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Benefits Coordinator Sr Software

Location:
Glen Allen, VA, 23060
Posted:
May 20, 2023

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Resume:

PROFESSIONAL SUMMARY

Sr Software Eng

** years of experience in the IT Field. AWS Developer Certified.

●A skilled communicator able to maintain cultural sensitivity, establish rapport with members of diverse groups, and promote team cohesiveness.

●Highly organized and independent; able to effectively coordinate tasks to accomplish projects with timeliness and creativity.

●An organized, detail-oriented, and conscientious self-starter, able to strategize and prioritize effectively to accomplish multiple tasks and stay calm under pressure.

●Flexible and analytical with a keen eye for details; skilled at synthesizing and editing information to achieve overall objectives. An effective leader, skilled in enlisting the support of all team members in aligning with project and organizational goals.

●High-energy, confident professional with an infectious enthusiasm for technology.

●Highly organized and efficient in fast-paced multitasking environments; able to prioritize effectively to accomplish objectives with creativity, enthusiasm and humor.

Technical Skills Set:

ETL: AbInitio GDE, SSIS, Informatica, SnapLogic

AWS Services: EC2, EMR, S3, Lambda, SNS, AWS CLI and Redshift

Frameworks: Spark, Scala

Programming Language: Python, PL/SQL, Ruby, Gherkin, VB

Business Intelligence Tools: Business Objects 5.1/6.0, Crystal Reports 9.0/10.0

Database: Amazon RedShift, Teradata 13/12, Oracle 10g/9i, Mainframe, SQL server Operating System: Mac OS, Windows NT/ 95/98/2000/2003/XP, Linux

Version Control Tools: Ab Initio EME, GitHub, Clear Case and VSS

Other Tools: Jenkins, Cucumber, TeamSites, JIRA, Selenium, Mercury tools, Control-M

Experience

10/7/2018– Till Date

Sr. Product Owner

Advantasure

Proof of Concept for Payer Benchmarking

When not receiving Provider Network file from Payers:

Payer benchmarking by state using claims data involves analyzing and comparing the performance of different payers in a particular state based on claims submitted. This can provide insights into how well a particular payer is performing relative to its peers and help identify areas where they may need to improve.

When receiving Provider Network files from Payers

By analyzing this data across different payers, organizations can gain insights into how their provider networks compare with those of other payers in terms of breadth, depth, and quality.

OOA

Sr. Product Owner

Advantasure

BCBS Association has mandated a data exchange between Home and Host Plans so that Home plans can better manage the care of their out-of-area members. This approach requires home plans to send gap closure requests.

Medical Record Retrieval for Hosted Member in client area – For hosted members, the chart retrieval list is received from the host plan through the Association. Medical records are retrieved either using our PECs or a retrieval vendor. We will manage the chart retrieval process, and send the medical record and the provide engagement response back through the host plan to the Association.

Medical Record Retrieval Requests for members that are not a hosted member for the client – For hosted members who have medical records in a third state (primarily due to traveling) – if a request is received from the host plan through the Association, we will reject the request and the home plan will pursue this record with Inovalon which is the current process. We will reject the request because the Host/Par Plan will not be paid for this member.

OOA member support, including file exchange – Receive risk adjustment and Stars gaps for all home/control plan OOA members from the home plan. Send updated gap files to the Control Plan to send to the Association on a regular basis. Receive gap closure provider engagement response file back from the Host/Par Plan and track gap closure. Send medical record chase list for retrospective chart review programs, HEDIS, RADV, etc. in the appropriate format to the Home/Control Plan to send to the Association based on timing of each program. Receive provider engagement response file back and medical records from the Host/Par Plan and track records received and outstanding.

• Collaborating with prospective users and clients to understand and anticipate their needs and translate them into product requirements

• Defining the vision for the team’s product

• Creating a product road map based on this vision

• Managing the product backlog and prioritizing them based on changing requirements

• Overseeing all stages of product creation including design and development

• Developing user stories

• Monitoring and evaluating product progress at each stage of the process

• Liaising with the product team and end-users to deliver updates

• Participating in Scrum meetings and product sprints

Worked in QME Project and Commercial within Advantasure

QME

To provide the market with a HEDIS Solution that includes our own NCQA-Certified HEDIS engine. This business case describes different phases of this process, developing the HEDIS engine and implementing all MA, Commercial and QRS measures.

Commercial

The ACA Commercial Risk Adjustment initiative is the development of Commercial prospective and retrospective capabilities and functionality enhancements in the base platform and MRR, allowing Tessellate to provide new and existing clients with Commercial products and services, including gap identification, prospective programs, and retrospective programs.

●Skilled in Analysis, Design and Developing test cases for SQL objects verification and testing.

●Responsible for testing database program application and developing data models.

●Experience in Execution of Test Cases and Preparation of Test Data.

●Experience in Defect management and Bug Reporting using JIRA.

●Perform manual testing, ensuring that content and structure of all testing documents/artifacts is documented and maintained.

●Perform ad-hoc and Regression testing of system components.

●Experience in all types of Test Documentation: Test Scenarios, Test Cases etc.

●Possess good Knowledge of Software Testing Levels, SDLC, Bug Life Cycle, Testing Life Cycle and database testing procedures.

●Wrote ad-hoc stored procedures to generate various reports for the Benefits Coordinator

●Created and debugged complex ETL processes using T-SQL queries, functions, stored procedures and SQL Server Agent jobs.

●When problems occurred, I was always the first person our Benefits Coordinator would come to with the question "Is this a bug, bad data or wrong specifications?"

●Created and debugged various SQL Server SSIS processes and Agents.

●Creating and updating tables, views, working with triggers, stored procedures

●Assist in designing physical data structures to support application's requirements

Experience

2011-05 –2018-03

Sr Software Engg

CAPITALONE Richmond, VA

Worked in Basel, Market Intelligence and Cemp Project.

•Production Monitoring and sending reports daily to the team and Product Owner.

•Managing Releases for the team and performing Post Launch Validations.

•Analyzing Prod Failures and Submitting ECO as needed.

•Raising quotes to rerun the jobs or to force start the jobs.

•Forklifting data from Teradata to Hadoop and to S3.

•Worked on Jenkins to Rehydrate instances.

•Participate in various projects and change orders as assigned and complete assigned tasks on time.

•Provide support to the technical escalation from the team and Coordinate service calls and requests with team members where necessary.

•Coordinate and implement change as a result of Break Fixes.

•Manage and configure AWS services as per the business needs (ELB, SNS, EC2, Route53, S3, RDS, CloudWatch, IAM, SNS, VPC,, SES,ETC)

•Analyzed detailed design or Specifications document, Requirements (FSR, DR, DQ), Logical data model (LDM) and Physical data Model (PDM) for various kind of ETL Testing.

•Developed Test plan, Test strategy, Test Scenarios, Test cases and execute test cases for ETL testing in complex, high volume data warehousing projects to cover overall quality assurance testing.

•Data validation and backend testing mostly done using SQL Developer/Teradata.

•Develop SQL queries and carried out Back end testing and Data Validation and Data conversion testing.

•Work in multiple projects simultaneously in different environment.

•Proficient in UNIX environment especially with executing Shell Script.

•Work extensively with Quality Center to tracked defect and manage and execute test cases.

•During the testing phase schedule and lead defect review meeting as needed.

•Participated in peer review meeting for created Test plan, test cases and analyzing various testing documents and process of testing life cycle.

•Participated to create Test Analysis reports (TAR) and stored them into the Knowledge Link.

•Updated RTM in daily, send status report and daily tracking report to test manager.

•Support IV&V testing team and UAT user on project basis and coordinate with development to resolve the issues immediately.

•Worked closely with the application development and design and testing team to resolve technical issues and interacted with them to ensure overall quality of the software.

•Trained new hire and made sure that they catch up to speed.

•Also did setup the Offshore team for Basel in India.

•Daily basis support regression, integration and IV&V testing team member with different question.

•Attended weekly review meetings conducted by QA Team and updated the status and also discussed about QA goals, Risks and future plans.

•Took part in the creation of QA metrics and Graphs to help the top management to keep update with the QA Team progress.

Experience

2009-04 - 2011-02

BODI Developer

CITIBANK West Orange, NJ

•Extracted data from the different Database like Oracle, DB2, etc

•Created Repository Users and Groups. Analyzed and imported the Source definitions and created target definitions, logical and physical designing of target tables.

•Created Data Sources, Data flows, Workflows and jobs to implement complex business logic

•Used standard functions and created a few custom functions and debugged failed Data flows

•Designed and Developed complex aggregate joins look up transformation rules to generate consolidated data identified by dimensions. Implemented the logic for Slowly Changing Dimensions

•Extensively used Row Generation, History Preserving, Key Generation, Query, SQL, Merge, Validation transforms to transform the data for loading into the warehouse tables.

•Setting up Batches and sessions to schedule the loads at required frequency and generated completion messages and status reports.

•Technical analysis of the data warehouse and relate to the user requirements to find the source of the problems

•Designed ETL process flow and developed data mapping spread sheets to define transformation rules for each stage of ETL process

•Responsible for monitoring, scheduling and running the ETL jobs.

•Unit and integrated testing of developed solutions in the data warehouse, ETL

•Worked on Stored Procedures Oracle using PL/SQL

•Configured Server Groups, scheduling the jobs

•Error handling and Auditing

•Created local and global variables and used the scripting language

Education

2001-06 - 2004-02

Bachelor’s in Electronics

DC and AC response of electronic passive components. Network theorems (DC analysis only).

Semiconductor Diode and its applications. BJT and FET.

Number systems & Codes.



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