI stream involved verification of correct Gentran translation into the Legacy system.
• Additional responsibilities included the creation, integration and maintenance of a relational database and a handheld data collection device to gather the necessary information to send Advance Ship Notices (ASN) to the necessary trading partners.

Environment: COBOL, OS/390, CICS, JCL, DB2, VSAM, MVS/ESA, UNIX (AIX), GENTRAN and TSO/ISPF.

Confidential

Programmer Analyst

Responsibilities:

• The fixed deposits management system is a part of the total computerization of all the activities of the finance company. This module deals with the various types of deposit schemes such as short term, long term and Cumulative deposits which the company offers to the public.
• Analyzed, designed, coded, tested, and implemented Command Level CICS and Batch COBOL programs under MVS, Online Assistance are provided to implement the system.
• Testing to verify that developed software meets specified requirements. Delivery of the system includes test plan development, planning, execution, measurement & analysis, associated documentation and meetings/reviews preparatory tasks of readying software for load on production systems, actual loading of software and necessary testing.

Environment: COBOL, OS/390, CICS, JCL, DB2, MVS/ESA, and TSO/ISPF