Responsible for application support for Electronic Data Interchange system.  This system a a Medical billing system the file insurance claims in 837 ANSI format  electronicially. It runs acucobl programming interactive langauge on a unix AIX platform. Development and revamping of the EDI systems to produce cost effective processing. This sytems uses unix scripting for running batch processes and reporting processes. 

Responsible for day-to-day operations as Team Lead/Technical Lead managing ISD2/DB2 mainframe systems that process both CICS online and COBOL batch for Human Services Department Agency.

Work on the reporting systems for the Agency’s general legder and end of year 1099 reporting. Work closely with end users and stakeholders in multiple agencies to gather requirements so that programming staff and software development cost estimation/development of technical design documentation can be done most cost effectively and responsively to meet customer needs. Also responsible for office networks and development of new configuration management mechanisms to conform to CMMI Level III operations. Also install and configure and QA Test all server software and applications for programming staff desktops with Micro Focus Mainframe Express. Also Programmed 50 percent of my time as well in Cobol, Cobol II, CICS, DB2 applications using latest tools within a MVS TSO Environment. Also participated in easytrieve conversions to cobol apllication with using vsam and qsam files for reporting generattion for the cleint and wrote some easytrieve quick reporting adhocs for the client as well. Mainframe testing , creating test cases and test execution and validation.

Responsible for configuring Micro Focus Mainframe Express on servers and desktops for development/support of ISD2 systems. Also used Appmaster Builder to configure new screens and programs in Micro Focus for new development. Lead Configuration Management of Visual Source Safe to create repository of all ISD2 components for migration and production synchronization.

Additionally responsible for County of San Diego project as Transition lead for all IT operations to another contractor. Responsible for converting all mainframe FTP Applications to correspond to new server addresses. Designed and developed new FTP email confirmation application for collection permits for San Diego County used by numerous third party vendors. Meet with San Diego County IT officials to gather requirements to facilitate all FTP processes for the County.

Involed in a major conversion of a current client Stelring Life Insurace company from there oracle base database system to a mainframe application system COBOL II, CICS, VSAM. The Conversion involved

writing cobol conversion programs to format there inbound oracle exported data files to a proper vsam load structure for there Subscriber, Membership, Provider subsystems. Loading there VSAM online files using IBM untilities IDCAMS. Also validating the data loaded to the VSAM files via the onlines CICS screens.

Designed, developed and help implement the Envision project for State of Mississippi HIPAA program aligned with existing healthcare systems. Tasked involved project analysis, design, and programming within the COBOL II, CICS, and DB2 mainframe environment. Retro fitting Missisippi requirements to

existing systems and documenting the system using reverse engineering. Using debugging tools such as SPUFI, EXPEDITER TSO/ISPF, and FILE-AID. Mainframe testing , creating test cases and test execution and validation.

Support LA County LEADER Unisys 2200 Mainframe processes for both online and bach. Medicaid processes involve data collection and claim editing. Formatted claims. Supported pre-authorization, adjudication policy rules/edits, and transmission of claims data for adjudication. Provided all development and testing done with UNISYS platform using COBOL II, DB2, SQL Server, client/server environment with PowerBuilder front end. Also provided analysis, implementation and installation of client requested enhancements to the LEADER system used to meet Federal regulatory guidelines. Mainframe testing, creating test cases and test execution and validation. Updated and maintained all eligibility routines for TANF systems and Food Stamp programs. Imlemented LA County LEADER EBT (electronic benefit transfer) Food Stamp system.

Designed, developed and implemented Prescription Drug Claims System HIPPA program used by multiple customers. Implementation of HIPAA requirements to existing system included project analysis, design and programming within the COBOL II, CICS, and DB2 mainframe environments. Duties also involved claims batch billing testing, JAVA front end and POS front end interface real-time adjudicator processes supporting. Mainframe testing , creating test cases and test execution and validation.

Also suported there Web Bulltin board web system for claim intake into mainframe system. Some Perl programming with the support but very minimal. Server application is written in CICS COBOL and employs TCPIP sockets in a client-iterative server setup. Experience with the NCPDP 5.1 transaction set.

Designed, developed and implemented Michigan HIPAA program aligned with existing healthcare systems. Tasked involved project analysis, design, and programming within the COBOL II, CICS, and DB2 mainframe environment. Using debugging tools such as SPUFI, EXPEDITER TSO/ISPF, and FILE-AID. Mainframe testing , creating test cases and test execution and validation.

Supported BAMS mainframe system processes, online/batch for the state’s Department of Labor. Provided analysis, implementation and installation of client requested enhancements to the BAMS system to meet federal guidelines. Tasks involved project coordination, analysis, design, and programming within the COBOL II, CICS, and DB2 mainframe environment. Mainframe testing , creating test cases and test execution and validation.

Supported New Mexico’s ISD2\DB2 mainframe Tanf, Food Stamps, and Medicaid system processes for both online and batch for the Human Services Department. Analysis, implementation and installation of client requested enhancements to the ISD2/DB2 system to meet federal regulatory guidelines. Updated and maintain all eligibility routines for there Tanf systems and Food Stamps. All development and testing

done within the Micro Focus COBOL II, CICS, DB2, client server environment. Created new applications with Appmaster Builder to configure new screens and prgorams in Micro Focus. Conversion of existing Assembler programs into Cobol II programs for date and I/O routines. Also design and implemented the New Mexico State’s EBT Food Stamp system. Built, tested and implemented logic matrixes for determining client eligibility. Mainframe testing , creating test cases and test execution and validation.

Implemented COLA (Cost Of Living Allowance) and Welfare to Work logic into existing sub systems. Also worked on there WINS applications on a client server platform using SQL server and Oracle databases.

Also was part of a 2 month project working on the WIC program for the State of New Mexico. Work on the reporting systems for the Agency’s general legder and end of year 1099 reporting. Converted all easytrieve jobstream to cobol application jobstreams.

Lead technician and senior developer for cutting-edge managed healthcare software company. Successfully developed, implemented, and maintained customized software for several large HMO companies. Extensive background in claims processing, benefit administration, pricing, membership, provider, and authorization subsystems for varying lines of business. Involved in the conversion of major HMO processing software from an IDMS database to a DB2 platform. Includes writing and testing DB2 interfaces and creating specs for programming staff to start the DB2 conversion. Also converted their mainframe applications to year 2000. Also converted their mainframe applications to a client server platform for the RISC 6000 project. Mainframe testing , creating test cases and test execution and validation. Using Micro-Focus design new and maintain existing applications. Also involved in analyzing and writing graphical user interfaces for the latest client server platform project. Also converted RISC 6000 platform systems to operate on the NT platform. Converted the DB2 database to Oracle for the NT project. Conversion of Assembler programs into Cobol II programs. Converted easytrieve jobstream to cobol job streams. As Development Lead for Health Scope United - Long Island, NY, responsible for EDI and conversion project for Medicaid claims, eligibility, and authorization data. Data subsequently loaded into MPOWER’S EDI meta-file processes. Tasks involved project coordination, analysis, design, and programming within the COBOL II, CICS, DB2, and UNIX RISC6000 client/server environment. As Technical Lead for Kaiser Permanente - Oakland, CA, designed and developed point-of-service adjudication and benefit administration subsystem. Client required the ability to receive and process claim, eligibility, and benefit information via real-time API calls from Kaiser’s 23 California legacy systems. The system integrated Kaiser’s member-centric eligibility, benefit plans, riders, thresholds, and cost share data from several individual systems. Prototype was developed using COBOL II, CICS, and DB2 within the IBM mainframe environment. Acted as Team Lead/Developer for MPOWER’S new Dental Claims Sbsystem, Great West Life, Denver, CO where responsibilities included integration of dental systems into the existing MPOWER claims, eligibility, authorization, and reference subsystems. Assisted in the development of several dental screens including claim entry, member tooth chart, pre-authorization, adjudication policy rules/edits, and GMIS Claim Check interface. Required COBOL II, CICS, and DB2 within the IBM mainframe environment. Team Lead/Developer for Aetna Health Plans, Hartford, and responsible for all inbound and outbound EDI interfaces to and from MPOWER’s claims, membership, provider, and authorization subsystems. Interfaces were utilized for the conversion of data and on-going EDI data transactions. Developed Medicare subsystem including screens to enter eligibility data and inbound/outbound HCFA interfaces. Utilized COBOL II, DB2, CICS, VSAM, and IDMS/ADSO.

Technical Support Consultant for Brokerage Services, Inc. (BSI), Albuquerque, NM and Employers Mutual, Inc. (EMI), Jacksonville, FL, provided ongoing technical support for MPOWER’S current HMO clients. Projects included the enhancement, maintenance and customization of MPOWER’S managed care claims, eligibility, and benefit, provider, certification, and reference subsystems.

Maintained service and support the regional healthcare and financial facilities, both batch and online.

Created easytrieve application for reporting purposes for client. Applications include release installation, problem solving, product planning, and end user service requests for all healthcare systems. Designed and developed point-of-service adjudication and benefit administration subsystem. Client required ability to receive and process claim, eligibility, and benefit information. Some processes included Medicaid claims. Medicaid processes involved, data collection and claim editing.Formated claim Pre-authorization, adjudication policy rules/edits, and transmitted claim data for adjudication. All development and testing done within Micro Focus COBOL II, CICS, VSAM, DB2,and client/server environment.

Wrote, tested, debugged and implemented COBOL-II and COBOL-II/CICS systems. Provided technical development and maintenance of COBOL-II and CICS systems. Supported technical development of procedures and documentation for development staff. Technical support and analysis for development staff. Assisted development group in the customization and implementation of fully integrated online Human Resource Management Information System that managed all information related to applicants and employees and their dependents and beneficiaries. Work on the configureation and implementation of there new WALKER financial system. Responsible for telephone batch application systems that produced corporate telephone utilization reports for management levels throughout organization. Provided maintenance on Assembler in-house utility programs. Read and debugged hex dumps.