Software Developer Resume

SUMMARY:

Mainframe developer with 7 years of experience in Healthcare claims adjudication system using IBM Mainframe and Micro Focus COBOL.
Expertise in claims adjudication (Pricing, DUR, Prior Authorization) in Confidential system (PBM).
Developed and maintained both batch & online systems using Mainframe and Micro Focus COBOL in claims adjudication.
Worked closely with business analysts to understand the business requirements in claims adjudication system.
Provided 24/7 on - call support whenever required and resolved technical issues.
Well-versed in application development life cycles like requirement analysis, design, development, unit & integration testing, UAT, production release and post production support.
Having hands on experience in using version control tools such as Tortoise SVN, IBM Clear case.

TECHNICAL SKILLS:

Languages: IBM Mainframe COBOL, Micro Focus COBOL, JCL

Database: DB2, Oracle SQL Developer

Software & Tools: Endeavour, File Master, Control-M (Job scheduler), PuTTY, UNIX animator

Methodology: Waterfall, Agile

WORK EXPERIENCE:

Confidential

Software Developer

Technology: Micro Focus COBOL, SQL Developer, Putty, WinSCP

Development and support of claims adjudication for Massachusetts Medicaid pharmacy online processing system (MA POPS). Enhancement of existing system with new features & standards.

Responsibilities:

Senior developer for maintaining and enhancing MA POPS system through which the pharmacy can submit claims for member.
Responsible for all batch interfaces (MMIS extract, Member input file, Provider input file, FDB file).
Successfully Implemented HCIDEA interface (Healthcare Identifier for all Drug Enforcement Agency) in MA POPS system.
Successfully implemented Children’s Medical Security Plan (CMSP special group for members under age 14 to adjudicate claims) in MA POPS and modified pricing benefits for members in the existing MA POPS system.
Successfully created SYSTEM GENERATED PRIOR AUTH logic to prevent control of drugs which might be used as abusive drugs.

Confidential

Software Developer

Technology: IBM Mainframe, Micro Focus COBOL, SQL Developer, Putty, WinSCP

Migration of claims adjudication for North Dakota pharmacy system from legacy system. Enhancement of the legacy system with new features like Batch claim processing by provider & member link/unlink.

Responsibilities:

Responsible for migrating business from legacy ND pharmacy system into Micro Focus platform.
Responsible for all development & maintenance of three batch interfaces from the scratch (Batch claims adjudication, Claims reprocessing, Claims suspense release).
Responsible for testing the client supplied unit test case scenarios.
Designed & implemented automation tool (CLAIMS FORMATTER) which is used to format old claims from ND legacy system and run it in new PBM system for parallel testing. This tool reduced lot of manual work and is currently used by ND state Medicaid pharmacy team to submit raw claims directly in UAT region.
Responsible for migrating data from ND legacy system and to load it into new adjudication system.

Confidential

Software Developer

Technology: IBM Mainframe

NCPDP upgraded its old format from NCPDP 5.1 to D.0 as standard format for submitting the pharmacy claims. Enhancement of existing claims adjudication system to accept new NCPDP D.0 claims format.

Responsibilities:

Responsible for making code changes in existing claims adjudication system to accept new D.0 format.
Modified both Interface batch jobs and online adjudication system to accept D.0 format.
Modified claims extract and EDI extract to upgrade with new format.
Responsible to test client supplied unit test case scenarios and to share it with client.

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