Candidates About

Experience:

                  Kern Health Systems                                                                              Bakersfield, CA

                  QNXT Configuration Supervisor                                                April 2017 to Present

                  •   In charge of a team of Benefits/Contracts/Service Groups QNXT Configuration Analysts for Medi-Cal claims payments. Configuration knowledge of Optum's CES DDR Rules and Integration Manager.

                  •   Provided data and maintenance analysis and recommendations for proper Provider/Benefit/Contract configurations using SQL Server to access QNXT databases.

                  •   Environment: QNXT 5.5, Optum CES (DDR Rules and Integration Manager), SQL Server, Agile Methodology (Scrum Master Certified).

                  Molina Healthcare                                                                                       San Juan, PR

                  QNXT Configuration Manager/IT Business Analyst        April 2015 to March 2017

                  •   In charge of a team of Benefits/Contracts Configuration Analysts for Medicaid claims payments. IT Business Analyst for Catamaran PBM interface for members and providers based on Medicaid business line for the IT team located in Long Beach, CA.

                  •   Provided data and maintenance analysis and recommendations for proper Provider/Benefit/Contract configurations using SQL Server to access QNXT databases.

                  •   Environment:  QNXT 5.3, SQL Server.

                  Triple-S (BlueCross/BlueShield of PR)                                                       San Juan, PR

                  EDI Manager/IT Business Analyst                                      March 2004 to April 2015

                  •   Develop a Healthcare Electronic Enrollment division by applying my expertise as an IT Developer and Business Analyst. Included processing of HIPAA 834 (5010), AON/Hewitt, US Government and other proprietary formats to generate electronic enrollment transactions for QNXT 5.1. Provide Business Requirement Documents for B2B and other QNXT interfaces for Membership applications. Enhance controls and audit reports related to the Electronic Enrollment process. Previously worked as an IT Business Analyst for Mi Salud (PR Government Healthcare Reform).

                  •   Provided projects and maintenance analysis based on the SDLC (Software Development Life Cycle) methodology for the programming personnel responsible of the Healthcare Insurance applications. Provide Business and Technical Requirement Documents for B2B and QNXT/Mainframe interfaces for Membership, Claims and Finance applications.

                  •   Environment:  QNXT 5.1, QConnect, SQL Server, Informatica, Axure, IBM Mainframe Z890 Server, Z/VM, Z/OS, COBOL 370, CICS, VSAM, JCL, TSO, Intertest, Xpediter, FTP, NDM, Serena’s TeamTrack and Version Manager.

                  Banco Popular of Puerto Rico                                                                     San Juan, PR

                  Senior Programmer/Analyst                                                 April 2002 to March 2004

                  •   Responsible for on-line and batch project analysis, cost estimates and programming support to the MIS department at Popular Bank of PR. Acting as a project director to implement Baker Hill’s One Point software. Have been in charge of analysis and programming support to Computer Associate’s Account Analysis Mainframe package. Also, have supported Computrol’s Investment (CD and IRA accounts) on-line programming.

                  •   Environment:  IBM Mainframe, MVS, COBOL II/COBOL 370, CICS, VSAM, JCL, TSO, Intertest, ChangeMan and JCL DB2 environment.

                  Keane, Inc. / Formerly Metro Information Services                                    San Juan, PR

                  Senior IT Consultant                                                    September 1996 to March 2002

                  •   Led Metro Consultant's team to develop the Puerto Rico’s Medicaid Healthcare system at ASES, the Puerto Rico's Government Healthcare Medicaid regulator agency.

                  •   Performed consulting services at Triple-S/Interactive Systems, Inc including analysis and programming for Healthcare Insurance On-line & Batch applications such as Subscription, Finance & Claims. Also developed the A/R Finance system using an IBM Mainframe MVS environment.

                  •   Environment:  IBM Mainframe, MVS, COBOL/COBOL II/COBOL 370, CICS, VSAM, JCL, ROSCOE/TSO, ChangeMan and JCL DB2 environment, MicroFocus COBOL II, SYBASE, SQL, UNIX.

                  Education:

                  University of the Sacred Heart                                                                    San Juan, PR

                  B.S. in Computer Science                                                                               May 1985

                  Graduated Magna Cum Laude, GPA: 3.64/4.00

                  Productivity Point                                                                                       San Juan, PR

                  SQL Server 2000 Administration                                                               January 2001

                  ERC Computer Educational Services                                                         San Juan, PR

                  Visual Basic 6 – Basic Level                                                                             May 2005

                  Advanced Computer Technology                                                               San Juan, PR

                  Project Management Fundamentals (PMBOK)                                        February 2007

                  ExecuTrain of Puerto Rico                                                                          San Juan, PR

                  ITIL/IT Service Management Fundamentals – Certified                             January 2008