SUMMARY:

• Highly analytical, self - starter with strong experience performing as a Business Systems Analyst, Project Manager and Lead Developer.
• Extensive experience working with Facets in the healthcare industry. Facets experience includes role of technical lead, project management, Facets Patch upgrade impact analysis, design, development and deployment of custom interfaces/extensions for Claims, Benefits, Membership and Customer service, capitation and Data migration.
• Strong business and functional domain knowledge in Healthcare with experience in the full Software Development Life Cycle using Agile methodology (requirements gathering and analysis, design, development, unit testing, user acceptance testing, implementation and ongoing support).
• Strong expertise in Managed Healthcare domain including multiple life cycle Facets implementation projects.
• Exceptional ability on multiple platforms in web development, FACETS, .Net, VBscript, Informatica, PowerBuilder, Sybase, Oracle, SQL SERVER, Unix, and C/C++.
• Strong overall technical acumen and knowledge of FACETS, .Net, PowerBuilder 5/6/7, Java / J2EE, JSP, Servlets/EJB, ASP, TIDAL, Oracle, Sybase, Big data, Informatica and XML.
• Excellent interpersonal, communication and documentation skills with the ability to adapt to new and dynamic environments.
• Solid analytical skills, exceptionally strong decision making, and problem solving skills.
• Possesses Master Degree in Computer Science.
• Pandu is very interested in this opportunity and is available for immediate consideration.

TECHNICAL SKILLS:

Languages: C, C++, PowerBuilder 5/6/7, Java, JSP, ASP, Servlets, HTML, XML, COBOL, .NET, Visual Basic

Databases: Sybase, MS SQL Server 6.5/7.0/2000 , Oracle, DB2, Informix, MS Access

Operating Systems: UNIX, MS-DOS, MS Windows 3.x/95/98/NT, AS400, IBM Mainframe

Software: FACETS, JIRA, Rally, EAS Server, Power Site, Power Dynamo, Jaguar transaction Server, SilverStream, Novell Netware, Lanman, Replication Server, Db library, MDI Gateway, Net Gateway, Apt, Impromptu, RPC Make, SQL Anywhere, Open Server, J Runner, Irwin, MS Access, Power Designer, Erwin, VBScript, JavaScript, IIS, WebSphere Studio, Connect Direct, Business Objects, Microsoft Project, Visual Age for Java J2EE, Rational XDE, JDBC, Erisco Facets, Tomcat Servlet engine, Web logic, INFORMATICA, TIDAL

PROFESSIONAL EXPERIENCE:

Confidential

Lead Analyst/Project Manager

Responsibilities:

• Responsible for oversight of the Impact analysis, development and delivery and testing of custom interfaces/extensions/batches, test case management and defect resolution for all Facets patch upgrade projects.
• Since 2013, team successfully implemented Facets upgrade for 5.01(R9, R11, R13), 5.1(R1, R2, R3, R5, R7), 5.2(R2, R3), 5.3 R2/R3.
• Coordinating/Impact analysis of Facets Patches on Priority Code base and publishing Impact analysis document and reviewing changes with users.
• Delivering remediated code/objects for impacted processes and implementing change control process.
• Successfully implemented two new Facets extensions for COB and MI tax.
• Managing shake down and Patch level test cases using Jira and Rally for each patch.
• Managed/resolved defects and provided testing status reports for project sponsors/managers.
• Support for production deployment for each upgrade.
• Impact analysis done on Priority code base for ICD10 changes and provided a comprehensive document for the impact processes.
• Tested/resolved all custom and core batch processes for every patch upgrade.
• Providing training document for new features.
• Each patch upgrade implemented in 8 to 12 week cycle using Agile process.

Confidential

Senior Analyst

Responsibilities:

• Responsible for analysis of requirements and detail design.
• Developed sync process to create Keywords for all member changes by comparing MP data to Facets member information including all Medicare event data.
• Developed extension code using Informatica and Oracle 11g.

Confidential

Senior Analyst

Responsibilities:

• Responsible for analysis of new requirements and detail design.
• Worked with offshore development team for changes and testing.
• Worked on new custom claims extension/interface analysis and development.
• Developed extension code using .NET and Oracle 11g.

Confidential

Senior Analyst

Responsibilities:

• Responsible for analysis of new Facets 451 Service Domain interfaces and extensions requests and requirement gathering and functional specification and technical specification document publishing.
• Worked with offshore development team for changes and testing.
• Worked on new custom claims extension/interface analysis, testing and extension related configuration changes.
• Supported extension/interface code deployment to different environments.
• Responsible for monthly groups migration support and developed new accumulation process to support deductible carry over for FLEX/EAB members.
• Developed/supported Group/member/billing/Claim history/accums and Rate information from Facets 431 to Facets 451 using new rules/configurations.
• Developed all migration scripts using Oracle 10g and VB scripts and Facets 451 extension code using .NET and Oracle 10g.

Senior Analyst

Responsibilities:

• Developed custom UM letters and trained client on custom letter development process including hosting code review/migration policy.
• Developed Custom billing invoices/reports using Ruby application. This includes invoices for Individual, Group, Medicare/Medicaid and Cobra bills.
• Developed Custom EOP/Checks using Ruby for each line of business.
• Developed this process using SQL Server 9.0, Ruby and Facets 451.

Senior Analyst

Responsibilities:

• Developed process to identify all member changes including retro for eligibility changes, PCP changes, Network changes, age changes that can impact cap rate change and Rate schedule changes.
• Developed Cap membership file using eligibility, product, class plan, network, and members cap schedule and rate relationship.
• Developed PMPM cap file for Global, Secondary and Primary capitation, for change events this process created data for using old configuration and new configuration and cap file lists only if the payment amounts are not matching.
• Developed daily pre cap summary report and daily provider variance report.
• Developed error report that identifies members with missing cap relationship.
• Developed this process using Oracle 10g and Facets 451.

Senior Analyst

Responsibilities:

• Development of batch process to calculate DC payments for all dc pended claims based on RVUs at provider level.
• Developed process to update Facets with newly calculated DPCF (claims conversion factor).
• Developed process to update DC application with Facets payment information after DC claims payment.
• Implemented process to re-pend dc error claims from daily claim adjudication process.
• Re-mediated all direct compensation code to Facets 431.
• Responsible for scheduling/testing Facets 431 batch job scheduler using TIDAL.

Senior Programmer/Analyst

Responsibilities:

• Responsible for technical assessment review, testing of Facets extensions and impact analyses of M-plans INFORMATICA data ware house for Facets Upgrade from 2.96 to 4.21.
• Published Staging ODS and INFORMATICA tables Impact document due to changes in Facets 4.21 data model.
• Reviewed Rubi, COGNOS reports, warehouse extract and published impact documents for users.
• Reviewed external application testing with Trizetto testing team.
• Reviewed Facets core data after each conversion.

Senior Analyst

Responsibilities:

• Responsible for converting Presbyterian Utilization Management information (UMI) data from AMISYS to FACETS. Conversion process includes converting AMISYS data to Facets look like data and implementing business rules and cross walks, keyword generation and loading data to Facets using UMI batch process. This was implemented using ORACLE and PL-SQL.
• Implemented synchronization process for Medicare Membership data between Facets 2.96 (SYBASE) and Facets 4.31(ORACLE) using MMS process and provider data between Facets 4.31 (Oracle) and Facets 2.96 using Facets XPF Batch process for Priority Heath Systems.
• Worked on enhancements to MPLAN Network capitation application and published functional assessment document for existing process.

Senior Analyst

Responsibilities:

• Responsible for functional assessment process of existing enrollment process for THCG and design/development of new unified electronic enrollment (UEP) system to handle various specifications of enrollment data and programmatically convert data (as defined) from various Groups into FACETS, database design/implementation and development of pre-mms conversion process to convert staging data to facets look like data.
• Implemented client specific business rules using UEP configuration.
• THCG currently receives enrollment information from 42 employer groups electronically; each uses a proprietary 834 or other format. Data interpretation for each group is different when mapping client data to FACETS. The new system was developed in such way that it will support any type of file format and any changes in file layout. Support for user is via a configurable business rules interface. UEP application was implemented using .NET, SQL SERVER and DTS process.
• Published enrollment functional assessment document for all electronically supported employer groups.
• Published design document/business requirement document and project plan for new unified enrollment application
• Designed/implemented database design for config/staging and pre-mms tables.
• Application was implemented in five modules, front end for group configuration screens, parser program to load any group file data to staging using config modules, conversion
• Of staging data to mms look like table including implementing group specific business rules, front-end to display/correct pre-mms data and keyword generation process to create keyword file MMS job.
• Responsible for designing config screens for parser/pre-mms process and implementation of pre-mms conversion.
• Coordinated testing team and development team.