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Hipaa Resume

Sacramento, CA

Summary

  • Senior IT consultant with over 10 years of experience in IT industry while working as an EDI analyst and consultant.
  • Sector-wise experience encompasses healthcare, logistics, insurance and services sectors.
  • Very good experience working on HIPAA translation based claim processing systems (claims and encounters) and other ANSI X12 EDI implementations.
  • Transaction-wise experience includes 837/835, 270/271, 276/277 and 834
  • Highly skilled in performing business analyst related activities which include creating specification, requirements and generating test scripts as well as test data.
  • Expertise in setting up B2B data transfer scenarios and working with trading partners.
  • As an EDI analyst highly experience creating mappings, validation and transformation rules for translating documents from X12 to proprietary format.
  • Knowledge of HIPAA (5010) along with ICD code migration from ICD-9 to ICD-10.
  • Excellent documentation and communication skills.

Technical Expertise

  • Languages: Java, SQL, HTML, BPEL4WS
  • ASC X12 Sets: X12 (850, 814, 811, 272 )
  • HIPAA: 837/835, 270/271, 276/277
  • HL7: version 2.x and 3.0 (RIM) – ADT, Orders, Results, Schedules, billing.
  • EAI Tools: SeeSeebeyond e*Gate (JCAPS) , Biztalk, XI/PI, Tibco, MQ Series
  • Platforms: Windows (2000,NT,XP) ,HP Unix, IBM AIX, Sun Solaris.
  • Databases: SQL (T-SQL), PL/SQL, Oracle, MS SQL Server, DB2, Sybase
  • Microsoft: Office, Access, Visio, Project.
  • IDEs: NetBeans, XML Spy

Professional Experience

Confidential, Sacramento, CA Jan 08- Current

Client: Confidential,

Role: HIPAA Business Analyst

  • Justified the need of an ESB as a part of their SOA landscape
  • Provided suggestions for leveraging the use of ESB and its features.
  • Supervised the implementation and testing efforts for individual testing partners in a B2B environment.
  • Created a high-level document outlining migration procedure from 4010 to 5010 and ICD-9 to IC-10 migration.
  • Created web service definitions for some of their encryption and logging services.
  • Conducted impact analysis to identify areas affected due to enhancements.
  • Documented the enhancements in the Companion Guide for 837/835 submission and retrieval by the service provider companies.
  • Responsible for maintaining implementation documentation as well as SOP documents and tracking changes in those.
  • Identified risks, estimated project duration and allocated proper resources.
  • Environment: HIPAA, X12 EDI, JCAPS 5.1.3 , JCAPS 6.0 SOA Software, Oracle and Weblogic AS.

Confidential,

Role: HIPAA Analyst

  • As an HIPAA EDI analyst involved in creating functional and technical specifications for 837/835 transactions involving claims and response remittance advice.
  • Involved in validating mapping of data values from HIPAA to data containers in e-HR system.
  • Overseeing of development efforts and managing programmers. Lead all the technical efforts revolving around NPI implementation and designed the NPI crosswalk logic.
  • Responsible for system maintenance and adherence to compliance rules.
  • Environment: Java CAPS 5.1.3,SRE, Oracle, Sun Solaris.

Confidential, Springfield, IL Nov 05 – Sep 07

Client: Confidential,

Role: EDI analyst – HIPAA (4010- 837/835, 276/277)

Worked DMHs 837/835 claiming system enhancement project to implement void and replace functionality. Also created initial design for 276/277 transactions for claim status.
Developed technical specifications for incorporating void and replace functionality into current claiming system.
Created technical and functional requirements for translation of 837 (P and I) files into proprietary format files.
Identified key fields to be populated in the 835 outbound transaction for remittance advice to the counties from the EOB.
Documented the enhancements in the DMH Companion Guide.
Revamped the claims balancing module for matching of various amounts.
Filtered out unwanted errors encountered in the Claredi tool and incorporated Claredi errors in the overall error schema.
Lead all the technical efforts revolving around NPI implementation and designed the NPI crosswalk logic.
Environment: e*Gate/e*Xchange 4.5.3, IBM mainframe, MS SQLServer 2004

Client: Confidential,

Role: Business Process Analyst

Designed business processes in e*Insight for their payment processes.
Created activity elements (receive, reply etc.), branching activities (decision, flow etc) and intermediate events (error and compensation handlers).
Exposed business processes as services and invoked services from them.
Used sub-processes for resuability and business rules for passing data.
Created XSD files and exported their nodes to be used as OTD (Object Type Definition) for collaboration rules to be exposed as services.
Environment: EAI software, Oracle, J2EE, Apache Tomcat, Sun Solaris.

Confidential,Monrovia,CA Mar 03-Nov 05

Client: Confidential,

Role: EDI analyst - HIPAA (4010 - 270/271) HL7 (ADT)

Worked on interfaces for eligibility request and patient administration messages.
Involved in mapping of key fields for claim status request/response interfaces.
Created an SRS document containing all the functional requirements.
Worked with FacilEDI(Claredi) validation tool to incorporate various edits in order to achieve WEDI level 6 compliance.
Acted as a liaison between the Montifiore and NY DOH for resolving data issues.
Designed interfaces and designed end-to-end scenario for processing.
Conducted a system analysis and suggested message size, component scaling options for optimal performance and high availability.
Provided an outline of a custom error schema for error and exceptions.
Acted as a liaison and coordinated all the development efforts.
Environment: HIPAA 4010, HL7 v2.

Client: Confidential,

Role: B2B analyst and consultant

Architected the entire B2B solution including network topology and components.
Placed B2B components in separate DMZ zone and sensitive data behind firewall.
Created partner profiles in the B2B interface for all the trading partners which included setting up of ISA/IEA, GS/GE and ST/SE envelope information.
Set up validations scripts for all incoming transactions.
Designed a PGP encryption interface embedded in the B2B gateway.
Set-up profiles, protocol (communication and B2B) and envelope structure parameters for all trading partners (TP) and external parties.
Configured seebeyond eX_schema and eX_ePM component for data routes.
Used ePM web interface and eXchange database tables to monitor messages.
Environment: e*Gate/e*Xchange 4.5.3, MS SQL Server 2000, Claredi (FacilEDI).

Client: Confidential,

Role: Seebeyond/e*Gate developer/support

Developed interfaces for data transfer from mainframe to ERP system.
Created MM and monk e*Ways, java collaboration rules and JMS IQs.
Created DB ETDs (tables, prepared statement) and X12 ETDs.
Used Batch (FTP), HTTP(S), Oracle, Email and JMS eWay connectors
Worked extensively with SSL : certificates, truststores and keystores using
Used e*Gate monitor for components, log levels and IQ Administration.
Environment: e*Gate 4.5.2, IBM AS400, Oracle Financials(9.1), java keytool utility.

Confidential, Albany, NY Sep 99 – Mar 01

Client: Confidential,

Role: Application Developer

Worked on an n-tier online application for tracking of HIV patients in the state
Created front end dynamic web pages using HTML and javascript.
Accessed methods for identity matching remotely using Java RMI technology.
Connected to back-end Sybase database using JDBC API.

Client: Confidential,Role: Associate Consultant

Implemented a POC (proof-of-concept) project which involved creating a palm-pilot based to showcase the features of sybase’s thumbnail database (db for handheld mobile devices).
Conducted technical presentations and generated technical documentation.

Education and Training

  • Bachelors in Computer Science (BE CS)
  • Masters in Computer Science (MS CS)
  • Seebeyond ICAN 5.01 and e*Gate 4.5.2
  • Sybase ASE, ASA and Java training

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