B2B integration Resume

SUMMARY

15 years of experience in design, mapping and development of maps and components for B2B integration. Strong debugging and problem solving skills with excellent understanding of system development methodologies, techniques and tools. Excellent understanding about ANSI X12, UN/EDIFACT, XML, EDI and Health Care (HIPAA) Transactions.
Experience in EDI transaction 837 P/me/D, 276/277, 270/271, 834 835 and 820, 824, 997, 999 for 5010 version. Good Experience in migrating the EDI X12 all transactions version 5010 transactions. Worked on EDIFECS, EAM, Xengine, Spec Builder, Map Builder Trading Platforms. HCSC (Health Care Service Corporation), NY, IL TX State Medicaid Implementations and Enterprise projects involving electronic data interchange (EDI).
Maintain client compliance with ASC X12 and CORE requirements, State Medicaid rules, and Centres for Medicaid & Medicare Services (CMS) guidance via review of industry/state guides and information - sharing with subject matter experts. Working on State-specific business rules and upfront edits, prioritize encounter (Encounter Management) exceptions and remediate via built-in workflows. Assist on Interoperability and Patient Access rules Proof of Concepts and implementation of patient access Application Program Interface (API), HL7 Fast Healthcare Interoperability Resources (FHIR). As part of Interoperability implementation to support patient access API (which includes claims, encounters, pharmacy, and select clinical information), and HL7 FHIR formats needs to understand various systems to gather required data and understand various paradigms to deal with interchange key concepts.

TECHNICAL SKILLS

EDI: 5010/ICD10, 4010/ICD 9, HIPPA, EDIFECS, Spec Builder, EAM, ECMap, Paper Free, Mercator 6.7, Informatica DT and DX. Java, J2EE, Java Script, XML, XSD, Groovy, Drools, REST Web services, Test Automation, Oracle, SQL, Encounters Management, FHIR, HL7 Version 2 and 3, CDA, CCDA, Healthcare Interoperability.

EDI Tools: EC Map, EC Gateway, Paper Free, Edifecs Encounters Management, Edifecs RRM. EDIFECS, EAM, Xengine, Spec Builder, Map BuilderMercator 6.x, BizTalk 2002Informatica PowerCenter, Informatica Data Transformations, Informatica Data ExchangeDTA( Informatica Data Transformations Accelerator). HL7 FHIR release 2, 3 and 4

Programming Languages: Java, J2EE, Drools, Perl, XML, xsd, Groovy, Web services

Knowledge on HealthCare Products: Advanced - Claims processing owned by DST. MMIS Medicaid Management Information System-ACS FACETS Affinity Health Plan QNXT MMS Molina Medicaid Solutions

Transaction sets: 834,835, 837 me P D, 270/271, 276/277, 278, 275, 820.277RFAI, 275, 277CA, 999, 299, 298.

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