RAGHAVENDRA (Raghu) RAO

Tampa, FL.

Phone: 585-***-**** (cell)

Email: ac0gd0@r.postjobfree.com

LinkedIn: http://www.linkedin.com/in/ragrao

CAREER OBJECTIVE

A Challenging Career in Software Engineering, Development and Management in a Competitive Environment.

EXPERIENCE SUMMARY

Experienced professional who has delivered quantifiable results and achievements. Successfully led numerous offshore and onsite software development and quality initiatives in IT projects.

CAREER BACKGROUND

20 years experienced professional with both managerial and technical expertise.

Excellent exposure to design, development and maintenance in Hp3000, Hp9000, COBOL, MFCobol, Suprtool, Powerhouse, AMISYS Release 11, Amisys Advance (Release 3.x, 4.x, 5.x, 6.x, 7.x), HP-UX, DOS, Windows. Skills in the areas of Oracle, SQL Server, T-SQL, PL/SQL, SSAS, SSRS, SSIS, Java, XML, RDBMS & C also.

Over 17 yrs of extensive Healthcare Payer Information Systems experience in US, specifically in Healthcare day-to-day processing software AMISYS, Amisys Advance, Facets and Cactus. Experiences also in manufacturing, retailing and finance industries.

Extensive experience in all levels of Software Development Life-Cycle which includes management, analysis, development, testing, coding, quality assurance, production support, documentation and training.

Prepared all types SDLC documents like Project charter, Project Plan, BRD, FRD, RTM, TDD, QA test plan, Production Implementation plan, Production support documentation, etc

Extensive knowledge of Healthcare Claims 837, Membership 834, Billing, Provider, Credentialing, EOP, EOB, Employer Group, Finance, Accounting, Revenue Recovery, Underwriting, and Configuration areas.

Completed analysis and estimates for new projects in all areas of HMO business, including Medicare, Medicaid, Administrative and Commercial lines of business, Exchange and ICD10.

An expert in designing, planning, implementing and maintaining IT projects.

Extensive experience in ETL, Business Intelligence, Data modeling, Data mapping and Business Analytics, to forecast healthcare data trends and reports from EDW, ODS and Legacy databases.

Hands-on experience working in big data environments with more than 100+ million records.

Worked extensively as an Implementation consultant and advising clients on process and performance improvements.

PERSONAL SKILLS

Strong analytical and problem solving skills. Self-starter, Persistent. Determined. Logical. Diligent. Dedicated, Loyal. Open minded. Excellent Customer Service and Goal oriented. Structured. Good leadership and strong organizational skills. Strong communication skills. Responsible with follow-up.

Unique personal ability to interact/understand and analyze various issues with users from the President to the shop floor. Evaluation skills to determine alternate courses of action in a project, just results, or in appraising performance.

Ability to handle confidential HIPAA, payroll, fee schedules, cost and profitability data.

EDUCATIONAL BACKGROUND

Bachelor of Engineering in Electrical and Electronics,

Manipal Institute of Technology, MANIPAL, Udupi Taluk, Karnataka, INDIA

REFERENCES

Available upon request.

PROJECT EXPERIENCE

Jan 2007 – Current

Specialty IT consultant

CLIENTS SERVED

UCARE, Minneapolis, MN

DST Health Solutions.

Preferred Care / MVP Healthcare, Rochester, NY.

Burgess Group, Alexandria, VA.

Mt. Carmel Health Plan, Columbus, OH

Geisinger Health Plan, Danville, PA

BCBSNC, Winston-Salem, NC.

AvMed Health Plans, Miami, FL.

Health Plus of Michigan, Flint, MI.

Invidasys, Mesa, AZ.

ConnectiCare, Hartford, CT.

Responsibilities:

Provide support and advice on the day-to-day operations of AMISYS Managed Care software.

Complete analysis and project estimate for new projects in all areas of managed care HMO business, including Medicare, Medicaid, Administrative and Commercial lines of business.

Single person point of contact for 3rd party vendors and Provider networking customers like CIGNA, Multi-Plan, VO, DQ, HEG, Davis Vision, McKesson, CVS Caremark, Merck-Medco, ESI, Benecare, RedCard, VPay, etc.

Extensive knowledge of the Claims, Membership, Accumulators, Provider, Credentialing, Authorization, Employer Group, and Configuration areas of the HMO operations.

Software Systems Implementations. Lead small, medium and large internal IT projects.

Involved in implementation from AMISYS to FACETS, new Medicare products in Amisys Advance 7.x

Involved in IT merger between the parent companies. Provided appropriate communication to senior management. Performed weekly, monthly, quarterly, and annual reporting

Ensured highest quality of products delivered with “zero-bug” production GO-LIVE implementations.

Built Cactus to Amisys Advance 6.x and 7.x Provider data flow via ETL process. Clean-up Cactus data. Coordinate different project tasks with entire client team and their partner company Emblem Health.

Managed client relationships. Developed and maintained effective working relationships with key departments. Provided direction including project management, customer management, and conflict resolution. Monitored project plans, scope of work, documentation and communications.

Participated in the development of documents and new policies and procedures. Managed tracking of the implementation life cycle, ensuring projects met deadlines and were within budget. Proficient in Project Management including project planning and monitoring, project tracking, work allocation, client and user communication and status reporting.

Interviewed new candidates for specific openings in IT department. Participated in IT Project level quality audits and SAS70 audits. Analyzed code for upgrades and ICD-10 conversion.

Worked on program-carrier framework development for client to switch from hard-coded products to looking up Oracle tables containing the product information, thus enabling the client to add more products in future very easily and with extensive savings. Worked on new products implementation for NJ Medicare, PA Medicaid and Eastern Maine TPA in the functional areas of EOP, Capitation and Enrollment. Completed 834 COB loads/reporting and Provider loads for PA Medicaid.

Migrated and built jobs from Appworx and other scheduler systems to UC4.

Hands-on programming experience in MF Cobol, PL/SQL, JCL, Unix Shell scripting, Suprtool, T-SQL, SSIS, SSRS. Complex SQL queries for data extracts, reporting and analysis purposes.

Performed data modeling, profiling, mapping and built data models to help customers forecast healthcare data trends. Worked on ETL to source the data from legacy systems to ODS/DW and then produce analytical reports through Business Objects from those data.

Working on Amisys Advance Release 6.3 and 6.4 defects and maintenance directly with DST in the areas of Membership, Billing and Claims Payable.

Involved in building the architecture of the new process to be built for batch Medicare pricer. Completed the Technical Design document to build the new interface. Completed the development for the new interface by modifying User-Exit Cobol program CLS0400 and built new Cobol program and PL/SQL to initiate the pricing HTTP call to Invidasys Integration component that returns the Medicare allowed amount pricing, DRG code and any necessary Error messages that are all passed back to the Amisys claims. Completed unit-testing, system testing, load testing, integrated testing, customer acceptance testing and production support for the new interface after it went live.

Worked as Operations PM to help client reduce their 30K claims backlog to be released for payment. Built project plan and shared with COO and CEO on how to clear the backlog in 2 months. Communicated the plan effectively to Claims Managers and team of 20+ claims analysts to have the claims adjudicated correctly. Monitor the programs daily and weekly to ensure correct status is being reported to senior management.

Completed hands-on training in SAP HANA platform which includes technical architecture, ETL from SAP BW and other ERP systems into SAP HANA, built data models and performed analytical reporting on them. Worked on project to extract specific data from COPA tables and load them into newly modeled tables based on reporting needs.

Roles

Sr. Systems Analyst, Sr. Business Analyst, Sr. Programmer, Technical Project Manager.

Hardware

HP3000 with MPE/Ix 6.5, 7.0 pp2, Hp9000 and Unix, Windows Servers

Software

COBOL, Amisys Advance version 4.x, 5.x, 6.x, 7.x, Suprtool, Shell Scripts, PL/SQL, SQLPLUS, Java, Appworx, UC4, Cactus, Remedy, T-SQL, ERWin, Business Objects, Lumira, Maestro, SQL Developer, WorkFront, SSMS, Eclipse.

Databases

IMAGE, ORACLE, SYBASE, SQL SERVER, MS ACCESS, SAP HANA.

June 2001 – Dec 2006

IT Consultant

Preferred Care, Rochester, NY.

Project Name

Application Systems.

Client

Preferred Care, Rochester, NY, USA.

Description of the Project:

Maintenance and Customer Support for the AMISYS, Amisys Advance, Operational Data Store ODS, Data Warehouse Applications. Interaction for implementing the latest version 10.05 of the software, getting requirement analysis for the maintenance request. Data migration through Suprtool and other JCL's. Extensive work for the Amisys Advance migration involving all aspects of analysis, coding, testing, reviews, quality assurances in both Hp3000 and Hp9000 systems.

Roles

Systems Analyst and Project Leader

Responsibility

Analysis and conversion from old Medclass systems to Amisys. Analyze, document, program and implement AR new cash flow posting applications. Analyzing, documenting and testing for all the in-house applications for Amisys Advance. Implement HEG Dental Claim Load project, PHCS Provider Data loads and SRI transplant reinsurance electronic claim loads. Prepare flexible benefit copy system, benefit counter copy process. Preparing for Amisys Advance in HP-UX systems and analysis for all conversion related to this new system. Project lead responsible for various migration stages and complete system testing.

Hardware

HP3000 with MPE/Ix 6.5, 7.0 pp2, Hp9000 and Unix.

Software

COBOL, Powerhouse, IMAGE database, AMISYS, Amisys Advance, Suprtool, Adager, OCS EXPRESS, Actuate, Shell Scripts, PL/SQL, SQLPLUS.

April. 1999 – May 2001

Systems Analyst

BlueCross BlueShield of Tennessee, Chattanooga, TN – 37402, USA.

Project Name

I/S Government Systems, I/S BlueCare Systems.

Client

BlueCross BlueShield of Tennessee, Chattanooga, TN, USA.

Description of the Project:

Maintenance and Customer Support for the AMISYS 9.5 Applications. Interaction for implementing the latest 10.05 versions of the software, getting requirement analysis for the maintenance request. Data migration through Suprtool and other JCL's. Day-to-day processing for Amisys jobs.

Roles

Programmer Analyst, Systems Analyst

Responsibility

1.Co-ordination activities for Systems Configuration Team.

2.Defining quality procedures.

3.Impact Analysis, functional design, coding and testing of maintenance requests like report changing using Cobol and Powerhouse.

4.Planning & scheduling of the OCS Scheduler project.

5.Production Support.

Hardware

HP3000 with MPE/Ix 5.5 and 6.5.

Software

COBOL, Powerhouse, IMAGE database, AMISYS, Suprtool, Adager, Vista, NBSpool, Netbase, OCS EXPRESS.

SKILL SET:

Systems Worked

IBM 3090 (Mainframe), IBM PC, HPe3000, Hp9000, SAP HANA, Windows Servers, SAP.

Computer Languages

Cobol, Basic, Fortran, Telon, C, Shell Scripts, PL/SQL, Easytrieve, CBAS, Amisys, Powerhouse, Java, .NET, BO analytical reporting, HANA scripting.

Operating Systems

MVS, MPE/ix 5.5/6.5/7.0, Windows 3.1/95/NT/98/2000, PC DOS, Unix, SAP HANA.

Databases Worked

DB2, IMS, Microsoft Access, VSAM, IMAGE, ORACLE, SYBASE, SQL Server, SAP HANA.

3rd Party Software’s

Suprtool, Powerhouse, Adager, JMS3000, Query, SuprLink, StreamX, Security 3000, QEDIT, Editor, Vista, NBSpool, MPEX, OMNIDEX, Superdex, VCS, Tidal, Appworx, OCS Express, UC4, Actuate, ERWin, TOAD, SQLPLUS, Cognos and FTP, T-SQL, Business Objects. ColdFusion, QUIZ, QTP.

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