SUMMARY:

• Twenty years of IT industry experience encompassing a wide range of skill set, roles and industry verticals
• Strong Subject Matter understanding of HealthCare Claims Processing System
• Experience in leading and managing teams. Handled multiple roles - Business System Analyst, Project Lead, Subject Matter Expert, Application Architect, Developer, SQA Practitioner
• Extensive experience with system analysis, design, development, testing, implementation and support of IBM mainframe application software
• Proficient in Business Requirement gathering, Functional specification preparation, analyzing, and translating business requirements to technical requirements
• Strong experience in California Medicaid Claim Processing System (CA-MMIS) and Confidential  Claim Processing System (NPS)
• Strong experience in the DRG (Diagnosis Related Grouping) Inpatient Claim Reimbursement Methodology
• Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy
• Good communication skills, interpersonal skills, self-motivated, quick learner, team player.

KNOWLEDGE AND SKILL AREAS:

• Health Care IT Skills: MMIS- Medicaid Management Information System, HCPCS, Claims Processing/Adjudication, Affordable Care Act (ACA), NASCO Claims Processing System
• Business Analysis Tools/ Processes: JAD Sessions, Functional Requirements, Interviewing, Mock ups, Elicitation, SDLC, Technical documentation, System analysis, Process Flow diagramming, Data Flow Diagramming, Data mapping, Root Cause analysis, Data mining,Cognos Report Studio
• Mainframe Skills: COBOL,CICS,DB2, IDMS, IMS DB,IMS DC, EASYTRIEVE PLUS, FOCUS, REXX, JCL, SQL,ENDEVOR, CHANGEMAN, PANVALET, XPEDITER, INTERTEST,SDF, FILEAID, FILE MANAGER, INFOMAN, DMLO, OLQ, QMF

PROFESSIONAL EXPERIENCE

System Analyst III

Detroit, MI

Responsibilities:

• Responsible for providing support to the Accumulator Application that integrates Blue
• Cross Blue Shield of Michigan (BCBSM) Subscriber’s Pharmacy Claims processed at the Pharmacy
• Vendor System and Medical Claims Processed at the Confidential Claim Processing System
• Perform Benefit Analysis, setup the Accumulation to integrate new Groups (Customers) and new Pharmacy Benefit Managers for Blue Cross Blue Shield Michigan Accumulator /Enhance Ancillary Vendor (EAV) system
• WORK in close collaboration with the Blue Cross Blue Shield Michigan Project Managers and Business Team to gather, analyze and document the functional requirements for new Group implementation or to implement new Pharmacy Claim Vendors
• Perform Technical and Business Support to the Blue Cross Blue Shield Michigan Accumulator /Enhance Ancillary Vendor (EAV) and Benefit Accumulation Systems
• Work with Blue Cross Blue Shield Michigan Business Team, NASCO Development Team to identify problems, analyze data for Accumulator /Enhance Ancillary Vendor (EAV) and Benefit Accumulation Systems
• Analyzing and mining business data to identify patterns, mapping and tracing data from system to system in order to solve a given business or system problem
• Requirement Gathering, Define and document business and system requirements
• Daily review of data integration between Confidential and Pharmacy vendors
• Daily interaction with the business, marketing, Confidential and Pharmacy vendors to ensure systems are operating according to expectations
• Design and create data reports and reporting tools to help business executives in their decision making
• Create and execute reports using Cognos Report Studio
• Develop testing artifacts such as test cases, test data, and test status
• Execute test cases, document results
• Analyze testing results to ensure the solution meets the needs of the business.

Business System Analyst

West Sacramento, CA

Responsibilities:

• Business System Analyst and Subject Matter Expert for California Medicaid (CA-MMIS) Inpatient Diagnosis Related Grouping (DRG) payment methodology IT Projects.
• Business System Analyst for California Medicaid (CA-MMIS) Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) Outpatient Code Conversion IT Project.
• Business System Analyst and Subject Matter Expert for California Medicaid (CA-MMIS) Child Health and Disability Prevention (CHDP) IT Projects.
• Gather, document, and analyze business and functional needs and requirements for California Medicaid (CA-MMIS) IT projects. Create Business Requirements Document.
• Facilitate JAD/Elicitation sessions with business users, business analysts and technical teams for California Medicaid (CA-MMIS) IT Projects.
• Provide CA-MMIS/Medicaid Subject Matter Expertise to identify requirements and develop estimates for California Medicaid (CA-MMIS) IT Projects. 
• Develop,write,edit,rewrite and/or format billing manuals, announcement articles, provider bulletins,instruction materials and procedure manuals for California Medicaid (CA-MMIS) IT projects.
• Analyze and ensure that the proposed solutions are technically feasible.
• Write physical system designs, flow charts and diagrams to address the requirements.
• Responsible for the production of the Functional Design document and working with the development and testing team to ensure that the project is implemented successfully.
• Interface with business users to prepare and update the requirements and business rules.
• Perform architecture analysis and design.
• Extraction and documentation of Business process logic/rules from legacy programs to understand the actual business logic in production as opposed to the business rules believed to be in place. Gap analysis.
• Write High Level Design and Low level Design Documents.
• Develop and maintain the application components. Validates and verifies the code and test results developed for conformance to requirements.
• Participate in Performance Testing, Regression Testing to make sure that the new functionality has no negative impact on the existing functionality or performance.
• Participate in Unit Testing, System Integration Testing and User Acceptance Testing.
• Support testing team in data validation and functionality testing, providing data from a mainframe system.
• Participate in project planning sessions, assist in root cause analysis and resolutions.

Senior System Analyst

Responsibilities:

• Subject Matter Expert for Blue Cross Blue Shield of Massachusetts (BCBSMA) Total Plan System (TPS) Claims Backend System.
• Project Lead / Maintenance and Enhancement Lead of Claims Application Area.
• Project Lead for Phase II NASCO Migration Project.
• Define requirements, process improvement, defining project scope, gap analysis, configuration, testing, documentation and deployment.
• Prepare Detailed Design, Coding and Unit Testing of components involving technologies COBOL, JCL, DB2 and VSAM.
• Participate in System Integration and User Acceptance testing.
• Incident ticket handling and monitoring.
• On-call production support to resolve production issues which are generated during the execution of business.
• Requirement gathering and studying the business process of the client.
• Involve in post go live support and stabilization process.
• Review, suggest and implement business value add solution services like permanent fix to the repeated problems, automate routine tasks to improve the stability, performance to minimize the maintenance cost of the system.

Senior System Analyst

Mechanicsburg, PA

Responsibilities:

• Subject Matter Expert for National Account Service Company (NASCO) Claims Backend Systems.
• Subject Matter Expert for National Account Service Company (NASCO) Claims Enhanced Ancillary Vendor (EAV) and Consumer Directed Health (CDH) Application.
• Analyze the requirement, estimate and translate business requirements into Detailed Design Documents.
• Analyze the requirement and develop customized solutions to meet quality management requirements.
• Analyze business processes, flows and functions of legacy system.
• Prepare Detailed Design, Coding and Testing of components involving technologies COBOL, JCL, and VSAM.
• Code new complex components and modify existing components.
• Perform Unit Testing.
• Coordinate with System Test team and UAT team during SIT and UAT phases of the project. Provide quick resolution and fixes for the issues raised.
• Involve in implementation activities like preparing production-ready components, creating change control requests, staging, implementation and validation.
• Provide domain and technical expertise to the project team.
• Onsite assignment (Mechanicsburg, PA) for 18 months to support the development and implementation of EAVP subsystem.

Application Architect

New York, NY 

Responsibilities:

• Application Architect and Asset Area Lead of Empire Blue Cross Blue Shield Customer Service Application - EXCEL.
• Leading a project team in implementing the Change Request for our customer.
• Prioritizing, tracking, change control, aspects of the project.
• Responsible for effective communication between the project team and the customer. Provide day-to-day direction to the project team and regular project status to the customer.
• Translate customer requirements into formal requirements and design documents, establish specific solutions, and leading the efforts, including programming and testing that culminate in client acceptance of the results.
• Prepare High Level Design & Low Level Design Documents.
• Code new complex components or modify existing components that involve CICS, IMS DB/DC and IDMS. 
• Prepare Unit Test Cases and perform Unit Testing.
• Participate in System Integration Testing and User Acceptance Testing.
• Involve in implementation activities like preparing production-ready components, creating change control requests, staging, implementation and validation 
• Establish Quality Procedure for the team and continuously monitor and audit to ensure the team meets quality goals.
• Monitor Production Cycle.
• On-call production support to resolve production issues.
• After implementation, prepare Defect log and Defect Action Plan documents. 
• Induction and training of new members

Technical Lead

Responsibilities:

• Worked on the maintenance and conversion of the existing application modules for a Store Field Expansion and COBOL migration project of the client’s system.
• Impact Analysis for store field expansion.
• Baseline and System Integration Testing.
• UAT and implementation support.

Team Lead

Responsibilities:

• Application design and maintenance, system Integration testing and offshore support during implementation of Purchase Sales and Trade Processing System for the client Pershing .
• Coordinate and communicate tasks with developers.
• Ensure that development is performed as per requirements.
• Communicate activities/progress to project lead.
• Develop implementation and test plans.

Programmer Analyst

Responsibilities:

• Worked on projects for the client (1) Provident Bank and (2) United Parcel Service
• Design and development of application modules.
• Unit and system integration testing.
• UAT and implementation support.

Application Developer

Responsibilities:

• Development of new application module, conversion of existing applications of the client’s system from ADS/O - IDMS to CICS-DB2.

Programmer

Responsibilities:

• Year 2000 code conversion and testing of client software.