• Examined the JSON schema of a vendor replacement product to identify necessary modifications for replacing the current SOAP interface. Translated the JSON schema into COBOL working storage and produced source code based on the schema.• Revamped the design of existing online programs to accommodate the new API structures and methods. Introduced new elements to support the MVC architecture methodology and modularized recurring business logic into callable modules. Conducted meetings with the vendor and business to validate findings and refine the design accordingly.• Supervised the development of crucial components, collaborating with external teams to implement changes in MQ and MuleSoft.

Devised a solution to track program processing statistics for job processes and programs. The statistics combined with generic email templates are used to generate emails when jobs have completed and report them. MHS claim system analysis to change hard coded business name in existing code base and configuration files. • Met with user to determine the type of data to track from the existing import and extract processes. Analyze existing processes to determine how data was captured and disseminated. • Design database tables to track process names, statistics and expected job run dates. Design subroutine to add to control language and COBOL programs. Design generic email templates and methodologies that allow data from multiple sources to create the same emails with variable substitution. Evaluate SQL and create necessary indexes for performance. Built all objects. • Create user manual to support code review and roll out of the statistics and email project to other developers. Rollout is in progress. • Evaluate system API call and system command to generate code search results. Create a process to find multiple strings in the source code and configuration files putting the results into a database table for querying. Queries built to determine the number of objects that required changes to support the business name change.

PowerMHS claim system reverse engineering to map existing processes, creating program and data flow diagrams. • Created a process to extract all the SQL and decision logic from programs that were feed into an Excel spreadsheet for analysis to build the business rules. • Consolidate and cross reference the detail business rules into a summary that is compared against the rules of Proclaim claim system to determine the differences between the two systems.• Presented rule results and data mappings with Proclaim counterpart to business analysts and developers.

Rewrite the explanation of benefits (EOB) process to meet new standards and healthcare reform legislation. Build an income extract process for commission payments. Create process to determine and charge interest on accounts that did not pay full premium amount in timely basis. • Met with enterprise system architects to generate EOBs at the subscriber level in XML replacing the flat file structure. The EOBs are sent via MQ to a Java system that packages all the EOBs into a single stream file that is secure FTP’d to the print vendor. Met with business users to determine new text and data requirements on the EOBs. • Evaluate COBOL XML generation statement capabilities and determined a generic subroutine that could build XML strings was required due to lack of ability to process OCCURS clauses by the statement. New text required data substitutions within the text in some cases. Existing process was long running due to continual look ups of text inserted into the EOBs. • Design XML generation subroutine, multiple subroutines that would load text into working storage tables for performance and a process that would determine the benefit usage summary for the family. Changed data sort of input data to facilitate grouping of related data for performance. Evaluate, reorganize and create indexes for SQL performance. Built all objects.• Coordinated activities with iSeries technical, QA, MQ, Java, performance testing, enterprise architects and business teams as code progressed through the testing regions and into production.• Review code base and recommended major enhancements to a Java web-based front-end that called COBOL PowerMHS API’s to perform specific BCBSNC membership edits prior to updating the system. Enhancements reduced the number of existing production defects. • Create ad-hoc SQL queries to support research into issues. Evaluate SQL for performance issues using Explain. Change SQL queries when possible and create necessary indexes for performance.

Finalize design and implement critical processing requirements for claims adjudication process. • Implement calculation of member benefit liabilities (co-pays, deductibles, coinsurance, out of pocket maximums) and track the coverage and usage limits. Aggressive timeframes using a phased deliverable approach. Timeframes met.• Implement claims adjustment process to correctly void/adjust previously paid claims and associated member accumulators. Aggressive timeframes. Timeframes met.

Recruited to secure business requirements, create design documents and build commercial claims adjudication system. Directed the daily activities of five developers. Priorities, issues and solutions communicated to senior management in a timely manner. Coordinate design and development activities with system architects, data modeler, DBAs, windows developers and Medicaid membership team. Membership sub-system completed on time. • Create technical solution blueprint documents for major membership eligibility processes: Member identification, member eligibility interfaces and the organizational structures required to group members for administrative and financial purposes. Resulting documents reviewed with system architects and management and provided the foundation for the membership eligibility subsystem.• Communicate solution approach to customers. Multiple presentations delivered to state of Georgia technical and business owners addressing issues and solutions. • Integrate online and batch member eligibility business edits to reduce development costs and programming errors. Create design documents to describe the process flow, program processing requirements and database access required. The document package resulted in the creation of the membership project plan and a communication tool to direct design and programming work.• Mitigate risk of new membership eligibility process using a proof of concept model. Project plan structured to allow testing of the complete process with reduced program functionality. The first successful member adds occurred two months prior to the end date. Weekly builds were maintained.• Design and code review for adherence to standards.

Recruited to create design specifications for the PowerMHS system and evaluate system impacts of enhancements to the membership, financial and claims system. Create functional and technical specifications. Assist programmers, quality assurance and documentation teams create scheduled system releases.• Design tier calculation process to automate the assignment of tiers used for premium billing. Process available in both online and batch environments. Batch process creates a queue of subscribers that have multiple tier choices. User specifies selection criteria and works the queue based on business needs. Business value: reduction of manual errors and time spent to determine the tier.• Design premium billing changes to support annual, semi-annual, quarterly and bimonthly billing periods and to set the billing period to any day of the month. Business value: provide flexible premium billing options to existing and prospective customers.• Design premium billing and financial system enhancement to track the premium billed to the general ledger account and assign accounts receivable partial payments to related general ledger accounts. Business value: split partial payments to meet state reporting requirements.• Design additional claim calculation fields to user definable to-pay formulas. Business value: support user ability to customize the claim adjudication process.

Analyze and document life insurance system for year 2000 date change. Verify vendor solution corrected year 2000 date calculations. Generate year 1999 and 2000 test data to verify functionality for current and year 2000 processing.

Determine business objectives for internal and external customers. Lead a team of software developers. Design and create necessary applications and databases. Coordinate with quality assurance and platform support services to implement application systems.• Work with business users to create a requirement and design document for a plan migration process. Reviewed system design with architect and platform technical services. Created project plans and determined resource needs. Created CICS screens with remote DB2 programs providing data. Led a team of four developers to implement Phase I on time.• Led a work group to create a plan benefit translation database. Led a development team to create application program interfaces that generate keys, identify duplicate data and add records to the system. This process automated conversion of over 700,000 benefit plans.• Analyzed a plan benefit system to determine gaps. Designed additional databases and applications to address gaps. Coordinated design efforts with subject area teams that required plan information. Deliverable timeframes met. Design deliverables completed on time. • Led a team of five developers to design and implement plan benefit changes. Coordinated development activities with the quality assurance team and the platform technical support personnel to implement software into production. Completed ahead of schedule.• Coordinated with system architect, Visual Basic and mainframe developers to create a three tiered client/server process to update plan benefit data. Led a work group with database administrators to normalize the benefit plan VSAM file structure into a DB2 database structure for the client/server application.• Manage twelve programmers and business analysts to install end of year release under tight time constraints. Release installed on time.

Determine client requirements for system enhancements to the PowerMHS system. Design, document and create applications to meet the business needs. Provide ongoing production support.• Enhance existing customer programs to automate capitation and reconciliation payments. Coordinate business and technical efforts to install required changes. Business results: reduction in manual errors. Payments totaled over $800,000 monthly to providers. • Change claim adjudication process to automatically generate an additional payment per service date. Business result: automated manual payment process and reduced payment error.• Create and document automated process to load member eligibility changes by tape. Process installed in two client sites and updated over 15,000 members per month. • Design and implement a provider credentialing system. Business value: automation of entire department.

Determine client requirements for system enhancements to the PowerMHS system.• Determine the scope of client enhancements, create schedules and assign resources. • Schedule and direct the work of four application programmers.• Maintain premium billing processes.• Develop, enhance and maintain capitation, on-line and batch membership entry.• Develop membership, plan, references, provider and utilization review subsystems.