Acquired 9+ years of experience in Health care IT industry. Extensively worked on Microsoft Technologies including .Net, C#, SQL Server 2008-2019, SSRS reporting tool and integration services SSIS. 8 years of experience working with Agile methodology.
Extensively worked on creating customized solutions in multiple QNXT 5.1-6-1 version modules on multiple line of business-like Medicare, Medicaid, Commercial Etc. Involve in Carrier/Programs, Contacts, Provider, Member, and Benefit configuration in QNXT 5.0-6.0.
Extensively worked on FACET benefits and Claim processing and application group Subscriber/Family, Claims processing, Provider, Utilization Management, Medical Provider. FACETS EDI 837 and 834.
Experience in Production Support and application management of web applications.
Excellent Team player and constantly striving for excellence, relentlessly pursuing what's best for our clients and balancing pragmatism and perfection. Passionate about technology, solving problems and learning new tools and technologies. Goal oriented self-starter, quick learner and proficient in handling multiple projects simultaneously.Good understanding of the Facets Data Model.Familiar with the Core Facets batch jobs and EDI transactions (834 and 837).Understand functional specs and create a detailed technical design (technical Design document).Develop solutions following industry best practices and perform thorough unit testing.Hands-on knowledge with Sqlserver, DataStage, Facets,
Supported end to end deployment of 834 and 837 custom solutions to production.
Worked closely with the project management team to help successful project deliverable. Functional domain experience involves Insurance and Healthcare.
Responsible for performing research and requirement analysis, creation and design of QNXT 6.0 mapping documents, and presents findings to appropriate team members, clients and vendors.
Develop program specifications and mapping documents. Perform analysis on data to understand transformation requirements, work with ETL/Reporting/Conversion staff to ensure code has been developed that meet the business requirements documented, test the interface/report to ensure requirements are met and work with other team member members.
Application Developer:
Worked on multiple projects including the development of IDN (Integrated Denial language) letter creating for the member based on the denial reason and PAR and NON-Par conditions. Used SSIS and SQL to implement this process.
837 EDI: Worked on the 837 Add-in to add the custom requirement for the COVID claims and adding the member match criteria in the pre as well as post adding. Used C#, SQL to implement this process.
834 EDI: Worked extensively on 834 EDI file processing. Created custom solution using the 834 custom frameworks to add the custom business requirement for the 834 files for adding members in the QNXT Database. Utilized EDI manager and QNXT connect to process the EDI files and configured trading partner to process the 834 files. Troubleshoot issues or production defects that triggered during the EDI file loads.
Involved in AEP processes: creating the automated AEP process. Used SSIS and SQL to implement the solutions.
Production Support: Worked on production support on daily production issues based on incident tickets created on different solutions implemented in C#, SQL, SSIS, SSRS and Power BI reporting.
· Developed and maintained QNXT solutions to support business applications.
· Designed and implemented database schemas, tables, views, and indexes.
· Wrote complex SQL queries to extract, manipulate, and analyze data.
· Created stored procedures, triggers, and functions to automate database tasks.
· Conducted performance tuning and optimization to improve database efficiency.
· Collaborated with cross-functional teams to gather requirements and define database specifications.
· Provided technical support and troubleshooting for database-related issues.
· Ensured data integrity, security, and compliance with best practices and standards.
Worked on multiple QNXT projects including the development of IDN (Integrated Denial language) letter creating for the member based on the denial reason and PAR and NON-Par conditions. Used SSIS and SQL to implement this process.
837 EDI: Worked on the 837 Add-in to add the custom requirement for the COVID claims and adding the member match criteria in the pre as well as post adding. Used C#, SQL to implement this process.
834 EDI: Worked on 834 Member Add-In (APP). Add member and provider match criteria to correctly configured the members into the QNXT system for the claims processing.
FACETS: Involved in FACETS upgrade and performed impact analysis. Define system requirements associated with members benefits and provider reimbursement.
Involved in AEP processes: creating the automated AEP process. Used SSIS and SQL to implement the solutions.
Production Support: Worked on production support on daily production issues based on incident tickets created on different solutions implemented in C#, SQL, SSIS, SSRS and Power BI reporting.
• Lead Developer responsible for design and implementation of 834 pre-addin and post-addin Import.
· Worked on REST web service for processing payments for external vendors from QNXT
· Worked on micro service for member import from external system.
· Extensively used C#, SQL Server 2017, Created tables and stored procedures.
· Created Test plans, test cases and test scripts.
· Supported deployed of QA certified code to pre-production and production environments.
· Involve in configuring Carrier/Program, Contracts, Provider and Benefits in QNXT 5.9.
· Worked on building custom solution for 834 process for new member enrollment and updating existing members.
· Created reports using SSRS for the members with missing information or the member records that were not loaded into QNXT.
· Configured EDI and Trading Partners in QNXT
· Worked on troubleshooting issues BIZTalk server for 834 pre-addin and post-addin.