Developer Project
Resume:
Talented Systems Analyst Lead (Technical) with **+ years of experience in
US Healthcare domain
Martin Maria Antony H1B visa – Valid till Apr 2020
Tampa, FL. Ph: +1-302-***-****
*****************@*****.***
SUMMARY
●Dynamic, competent and client focused Software Professional 13+ years of IT experience in Healthcare domain including Medicare and Medicaid line of business.
●Experienced as a Business Systems Analyst where primary responsibilities included gathering of Business Requirements, System Analysis, performing hand-off/review with Business stakeholders and IT Project team.
●Experience in Design, Development and Implementation on Internet & Intranet using ASP.NET, VB.NET, ASP, VB6.0, SQL Server, Oracle and Sybase.
●Designing conceptual diagrams, Use cases, Class diagrams, Sequence diagrams.
●Experience in Data Analysis, Data mapping, current and future state workflows, activity and transition state diagrams, traceability matrices, data dictionaries, translation logic rules.
●Strong experience in eliciting, writing, presenting and facilitating Business, Functional and Non-Functional Requirements and technical specifications.
●Experienced as Project Lead in Onsite-Offshore model involving all stages of Software development life cycles followed in CMMI Level 5 companies. Performed requirement gathering/analysis, data analysis, design & data modelling, development, testing, Implementation, performance tuning and functional consulting.
●Experienced in Healthcare/Claims adjudication with knowledge of industry compliance standards like EDI X12 transactions 834 and 837.
●Specialized knowledge in modules of Trizetto's FACETS such as Claims processing and Enrolment/Membership.
●Experience in Data migration, Facets and QNXT version upgrades, Interfaces and Facets Extensions.
●Expertise in Web Development Tools - HTML, DHTML, XML, XSL, CSS, VB Script, JavaScript, ASP, ASP.Net, IIS, Visual Interdev & VSS, VTFS.
●Extensive experienced in impact analysis and implement remediation for customer’s existing IT applications for Facets 4.81 to Facets 5.01 upgrade by following Software Development Life Cycle.
●Experience with SQL Server 2005/2008/2012 including Database Design, Stored Procedures, Database Structures and Tables, Views, Triggers, Cursors, BCP and complex queries.
●Work experience in AGILE model; Project Management and Project Quality activities on projects
●Define processes to increase operational efficiency; identify risks, perform risk analysis and provide baseline acceptance criteria and deliverables.
●Understanding & mapping client’s requirements / enhancements to the product and provide technical solutions.
●Liaison between onsite and offshore teams during project delivery.
●Exceptional ability to maintain and build client relationships, frequent travel meeting with clients, able to comfortably converse with people at all levels at client organization.
●Extensive experience with standard Microsoft applications (Word, Excel, Visio, PowerPoint)
●Very strong analytical and problem solving techniques, presentation skills & deliverance and proven team player qualities.
EDUCATION
●Master of Science in Computer Science, Loyola College, Chennai, India.
●Bachelor of Science in Computer Science, St. Xavier’s College, Palayamkottai, India.
TECHNICAL SKILLS
Technology & Tools
Experience
SQL Server 2000/2005/2012/2014, Sybase
10 Years
Trizetto’s FACETS, JIRA, Microsoft Visio, HP Quality Centre
8 Years
Oracle PL/SQL, ASP, ASP.net, VB, QNXT, SQL Developer, VB Script, HTML, Web Services, CSS, XML
4 Years
Remedy, MS Visual source safe
4 Years
PROFESSIONAL EXPERIENCE
Name of the Company
Designation
Address of the employer
From
To
Duration
Aditi Staffing
Systems Analyst Lead
Aditi Staffing, USA
May 2017
Till date
2 Years 7 Months
Cognizant Technology Solutions US Corp
Sr. Product Specialist –Technical
Cognizant Technology Solutions US Corp, USA.
Oct 2015
May 2017
1 Year 8 Months
Cognizant Technology Solutions India
Sr. Product Specialist –Technical
Cognizant Technology Solutions, Chennai, India
Apr 2010
Oct 2015
5 Years 6 Months
CapGemini Consulting India Pvt Ltd
Consultant
CapGemini Consulting India, Mumbai.
Jun 2007
Apr 2010
2 Years 10 Months
FinEng Solutions Pvt Ltd
Software Engineer
FinEng Solutions Pvt Ltd,
May 2006
Jun 2007
1 Year 2 Months
PROJECT DETAILS
Role: Systems Analyst Lead - Technical May 2017 – till date
Client: BlueShield of California, Sacramento, CA
Project: FEP Send File and Return File Interfaces
Federal Employee Program(FEP) is the benefit plan offered and administrated by BCBSA affiliates to provide health plan benefits to federal employees throughout nations.
FEP Send file interface is to send the FEP Claims data from FACETS to FEP system to support the claims processing. This interface is created to handle both medical and dental FEP claims and it get the inputs from 837 and Paper file format. The FEP Claim comes in for process, after the scrubbing process the claim is adjudicated in FACETS and will be send to FEP for approval. The claims will be paid in FACETS only after an approval is received from FEP.
FEP Return file interface is to receive the claims return file from FEP and process it by applying set of business rules to finalize in FACETS.
Project: FEP Blue Focus Product
Federal Employee Program(FEP) is the benefit plan offered and administrated by BCBSA affiliates to provide health plan benefits to federal employees throughout nations.
In addition to basic and standard product, FEP had introduced a new product for their employees from 1/1/2019. FEP Blue Focus is a national program that uses the same network of Preferred providers as Standard and Basic Option. This plan was introduced to provide the health benefit with lower cost.
Responsibilities:
●Involved in complete Software Development Life Cycle process for IT implementation.
●Interacted with business managers and other stakeholders to determine project scope thus defining key challenges and project deliverables.
●Conducted business requirement meetings with business unit teams to determine project goals and elicit Business requirements in accordance to SDLC deliverables.
●Analysed the requirements and existing systems on every quarter to enhance the system / interfaces as per the business need.
●Provided the FACETS consultation to project team.
●Responsible for conducting Business Impact Analysis and Gap Analysis to assess the “AS IS “and “TO BE” scenarios
●Defines application problem by discussing with clients/business people; evaluating procedures and processes.
●Creating SUC, functional documents and explain the requirements and functional support to development and testing team.
●Walk through the requirement to production support team before and after production implementation.
●Responsible to develop new process, analyzing and designing of database structures and written stored procedures and functions.
●Worked extensively in writing and debugging complex stored procedures, triggers, views and user-defined functions.
●Involved re-write of existing batch jobs
●Responsible for re-write and performance enhancements of the existing process.
●Managed Requirement Traceability Matrix (RTM) to trace and map Business requirements, Functional requirements, and System requirements.
●Created process flows diagrams for all “As Is” and “To Be” scenarios using MS Visio
●Done the impact analysis and reviewed the impacted analysis report with business users. IT head/PM and Tech leads.
●Analysing the production data and Identify performance bottle-necks and provide improvement suggestions/methods.
●Attending the client’s quarterly meetings and document the system changes. Generate ad-hoc report as per business need.
●Develop solution by preparing and evaluating alternative workflow solutions.
●Validates results by testing programs during Unit Testing and QA Testing.
●Providing appropriate solution, documenting the requirements as SUC and process flow diagram, transform all business requirements into system use case document and obtain approval from the subject matter experts and business users.
Accomplishments:
●Redesigned the FEP Send file interface to send the claim data to FEP for claim processing.
●Automated the FEP Return file process to avoid manual work to finalize the claims in FACETS. This has helped business and claim processing team to minimize manual efforts (like data correction, apply overrides, etc.) to adjudicate the claim in FACETS.
●New error reports – helped business to fix the issues on time.
●50% Production issues has been resolved due to redesign process.
Environment: Trizetto's Facets, EDI 834/837, FEP Direct site, ASP.NET, Visual Studio 2017-2008, SQL Server 2014, Sybase, PL SQL, SQL Developer, MSMQ, Tidal Scheduler, JIRA, SVN, Microsoft Visio, Microsoft Word, Windows 10, Source Deliverable Repository(SDR), HP Application Lifecycle Management(ALM), Citrix
Project: IFP off Exchange member enrollment
For IFP Off Exchange, consumers enroll for BSC insurance through the BSC portal, 3rd party, etc., Once the member is enrolled and paid the payments the via HPS Paysafe site, the enrollment information is sent to BSC through 834 transaction to load the date into FACETS.
This tool is used to process the enrollment request send by vendors, brokers, etc., and load the enrollment data into FACETS.
Responsibilities:
●Involved in complete Software Development Life Cycle process for IT implementation.
●Worked with business/ state for analysing new requirements and getting approval for business requirements documents.
●Designed and developed the software using Waterfall/Agile development practice.
●Designed GUI using ASP .NET and Responsible for Design, Development and implementation of Web application using ASP.NET, C#, JavaScript, XML and .NET Framework.
●Defines application problem by discussing with clients/business people; evaluating procedures and processes.
●Creating SUC, technical design documents and explain the requirements and functional support to development and testing team.
●Responsible for Bug fixing during QA and UAT. And developed test Case and extensive testing with various applicable scenarios for resolving functional issues and better performance.
●Responsible to develop new process, analyzing and designing of database structures and written stored procedures and functions.
●Worked extensively in writing and debugging complex stored procedures, triggers, views and user-defined functions.
●Involved re-write of existing batch jobs
●Responsible for re-write and performance enhancements of the existing process.
●Analysed the 834 mapping and provided the mapping logic to load the member enrollment data into FACETS.
●Walk through the requirement to production support team before and after production implementation.
●Managed Requirement Traceability Matrix (RTM) to trace and map Business requirements, Functional requirements, and System requirements.
●Validates results by testing programs during Unit Testing and QA Testing.
●Providing appropriate solution, documenting the requirements as SUC and process flow diagram, transform all business requirements into system use case document and obtain approval from the subject matter experts and business users.
Accomplishments:
●Optimized the member match logic to load the more members through batch process.
●Implemented the enrolment process to a great extent. This helps the business to minimize manual efforts (like data correction, etc.) to enrolment team.
Environment: Trizetto's Facets, EDI 834, BlueShield Broker Portal, ASP.NET, XML, Web Service, Visual Studio 2017-2008, SQL Server 2014, Sybase, MSMQ, JIRA, Microsoft Visio, Microsoft Word, Windows 10, Source Deliverable Repository(SDR), HP Application Lifecycle Management(ALM), Citrix
Project: Rx Shared Advantage Member identification
Blue Shield of California, an independent member of the Blue Shield Association, is a nonprofit health plan dedicated to providing Californians with access to high-quality health care at an affordable price.
This project scope is to create a new interface to identify the Shared Advantage plus member from Daily Claims Extract Files from Argus. Identify the SA+ members and create the outbound file for each TPA and send the Outbound file to respective TPA/client and send notification to business and clients.
Responsibilities:
●Involved in complete Software Development Life Cycle process for IT implementation.
●Worked with business/ state for analysing new requirements and getting approval for business requirements documents.
●Defines application problem by discussing with clients/business people; evaluating procedures and processes.
●Creating SUC, functional documents and explain the requirements and functional support to development and testing team.
●Walk through the requirement to production support team before and after production implementation.
●Managed Requirement Traceability Matrix (RTM) to trace and map Business requirements, Functional requirements, and System requirements.
●Develop solution by preparing and evaluating alternative workflow solutions.
●Validates results by testing programs during Unit Testing and QA Testing.
●Providing appropriate solution, documenting the requirements as SUC and process flow diagram, transform all business requirements into system use case document and obtain approval from the subject matter experts and business users.
Environment: Trizetto's Facets, EDI 834/837, SQL Server 2014, Sybase, PL SQL, SQL Developer, JIRA, SVN, Microsoft Visio, Microsoft Word, Windows 10, Source Deliverable Repository(SDR), HP Application Lifecycle Management(ALM), Citrix
Role: Technical Lead Apr 2016 – May 2017
Client: CareSource Management Group Co, Dayton, OH
Cognizant Technology Solutions US Corp
Project: 834 MMP Enrollment Process Implementation and enhancement.
CareSource is a nonprofit health plan providing member-centric health care coverage to a wide variety of consumers in Ohio, Kentucky, Indiana, Georgia and West Virginia. CareSource is one of the nation's largest Medicaid managed care plans, but today also offers a lifetime of health coverage to more than 1.5 million members including offerings on the Health Insurance Marketplace and Medicare Advantage plans. With more than 10 years of experience managing care for individuals and families in publicly-funded programs, they’ve become known for developing innovative solutions that help maximize health outcomes while reducing costs. Their mission is to help people get care, stay well and build healthy communities.
This project scope is to create a new process to load the 834enrollment file into Facets via MMS batch.
Responsibilities:
●Involved in complete Software Development Life Cycle process for IT implementation.
●Work with business/ state for analysing new requirements and getting approval for business requirements documents.
●Estimate the work duration/effort, prepare project plan(s) and status reports to present to the respective stake holders.
●Providing appropriate solution, documenting the requirements as Functional requirement specification documents, transform all functional requirements into technical design and obtain approval from the subject matter experts and business users.
●Designed and developed the Stored Procedures, Functions and view applying the business logic to extract member details from custom tables and load into FACETS tables.
●Provided technical and functional support to parse the 834 EDI X12 file and load into the 834 custom tables.
●Extensively involved in tuning the queries and applying hints for faster and better performance of the SQL queries.
●Deployed and tested Web Application before going to the production using IIS web server.
●Experience with Microsoft Team Foundation Server (TFS) for Versioning and security issues.
●Developed test strategies, test plans and test cases and performed Unit Testing to identify and resolve integration, functional and usability issues before deployment.
●Configured the job details in TIDAL to process the 834 EDI X12 files from FTP path to Stage table and Stage tables to FACETS tables.
●Migrating the process to production and provide maintenance support.
●Using ITSM tool for change deployment, service request and incident management.
●Implement enrolment business using Facets, UNIX and SQL script in very short span.
●Automate enrolment business to process multiple LOBs to process at same time to save production window and operations cost.
●Identify performance bottle-necks and provide improvement suggestions/methods. Troubleshoot production processes failures and remediation. Monitor production jobs; work with Production control team and Database Administrator in case of any issues.
Accomplishments:
●Optimized the performances of production jobs to a great extent
●Implemented the enrolment process to a great extent. This helps the business to minimize manual efforts (like data correction, etc.) to enrolment team.
●Gained the client’s confidence by managing all the work related to enrolment process.
Environment: Trizetto's Facets, EDI 834/837, ASP.NET, XML, Web Services, Java Script, Visual Studio 2017-2008, SQL Server 2014, Sybase, SQL Developer, MSMQ, Tidal Scheduler, JIRA, SVN, Microsoft Visio, Microsoft Word, Windows 10, Citrix
Role: Sr. SQL Server Developer Oct 2015 – Mar 2016
Client: AMFC (AmeriHealth Mercy Family of Companies), Philadelphia, PA
Project: Death & Incarceration Process
AmeriHealth Caritas is the nation's leader in health care solutions for the underserved and chronically ill, impacting the lives of more than 6-million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, they’ve become known for developing innovative solutions that help maximize health outcomes while reducing costs.
From 1st Jan 2016, the IOWA state has asked AmeriHealth Caritas to send the deceased member details and Incarcerated member details on every Wednesday. By using the reported member details the state will do the verification and based on the validation the state can take the action of either terminating the healthcare member permanently or not.
To achieve this, we have developed a new process to find the members by using the defined business logic and/or rule. Using FTP, we are sending the member extract file to state. This is an end-to-end application development project involving requirement gathering, designing, development and unit testing,
RESPONSIBILITIES:
●Gathering the Requirement from the business user and prepared the program specification & design document and process flow diagram for the development of the new processes.
●Developed both high-level and detailed application architecture to meet user requests and business needs. Also, involved in project planning and estimation.
●Coordinating the development activities with the Onshore-Offshore team, delegating day to day activities to the onshore team members, testing the deliverables, presenting UAT sessions to the Client and remove bottlenecks.
●Designed and developed the scripts to create table, views and indexes. Created the procedures, functions and view applying the business logic to extract member details from FACETS database.
●Developed the transformation job in Data Stage to extract member data from database and send the extract file to state using FTP.
●Extensively involved in tuning the queries and applying hints for faster and better performance of the SQL queries.
●Configured the job details in TIDAL to invoke the Death and Incarceration process.
Accomplishments:
●Optimized the performances of production jobs to a great extent
●Implemented the Death and Incarceration referral program to a great extent. This helps the business to minimize manual efforts to term members.
●Gained the client’s confidence by managing all the work related to new process implementation.
Environment: Trizetto's Facets, EDI 834, ASP.NET, DataStage, Java Script, Visual Studio 2017-2008, SQL Server 2014, Sybase, SQL Developer, Tidal, SVN, Microsoft Visio, Microsoft Word, Windows 10
Role: Project Lead - Technical Jul 2013 – Sep 2015
Client: MVP (“Mohawk Valley Physicians’ Health Plan), USA
Project: MVP – UM Letters
MVP Health Care is committed to having a positive impact on health and wellness of those we serve so that our members can take on life and live well. MVP is a nationally-recognized, not-for-profit health plan providing benefits to members for more than 30 years. The MVP business group will require a process to enable the UM staff to create an approval letter and denial and Miscellaneous letters without having to manually fill out a form. Perform the business validation and error out or hold the assessment details before the letter generation process. The generated letters will be mail to INPATIENT and/or OUTPATIENT (i.e. Member, PCP etc.) based on the business requirement. Also create the log detail to track the flow of UM process.
The letter content will be generated in English or Spanish based on the member preferred language. This is an end-to-end application development project involving requirement gathering, designing, development and unit testing,
RESPONSIBILITIES:
●Involved in requirement gathering, process of analyzing and designing the business process movements of the UM letters.
●Created the design document, process flow diagrams and understanding documents to the project team.
●Developed both high-level and detailed application architecture to meet user requests and business needs.
●As a Lead, assigned tasks to the team members and helped them to resolve their doubts. And involved in the review activities, project planning and estimation.
●Responsible for creating database objects like Views, Store Procedure, Triggers, Functions etc. using SQL Server and Sybase to store data and to maintain database efficiently
●Responsible for Project maintenance activities like invoice preparation, daily and weekly status update to Account manager and document maintenance.
Environment: Trizetto's Facets, EDI 834/837, ASP.NET, Java Script, Sybase, SQL Developer, SVN, Microsoft Visio, Microsoft Word, Microsoft Excel, Windows 10
Project: MVP – Auto PCP Assignment
The MVP E&E group will require a fully automated process of assigning a PCP for existing MVP members whose PCP is no longer part of the MVP Network. Develop an automated validation/assignment step for current MVP Members (including Medicaid Members) who re-enroll with MVP through the Exchange and already have a PCP listed in Facets. This validation/assignment step would be executed before the Members are loaded into Facets or are sent a Point of Enrollment PCP Reminder Letter.
RESPONSIBILITIES:
●Involved in process of analyzing and designing the business process movements of the auto PCP assignment in FACETS.
●Involved in gathering the requirements, analyzing and designing the interface, provide support during the development phases and perform quality testing and support during the production deployment and post production phases for the same.
●Responsible for creating database objects like Views, Store Procedure, Triggers, Functions etc. using SQL Server and Sybase to store data and to maintain database efficiently
●Responsible for documentation and deliver the functional specification document to the project team.
●Developed both high-level and detailed application architecture to meet user requests and business needs. Assign the task to the team and responsible for the project deliverables.
●Responsible for Project maintenance activities like invoice preparation, daily and weekly status update to Account manager and document maintenance.
Accomplishments:
●Optimized the performances of production jobs to a great extent
●Optimized the Auto PCP assignment process to a great extent. This helps the business to minimize manual efforts.
●Gained the client’s confidence by managing all the work related to PCP Assignment processes
●Was able to scale up in the ladder from a senior developer to Project lead.
Environment: Trizetto's Facets, EDI 834/837, ASP.NET, Java Script, Sybase, SQL Developer, SVN, Microsoft Visio, Microsoft Word, Microsoft Excel, Windows XP
Role: Sr. SQL Server Developer Jan 2011 – Jun 2013
Client: Molina healthcare, USA
Project: Molina Encounter Inbound HCR2014
Molina expects huge increase in membership due to the 2014 Healthcare reform and also from addition of new states and LOBs. This is expected to increase the volume of data probably up to 3 times, greater than the current volume. Molina has undertaken an initiative to redesign the Encounter system, to handle the volume efficiently, reduce the processing time window and to improve the flexibility of the overall processing.
This project involves analysis and development of a .net application and Stored Procedures for Molina for loading the HIPAA compliant and Non-Compliant 837 files to their system. This is an end-to-end application development project involving requirement gathering, designing, development and unit testing
RESPONSIBILITIES:
●Involved in complete life cycle of the project like project estimation, analysis and understanding of requirement with required data sources/destination, development of the Application and Stored Procedures for Inbound process.
●Responsible to develop new process, analyzing and designing of database structures and written stored procedures and functions.
●Worked extensively in writing and debugging complex stored procedures, triggers, Inner Joins, Outer Joins, views and user-defined functions.
●Involved in the development to load the 837 (Claim) file to QNXT Database
●Implemented the business and validation logic in C#.net to validate the claim data.
●Involved in the User acceptance test support and post production audits.
●Assigned tasks to the team members and helped them to resolve their doubts.
●Responsible to review development activities, project planning & estimation and project deliverables and deployment.
Environment: QNXT 4.81, SQL Server 2008/2012, BizTalk 2009, C#.net, EDI 837, Java Script, SVN, Microsoft Visio, Microsoft Word, Microsoft Excel, Windows XP
Project: HIPAA Rejection Lite
This project involves analysis and development of a .net application and Stored Procedures for Molina for loading the HIPAA Noncompliant files to their system. The scope of the project is to keep track the non-complaint files and send the claim/encounter details to provider and business to take necessary steps. This is an end-to-end application development project involving requirement gathering, designing, development and unit testing,
RESPONSIBILITIES:
●Interacted with customers to analyze business needs. Provide software product design and developed technical roadmap for the solution through the project lifecycle and beyond.
●Involved in complete life cycle of the project like project estimation, analysis and understanding of requirement with required data sources/destination, development of the Application and Stored Procedures for Inbound process.
●Responsible to prepare checklist and other process related documents. Also includes updating the senior management on project status periodically.
●Actively involved in creation of database, modified tables, triggers, procedures to clean and validate the data about the HIPAA Noncompliant file data.
●Worked extensively in writing and debugging complex stored procedures, triggers, Joins, views and user-defined functions.
●Coordinated with the front-end developer to put in the business rules. Wrote procedure to check some of the rules at the backend at the time of entering data.
●Responsible to schedule the monthly/weekly/daily reports to run automatically and run the process based on the client request or need.
Environment: QNXT 4.81, SQL Server 2008/2012, BizTalk 2009, C#.net, EDI 837, Encounters, Java Script, SVN, Microsoft Visio, Microsoft Word, Microsoft Excel, Windows XP
Role: SQL Server Developer Apr 2010 – Dec 2010
Client: AHP (Affinity Health Plan), USA
Project: Facets Upgrade 4.71 & 4.81
Affinity Health Plan uses Facets systems to cater to their needs. Affinity need to migrate the Facets version from 4.61 to 4.81 so as to process all the business needs. The migration to the higher version would result in subsequent impact on some of the reports, interfaces and extensions due to the changes/ enhancements that has been incorporated in the higher version 4.81.
RESPONSIBILITIES:
●Gathered the requirement from business and set up the meeting with client and documented the requirements.
●Analyzed the FACETS data model and did the manual assessment to identify the impacts.
●Done the remediation on impacted objects (I.e. procedures, functions and SQL scripts).
●Prepared test scripts and documented the test results for further validation.
●Actively involved in deployment and post production activities.
●Responsible for scheduling the status call and weekly call and sending status mail to onsite every day.
●Prepared the mapping sheet, status report and project related documents.
●Responsible for project audit related activities and point of contact for testing team and audit team.
●Assigned tasks to the team members and helped them to resolve their doubts.
●Prepared migration sheet for deployment and involved in deployment phase.
Environment: Trizetto's Facets, SQL Server 2005/2008, VB, ASP.net, Java Script, SVN, Microsoft Word, Microsoft Excel, Windows XP
Role: Technical Analyst Jun 2007 - Apr 2010
Client: UK Railways, India
CapGemini Consulting India Pvt Limited
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