SUMMARY:

• 8+ years of experience in IT out of which 5+ years of experience in Health Care Domain
• Experience in Facets tool functionality
• Hands on Experience on FACETS Data models and FACETS core tables
• Strong business acumen to quickly grasp user requirements and relate them to the application development
• Worked on Managing lifecycle of FACETS and surrounding applications/systems to sync with the processes and schedules.
• Worked on Membership, Provider, Billing, Claims and Commissions modules.
• Certified AHM 250 professional (Academy for Health Management).
• Certified AHM 510 professional (Health Plans: Governance and Regulation).
• Extensively worked on XSQL and XCOM Trizetto FACETS Extensions.
• Extensively worked on Onsite and offshore model, provided effective coordination to gratify client needs
• Stringently followed standards, processes and created documentation at every phase of SDLC
• Apart from the Unit Testing, also involved in Functional and User Acceptance testing activities.
• Worked extensively on Database Design, Normalization. Strong abilities in Data Modeling, Database Design, Views, Normalization, Stored Procedures, joins, Triggers and Functions using SQL Server, Oracle 9i and MS Access.
• Hands - on experience with SQL in constructing all Data Objects like tables, views, indexes etc.
• Strong analytical and problem solving skills with ability to work within a team environment and independently when needed.
• Experienced in team programming and also accomplished at working independently.
• Worked closely with Corporate Interfaces Group to maintain detailed knowledge of the company’s Corporate Data flows, Managing Production, Test and Development environments.
• Good ability to quickly grasp and master new concepts and technologies.
• Worked for Health Care workers compensation and has strong understanding and experience in the Health Care Domain.
• Worked on all phases of SDLC.
• Highly accomplished and motivated PEGA Consultant, involved in Business Requirement Sessions and using DCO created Basic PRPC Components, hands on development and architectural design experience implementing software solutions using industry leading BPM application Pega PRPC.
• Have experience in health care products like Facets, Facets Extension and McKesson Web services.
• Excellent communication and presentation skills.
• Commendable Knowledge in health care domain.
• Experience in working on Agile and Scrum (Rally, Jira), Waterfall Methodologies.
• Knowledge on database backup, recovery, UML, HIPAA Gateway, scheduling batch jobs
• Expertise in programming with ORACLE, SQL, PL/SQL, SSIS, .Net and Stored Procedures.
• Expertise in developing both Front End & Back End applications using Java, Servlets, JSP, JAXP, HTML, JDBC, XML
• Good knowledge of XML parsing JAXP, DOM Parser
• Proficiency in programming with Java IDE's like Eclipse-JUNO, Eclipse-Galileo
• Ability to grasp new technologies and to correctly apply new tools to build applications
• Good Interpersonal Skills, team-working attitude, takes initiatives
• Proactive in solving problems and providing best solutions

TECHNICAL SKILLS:

Programming Languages: Core Java, HTML, CSS, XML, Java Script, J2EE, JUnit, JAXP, DOM Parsing, JSP, Servlets,.NET Framework 1.1/2.0/3.0, C#,SSIS

Operating Systems: Windows, Mac OSX, UNIX

Databases: Oracle 9i/10g, MySQL, SQL Server, Pega.

Software Platform and Tools: Eclipse, Toad, CVS, Molybdenum Testing

ETL Tools: Informatica, SSIS

Web and Application Servers: Tomcat, Apache

Web Technologies: HTML,XHTML,CSS,XML

Documentation Tools: MS Office, MS Visio, MS Project

Modeling Tools: UML, MS Visio

SDLC Methodologies: Rational Unified Process(RUP), Agile, SCRUM, Pega

Health Care Tools: Facets, TMG Core

PROFESSIONAL EXPERIENCE:

Confidential - Virginia Beach, VA

FACETS Systems Analyst/ Pega Business Analyst

Responsibilities:

• Played pivotal role in preparing BRD by facilitating meeting with stakeholders to design the current business process into a future state model/system; the to-be model/process clearly expressed how process relate to and embody the fulfillment of business requirements.
• Analyzed the existing Legacy MS Access code to create BRD specs and Mapping documents for GBD Phase1.
• Lead DCO Elaboration sessions to identify detailed requirements and successfully document these specifications for Phase 1 and Phase 2.
• Worked on FACETS Modules like Claims, Providers, and Membership etc.
• Translated stakeholder requirements into tangible deliverables such as functional specification document, use cases, workflow/process flow diagrams, data flow/model diagrams, Mock UIs
• Worked with LSA and created class structure, case types, stages and steps.
• Created Properties, Layouts, and sections for UI Mockups.
• Worked on FACETS Claim Batch load for the Providers that are currently under investigation for fraud into CRAV Interface.
• Developed and communicated Business Requirements to technical team by constructing easy to understand data and process flows.
• Conducted meetings and worked with different system Integration teams to identify and map the data required to meet the business/system requirements.
• Worked in Onshore- Offshore model and conducted meetings/status with offshore team on daily basis to clarify all queries and ensure smooth flow of development.
• Presented Demo of Application to key stakeholders after each Iteration to gain their confidence and to also make sure all are on the same page.
• Prepared release notes before deploying each Iteration which included Use cases, defect fixes, release version for that Implementation and shared the same with project stakeholders
• Conducted multiple levels of testing including sanity, functional, regression, user acceptance and Integration to verify the client’s needs are met.
• Ensured Legacy Providers and Claims are mapped correctly in the Pega System.
• Involved in writing Specifications, Mapping Specs and Requirements in Jira for Phase1, Phase2 and Phase3.
• Created Test Plan for SIT and UAT Phase1 and Phase2.
• Involved in Sprint Planning and Back Log grooming sessions.
• Worked on creating PCA configuration setup in FACETS for various Medicare and Medicaid Providers that are under investigation.
• Tested PCA Configuration setup for GBD providers in Dev and SIT.
• Involved in testing for Phase1, Phase 2 and Phase 3.
• Worked on Project status reports and Inventory reports.
• Fine-tuned the existing Batch SQL server queries for Phase 1.
• Helped testing team prepare test cases and approved the same.
• Facilitated defect Triage call on daily basis with the SIT testing team to discuss over all the defects raised and make sure it’s a valid defect

Environment: Pega 4.7, FACETS 4.4x/4.7x, VB.NET, Microsoft Access, Oracle, SQL Server 2009,Microsoft Excel, Soap UI, Microsoft Project, SSIS, Microsoft Power Point, Adobe Acrobat XI Pro, Jira

Confidential- Scranton, PA

Facets Systems Analyst/ Programmer Analyst

Responsibilities:

• Worked with Business analysts to gather requirements from Client and Business teams.
• Ability to provide a high level overview during Project initiation phase and estimation phase for the requirements.
• Updated the existing processes to serve the new enhancements and updated Use Case documents accordingly.
• Proficiency in planning and management of scope of work and time estimation across the Project phase.
• Worked on ITS Claims extracts to extract.
• Involved in creating mapping and use case documents according to business requirements.
• Created mapping documents and system requirements for ITS (PCE) claim process and 1500 byte accumulator file.
• Distribute the task between onsite and offshore team and Coordinate with the client and the business for the approval of the design meeting the requirements.
• Worked on Various projects and various modules of FACETS (claims, Providers, Members, pricing, utilization management, Letters, Welcome Kits, EDI 834, and EDI 837).
• Worked on interfaces which feed data from FACETS to External Vendor Systems.
• Worked on all levels of complexity programs/projects from high level design till deployment.
• Configure the application with different exit points like POSTPRICING, PREPOSTPROC in the Facets Adjudication process and verify the data in facets tables.
• Worked on Automatic Action criteria letters configuration in FACETS for subscriber and member level letters.
• Create the custom stored procedure to load and unload the facets extension configuration.
• Create the Facets extension Log tables to capture the date retrieved from the facets exit points.
• Worked on project status reports and inventory reports
• Developed various reports using VB Script, ADO.NET, SSIS and Crystal Reports.
• Develop source code according to design.
• Guide &Assist the team members in development, fix issues if any.
• Review the developed source code and approve.
• Deliver the developed source code to Quality Assurance.
• Creating Technical Specification document based on the system requirement document, which includes the database objects/changes needed and the clear approach includes pseudo code to meet the project requirement s for the custom applications and interfaces.
• Creating database objects like tables, views, procedures, functions and data base triggers to meet the business requirement.
• Analysis of mapping fields and changing the business logic of program as per requirements.
• Working on T-SQL to migrate data into (Facets) application using Rapid SQL and SQL Server Management Studio.
• Defect fixing according to Clients requirement and mapping document.
• Knowledge transfers session to the new comers in the team.
• Analysis of System (Facets) Requirement.
• Involved in development and testing from onsite.
• Built the workflow having interaction with database.
• Error handling related issues.
• Managed the reporting and Unit Testing activities (running the queries) of the team.
• Tuning the data and improved the performance of the application using Indexes.
• Developed many complex reports using SSRS and Crystal Reports.
• Generate the client specific report with respect to the clients and modules.
• Worked on Claims Extract, Eligibility extract for various clients in Medicare and Medicaid.
• Register the XSQL Facets extension in different environments and check the performance.
• Plug-In the facets extension and verify the claims data after the Claims Adjudication and the payment process.
• Split billing keyword generation for Medicare part D.
• Other Maintenance related tickets and Productions fixes.
• Ability to work effectively both individually and in a Team.
• Reviewed and Approved UT files in both in DEV, SIT and UAT.
• Worked on several other tasks as assigned and demanded by the project.
• Created Requirement documents and reviewed with peers to understand the dependency and reduce redundancy in creating tables.

Environment: FACETS 4.8x/5.01x, .NET, Windows Server 2006, SSIS, SSRS, VB.NET, Informatica, Oracle, Unix, Microsoft Excel, Microsoft Project, Microsoft Word, XML, Project Web, CDM(Common Data Model), Jira

Confidential- Greenwood Village, CO

Systems Analyst

Responsibilities:

• Involved in writing logic, system requirements and mapping specs updates/changes for the Cust 360 requirements.
• Changed the primary source of feeds for the Acxiom policy and Acxiom customer data to be sourced from the IL data instead of HPS ware house files.
• Involved in reviewing all the test data and unit test cases in DEV environment to make sure the code is in sync with the requirements.
• Analyzed the BRD document for CUST 360 and involved in writing use cases for the requirements like Acxiom policy, Acxiom customer, Acxiom demographic, Sales block, CES 2.0
• A new system requirement and mapping documents are created to change the source to IL data for the new version of Customer Enrollment status.
• Participated in the meetings with BI Analytics team to understand the scope of the requirements.
• Analyzed the CES data to make sure the data is having all the membership, eligibility and demographic information in sync with HPS data.
• Participated in the system requirements walk through with the business for clarifications and to update and modify the requirements.
• Analysis of business and system requirements.
• Review the developed source code and approve.
• Involved in data quality and clean up.
• Actively involved in meetings with offshore to discuss and clarify the requirements.
• A new requirement is added to load pending cases into the new version of CES table.
• Assisted QA team in case of any requirement clarifications and issues.
• Developed mapping spec documents according to the BRD.
• A new mapping document is created to load the CSB data into the new CES and Block tables.
• Worked on Agile and Scrum (rally) methodologies.
• Created DML statements to clean the data in production.
• Created system requirement document based on the business document, which includes mapping documents, join statements and clear approach to meet the business requirements.
• Analyzed the gaps and missing data between HPS and IL sourced data and reported the discrepancies to the triage team.
• Participated in meeting for the all the downstream processes and the BI team to discuss and update the requirements if necessary.
• Participated in all status calls and daily stand up meetings to discuss and update the road blocks and status of my user stories/tasks to the scrum master.
• Involved in writing Confidential wiki and agile rally pages for the current and new sprints.
• Conducted meetings with all the stake holders to review the system requirements and mapping documents to make sure the changes are not affecting their processes.

Environment: FACETS 4.4x/4.7x, Oracle, Sybase, IBM Mainframes, SAS, Unix, Microsoft Excel, Microsoft Project, Microsoft Word, XML, Notepad++.

Confidential - SFO, CA

Functional designer, PLSQL Developer

Responsibilities:

• Complete analysis of Client requirements.
• Involved in developing data extracts and Operational, analytical and ad-hoc reports from facets.
• Involved in the development of Blue Shield Advance Project, Small groupProject,testing and deployment.
• Developed design Documents for ID card, Membership, Billing, Claims and Letters using facets application and PL/SQL queries.
• Created data flow diagrams and use case diagrams for completely new processes.
• Defect fixing according to Clients requirement and mapping document.
• Remediation of the impacted stored procedures, data transformation packages and reports that are affected by annual health care changes or Facets version change from .
• Analyzed, design and developed generic applications for keyword generation for multiple FACETS jobs like MMS, UMI etc.
• Involved in development and testing from onsite.
• Built the workflow having interaction with database.
• Working with QA team to come up with Test cases and support them in all testing activities.
• Follow up the end to end process of application.
• Redesigned, developed and tested Key application and HRA process to enhance performance.
• Worked with Enterprise Library and Implemented features like Logging, Caching, Exception Handling, and Validation.
• Helped Peer developers to understand complex processes.
• Prepare possible approaches for the requirement to design and develop the interfaces and letters build up the FACETS Application.
• Production support for enrolment, claims and billing processes.
• Involved in design and preparation of test cases.
• Assist QA team in testing.
• Assist in Implementation of the enhancements.

Environment: FACETS 4.8x/5.01x, .NET, Windows Server 2003, NT 4.0, Informatica, Oracle, Unix, Microsoft Excel, Microsoft Project, Microsoft Word, XML, Project Web, CDM(Common Data Model)

Confidential - Lawrence, KS

PLSQL Developer/Java Developer

Responsibilities:

• Analyzed, Designed and developed single sign on application.
• Developed the application using Spring Framework. Used Spring IOC (dependency Injection) for providing.
• Implemented persistence layer using Spring JDBC.
• Responsible for requirement collection and analysis.
• Implemented the application using the concrete principles laid down by several design patterns such as MVC, Business Delegate, Session Façade, Service Locator, Data Access Object, and Singleton.
• Prepare the architecture and present the demo to the project manager and clients.
• Involved in Unit Testing and Unit Test Case preparation.
• Involved in the implementation, testing and support of the application.
• Developed user interface using JSP, Struts tag libraries to simplify the complexities of the application.
• Developed Client side validations using JavaScript, and developed client side components to make asynchronous calls using JavaScript library AJAX.
• Developed logging component using Log4j framework.
• Developed data access layer using Hibernate.
• Coordinated with other teams in the IT organization in preparing test data and in performing UAT.
• Closely worked with Business users to validate the control flow and user accessibility.
• Worked closely with user community and defined detailed functional requirements.
• Actively involved in writing unit tests for application classes using JUnit framework.

Environment: Java, J2ee, Hibernate, Spring JDBC, Hibernate, Oracle, SQL Server, Microsoft Visio 2003, MS Excel, .Net, PLSQL, T-SQL, Query Analyzer, SQL Profiler

Confidential

.Net and Sequel Server developer

Responsibilities:

• Participated in software development life cycle, from the Analysis, Design, Implementation, Testing, and Deployment phase.
• Performed Database Normalization and designed data model using Microsoft Visio.
• Responsible for creating database, tables, indexes and table references.
• Designed and optimized indexes, views, stored procedures and functions using T-SQL.
• Performance Tuning of SQL queries and stored procedures using SQL Profiler and Database Engine Index Tuning Advisor.
• Worked with Storage management group to develop backup and restore strategy.
• Created Databases, Tables, Views, Indexes.
• Migrated data from Oracle database to SQL Server 2005 using SSIS.
• Involved in developing and deploying SSIS packages.
• Wrote complex stored procedures, queries, triggers, transactions and cursors.
• Developed triggers to check referential integrity and to update audit tables to track changes to information.
• Identified and created new datasets to design the queries for the report generation.
• Creation of Stored Procedures and Nested Stored Procedures for Batch Processing using Cursors
• Maintained data integrity by performing validation checks.
• Developed, monitored and deployed SSIS packages.
• Involved in administration of multiple servers with SQL Server 2000 and SQL Server.
• Responsible for troubleshooting database performance and capacity issues.

Environment: Windows Server 2003,.Net Framework 2.0, Visual Studio 2005, SQL Server 2005, T-SQL, Query Analyzer, SQL Profiler, SQL Server Integration Services, SQL Server Reporting Services, Microsoft Visio 2003, MS Excel