Mainframe Developer Software

Sai Prathyusha

Mainframe developer with ** years of experience

E-mail: ***.************@*****.*** Ph: 425-***-****

Executive Synopsis

Adaptive to any technology to meet company and/or project needs.

Experience in Development and Maintenance projects.

Extensive experience in healthcare domain.

Good Analytical and Logical Skills.

Lead various mission critical projects like

a.ICD-9 to ICD-10 conversion,

b.IDMS to DB2 migration,

c.Automaton of industry formats like CMS 837 reports for major US Healthcare Payer, with high quality and customer satisfaction.

d.Intake/migration of major accounts in WGS for a major healthcare payer.

e.Develop a new backend application for reinstatement of healthcare contracts.

Delivered multiple projects with both on-line and batch functionality using CICS/ADSO Maps for UI, MQ series for interaction with other applications, DB2/IDMS/IMS/VSAM for Database and COBOL/JCL/Eztrieve for batch processing.

Worked on mainframe tools like FILE-AID, FILE MANAGER, ABEND-AID, ISPF, PANVALET, ENDEVOR, SPUFI, PLATINUM, CA-7, DMLO, OLQ, IDDM, ADSALIVE, SYNCSORT, SDF II, Ideal, Datacom etc.

Proven experience in end-to-end project delivery effort from project initiation to closure.

Analyse and establish Detailed Designs for applications.

Experience the full life cycle of the software design process including requirements definition, design, develop, debug, test and maintenance.

Strong Cultural Intelligence with experience in managing Onshore and Offshore teams.

Strong skills in project documentation, tracking, reporting and stakeholder communication.

Proven experience in all stages of Software Development Life Cycle. Good understanding of Waterfall and Agile (Scrum) methodologies.

Proven experience in coaching, mentoring teams to achieve project goals/objectives.

Core Competencies

Operating Systems:

Windows series, Unix, Z/OS

Tools/ UI:

FILE-AID, File-Manager, ABEND-AID, ISPF, PANVALET, ENDEVOR, SPUFI, PLATINUM, CA-7, DMLO, OLQ, IDDM, ADSALIVE, SYNCSORT, SDF II, Ideal, Datacom, easytrieve, FOCUS, CICS and ADSO, IDMS, IMS.

Programming Languages:

COBOL, JCL, REXX, CICS

Databases:

DB2, IDMS, IMS, VSAM.

PROFESSIONAL EXPERIENCE

Sep 2019 – May 2024 Senior Software developer.

Client Anthem

Project Name WGS Inquiry Tracking

Project Description

Inquiry Tracking is an independent system that handles inquiries, disputes, grievances and appeals from providers and subscribers belonging to all the blue states and processes them. Keeps track of all inquiries and generates required mails to providers and subscribers about the contract status and other important details.

Developed a new application in 2024 to reinstate subscriber’s medical policy within 30 days of the policy cancellation/expiry. This application is associated with other front-end applications like PEGA and .net using RPCs.

Project Name NASCO Migration

Project Description

NASCO was a major healthcare account that was migrated into WGS (Wellpoint Group Systems). This project involved a major development/maintenance as the existing system had to be replicated and modified as required in order to support intake of multiple NASCO contracts.

Project Name WGS Claims

Project Description

WGS Claims is the claims processing system of Anthem Healthcare. The WGS system is designed to automate claims adjudication and payments. System receives Institutional and professional encounter (737) files though secure FTP. WGS System performs In-network review to make sure doctor/Facility are In-network based on member’s plan. Calculate pricing and responsibilities of payer/member. Calculate capitation to provider. Prepare and send EOBs and EORs.

Domain : Healthcare.

Languages/Tools : COBOL, JCL, SORT, ENDEVOR, File-Manager, SPUFI, PLATINUM

Databases : DB2, IMS, VSAM

Role : Developer/On-Site Tech Lead.

Responsibilities

Working with business to understand requirements. Document requirements and create low level design to be used by offshore counter parts.

Estimating story points and prioritizing.

Review code and unit test results.

Report status in project review meetings to business.

Participation in SIT and UAT, verification of test results and fixing the bugs.

Support Region refresh and release activities.

Documentation of processes/changes to existing system.

July 2016 – Aug 2019 Break for maternity and childcare.

Apr 2014 – Jun 2016 Senior Software developer/ tester.

Client Humana

Project Name Humana Service Fund

Project Description

Service Fund is Humana’s automated system for reimbursing contracted physicians. It provides payment and accounting services for thousands of network physicians nationwide. Service Fund plays a major role in several physician payment and accounting processes, including capitation calculation, capitation payment, claim payment, claims expensing, reconciliation and manual adjustments. It also helps determine reimbursement for ancillary providers such as hospitals, skilled nursing facilities and home health agencies. The most important function performed by service fund is reimbursement and Manual Adjustments where in a new system was created to pull in claims information using CICS online interface from CAS systems though MQ series by defining a set of queues and passing claim details to CAS systems and getting the membership details back. These details are then verified, and manual adjustments are processed on a claim and are sent further for payments.

Domain : Healthcare.

Languages/Tools : COBOL, JCL, CICS, SORT, PANVALET, File-aid, SPUFI, PLATINUM

Databases : DB2, IDMS, VSAM

Role : Developer/tester

Responsibilities

Analyzing, Estimating and documenting the risks associated with the project execution.

Impact analysis and development of new programs using detailed design documents

Region Building and Release activities.

Preparing test cases and other related documentation.

Code review and preparation of functionality flow documents.

Participation in SIT and UAT, verification of test results and fixing the bugs.

Documentation of processes/changes to existing system.

Mar 2013 – Mar 2014 Senior software developer/ tester

Client Group Health Cooperative, Seattle USA.

Project Name BTS Claims

Project Description

Group Health Cooperative, now acquired by Kaiser Permanente, was a member-governed, nonprofit health care system that coordinated care and coverage.

The two important processes in GHC are membership and claims. The Membership process deals with updating the member information, member – provider relationship/validation, calculation of capitation and reporting while claims process handles claim expensing, disposition, manual adjustments, creation of EOBs and EORs and reporting. Apart from this, claims also created and sent as CMS 835 and 837 to major healthcare payer.

Domain : Healthcare.

Languages/Tools : COBOL, JCL, CICS, SORT, File-aid, SPUFI, PLATINUM

Databases : DB2, VSAM

Role : Developer/tester

Responsibilities

Analyzing, Estimating and documenting the risks associated with the project execution.

Interaction with Business Users to understand requirements.

Planning the deployment strategy.

Impact analysis and development of new programs using detailed design documents

Preparing test cases and other related documentation.

Code review and preparation of functionality flow documents.

Manage the overall planning, execution, and delivery of project.

Track project status, manage and escalate project issues and risks as appropriate.

Creating the Low-level design and make on the spot decisions about the last minute design changes.

Help Performance team build the load test scenarios.

Helping the team during build process.

Arrange for knowledge transition of projects to maintenance and support teams.

Documentation of processes/changes to existing system.

Nov 2009 – Feb 2013 Senior software developer/ tester

Client Humana USA.

Project Name Metavance Claims/ Service Fund/CAS

Project Description

HUMANA is one of the biggest Healthcare Payers in the USA. METAVANCE is the application which is owned by HP. The main motive of the MTV Claims team is to involve in the various phases of Claim adjudication processes like receiving the claims from eHUB through MQ series and “LOAD process” to load the claims in METAVANCE and pre-edits and pre-adjudication process against Metavance. The outcome of the process is to generate the EOBs & EORs.

Domain : Healthcare.

Languages/Tools : COBOL, JCL, CICS, SORT, PANVALET, File-aid, SPUFI, PLATINUM

Databases : DB2, IDMS, VSAM

Role : Developer/tester

Responsibilities

Analyzing, Estimating and documenting the risks associated with the project execution.

Interaction with Business Users to understand requirements.

Planning the deployment strategy.

Impact analysis and development of new programs using detailed design documents

Preparing test cases and other related documentation.

Code review and preparation of functionality flow documents.

Manage the overall planning, execution and delivery of project.

Track project status, manage and escalate project issues and risks as appropriate.

Creating the low-level design and making on the spot decisions about the last-minute design changes.

Help Performance team build the load test scenarios.

Helping the team during the building process.

Arrange for knowledge transition of projects to maintenance and support teams.

Documentation of processes/changes to existing system.

Sincerely,

Sai Prathyusha Dokkupalli

Current Location: Atlanta, GA

Email: ***.************@*****.***

Ph: 425-***-****

Strengths

Ownership, commitment & responsiveness.

Excellent communication skills

Analytical, Technical & Management skills.

Ability to work effectively under pressure

Team player

Education

Bachelor of Technology from Jawaharlal Nehru Technological University in the year 2008 with 60.2%.

Intermediate (M.P.C) with 85.9% marks in May 2004.

S.S.C. with score of 83% in March 2002.

Personal Details

Date of Birth: 5th Jan, 1987

References

References can be provided on request.

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