SUMMARY

• Software professional with 5 years of experience in software development and support in Healthcare Business and IT services. Having good experience on FACETS and McKesson portico products.
• Expertise in pricing configuration in Facets NetworX.
• Expertise in FACETS benefits and pricing Configuration.
• Expertise in Facets Upgrades to 4.81 from previous versions.
• Expertise in FACETS accumulator setup with corresponding LTLT,DEDE prefixes
• Experience in Facets batch jobs using HBA architecture.
• Good Experience in Claims Adjudication& Processing.
• Created and tested Facets Extensions using XCOM/Embedded Extensions development.
• Having 4 years of experience in FACETS 4.21, 4.51, 5.01 Modules (NetworX, Billing, Subscriber, Member, Providers, Claims etc.)
• Good knowledge in Facets Configuration like Class, Plan, Product, Limits, Copay, Coinsurance, Deductibles, Supplemental Qualifier rules, Provider Agreements, Service rules, Service definition, Service Pricing, Service Payment, Processing Control Agent, Clinical Edits, Medical and Hospital Pricing setup and Claims Testing, Subscriber/Member, Network Set up in Facets Terminology its PDPD, CSCS, CSPI,GRGR, PLDS, PDBC, PDVC, LTLT, SPCT, SRCT, TPCT, RCCT, SRCR, SPCR, SEDS, SESE, SETR, SEPY, SEDF, AGAG, NPPR, NWPR, AGIP,AGPD, AGRT, PFFS, IPRS, PCAC,PCAG, CLCL, CDML etc.
• Professional development experience in writing MS - SQL Server and Sybase Queries, Oracle pl/sql, VB Scripts and XML Batch Jobs.
• Having good experience on the NetworX module, creating the agreements/contracts, fee schedules etc.
• Very Good knowledge on McKesson PNO module, Studio, Data Administrator, security manager and implementing wizards as per business needs. manager and implementing wizards as per business needs.
• Have Good Experience mainly on Custom Work Orders.
• Knowledge on CPT, HCPC codes.
• Experience in Writing Stored procedures, functions, Triggers.
• Preparation of Functional design, Detail design, and test case documents.
• Experience in creating EDI Scripts.
• Scripting languages python in McKesson Studio(Portico).
• Experience in converting sql scripts into Oracle format.
• Experience on SSIS.
• Programming knowledge in .NET and Scripting Languages.
• Proficiency in MS Office (Word, Excel (Pivot tables, VLookups etc), Outlook, PowerPoint, Access)
• Good Understanding on Facets Data model and Data Dictionary.
• Good Understanding of TriZetto Environment and Process.

TECHNICAL SKILLS

Operating Systems: Windows XP/2003.

Programming Languages: .NET Framework (2.0/1.1), VB.NET, C#, C, C++, HTML.

Scripting Languages: VB Script, java Script, Perl script, Python

Databases: SQL Server 2000/2005, Sybase ASE 12.5/15, Oracle 10g.

Tools: Visual Studio.NET, SSIS, Visual SourceSafe, MS Office, IBM Clear Quest

PROFESSIONAL EXPERIENCE

Confidential, New Jersey

Facets Developer

Responsibilities:

• Gathering and exploring the technical and business requirements from Health systems and create solutions for requirements in facets Providers module
• Transform requirements into configurations solutions and Identified provider networks, medical agreements as per health system. Worked on different state markets
• Assisted in framing requirements for automation script to load provider data to Facets - which handles
• Provider Creations
• Provider Terminations
• Demographic Updates
• Network additions and Terminations
• Creation of new practitioners, providers, provider groups, facilities and IPA’s and attaching corresponding agreements based on provider networks.
• Changing the existing provider data like networks changes, agreements changes, pricing changes, provider group, facilities and IPA changes, demographic changes, registration changes.
• Termination of providers, provider groups.
• Adding and Terminations of Provider primary, Remittance and mail addresses based on their Specialty like PCP, Dual and Specialty.
• Database analysis using provider module tables PRCP, PRPR, PRER, PRAD, PRRG, NWPR, NPPR, NWNW, NWGR, AGAG
• Analyzing and correcting Provider information by doing auditing on existing Facets data and making corrections in facets
• Processed claims and validated pricing based on Network and agreement for configured Providers.
• Created new PCP, specialists, duals based on the market plans

Confidential, MI

Facets Developer

Responsibilities:

• Gathering and exploring the technical and business requirements from client and develop solutions for requirements in facets NetworX
• Utilize facets functional applications to build, test and implement configuration solutions
• Transform requirements into configurations solutions
• Design, build and test facets configuration in support of business requirement
• Participate in functional specification and design reviews and validating configuration
• Work with facets table and data models using analytical tools to extract and assess data
• Generate clear and summarizing documentation and communicate effectively to customers and management
• Regularly coordinating with off-shore team and schedules meetings to make them clear understanding of requirements and clarify doubts.
• Creating new Qualifier types, Qualifier groups to meet the requirements in Agreements
• Calculating the Anesthesia factor, DRG in Agreements while testing the claims to verify the configuration configured correctly.
• Creating the Complex qualifiers when necessary
• Creating the global modifiers to simplify the bulk agreements creation at same time
• Calculating RBRVU, RVU Fee-Schedules
• Created around 300+ fee schedules(Professional& Institutional ) and also done in-depth duplicate analysis in backend for all 300+ fee-schedules
• Build around 100 agreements for Hospital, professional.
• Validated Agreements in NetworX and related Facets backend tables using NSVM, NSHC, NCGP, NCGV, NRST, NSRS, AGAG tables
• After creating agreements- mapping providers to corresponding Agreements
• Creating test logs and created a test-case for each and every term in the agreements to verify the configuration works according to requirements.
• Performed on pricing changes
• Created new and updated existing terms based on pricing request
• Test new and existing configuration to ensure correct payment reimbursement by unit testing
• Created queries and validated changes
• Run access queries
• Analyze service id and mapping, including supplemental procedure code and revenue code
• Conversion table mapping

Confidential, Houston, TX

Facets Developer

Responsibilities:

• Performed installation and upgrading MS SQL Server 6.5 to SQL Server 7.0.
• Created new database objects like Procedures, Functions, Packages, Indexes and Views using T-SQL.
• Developed SQL Queries to fetch complex data from different tables in remote databases using joins,
• Created Stored Procedures to load the problem ticket tables from multiple different servers.
• Performance tuning of SQL queries and stored procedures using SQL Profiler and Index Tuning
• Experienced in ETL (Extract, Transform and Load) development using Data Transformation Services
• Development and Production environment for SQL Server, database links and formatted the results into reports and kept logs..
• Created and managed users, roles and groups and handled database security.
• Developed standards and guidelines to maintain develop and administer the SQL Server database and Performed development support, document reviews, test plan, integration of the system.

Environment: Microsoft SQL Server 2000/2005/2008/ R2, SSIS, SSRS, MS Visio, DTS, MS excel 2003, T-SQL, HTML, SQL Profiler, Index Tuning. (DTS) for migration of data from legacy systems to SQL Server 2000.handled corrupt databases and diagnosed and repaired them.

Confidential, Houston, TX

Application developer

Responsibilities:

• Developed a Sharepoint website for client to maintain daily automated schedule and tasks assigned.
• Implemented designer to customize the look, feel and created robust data view web parts
• Created a security portal for client which allows to access documents and workspaces to be shared between a numbers of individuals, such as databases and forms in common use.
• Fully serviced SQL server Management Services
• Created accumulated reports using TSQL, SQL server
• Developed and supported the Extraction, Transformation and Load process (ETL) for a data warehouse from various data sources.
• Installed Reporting Services add-in on web server from which web application features are utilized as viewing reports
• Designing and building reports to create aggregate reports using SQL server database
• Utilized SSRS to deliver reporting content.
• The reports are extracted to various formats like MS excel, XML, SharePoint list etc.
• Generated the tabular, graphical reports from relational data source.
• Developed and updated the tools and master data using VB.Net and SQL server 2008
• Participated in PEER reviews on the requirements developed
• Developed the architecture of website workflow by using UML modeling

Confidential

Facets Developer

Responsibilities:

• Worked on PHP (Physicians Health Plans) Upgrade, which is a facet Upgrade.
• Upgraded all database components to be compatible with Facets database architecture changes and coding standards.
• Worked on the extensions like BankID Edit and PHP Medicaid enrollment in testing part.