Professional Summary:

• 10 + years of IT industry experience encompassing a wide range of skill sets and roles
• Expert in EDI based transactions and ANSI X12 files also has experience in EDI tools like Mercator and WTX (WebSphere Transformation Extender).
• Excellent knowledge and exposure to Health care domain
• Excellent Medicaid, Medicare domain knowledge.
• Extensive experience in Analysis, design, development, customizations and implementation of software applications
• Proficient in analyzing and translating business requirements into technical requirements and architecture design
• Strong database skills and proficient in writing complex SQL queries
• Strong development skills and proficient in OLTP programming
• Capable of handling multiple projects and delivering high quality results
• Impressive work ethic, reliable, dependable and conscious of duties and responsibilities
• Positive approach handling tasks with excellent organizational skills
• Strong communication skills in both verbal and written
• Self-motivated and target oriented individual.
• Fast learner who is capable of learning new tools & technologies quickly
• Good interpersonal skills and ability to maintain good relationships with co-workers and business partners.
• Good team player who can also work independently.

Technical Skills:
Languages: COBOL, JCL, DYL280, EAZYTRIVE, REXX,SAS
OLTP: CICS
Access Methods: VSAM
Utility Tools: QMF, SPUFI, XPEDITOR, SYNCSORT, CA7, ENDEVOR, PANVALET, ISPF, FILEAID, INFOMAN, FILE MANAGER, DB2 Admin Tool, WAAPDSUT, Viasoft, Optim for DB2.
Databases: DB2
EAI Tool: WTX
Mainframe Interfaces: MQ, FTP
Operating Systems: z/OS, Windows 98/2000/XP

Experience:
Confidential , Richmond, VA
Title: Senior Mainframe Developer

• Confidential Medicaid furnishes medical assistance to eligible low-income families and to eligible aged, blind and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Medicaid pays for: doctor visits, hospital care, labs, prescription drugs, transportation, and routine shots for children, mental health and substance abuse services. Virginia Medicaid system (Va-MMIS) for Department of Medical Assistance Services. The system handles various transactions related to the claims/benefits placed by service provider
• Release 59 implements CMS’ Modified Adjusted Gross Income (MAGI) rules to replace current Medicaid/CHIP rules for families and children under the Patient Protection and Affordable Care Act (PPACA). Under PPACA, DMAS must be able to accept the new applications by October 1, 2013. Coverage will become effective January 1, 2014. This Release will also implement modifications to data exchange requirements between VaCMS and
• The objective of this project is to enroll members who are eligible for Medicare and full Medicaid benefits into managed care organizations (MCOs) to receive all covered Medicare and Medicaid benefits through one MCO through the Medicare-Medicaid Financial Alignment Demonstration. NOTE: Duals is referenced throughout this Requirement document was a place holder. The official program name selected is Commonwealth Coordinated Care (CCC).
• As a senior mainframe developer participated in all requirement discussions and technical design discussions in projects to fill the gaps in requirements and technical design.
• Modified COBOL, CICS and DB2 programs as part of VA-MMIS system enhancements.
• Modified CICS Map screens to incorporate new requirements for provider subsystem.
• Involved in creating Unit test plan, UIT test plan assisted team to create the test cases and test data.
• Analyzed the business requirements for received in the form of a SDN (Change request) by interacting with client and translating into Technical Design document (TSD) by establishing a specific solution.
• Developed and Unit tested the application with robust test cases covering all of the scenarios. Doing peer reviews of other team member’s code.
• Monitored first run of jobs after code deployed into production.

Environment: COBOL, JCL, DB2, VSAM, CICS, Viasoft.

Confidential Sacramento, CA
Title: Senior Mainframe Developer

• Confidential This project is to support the Department of Healthcare Services in Medi-cal which is responsible for coordinating and directing the delivery of health care services to 6.7 million qualified persons and families. Medical billing is the process of submitting and following up on CLAIM with DHCS in order to receive payment for services rendered by a healthcare provider. The Medical Billing Process is an interaction between a healthcare provider and the insurance company (payer-in this case DHCS) after a Recipient/Beneficiary is treated in a facility.
• Department of Health Care Services (DHCS) is developing a new method of paying for hospital inpatient services in the fee-for-service Medi-Cal program. The Medi-Cal Claims Processing system will assign the APR-DRG and calculate payment without any need for the hospital to put the DRG on the claim. In general, every complete inpatient stay is assigned to a single diagnosis related group using a computerized algorithm that takes into account the patient’s diagnoses, age, major procedures performed, and discharge status. Each APR-DRG has a relative weight that reflects the typical hospital resources needed to care for a patient in that APR-DRG, relative to the hospital resources needed to take care of the average patien
• HIPAA project is an enhancement to replace the current HIPAA transactions standards (Version 4010/4010A1) and NCPDP Version 5.1 pharmacy transactions with the HIPAA 5010 Transactions and the NCPDP D.0 transaction respectively,. The scope included accepting the new (or changed) elements/segments coming in from 5010 transactions, validate the transactions, store it in a repository and enhance the CAMMIS formats, with minimal required changes, as needed by the required by the downstream applications.
• CA-MMIS shall reimburse inpatient services rendered to CCS-Only, CCS/Healthy Families, and GHPP-Only clients, for claims billed with a date of service on or after January 1, 2011, at the California Medical Assistance Commission (CMAC) Contract Rate when the provider has inpatient contract rates.

Responsibilities:

• As a senior developer participated in all requirement discussions and technical design discussions in major projects to fill the gaps in requirements and technical design.
• Involved in creating Unit test plan, UIT test plan assisted team to create the test cases and test data.
• Analyzed the business requirements for received in the form of a SDN (Change request) by interacting with client and translating into Technical Design document (TSD) by establishing a specific solution.
• Developed and Unit tested the application with robust test cases covering all of the scenarios. Doing peer reviews of other team member’s code.
• Monitored first run of jobs after code deployed into production.
• Prepared WTX mapping document from 4010 to 5010 as part of HIPAA 5010 project.
• Supported data migration activities as part of project take over.
• Ensuring smooth running of fiscal intermediary operations by providing technical support.
• Report processing using DYL280.
• Resolved technical issues raised by business users.

Environment: COBOL, JCL, VSAM, CICS, DYL280, WTX

Confidential, Syracuse, NY
Title: Mainframe Developer
Project: EMC (EMC-Electronic Media Claims)

• Confidential front end system which is the gateway for receiving the claims. The functionality involves extracting the claims, validating the claims, formatting and feeding/routing the claims to various core systems. Business operations involved mostly maintenance where work comes as a change request which contain the High level Business requirements
• This project is to migrate to HIPAA ANSI 837 5010 X12 format from existing 4010. This project is to transition the NY-EDI Pre-Adjudication Process (current) to the CS90 Adjudication System as part of the overall Enterprise Consolidation Project. New system will be established after implementation of this project
• This project is to support the 5010 claims. WellPoint is enabling Trading Partners to upgrade to 5010 format beginning January, 2011 by implementing a “Step Up/Step Down” functionality at Enterprise EDI so that back end adjudication systems will not have any impact if they are not “5010 ready” in January, 2011.This project deals with Claim correction process which has to include indicator showing the original claim submitted had a POA value in it and all the claims will be loaded online for the correction process. It is teamwork between the mainframes side and the online portal application where in the online entry of the diagnosis codes which determines the treatment type and the POA indicator submitted will be validate form CICS programs. Valid and invalid entries of the diagnosis codes and the POA values will be checked and a message will be thrown to the provider o correct the invalid entries.

Responsibilities:

• Worked as a Mainframe Developer and test lead in the above project modules.
• Analyzed the business requirements received in the form of a change request by interacting with the client and translating them into Design documents by providing them a resolution.
• Prepared estimates for the work received.
• Facilitated meetings for obtaining the requirements.
• Developed and Unit tested the application with robust test cases covering all of the scenarios.
• Performed peer reviews on the developed application code.
• Delivered the results to the customer in a timely manner and obtained the customer approvals, facilitated the code migrations and Prod implementations by meeting the deliverables.
• Ran system test cycles as scheduled.
• Load system test claims into IMS data base for adjudication.
• Maintained the test system like refreshing VSAM files with Prod data and DASD clean up etc..
• Fixed the production abends without missing SLA.
• Prepared the documents for quality purpose and delivering them for audits.
• Supported production system (on call) and fixing all abends without missing SLAs.
• Modified WTX maps/type trees to incorporate requested changes as a part of Mercator migration to WTX.
• Improved the System testing performance and reducing the cycle time
• Trouble shooted and de bottlenecking the testing related issues
• Coordinated and advising the System test analyst.
• Facilitated regression setup and Support
• Coordinated and executing the customer test requests.
• Performed QA reviews and walkthrough’s
• Documentation as required
• Tracked all defects in Clear Quest

Environment: COBOL, JCL, VSAM, WTX, DB2, MQ, CICS

Confidential, Syracuse,NY
Title: Mainframe Developer
Confidential This application is to extracts the all 837 claims from warehouse and does pre adjudication and edits. Provide the production support activities involved in supporting the Jobs that generate 837 Outbound Extracts from VA data warehouse for transmission to DMAS (Department Of Medical Assistance Services).
Responsibilities:

• Verifying output files from monthly extract jobs and correct them if any junk data found.
• Fix amended monthly jobs.
• FTP files to DMAS DATA warehousing system.
• Prepare estimates for changes in system.
• Design technical solution for requirement.
• Coding unit testing and monitor first run jobs after code deployed in production system.

Environment: COBOL, JCL, DB2, DYL280.

Confidential
Title: Mainframe Developer
Confidential The purpose of the QA environments is to support the QA testing endeavors of the Morgan Stanley Application Development teams. The QA environment is a mirror image of the production to an extent. IBM manages a series of tasks to sync up all the DB2 components of resources that are needed for each of Morgan Stanley's applications. These components include DB2 objects and non DB2 datasets. For the DB2 objects, and non DB2 datasets GWMG QA tam is responsible for refreshing the data between production environment and the QA environment(s).

Responsibilities:

• Implemented DB2 components structure changes in QA systems.
• Supported 24x7 on call for QA batch loads.
• Performed ad hoc file and DB2 table refresh request from production to QA systems.
• Resolved DB2 Related Problems in QA environments.
• Prepared weekly structure / Authorization compare reports between QA and prod and implemented discrepancies in QA.
• Participated in major refresh activities which involves unload data over 2000 tables and 3000 files from prod and load into QA system.

Environment: COBOL, JCL, DB2, DB2-ADMIN Tool, CHANGEMAN, REXX, VSAM.

Confidential
Title: Mainframe Developer
Confidential t is the world’s leading provider of global business information, which empowers customers to make informed critical business decision. They offer a variety of business information for Risk Management, Sales & Marketing and Supply Management decisions worldwide.
The work mainly deals with identification of the DUNS number assigned to each company and using those DUNS to link information about the business performance, history, risks and opportunities in their business relationship.
Responsibilities:

• Requirement Analysis, Design, Coding, Quality Review and delivery of customer requests using
• COBOL (Common Business Oriented Language)
• Delivered new and complex high quality solutions to clients in response to various customer
• Solved and helped the technical problems of all the team members.
• Responsible for Work allocation to team members in the absence of team lead
• Ensure that proper quality procedures are followed in all the phases
• Trained and guided the new team members on technical as well as process areas
• Maintained good documentation for all the tasks developed as per the client’s documentation policy.

Environment: OS-390, EZYTRIEVE, COBOL (Common Business Oriented Language), JCL (Job Control Language), VSAM (Virtual Sequential Access Method), DB2.