Information Technology Resume Profile

Summary

Positive, results-driven, and innovative individual with over 10 years technical mainframe expertise including COBOL-II, PACBASE, XGEN, APS, JCL, DB2, CICS, MQ-Series, IMS and VSAM as well as working directly with customers in a consulting capacity throughout the full software/system life cycle, SDLC , utilizing Agile, waterfall, Sequential Development or IFW Methodologies. Background includes international and domestic experiences in leadership role, three 3 years of team lead experience, business administration and project management. Projects included implementation of software applications, modules, and upgrades, as well as conversions within the industries of Government, Health Insurance, Insurance, Automobile distributor, Financial, and Telephone Communication. Develop matrix for RAPSODY to map their EDI files to the 5010 transactions.
Project management expertise includes analysis and planning, systems implementation and methodologies, technical training, and documentation review. Completed CompTIA A certification, and in the process of completing DotNET Program.

Keywords/Technologies

TSO/ISPF 10 , CEDF/CEMT 10 , Expeditor 10 , Intertest 4 , SmartTest 3 ,
ZEKE 5 , SAR 3 , Quality Center 2 , MS SourceSafe 1 , SharePoint 1 , J2EE 2 , MFE 1 , XIDE 1 , MVS JCL 10 , MS Access 2 , VBA 3 , Visual Basic 1 ,
SDSF 7 , IMS DB/DL1 10 , IMS DC 5 , JAVA 1 , HTML 1 , XML 1 , Shell Script 1 , Eztrieve 5 , TELON 2 , APS 2 , DB2 and DB2 UDB 10 , SQL 10 , EDI X012, 835, 837, 270, 271 276 , QMF 5 , SPUFI 5 , VSAM 10 , STROBE 2 , Stored Procedures 4 , ROSCOE 2 ,
Claims Processing, EDI claim processing, Conversions Skills Summary years : PACBASE 10 , COBOL, COBOL II, III 10 , SDLC 10 , XGEN 1 , CICS/BMS 10 ,
Industry: Life and Health Insurance, Government, Manufacturing, Inventory Control, Automotive Finance, Financials, HIPAA transactions X12, 835, 837, 270, 271 276 ,
FTP and SFTP 5 , ABENDAID 5 , ENDEVOR 10 , Panvalet 5 , ChangeMAN 5 , DumpMaster 3 , FileAid 10 , GSAM 2 , MS Office Suite 5 , Visio 2 , MS Outlook 3 Operating Systems years : z/Linux 1 , Z/OS and OS/MVS 390 10 , UNIX 1 , UNISYS 1 , DOS/VSE 1 , VM/CMS 1 , Windows NT/2000/XP, 2003, 98, 95 10 .

Experiences:

Confidential

Project 1:

Provided Information Technology service for MMIS at HMA for their claim processing system. Converted CMS version 4010 to 5010, this included identifying the gap between CMS version 4010 and 5010calim system, then developed the system change specification. Once the system change document identified where the changes are needed, the specification for the system and programs were also developed. Worked with third party payers and CMS to produce files for testing the new 5010 changes. Developed the developed new program and updated old one, developed new file structure and data needed to test the new applications and changes. Worked with most of the 66 hospitals to ensure there needs are met during the development stage. Have each hospital Service Providers test their new interface to ensure proper transmission of the new data file carrying the 834, 835, 837 transactions. Worked with Payer to ensure the 835 and or 270, 271, 272, 273, 274, 997, 999 transactions are flowing through the systems. Developed the EDI map for the system to map the data to interfaces. Processed hospital claims and then supply the claims data to third party clearing houses for processing at CMS, HMA process include sending claims directly to CMS for payment. We process institutional, professional and individual claims for our clients. Researched requirements for converting the 4010 existing claims to the new 5010 format. This would include the processing of X12 to submit the ICD09 ICD10 claims. Identifying the changes needed for the new CMS Version 5010. Applications for this system were developed in COBOL-II. Enterprise Workbench, Quality Center. Coordinate changes with local and national sites. Schedule delivery of updates through QC. Used Enterprise Workbench application s to download/upload changed modules from production to test or test to stages, through production environment.
Developing strategy to change the applications needed to do the conversion from 4010 to 5010 data to comply with CMS Version 5010 D.0/3, HIPPA requirements
Responsible for enhancements, upgrades, and fixes to Claims transactions that were impacted from production cycle run.
Mapping the data to the old file 4010, mapping the data to the new file for 5010.
Promoted code changes and new programs utilizing proper methodologies to maintain quality control standards and integrity via Enterprise Workbench system or ENDEVOR
Negative and Positive Testing Verification.
Prepared test plans to ensure application is fully tested.
Create the crosswalk for EDI transaction to be mapped in RAPSODY
Provided the LOOP for each field in the crosswalk for RAPSODY to build the HL7 HL12

Tools used: Excel, Word, VISIO, VSAM, CICS, DOS/e-VSE, Quality Center, RAPSODY transaction generator for 837, 834, 835.

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