Ganesh Margasaya Meigandasivam

Summary:

Around *0 years of IT experience in analysis, design, development, implementation, troubleshooting and support for MSSQL and .Net based multi-tiered systems.

Around 4 years of experience in Healthcare domain and Facets.

During various Facets upgrades involved activities like analyze and create report on impacted objects in modules, batch jobs,runbooks,incorporate upgrade changes, unit testing,QA and UAT support,production deployment and

Support.

During Facets upgrades involved Trizetto HIPAA Gateway trading partner set up, Regions set up, Gateway Batch Processing and Troubleshooting.

Good knowledge in following healthcare transactions – 834, 837, 835, 820 and Trizetto FACETS aided processes like Membership, Billing, Claims Management

Good Knowledge in Trizetto HIPAA Gateway configuration and processing.

Knowledge of HIPAA Gateway Data Model (Transaction (FHG) & Development (FHD)) and functioning of BINB and BOTB jobs and its run book parameters.

Implemented Member enrollment process for couple of Lob’s by creating dot. Net application, processing the EDI file using HIPAA Gateway BINB, loading the records into database via Facets batches like MMS, ELIG.

Enrolling SCO dual eligible members (Medicaid and Medicare) from EAM to Facets using legacy transaction and member batch, XMS batches (XmsRunTmsFileIntake, XmsRunTmsLegacyLoad, XmsRunTmsKeyGen), MMS and ELIG batches.

Processing claims using HIPAA Gateway BINB, 837 Inbound Process, claim adjudication (CLMU) and Payment batch (CKMM).

Facets extensions development using XCOM, deployment and integration with Facets modules.

Methodical knowledge of application development life cycle and software engineering principles

Proficient in DOTNET technology frameworks, SSIS, VBScript, JavaScript, Web services, HTML, CSS and XML

Highly skilled in MS SQL stored procs, view, triggers and DDL

Good hands-on experience in Devexpress tool for DOTNET, EDI suite

Smart trouble shooter and solution finder

Curious and quick to learn and implement new technologies and updates

Good team player and individual contributor in developing reusable systems

Experience in handling cross-functional projects with complete software development life cycle (SDLC)

Excellent analytical, problem solving, communication and interpersonal skills with good work ethics and ability to interact with individuals at all levels of the organization.

Ability to lead the team, to work as an efficient team player, to learn new technologies and to handle the job responsibilities with minimal directions

Technical Skills:

Development Tech : C#.Net, VB.Net, ASP.Net, WCF

Client Side Tech : AJAX, JavaScript, VBScript, HTML, XML, CSS, XSLT

Databases & Tools : SQL Server 2000/2005 /2008, MSAccess, SSIS, Devexpress for DOTNET

Other Utilities : MS-Office, MS Visual SourceSafe 6.0, MS Access, Clear Case, Team Foundation Server (TFS)

Healthcare Product : Trizetto FACETS, Trizetto HIPAA Gateway, Facets Configuration, Facets Extensions

EDI : EDI 834, 837, 835 and 820

Education:

MASTER OF COMPUTER APPLICATIONS(M.C.A), Madras University, Tamil Nadu, India, October 2004

Bachelor in Science (BSC) - Computer Science, Sri Sankara arts and Science College, April 2001

Certificates & Recognition:

AHM 250.

Health Insurance Advanced Studies, part A

Health Insurance Advanced Studies, part B

AHM 520 –In progress

Awarded Associate of the Quarter

Professional Experience:

Client : Boston Medical Center Healthnet Plan

Duration : Nov 2014 – Till Date

Location : Boston, MA

Project Description: Boston Medical Center Health Plan, Inc., offers several different health plans to meet the different health and financial needs of potential members. It offers plans in two states, Massachusetts and New Hampshire. In Massachusetts State they offer four types of plans like MassHealth, Qualified Health Plans, and Senior Care Options (SCO) plan it included two products SCO Medicaid for individuals over 65 eligible for Medicaid but not Medicare, SNP Dual-Eligible Special Needs Plan, for individuals over 65 eligible for both Medicare and Medicaid. In New Hampshire Well Sense Health Plan is the business name for BMC HealthNet Plan offers subsidized health insurance to eligible low to medium income NH residents. Members are eligible for the coverage depending on their age, disability, health status, and/or family status. Individuals select the Well Sense Health Plan to join. Well Sense Health Plan offers two products NH Standard Medicaid and NH Health Protection Program (NHHPP).

The Scope of these projects includes Implementation of Membership (EDI 834) Enrollment process for MassHealth state sponsor plans, implementation of Member enrollment process for New Hampshire sponsor plans and Member enrollment process implementation for senior care option (SCO) using .NET application, HIPAA Gateway job, Facets Batches.

EDI 834 outbound files generation for DHHS as per the requirement using custom .NET application and HIPAA Gateway BOTB job. Electronic Claims (EDI 837) processing for all these LOB’s using BINB Job, Facets batches like CLMU and CKMM. Vendor files inbound and outbound processing, Facets extension development and integrating the extensions with Facets modules/applications as per the business requirement. New orientation calls process implementation for Mass health and NewHampshire members as per the business requirement. Facets version upgrades, Implementation of new products for small group, production support and providing solutions in terms fixes and enhancements.

Responsibilities:

Analysis of requirements

Process the EDI (837, 834, 835files using Trizetto HIPAA gateway, custom Dot net code and using Facets batches.

Design enrollment process and rules for processing

Develop application and database objects

Design application screens and logics for processing the records

Utilize Facets batch processing for moving records to database

Unit Test code

End to end support for testing with health plan connector

QA support and defect fix

UAT support

Develop additional enhancements

Provide quick fixes for any production issues

Point of contact for queries on the application

Provide day to day support in case of failure

Accommodate any special request for processing certain files

Performance improvement of existing application

Provide Implementation support for the process change in the client’s production environment and provide post production support in case of any production issues.

Environment: SQL Server 2012, ASP.Net, C#, VB.Net, VB Scripting, SSIS, Dev express for DOTNET WCF, Web services, Facets 5.20, Facets 5.30, Trizetto HIPAA Gateway, Facets Batches,Microsoft Visual Source Safe, TFS (Team Foundation Server), Facets Extensions, Windows 7

Client : Blue Cross and Blue Shield of Louisiana, (BCBSLA)

Duration : Dec 2013 – Oct 2014

Location : Baton Rouge, LA

Project Title : Quality Blue Primary Care – Reporting/Extracts/ Interfaces

Project Description: The BCBSLA Quality Blue Primary Care is designed to help Louisiana doctor’s better care for their patients with long-term health conditions. QBPC builds on the basic features of PCMH to offer an enhanced model for population health, in which providers can focus on improving care quality for their total patient population, not just those who are actively seeking treatment. Blue Cross contracted with two strategic collaborators, MDdatacor and Integrated Medical Practices, to support QBPC. This project will collect and assemble medical information into a data store that will include data feeds from various other systems, including Membership, Claims, Lab Results, Pharmacy data, TREO, MDdatacor and will be collectively called as QBPC Data Store(Quality Blue Primary Care Data Store). The Data Store will be used for sending data to MDD, TREO and for generating a payment file for the S-Code billing process. The data store will retain history of this information for each active member, and will support long-term trending and performance analysis. PCPs will be incentivized for member chronic condition healthcare improvement trends over time

Responsibilities:

Responsible for entire SDLC life cycle from requirement analysis, identify table and field mapping, design, develop SSIS packages

Develop SSIS package to extract outbound Membership, Claims, Lab Results, Pharmacy, QB PCP Registry and IP/OP/Discharge data and send the data files to MDD Insight.

Develop package to store the TRAIT data export from MDD such as Member attribution, chronic conditions, and goal progress and quality scores in Quality Blue data store.

Develop package to store the data files from TREO such as Efficiency scores of Clinic/PCP, Member level base data and PCP-Member attribution. Also the member attribution from MDD will be extracted and sent to TREO on a monthly basis.

Develop package to store the member attribution data from MDD and TREO in Quality Blue data store and update the PCP’s in JIVA database for all the members who have attributed PCP in MDD/TREO file. Develop interfaces to add/update/delete the PCP registry information in Quality Blue data store. Develop package and SSRS report to generate the CMF (Care Management Fee) monthly claims payment file using the TRAIT data export from MDD and submit the claims for processing and then generate the CMF payment status report.

Design SSRS reports and subscriptions to generate the reports from Quality Blue and other data sources and deliver it to share point portal or FTP folder. Prepare design document, test plan, test cases and guide the team on any technical issues/analysis.

Perform system testing by configuring and deploying the packages and reports into Control-M and make sure reports are delivered to share point portal.

Support the business team during user acceptance testing. Prepare SDD document with approvals from all stakeholders and get the CAB approval for implementation

Unit testing production deployment

Production support in case of any production issues

Environment: Windows XP, Visual Studio 2010, SSIS, SSRS, SQL Server 2008/2012, C#

Client : Blue Cross and Blue Shield of Louisiana, (BCBSLA)

Duration : Sep 2013 – Nov 2013

Location : Baton Rouge, LA

Project Title : Healthcare Reform - Rating Web Service

Project Description: This application allows Benefit Focus to provide quotes for BCBSLA plan products. Based on Grandfather / non-Grandfather plans, this rating web service generate the quotes for the products and return an xml file to Benefit Focus. Benefit Focus will consume the xml file through web service call and will show it in their user interface when a member request to see BCBSLA product premium / compare the medical product premiums along with BCBSLA product premiums.

Responsibilities:

Analysis of requirements

Develop application and database objects

QA support and defect fix

Unit Testing

Support the business team during user acceptance testing. Prepare SDD document with approvals from all stakeholders and get the CAB approval for implementation

production deployment

Post implementation production support

Environment: Windows XP, C#.Net (.Net Framework 4.0), SQL Server 2008

Client : Emdeon

Duration : Oct 2012 – Jun 2013

Location : Chennai.

Project Title : Emdeon Office

Project Description: Emdeon Office is a web-based set of services designed to enable health care providers to manage their revenue cycle accurately and easily.

Office has multi-transaction capabilities including eligibility, service reviews, claims, remits, statements and clinical tools.

Responsibilities:

Analysis of requirements

Responsible for New Payer set up based on payer worksheet

Payer conversion: Converting existing payer’s which are in 4010 standards to 5010 standards

QA support

Unit Testing & Deployment

Support the business team during user acceptance testing. Prepare SDD document with approvals from all stakeholders and get the CAB approval for implementation

Post implementation production support

Coordinate with team to take tickets to closure

Production support and fix to production issues.

Environment: Windows XP/2003, C#.net, Asp.net, Sql server2005/2008

Client : Emdeon

Duration : Oct 2011 – Sep 2012

Location : Chennai

Project Title : EBS - IT ADM (PBPS-IXT)

Project Description: The Emdeon Patient Billing & Payment family of services provides comprehensive and secure online billing and payment management. These solutions will yield faster collection of patient-owed amounts, improved cash flow and reduced billing costs with less effort and paperwork.

Emdeon Patient Pay: OnLine Emdeon Patient Pay Online is a self-service patient application that provides comprehensive and secure online billing and payment management. Emdeon Patient Pay Online will yield faster collection of patient-owed amounts, improved cash flow, and reduced billing costs, all with less effort and paperwork. Patient billing will always be current, accurate, and accessible, 24 hours a day, 7 days a week.

Emdeon eCashiering: Emdeon eCashiering simplifies the payment process while improving operational efficiencies by providing an enterprise-wide approach to collecting patient payments. Authorized users now have the ability to accept co-payments, deductibles, and pre-payments while simultaneously accepting payments for outstanding patient balances improving point-of-service collection workflow

Emdeon Enterprise Studio: This service Provides intuitive statement design and state-of-the-art printing and mailing and processing costs by shortening the time it takes to get a statement from provider to patients.

Responsibilities:

Responsible for support & maintenance of following suit of applications Emdeon Patient Pay Online, Emdeon eCashiering, Emdeon Enterprise Studio,patient connect and other services provided by Emdeon.

Responsible to handle production support issues with solutions in terms of fix or enhancement, maintenance of color print and extraction struck and handling production support issues in this area,application Production deployment and post deployment verification and coordinating with team to take tickets to closure.

Environment: Windows XP/2003, C#.net, Asp.net, Sql server2005/2008

Client : Cognizant BPO team for clients NAM, AT&T, Belk

Duration : Aug 2010- Sep 2011

Location : Chennai.

Project Title : Cognizant Cloud

Project Description: “Cognizant Cloud (CC)” is a common platform for handling all our BPO related tasks. It is providing a platform for delivering process automation, accelerators and optimization solutions to clients.

The main functional deliverables for CC Core Platform Development involved in the development of the CC Tools, CC Framework Services and CC BPO UI.

CC Tools - CC Admin Console, Process Modeler and Cloud Manager

CC Framework Services - involves development of the components and window services

CC BPO UI - .Net web application for general purpose BPO implementation

Client Description:

Cognizant Cloud application is used by Cognizant BPO team.

For the following clients NAM, AT&T, Belk, Fico BPO Cognizant cloud application is implemented to track and handle BPO related tasks.

Responsibilities:

Responsible for the entire SDLC life cycle from requirement analysis, identify table and field mapping, design, development, Unit Testing and Deployment for this project.

Also I have done for Production support for post implementation issues.

Environment: Windows XP/2003, C#.net, Asp.net, sqlserver 2008

Client : Ford Motors Company

Duration : Oct 2008 – July 2010 2 years, 7 Months

Location : Chennai

Project Title : ColorTrax

Project Description: ColorTrax is a web based application used to capture and track color and trim related attributes for vehicle appearance items for all Ford vehicle programs. The attributes include color, texture, finish, gloss and others. It supports color and durability mastering for materials used in appearance items. ColorTrax also includes access for Tier 1 suppliers through the Ford Supplier Network and is more tightly integrated with WERS and C3P. The application has the ability to work with Color Digital Buck to see accurate color breakup for appearance items.

Client Description: Ford Motor Company, a global automotive industry leader based in Dearborn, Mich.manufactures or distributes automobiles across six continents. With about 166,000 employees and about 70 plants worldwide, the company's automotive brands include Ford and Lincoln.

Responsibilities:

Responsible for handling business, production support issues and Enhancement related activities.

Worked on enhancements of program-series level module, environment color module and appearance item module (Msjvm-Websphere), Migration from CDS2/FEDS to FDS environment (Ldap-Active Directory), Enhancements and maintenance of UNIX shell scripts, Enhancements in Interior and Exterior color intent modules, Usage of WERS, MATS and GSDB using db2 stored procedure (Mainframes), Involved in the WSL4.0 infrastructure enhancement.

Analyzed, Designed, Debugged and Fixed the CR (Change Requests is a unit of task) in the different version of CTX product. Each CR was assigned to software developer depending upon the level of severity, complexity and priority of the CR.

Environment: Windows XP, C#.net, Asp.net

Client : Ford Motors Company

Duration : Dec 2007 – Sep 2008

Location : Chennai

Project Title : Exemption Labels System (ELS)

Project Description: ELS is web portal which is used to request, approve, print and track (reports) labels used to exempt vehicles from environmental regulations.

Exemption Labels (ELS) is an application that enables request, approve, print and track (reports) labels used to exempt vehicles from environmental regulations. These labels must be affixed to any development vehicle or Ford is subject to heavy fines. Federal, State and other government entities require periodic reports of the kinds and number of vehicles that are active and exempt from regulations.

Responsibilities:

Responsible for support and handling business and production support issues in Test and Production environment, Involved in the WSL4.0 infrastructure enhancement, NHTSA 2010 update for Model Year and responsible for application deployment and post deployment verification.

Environment: Windows XP, MRS, Test Director, e-tracker MS-Access, Perl/CGI, MRS, Test Director,

E-tracker, Oracle 9i

Client : KNAPE & VOGT

Duration : Aug 2007 – Nov 2007

Location : Thirdware Solutions Limited, Chennai

Project Title : KV-ODS Database Migration

Project Description: Exporting data’s from two different databases into Sql server. K&V (Knape & Vogt) has a customer portal called as Customer Care Connection (CCC). This could be accessed by customers and employees of K&V. Currently this CCC application has two databases named as Legacy system which is connected through ODBC and another one is Oracle. Now K&V acquired another company namely WorkRite and this company using Progress database as a back-end.

Using Sql Server 2005 Integration Services .we are Migrating and integrating data’s from Legacy system, Oracle and Progress into Sql Server and now Customer Care Connection (CCC) portal points to new Sql Server Database and this accessible by K&V and WorkRite customers and their employees.

Responsibilities:

Responsible for entire SDLC life cycle from requirement analysis, identify table and field mapping, design, develop SSIS packages and SSRS reports, Unit Testing,Deployment, preparing supporting documents,supporting and maintenance of package after deployment.

Environment: Windows XP, Sql server 2005 and SSIS

Client : Pfizer

Duration : Jan 2007 – July 2007

Location : Pfizer, Chennai

Project Title : Sales Entry and Reporting Module

Project Description: SERM module is one of the interfaces for SUN systems

Easy entry of sales orders and non-stock credit notes, Ability to import orders from customers, Sales order approval rules, Business rules for ‘free goods’ type pricing and discounts, Grid for easy approval/release of sales orders, Orders exported from SERM in Sun Sales Import file layout and removed from SUN, Orders imported into Sun using standard Sales Import. Advance cheque logic is added in Sales Order Entry and Import files into Sun. Changes/Enhancement made according to the India Pfizer

Client Description: Pfizer is the world’s largest research-based pharmaceutical company.Pfizer develops and produces medicines and vaccines for a wide range of medical disciplines, including immunology, oncology, cardiology, diabetology/endocrinology, and neurology. Pfizer's products include the blockbuster drug Lipitor (atorvastatin), used to lower LDL blood cholesterol; Lyrica (pregabalin for neuropathic pain/fibromyalgia); Diflucan (fluconazole), an oral antifungal medication; Zithromax (azithromycin), an antibiotic; Viagra (sildenafil, for erectile dysfunction); and Celebrex/Celebra (celecoxib), an anti-inflammatory drug.

Responsibilities:

Responsible for the entire SDLC life cycle from requirement analysis, identify table and field mapping, design, development, Unit Testing and Deployment of Advance Cheque Module, C & F Locations Module, Approval Summery, Sales Export File Generation Module, Sales Export File Generation Module and Dbase Creator Module and also responsible for application support and maintenance.

Environment: Windows XP, Sun systems VB.NET, Sql server.

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