Rajesh Velayuthan

Email adci67@r.postjobfree.com

Phone 573-***-****

Professional Summary:

Extensive experience using Information Technology to solve business problems, through strong analysis, excellent design skills, very strong coding, and a dedication to success. Specialist in both batch and on-line business systems on IBM mainframes. Reputation in the field as the person to resolve planning/design issues and simplify/standardize complex projects. Known for determination, tenacity, and extreme high quality of work.

An astute Mainframe professional with 11 years of experience in the industry, handling the successful initiation & delivery of program/projects in Healthcare, Banking and Financial Domain.

Around 5+ years’ experience at client location doing business facing roles

Experience in application development using COBOL, JCL, DB2, IMS DB, IMS DC, CICS, SAS, File-Aid, Endevor, Changeman, Expediter, Control M and OPC.

Expertise includes project planning, risks and issues analysis and mitigation, business requirements elicitation, budget management and literature and communication strategies

Experience in writing Test Plans, Test Scripts, Test Cases and executing them.

Assisting the QA team in planning and performing Functional Testing, Integration Testing, and Regression Testing.

Experience in writing PL/SQL (Stored Procedures, Triggers, Cursors and Functions) and SQL statements.

Experience in facilitating session between SME and providing them with recommendations to resolve issues for various business/technical groups.

Extensive knowledge and experience in Software Development Life Cycle (SDLC) methodologies like Waterfall, and Agile (Scrum).

Expertise in capturing requirements to the core and developing precise Business Requirement Documents (BRD) and Functional Requirement Documents (FRD).

Experienced Joint Application Design (JAD) facilitator and meetings coordinator/moderator with excellent interpersonal and conflict resolution skills

Good Knowledge on Healthcare Claim’s Life Cycle and Clinical Editing.

Expert in McKesson’s – ClaimsXten Clinical Editing.

Working Knowledge of EDI, ANSI X12 and HIPAA Standards.

Knowledge in HealthCare EDI transactions: Eligibility Request/Response (270/271), Claim Status Request/Response (276/277), Enrollment (834), HealthCare Claims (837), Electronic Payments (835).

Track record for consistently meeting goals and delivering a high level of job performance

Confident, pro-active, analytical, fast learner and detail-oriented candidate with excellent multitasking capabilities to perform exceptionally in ever changing and stressful environments.

Certifications:

AHIP certified on Healthcare Management An Introduction (AHM250)

Cognizant Certified Healthcare Processional

Oracle Certified Professional on Oracle 9i. (OCP)

IBM Certified Database Associate on DB2 10.1

Technical Skills:

Operating System

MVS, OS/390, Windows, LINUX

Langage

COBOL, JCL, Easytrieve, C, Visual Studio, Selenium Wrapper

Database

DB2, IMS DB, Oracle 10g/11g, MS Access, SQL Server

Mainframe Tools/Utilities

CHANGEMAN, ENDEVOR, XPEDITOR, FILE-AID, SPUFI, QMF, Insync, Control M and OPC

OLTP

CICS

Domain

Healthcare, Securities, Auto Insurance

Business Process Modeling Tools

MS VISIO, Rational Rose

Documentation Tool

SharePoint, MS Office Suite(Word/Excel/Power Point)

Operations Research Techniques

GAP Analysis, SWOT Analysis, Risk Analysis, ROI

BA Méthodologies

SDLC, Waterfall, Agile (RUP and SCRUM)

Projects Summary:

GAP Inc, San Francisco, CA

Employer : Ingenworks Inc.

Technical Lead

Dec 2019 – Till Date

Revenue Acccounting :

Revenue Accounting is responsible for accounting and operational functions related to GAP Inc.’s revenue recognition. It takes care of processing of Sales Transactions at GAP Inc. stores and feeding the sales, traffic and payroll data to different downstream applications. Revenue accounting is also responsible for generating various reports for Business Partners to review on daily, monthly and weekly basis.

Responsibilities:

Inception, requirement gathering, estimation, staffing and planning.

Data modelling, architecture design, functional and Technical design and Review.

Build, automation and reviews.

Data Migration, Integration, End to End and Acceptance Testing.

Co-ordination with business, vendors and offshore teams.

Release management and knowledge transfer.

Environment:

COBOL, JCL, VSAM, DB2, CICS, Easytrieve, Rexx

IBM MQ

JIRA, Toad, Serena Dimensions(Version Control & Change management tool), CAWA scheduler, IBM Data Studio(Client for accessing DB-SQL tool), Service now (Tickets and change requests)

American Express, Phoenix, AZ

Employer : Ingenworks Inc.

Technical Lead

August 2018 – Nov 2019

SUBMON :

SUBMON (Submission Monitor) is the sub system of the Establishment Service Payables (ESP) which takes care of processing credit card transactions for a merchant & payments to the merchant's account for the value charged to AMEX credit card less all fees & discounts.

SUBMON system validates the SOCs (Summary of Charges) and ROCs (Record of Charge) submitted by the merchants and holds the payment for suspicious submissions.

Responsibilities:

Direct involvement in all phases of development lifecycle for complex requirements and high impact application areas.

Responsible for Analysis, Estimation of various enhancements based on business requirements.

Responsible for creating the tech documents for the distributed system team members for the smooth migration of the system from Mainframe to distributed system.

Direct Client interactions involving requirement understanding and then translating them into system/technical solution.

Responsible for preparing Design approach & Technical solutions

Helping the L2 support team in fixing the job abends on the critical path (same day pay cycle) with the work arounds.

Planning and execution of deliverables of different during all phases of SDLC lifecycle

Provide necessary support to the DevOps team on the following:

Migration from ISPF to ISPW and implementation of Topaz – Eclipse tool

Migration from Changeman to XLR on the version control and release management.

Implementation of Arena (new Pre prod mainframe environment).

Responsible for leading the mainframe team and accountable for all the team deliverables from onshore and offshore.

Responsible for helping the Scrum master and the business with the size and efforts of user stories.

Environment:

COBOL, JCL, VSAM, DB2, IMC DB, Changeman, BMC Admin, Control M, FILE-AID, SPUFI, QMF, TOPAZ, XLR

Wipro Infocrossing, Jefferson city, MO

Technical Lead

July 2016 – August 2018

Member360:

Member 360 is a Comprehensive Membership Management System. A member’s Medicare eligibility is verified using the Centers for Medicare and Medicaid (CMS) Medicare Beneficiary Database (MBD) as applications are entered either by batch or online. During the verification process, CMS member-specific data such as ESRD, Medicare eligibility dates, LIS, and LIC are automatically added to Member360.

The Infocrossing product Member 360 is used by number of Managed Care Organization throughout the United States. I am working on the enhancements and customizations of the Infocrossing product “Member 360” as per the requirements of one of the Managed Care organization (one of the end client) “Medical Mutual of Ohio (MMO).

Responsibilities:

Understanding the business requirements and functional specifications of the client module.

Preparing the design for the enhancements and customizations as per the requirements of the client and as per the compliance of Center of Medicare and Medicaid Services (CMS).

Monitor the EDI 834 extract that goes to client every day. Read, understand and analyze the records in the 834 reject file which is in the EDI format and identify the root cause of the error record. Correct the enrollment information in the Member 360 for the error records and make sure that the corrected information is passed in the next EDI 834 file.

Perform the production support for the M360 system on the rotation basis within the team.

Preparing the adhoc reports as per the client requirements from the Member 360 database. Using the Structured Query Language (SQL) on joining information from various data sources (data tables) and preparing reports such as PARTC and D reports for the submission to CMS.

Monitor the enrollment applications processed by the Infocrossing product “Member M360” and work on the errored out applications by analyzing the errors such as invalid coverage date, invalid election types etc. and providing suggestions to the client’s BBO team to rectify the error.

Perform development tasks to upgrade and maintain existing M360 applications as per the design document.

Prepare test cases and perform the unit testing on the code changes performed.

Document the test case scenario steps followed for various tasks for specific module.

Design, tracking and coordinating project activities to meet project deliverables

Develop enhancements, system documentation, and production support and implement procedures for quality improvement and development.

Environment:

COBOL, JCL, VSAM, DB2, ENDEVOR, XPEDITOR, FILE-AID, SPUFI, QMF

Cigna, Waterside Crossing, Windsor, CT

Employer : Cognizant Technologies

Senior Business System Analyst

February 2012 – June 2016

Enable Clinical Code Editing (ECCE):

As Claim Check 9 is not ICD-10 compliant, Cigna was migrating from Claim Check 9 to ClaimsXtens to perform Clinical Editing of their claims. ClaimsXten is McKesson's clinical editing software compliant with ICD-10 that enabled additional edit rules to significantly increase total Medical Cost Savings. The project enabled the ability to execute Medical Coverage Policies and Reimbursement Policies consistently across all claim platforms and managed these policies in line with Mandates, State Regulation and Client and Health Care Professional and Facility agreements.

ClaimsXten Facility Knowledge Pack Implementation:

Cigna was losing cost savings by not reviewing facility claims for either inappropriate services rendered or services incorrectly billed multiple times. The ClaimsXten Facility Knowledge Pack was purchased by Cigna and consists of rules designed to audit facility outpatient claims. This enabled the opportunity to use the facility knowledge pack to improve payment accuracy while ensuring facility claims adjudication stability and consistency across all of Cigna's core platforms. Further, this allowed Cigna to become more competitive by reducing facility reimbursement and manual adjudication administrative costs.

ClaimsXten Version upgrade from V5.02 to v6.0:

This initiative is to update Cigna’s current ClaimsXten v5.02 software to v6.0 to provide our solution for RAC Awareness, so that if there is a server outage the server will gracefully fail over to the active server, resulting in no disruption to the customer.

Responsibilities:

Requirement gathering by actively soliciting and analyzing the Medical and reimbursement Policies.

Coordinating and conducting JAD sessions on the ClaimsXten clinical editing requirements.

Preparation of CRAs to implement the Medical and Reimbursement policies into the ClaimsXten rules and pass it as Change request to the, External vendor, McKesson.

Developing automated tools for verifying the McKesson Deliveries.

Mapping the ClaimsXten Explanation Codes with the Claim engine's RNC codes and Hold codes and communicating the Claim engines for updating their Crosswalk tables.

Identifying the changes on the SMART HISTORY Tables (look back date for history claims for Clinical Editing) and make necessary changes.

Updating the clinical notes for the newly implemented policies.

Identifying the TPIC changes for the FACETS claim engine and raise CRAs to McKesson.

Coordinating between the Development, Testing and Release Management teams.

Creating Test Plans/test scripts and performed manual and automated testing on the clinical editing from Claim engines.

Identifying the defects from Testing and working with testing team to resolve the reported issues.

Conducting UAT walkthrough sessions to update participants on the expectation and the UAT process.

Reviewing the CMS Quarterly updates and updating it in the ClaimsXten dictionary.

Analyzing the discrepancies raised by the end user and providing necessary explanation on claim line denial by ClaimsXten.

Identifying the Production Claim for business team to conduct the business checkout on the release weekend.

Supporting the Business Checkout by providing necessary explanation to the business team on ClaimsXten edits.

Assisted in development of training materials for new technology and process improvements.

Environment:

Content Manager, Toad for Oracle 11.6, MS-Visio, Microsoft Office Suite (MS Word, Excel, PowerPoint), Microsoft Visual Studio, Selenium Wrapper.

Cigna – Offshore; CTS - Coimbatore

Application Developer

February 2012 – March 2014

Full Tin:

The Health Care Professionals & Hospital System Book of Record (HBOR)’s provider key was made up of two data elements, the tax ID and an association sequence number. The association sequence number was earlier capped at 9,999 entries. We had a number of providers (generally hospitals) that exceed the 9,999 entries. The work-around for this was to find an association that was no longer being used and re-used it for the new association. This manual process was time consuming – therefore, we were in the need to allow a provider tax ID to have as many associations as needed. The scope of the project was to expand the association sequence number field which was four digit numeric codes. As we were changing the provider key, the change impacted lot of databases including the claim and claim history Databases.

Provider Data Encapsulations:

The scope of the project was to implement the shared modules that expose data access functions for any consumer needing provider data by reducing coupling with physical database structure. The project was aiming to centralize all provider related data access (call patterns) that was earlier distributed in an application into specific data access routines. The changes made to the underlying provider data source enabled the HBOR data consumers to achieve a high-level of independence to access it.

Responsibilities:

Understand the business and Functional Requirements.

Performed Impact Analysis on the requirements before designing and given the Estimation of development and testing.

Analyzed the scope for enhancements, performing impact analysis.

Developed source code in COBOL, VSAM, JCL and CICS as per the requirement document.

Performed Unit Testing in the developed modules.

Utilized debugging tools including FILEAID, ABENDAID and XPEDITOR.

Utilized Changeman and Endeavor for version control.

Performed Code review & Peer testing for the team's deliverables.

Responsible for sending daily status reports to the onshore coordinator.

Responsible for automating the processes.

Environment:

CICS, COBOL, JCL, VSAM, DB2, IMS DB, SAS, CHANGEMAN, ENDEVOR, XPEDITOR, FILE-AID, SPUFI, QMF

Citi Bank – Offshore; L&T Infotech- Bangalore

Project Champion

December 2009 - January 2012

This is a production support project to support the end-to-end business activities of the user related to supply chain planning and demand fulfillment. MSD, IMS Accounts and IMS Products are the various applications supported by the team.

Responsibilities:

Understanding the business process, system integration & technical part of the system and provide support.

Assessing the batch job flow and fix any issues (provide L2 support) that come up in the nightly batch suite in Mainframes.

Fix the CICS online screen discrepancies and issues reported by the end client.

Providing permanent fixes to the jobs that fail regularly due to various reasons.

Assisting the onsite team to understand the business queries functionally and technically and provide resolutions to them.

Welcoming minor and medium level enhancement requests rose by the user & understanding them functionally and technically to implement the changes.

Delivering transition to the new joiners in the team & developing technical training documents for the future use of the team.

Environment:

COBOL, JCL, CICS, DB2, VSAM, Changman, OPC

Bank Of Newyork Mellon –Offshore;

Wipro Technologies- Bangalore

Application Developer

July 2007 - December 2009

This was a small enhancement project as part of the BNY & Mellon integration treasury services required a single combined billing system to support the legacy bank’s cash management customers.

Responsibilities:

Responsible for carrying out a detailed analysis and development of the code.

Conducting tests on the modules developed.

Provided UAT support to the client.

Environment:

COBOL, JCL, CICS, IMS, DB2, SAS, Easytrieve, Insync and Endevor

Education:

Master of Computer Applications, with 86.32%, Anna University, India

Key Skills and Competencies:

Professional

oIdentifying operational risks.

oAble to pick up new technologies quickly.

oAbility to absorb information and data from multiple sources.

oDetermining a projects scope and vision.

oSoftware implementation experience.

oIn-depth understanding of business environments.

oExperience in handling multiple projects & stake holders.

oStrong analytical skills.

oAbility to work on large-scale projects with many diverse contributors.

oAdvanced Excel & PowerPoint skills.

Personal

oAble to work accurately and efficiently under intense time pressure.

oCan quickly comprehend new business and technology concepts.

oComfortable working with Business users directly.

Contact this candidate