Project Title: Medicare Information and Billing System (MIBS) Mainframe Project

Software Environment:  COBOL , TELON, VSAM  CICS, JCL , FTP, IMSDB ,IBM UTILITIES, FAIL AID, UCC7, CA 7 ,  PROSE , REMEDY, SQL.

Project Abstract & Scope:

The Medicare Information and Billing System (MIBS) bills Medicare Part A claims through UB92s and provides information for the Medicare RISK program. RISK, which is known to Kaiser Members as Senior Advantage, is a Medicare form of compensating HMOs based on a flat rate per month per HMO Medicare member. MIBS is a homegrown application used by KP since 1985. It creates and processes, NCAL SNF< SCAL Home Health and Hospice claims.  Claims are sent to a fiscal intermediary GBA Centre for Medicare Services (CMS) . SNF claims are sent to GBA (Palmetto) for reimbursement. Home Wealth and Hospice claims are sent to NGS (National Governmental Services) for reimbursement.

  • Analyzing the Business Requirements and System specifications to understand the application.
  • Communicating with Business users.
  • Provide 24 x 7 on call support and Technical support on Mainframe Applications as well as third party applications.
  • Provide the RCA (Root Cause Analysis) and for the Abends and provide permanent solutions.
  • Support delivery of batch and online programs, customized reports, application/ date conversion and process improvements.
  • Designing FTP feeds using Batch JCL.
  • Modified and run the BATCH jobs for generating user specific reports.
  • Involving in fixing up production issues.
  • Creating and Executing JOBS, PROCS and Control Cards in Test environment.
  • Update the PROSE members.
  • Delete, Define and Restore the VSAM files.
  • Co-ordinate and communicate with Offshore.