JAMES NGUYEN

***** ****** ****** ****. 714-***-****

Garden Grove, CA 92844 Email. acz3qx@r.postjobfree.com

Professional Summary

Accomplished Senior SQL Developer and System Analyst professional with over 15 years of experience

Work with Project Managers to manage the projects, help to meet budget & schedule objectives

Experience in Information Technology/Consulting background

Extensive experience across full life cycle application development in multi-tier architecture Client/Server technology

Experience in working in team environment as a member and also in Lead role

Self-taught in many programming languages, application and operating system

Relevant Experience

QNXT Experience

Senior SQL Developer/Technical Analyst

FlexTech Inc 2013 - Present

445 Butternut Drive

Holland, MI 49424

Worked as a Technical Analyst Consultant at Washington healthcare organization since January 2016.

Analysis, development and validation 837P and 837I EDI transaction.

General data mapping of Claim Encounter EDI files 837I, 837P including coding, translation, development, testing and deployment.

Worked on System Requirement Design and Participated in the Incident Management and Problem Management processes for root cause analysis, resolution and reporting.

ETL Data Integration from source systems or legacy systems into ODS

Define and Improve tasks to ensure Data Quality

Improve the existing process towards more automated, reduce failure risks, improve data quality and increased resource utilization.

Automate Provider Lookup and Member Lookup processes.

Automate and Load debarred Providers to QNXT.

Worked as an EDI Consultant at a California healthcare organization from August 2014 to November 2015.

Create, analysis, design, implementation, development and validation 837P, 837I and 834 EDI transaction.

General data mapping of Claim Encounter EDI files 837I, 837P, 834 including coding, translation, development, testing and deployment.

Programming, including writing T-SQL in SQL Server and SSIS packages, which supports export Claim Encounter EDI files.

Data analysis entails understanding the flow of data and its interdependency among QNXT core modules such as Claim, Provider, Member and Affiliates module

Identifies and resolves problems related to EDI processes.

Assists in requirements gathering with end users to clearly define information needs and translate those requirements into specifications for development.

Tracks and monitors problem tickets to ensure timely resolution.

Extensive knowledge of SQL server and the ability to design and develop against processed EDI data.

Strong knowledge of Medicaid and Medicare transactions.

Experience in developing, implementing and testing EDI ANSI X12.

Ability to develop database queries using SQL to assist in testing effort.

Simultaneously serving as CMS111 Report Consultant at a Maryland based national healthcare organization since February 2015.

Create, analysis, design, implementation, development and validation of CMS SECTION111 Reports.

Presents thorough and accurate reports to clients and excess carriers on claims investigations/status updates.

Worked as a Technical Consultant at a large Tennessee healthcare organization for six (6) months.

Responsible for data extract, conversion, translation, and migration of historical data from QNXT to client system.

Migrated and converted Provider and Group MA Member data from ODS to QNXT environment.

Created Provider post-process to add, modify and delete provider and contract data in QNXT.

Created, analyzed, troubleshot and reviewed the code contained within the SSIS package and noted any potential areas where system configuration changes would cause the SSIS package fail.

Created various Excel ad-hoc reports to support the Provider and Member departments.

Performed analysis and data extraction for upper management.

Utilized existing attributes, dimensions, columns, transformations, tables and stored objects by using T-SQL, SSIS and Reporting Services, C# and ASP.NET.

Designed and developed C# and ASP.NET application for Member, Provider and Claim departments to view data from QNXT database.

Application Engineer 2010 – 2013

MDCare, Inc/Humana, Inc

1640 E. Hill st,

Signal Hill, California

Worked as an Application Engineer at a California health plan with a Medicare contract.

Provided business/system analysis, data flow and process mapping, software/system implementation for Medicare processes.

Designed and developed reliable automated solutions based on the identification collection and evaluation of business requirements using T-SQL, SSIS and Reporting Services and .NET.

Completed solutions and tasks within established timelines agreed upon by the IT management and clients.

Responsible for developing new and debugging existing SQL Server code (stored procedures, functions, triggers, SSIS packages).

Designed and developed Access application like HCA to view Member, Provider and Claim data from HCA database.

Provided validation, QA and testing of all developed software application to ensure the highest level of quality.

Assisted development and management teams in the gathering and documentation of business requirements analysis, and design of reporting tools to support business objectives.

Responsible for Capitation process including:

Ensuring the actuarial soundness of per member per month payment, based on precise scope of services to be covered by that payment.

Tracking detailed patient demographic and health status information, and ensuring that the actuarial projection is appropriately risk adjusted based on this information.

Ensuring receipt of accurate and timely capitation payments, including complete patient enrollment data and a detailed explanation of any capitation deductions.

Ensuring delivery of all reports for management review within established timelines.

Senior System Analyst/Lead 2001 – 2010

Molina Healthcare, Inc;

One Golden Shore Drive,

Long Beach, California

Worked as Lead/Senior Systems Analysis for a large multi-national healthcare company.

signed, developed, supported, maintained and debugged Client/Server F.S.R. (Facility Site Review) window-based applications in VB.net to support Credential department, to meet the quality improvement standards and ensure compliance with applicable local, state, and federal laws and regulations.

Lead for migration and standardization of over 700 Crystal and Excel reports from QMACS to QNXT.

Converted all types of reports (Crystal Reports, Excel and MS-Access reports) including: Cross-Tab (Crystal Report), Pivot table (Excel), Drill-down, Top N, Summary, Detail, Form, OLAP and Sub-Reports to California Rebuild, Indiana, New Mexico, QNXT Utah Rebuild, QNXT Ohio and QNXT Texas environments. Also supported Washington, Michigan Rebuild, Utah Rebuild and California legacy environments.

Enhanced, maintained and supported US Bank windows application for Finance department.

Trained staff, supported and managed all reports assignment to staff.

Migrated Claim, Eligibility, Provider, extract jobs from QNXT to ODS environment.

Developed and modified Claims functionality; provided clients with the ability to pay claims by line item and allow Claim Payments to Member, Subscriber or Vendor.

Enhanced, maintained and supported SOPHTECH windows application for CHDP department.

Created, maintained and supported EDITOR, Future Vision, Claim Viewer UB92/UB04 and HCFẠ1500 applications

Familiar with the ANSI ASC X12 837 claim health care standard format processes for data interchange.

Familiar with HIPAA Transactions testing and knowledge of HIPAA framework rules for ANSI X12 messages 837P/I standards.

Interacted with Claim, Payment and Enrollment departments - analyzing and documenting related business processes.

Designed and developed various DTS, SSIS packages.

Optimized stored procedures and views to improve performance.

QuadraMed, Corporation 1998 - 2001

Warner Center

Woodland Hills, California

Worked as Software Developer for a California-based healthcare software and services provider.

Responsible for specifications, programming, testing, and documenting of applications.

Responsible for the development of Functional Requirements and Details Design Documents for Managed Care application.

Designed and programmed a series of Client/Server applications that enhanced EZ-CAP with new functionality.

Designed and programmed database manipulation commands using the SQL language; coded stored commands, stored procedures, triggers and views.

Modified reports generated by Arpeggio and/or Crystal Report utilizing the above enhancements.

Converted embedded report execution logic from Arpeggio to Crystal Reports.

Developed Client/Server window applications that enhanced EZ-CAP managed care products.

Migrated applications from a single company SQL Base database to a multi-company SQL Server database.

MIS Analyst 1993 - 1998

Bank of America, Real Estate Loan Administration Center

Cypress, California

Worked as MIS Analyst for a large banking center in California.

Designed, created, implemented and modified Crystal Reports and Excel reports.

Provided and extracted specific data to management by using Passport tools application.

Provided technical guidance and support to staff for Microsoft Office and other PC applications.

Designed and created VB scripts to support various departments.

Analyzed department needs, created and modified databases and spreadsheets.

Computer Skills:

Development Tools: C#,ASP.NET,VB.NET, .NET Framework, VB 4.0/5.0/6.0, Visual Studio 2012/2010, VBA, ADO.NET, ADO, DAO, OLEDB, ASP 3.0, MS-SQL (4GL), JQuery, Bootstrap, HTML, XML, C++, XML Web Services, Crystal Reports 8.5/9.0, MS Reporting Services, Excel Reports, ActiveX Controls, SSIS, SSRS, Autosys Job Scheduler, n-tier client/server architecture,

Database: SQL Server Management Studio 2014/2012/2010, SQL 7.0, SQL Base, MS Access

Web/Windows Applications:

C#, Visual Basic.NET, Visual Basic 6.0/5.0, ASP.NET, ASP, .NET Framework, Visual Studio 2014/2012/2010, HTML, DHTML, XML, VBScript

Database Connectivity: ODBC, ADO, SQL Server

Reporting Tools: MS Reporting Services (SSRS), Excel Reports, Crystal Reports,

Development Tools: Autosys Job Scheduler, Diplomat application, n-tier Client/Server architecture,

O/S: MS Windows, UNIX, MS-DOS

EDUCATION

B.S. - Computer Science Sioux Center, IA College B.S. 1992

VB.NET, SQLWindows, Passport, Crystal and Arpeggio Report, HEDIS and Medical Terminology Certificates

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