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.