SUMMARY:

Innovative, analytical, Senior/Lead Programmer Analyst with extensive experience in billing, claims, eligibility, managed care, underwriting in group health care arena; Effectively planned and implemented new applications to enhance and improve productivity and quality of service. Expertise includes: SDLC…Operations…System Integration…Data Governance…Project Management…On - call Support.

TECHNICAL SKILLS:

Applications: Managed Care/HMO, A/R, Eligibility and Personnel, Inventory, HIPAA, ACA, ICD9, ICD10, Payroll, Group Life, HR, Claims, ERP, Actuarial, Billing, Accounting, Rating and Underwriting

Client Server: Databases Access, SQL, PL/SQL

Tools: Office, Project, PowerPoint, Visio, Putty

OS-Network: Windows, UNIX

ETL Tool: DataStage 9.1, QualityStage 9.1

Mainframe/ Databases: Oracle 11, DB2, IMS DB, DL/1, SQL, QMF, VSAM

On-Line: CICS, BMS, IMS DC, MFS

Languages: COBOL, COBOLII, COBOL 390, Enterprise COBOL, JCL

Tools: Abend-Aid, Autosys, Business Intelligence Software, BTS, Clist, Dads, Direct Connect, IMS-Xpert, Changeman, Easytrieve, Endeavor, Elixir, File-Aid, FOCUS, TSO/ISPF, Jes, Jil, Librarian, Panvalet, RACF, SharePoint, Spufi, Syncsort, Xpeditor, MQ Series, NDM, FTP, IBM Utilities, PKzip, IDCAMS,SAS, TOAD, XML, Tablebase

O/S-Network: OS MVS/XA/ESA, IBM Web sphere

PROFESSIONAL EXPERIENCE:

Confidential, New York, NY

Senior Programmer Analyst (Mainframe and ETL)

Responsibilities:

• Guiding as a Systems Matter Expert in the transition from Emblem’s Mainframe Business Process to Facets.
• Managed onshore/offshore resource for New York City Tier Benefit Projects to setup the Confidential Warehouse, Medical Management System and Vendor Extract JCL and Program Changes.
• Participated as System Matter Expert in data modeling mapping session between Mainframe and Trizetto Oracle Facets Health System.
• Developed, Analyzed, Redesigned modification to the Confidential Warehouse and Vendor Delegate Extract for Commercial and Medicare Renewal Project with emphasis on Data Governance
• Redesigned a mainframe DB2/IMS/COBOL/JCL GHI Truven Medstat business process using Oracle and DataStage 9.1 in the Confidential Data Warehouse while overseeing and reviewing the test quality data results from written regression and new functionality test plans as well Metadata data structures. Modeled several new tables to in corporate the Medstat business process.
• Created and Developed new Dimension DataMart to conform to Center of Medicare Services for provider and membership data using Oracle.
• Implemented several new parallel and sequence DataStage jobs that updated and extracted data from Oracle Membership, Provider, Claims and Actuarial databases in the Confidential Data Warehouse as well modified existing parallel jobs.
• Analyzed, designed, developed, validated data between several between Confidential and Vendors (Private and Government) such as CMS, Montefiore, Express Scripts, Orthonet, Healthplex, Truven, Quest and Davis Vision using COBOL, Datastage and XML
• Analyzed, designed, developed, tested, validated major modification changes to handle expanded 837I and 837P EDI input data to automate the coordination of benefit process with new and modified VSAM files and COBOL programs utilizing CICS for online screens while maintaining the quality of the current process.

Confidential, Hartford, CT

Team Lead/Programmer

Responsibilities:

• Managed successfully the development and coordination of offshore/onshore resources to re-engineering health claim and eligibility/personnel COBOL code and converting data from CICS/VSAM to CICS/DB2.
• Managed several release teams coordinating task and testing plans with developers, end-users and business partners for claim payment and pharmacy processing and HIPAA.
• Developed and designed a batch and online MQ process that communicated and connected with automated error fixing software. This process would put records in error to the message queue and reads the message queue to get records fixed.
• Programmed and tested CICS/VSAM/IMS claim auto adjudication process on vendor re-pricing initiatives, including complex code changes, collaborating and reviewing data test plans resulting in substantial savings in claim payments.

Confidential, Hartford, CT

Team Lead/Programmer

Responsibilities:

• Managed full life cycle of several projects with up to 10 team members collaborating with business customers and end-users. Resolving production support problems with end-user such as correcting data problems, training end-users on the system, on-line and batch system abends, and disconnected printers.
• Analyzed, designed, developed and implemented key modifications to Warehouse System at Confidential & Confidential, including technical specifications, testing, coding changes, to new/existing programs and SAP related business requirements. These new process inserted, selected and updated rows on the DB2 table when IMS databases were updated.
• Designed and modified many DB2 tables to facilitate transfer of data between SAP/ERP and existing legacy IMS/DB2 systems resulting in reduction of downtime to less than 1% and handle customer’s initiative.
• Designed process customer delivery pick-up system utilizing internal clock tables to calculate schedule substantially reducing number of truck pick-ups running through the plant.

Confidential, North Haven, CT

Senior Programmer

Responsibilities:

• Modified Claim programs to access new provider DB2 tables that were converted from IMS databases.
• Solved major modified claim production processing problem that cause the customer’s to reenter the whole claim again. The Code fix allowed the original modify claim to be processed saving time and money.

Confidential, Bloomfield, CT

Senior Programmer

Responsibilities:

• Developed, designed and programmed detail health insurance premium bill for small companies listing members and dependents on the bill from personnel records. The information was gathered from complex SQL inner and outer joins from several eligibility tables. The online screens displaying bill data was expanded using CICS/VSAM and DB2.
• Developed an Access back-up data entry system, with several screens to load data into database for eligibility information to facilitate user access in emergency situations.

Confidential, Hartford, CT

Senior Information Specialist, Information Specialist and Junior Information Specialist

Responsibilities:

• Redesigned Flex Benefits payroll/personnel process at Travelers utilizing, including increasing workflow by reducing transaction time and automating correction override process ensuring database integrity resulting in substantial increase in productivity and efficiency and enhanced customer service. Expanded DB2 tables to handle additional payroll rules utilizing Dialog Management/ISPF/REXX screens to enter change and delete data.
• Design a conversion of the eligibility rules IMS table to product called Table base. Reduced processing time of eligibility and personnel data in half.
• Removed Telon code from On-line COBOL/IMS programs to save licensing cost paid to Computer Associates.