SUMMARY:

• Around d 7 years of experience in Healthcare industries with thorough understanding of current business trends.
• Well experienced in all phases of SDLC (Software Development Life Cycle) with significant skills in requirement gathering, analysis, specification, design, development, deployment and testing.
• Good understanding and knowledge of Agile and Waterfall methodologies.
• Coordinated End to End testing with QA team. Collaborated with QA team for developing test scenarios for validation.
• Experience in using Microsoft Test Manager for creating Test cases and Reporting Bugs.
• Extensive Experience in preparing Test Plans, Test Scenarios, Test Cases and executing them based on the Business rules and System requirements.
• Excellent communication skills, strong decision making skills, organizational skills, work ethic, excellent analytical and problem solving skills.
• Design, develop, implement, and support various EDI transactions and application integration solutions that meet business needs, including transactions to be exchanged between applications
• Support production systems including analysing and resolving production problems and end user service requests
• Experience in healthcare industry working with various modules using EDI transactions like 837P,D,I, NCPDP, 276/277’s, 820, 999, TA1 and 834’s which fall under the HIPAA compliance
• Coordinating issues with New York State Department of Health (NYSOH) and Electronic Medicaid of NY (Emedny).
• Profound experience in understanding and analysing the differences between segments, elements, loops of various transactions for versions 4010A, 5010.
• In depth experiences of creating X12 files in both 4010 and 5010 versions for various transactions.
• Experience with structured QA Methodology and QA Process to ensure the Quality Assurance Control.
• Communicate with issuer community via phone on electronic data issues to provide Tier II support relating to all EDI tickets and escalates/assigns tickets to different teams according to their expertise among others.

TECHNICAL SKILLS:

Programming Languages: C, PL/SQL, C#.Net, Java, UNIX

EDI Transactions: 834,837(P,D,I),NCPDP Pharmacy transactions, 276, 277, 835,270,271,997,999,INVOICE,ORDERS,850,810,820,856, TA1 and 999

Standards: EDIFACT, ANSII 5010 & ANSII 4010 formats, ICD9 and ICD10

Protocols: SFTP, FTP

Databases: IBM DB2, Oracle SQL Developer Oracle11i,11g/10g/9i/8i, TOAD,, MS SQLServer2000/2005

Testing Tools: Microsoft Test Manager, Quick Test Pro (QTP), HP Quality Center, RTC, RQM and JIRA

Utility Tools: Liason EDI Notepad, EDIFECS Spec builder, Quality Center, Application Integrator, MS Office Suite, MS Project, MS Visio, Notepad ++, HTML, XML, Ultra Edit, Beyond Compare

Bug Tracking Tools: Team Foundation Service, Mercury Test Director, Rational Clear Quest

Widows7 Enterprise, MS: Windows 2003 Server/Vista/XP/98/95, Unix, Linux

PROFESSIONAL EXPERIENCE:

Confidential, Albany, NY

Software/EDI Claims Consultant

Responsibilities:

• Elicit and communicate requirements for changes to business processes, policies and information systems.
• Coordinates issues with appropriate departments, performs accurate and timely research, verification and analysis.
• Worked with Business analyst on gathering requirements and extracting date for the availed resources.
• Coordinating issues with New York State Department of Health (NYSOH) and Electronic Medicaid of NY (Emedny).
• Prepared preparing Test Plans, Test Scenarios, and Test Cases and executing them based on the Business rules and System requirements .
• Collects and analyses data to evaluate operations difficulties and makes recommendations to solve problems.
• Participating in QA team meeting and bug tracking meetings to see the accuracy of data going to Production.
• In depth knowledge of Medicare/Medicaid Claims processes.
• Worked on 837 Institutional, Professional Dental EDI Gateways.
• Worked on 834 Benefit Enrolment X12 processing.
• Worked on Pharmacy standard NCPDP files encounters processing.
• Worked on processing different transitions in various environments.
• Provided On call support over the weekends.
• Validated Notices and communication generated to the enrolled applicants through Market Place of New York State of Health.
• Generated Traceability Matrices to ensure that all the requirements are covered by the test cases.
• Recorded, maintained & tracked defects, assigned type & priority/severity levels.
• Worked on 834 and 837 Encounters for Post Adjudicated claims.
• Proficiency with regulatory requirements associated with HIPAA and the Affordable Care Act.
• Used EDIFECS tool for validation and analyse Encounters files and Enrolment files.
• Knowledge of industry standard health data code sets such as HCPCS, and Revenue Codes.
• Fluent with commonly used EDI concepts and ability to make changes to the file based on scenario test.
• Worked on claims, enrolment, and premium business processes in a commercial, Medicare, or Medicaid health plan/TPA (Third Party Administrator) organization.
• Validated X - 12 files sent by external vendors to ensure that they are passing WTX Gateway level using Spec Builder.
• Recorded, maintained & tracked defects, assigned type & priority/severity levels using RQM.
• Processed and verified date loaded into History data like Duplicate, Member and History edits.

Tools: MS-Visio, MS Office, MS Project, RQM, HIPAA/ EDI X12, NCPDP, Oracle 10g, MS Outlook, SharePoint, Oracle SQL, Quick Test Pro, IBM DB2, Ultra edit, Notepad ++, Liaison EDI Editor.

Confidential, Rockville, MD

Senior EDI Consultant

Responsibilities:

• Elicit and communicate requirements for changes to business processes, policies and information systems.
• Serves as a conduit between the internal, external customers and the software development team.
• Research and establish communication channels with organizations that provide EDI insights and direction Served as the coordination point for implementations.
• Collaborate with cross-functional teams to develop integrated solutions.
• Collaborate with internal and external stakeholders to design, develop, test and deploy these solutions.
• Share expertise with trading partners requesting clarification on EDI standards, file mapping and system logic.
• Prepared preparing Test Plans, Test Scenarios, and Test Cases and executing them based on the Business rules and System requirements .
• Worked on Administration and HUB approval for Adobe Live Cycle.
• Implements procedures to ensure that B2B support issues are resolved in a timely and professional manner and those issues are properly recorded back to our project and issues tracking systems.
• Support the data and reporting needs of our business owners to enable them to better run their business units.
• Coordinates issues with appropriate departments, performs accurate and timely research, verification and analysis.
• Collects and analyses data to evaluate operations difficulties and makes recommendations to solve problems.
• Maintain, manage and provide support for all electronic data exchange with B2B partners.
• Ensure and track volume and quality metrics for B2B enabled customers with emphasis toward compliance.
• Support test team on Integration and User Acceptance Tests.
• Communicate with issuer community via phone on electronic data issues to provide Tier II support relating to all EDI tickets and escalates/assigns tickets to different teams according to their expertise among others.

Tools: Mark logic SQL, Remedy, HPQC, Quick Test Pro, MS Word, MS Excel, MS Power Point, MS Access, MS Project, Transaction Management, Spec Builder.

Confidential, Rockville, MD

Senior EDI Consultant

Responsibilities:

• Elicit and communicate requirements for changes to business processes, policies and information systems.
• Serves as a conduit between the internal, external customers and the software development team.
• Prepared preparing Test Plans, Test Scenarios, and Test Cases and executing them based on the Business rules and System requirements .
• Research and establish communication channels with organizations that provide EDI insights and direction Served as the coordination point for implementations.
• Collaborate with cross-functional teams to develop integrated solutions.
• Collaborate with internal and external stakeholders to design, develop, test and deploy these solutions.
• Share expertise with trading partners requesting clarification on EDI standards, file mapping and system logic.
• Worked on Administration and HUB approval for Adobe Live Cycle.
• Implements procedures to ensure that B2B support issues are resolved in a timely and professional manner, and that issue are properly recorded back to our project and issues tracking systems.
• Support the data and reporting needs of our business owners to enable them to better run their business units.
• Coordinates issues with appropriate departments, performs accurate and timely research, verification and analysis.
• Collects and analyses data to evaluate operations difficulties and makes recommendations to solve problems.
• Maintain, manage and provide support for all electronic data exchange with B2B partners.
• Ensure and track volume and quality metrics for B2B enabled customers with emphasis toward compliance.
• Support test team on Integration and User Acceptance Tests
• Communicate with issuer community via phone on electronic data issues to provide Tier II support relating to all EDI tickets and escalates/assigns tickets to different teams according to their expertise among others.

Tools: Mark logic SQL, Remedy, HPQC, Quick Test Pro, MS Word, MS Excel, MS Power Point, MS Access, MS Project, Transaction Management, Spec Builder.

Confidential, Jacksonville, FL

EDI Software Engineer

Responsibilities:

• Understand Business requirements for HIPAA regulationsand policies by coordinating with various Business teams on 834 EDI .
• Analyze data gathered and develop solutions or alternative methods of implementation.
• Review requirements, and confer with management and users about format, distribution, and purpose, to identify problems and suggest improvements.
• Interview Business Users to ascertain functionality, work performed.
• Document findings of study and prepare recommendations for implementation of new systems, procedures.
• Prepare manuals and train users in use of new applications according to organizational policy.
• Design, evaluate, recommend, and approve changes of Project during SDLC life cycle.
• Coordinate End to End testing with QA team.
• Collaborate with QA team for developing test scenarios for validation.
• Create Use Case diagrams, flow chart diagrams and UML models to design the system.
• Verify the software application according to the requirement specification (SRS).
• Support Post Production Implementation and Production Support for 834 EDI transactions.
• Prepared preparing Test Plans, Test Scenarios, and Test Cases and executing them based on the Business rules and System requirements .

Tools: Microsoft Test Manager, Team Foundation Server, MS SQL Server, Visual Studio Test Manager, XML Editor, HIPPA Validator

Confidential, Collierville, TN

Technical Data Quality Analyst

Responsibilities:

• Develop and assist in the implementation of the project (SDLC) Software Development Lifecycle throughout the organization processes included Planning, Design, Testing and Implementation phases.
• Prepared preparing Test Plans, Test Scenarios, and Test Cases and executing them based on the Business rules and System requirements .
• Reported Directly to Manager of Day to day Testing Activities.
• Performed and Assisted in various testing which includes: System Testing, Smoke Testing, UAT, and Parallel Testing to ensure processing as per Business requirements.
• Track the defects in HP Quality Center, Resolved tickets that were opened by service centres in a timely manner to ensure Quality of the product.
• Responsible to coordinate with support center to send out notifications throughout organization regarding data refresh.
• Participated in defect meetings and team meetings.
• Provided support and guidance by creating Release, Deployment & Operation guide documents.
• Collection of data source information from all the legacy systems and existing data stores.
• Added ranges to Partitioned Primary Index tables that were about to expire.
• Testing maps and migrating from older versions to the current 5010 standard.
• Involved in scheduling Backups and archives and restoring data when required.Performed testing on all EDI transactions both inbound and outbound

Tools: HP Quality Center, MS SQL Server, XML Editor, Shell scripts, Net vault .