Application Developer III with 20 years of experience researching, documenting, programming, quality testing and implementing business requirements. Strong Pegasystems professional skilled in health insurance, requirements gathering, U.S. Health Insurance Portability and Accountability Act (HIPAA), and Microsoft Office.
Application Developer III
Jan 2004 - Jun 2017
Application Developer III - Information Technology (2004 - 2017)
Researched, developed and implemented a documentation system for all business rules developed within Pega using SDLC methodology. Trained new hires to the team on the health Insurance process and how it is developed with Pega. Coordinated cross team processing and development. Worked closely with the Quality Assurance team to achieve a high success rate before the implementing of business rules into Pega for use into Facets.
- Developed 65% of all business rules work for the entire organization with a zero production defect rate using Agile methodology.
- Coordinated Quality Assurance testing of Pega rules using HP Quality Center ALM and SQL.
- Received recognition for contributions made to the ICD-10 readiness project.
- Received recognition for training the organization on Case Complete document system.
- Created a documentation system using Case Complete to document all business rules housed in Pega.
- Developed all Preadjudication business rules in Pega for the entire organization. This included all HIPAA mandated rules by the Federal Government.
- Developed and performed all business rule updates to Preadjudication, Reporting and Quality Audit.
- Assisted in the migration of Pega 6.2 to Pega 7.2 platform.
- Assisted in building and maintained HIPAA transaction process for converting Eligibility, Claim Status Inquiry and Healthcare services review.
Jan 1998 - Jan 2004
Participated on team that wrote, tested, implemented and maintained claim adjudication programs. Handled updates to provider file. Developed on an IBM OS390 mainframe programming in SAS, Tables DLI and COBOL. Worked extensively with Microsoft Word/Excel and Time Wizard. Worked on EC Map for conversion purposes.
- Backed up all claims data and housing it off site. Worked off shift hours achieve due to system constraints.
- Handled emergency maintenance for Preadjudication programs.
- Built and maintained Tables DLI applications for housing extraneous provider information.
- Maintained updates to Preadjudication programs.
- Assisted with shutdown of mainframe Preadjudication programs and maintenance.
- Assisted with EC Map definitions and conversion of fields for HIPAA X12 conversions.
Programmer & Operator
Nov 1989 - Jan 1998
Handled 3rd shift operations and programming of Amisys software on an HP 9000 computer. Delivered reports to various departments. Managed the backup system for the weekly and monthly back up process. Maintained computer programs for modifications using COBOL programming language.
Management Information Systems
Jan 1981 - May 1987
State University College of New York at Buffalo