SUMMARY:

• Having 8+ years of total experience in analyzing, testing, developing, maintenance and Production Support Projects in Health Care Domain.
• Experienced in Requirement Gathering, Business Systems Planning, Procedural Development & Implementation, Business Process Mapping, Problem Solving/Workarounds
• Experience in implementation of X12 HIPAA standards.
• Application of Software Development Life Cycle (SDLC), with thorough understanding of various phases such as Requirements, Analysis/Design, Development, Testing and Implementation
• Experienced in conducting Joint Application Development (JAD) sessions with SMEs, Business Analysts, Software Developers and Quality Assurance teams for New Corporate Accounts or Clients.
• Experience in Edifecs XEngine, XEngine Server, Transaction Management, Spec Builder, Map Builder.
• Experience with Trizetto’s Facets and HIPAA Gateway
• Experience in Agile Methodology
• Experience in implementing HOpR rules using Edifecs Product Suite
• Experience in MMIS(Medicaid Management Information Systems)
• Experience in Health Care Domain - Health Care, EDI, HIPAA X12 Transactions, 4010 Development, 5010 Projects.
• Experience in Testing, Maintenance of UAT and Product Support Projects.
• Experience working in a large scale production environment and handling high transaction volume application with 24x7 On Call Production Support.
• Ability to work independently as well as in a group.
• Experience in Windows, Unix and Linux Operating Systems
• Experience in on-site / offshore model and communications.

TECHNICAL SKILLS:

Operating System: Windows XP, WINDOWS 2000, HP-UNIX, LINUX, Sun Solaris

Languages/ Technologies: Java /J2EE, JSP, Servlets, HTML, DHTML, Shell Script, COBOL, AS/400

Application /Web Servers: Web Sphere 6.1, Web logic 8.1/10, iPlanet 6.1, Jboss 4.0.4, Tomcat-5.0.27

Tools: EDIFECS 6.8.1, 7.x, 8.1, 8.3, JIRA, SOAP UI, POSTMAN

IDE: Eclipse.

Monitoring Tools: Control-M

Scripting: Java Script, Shell Scripting, Groovy

Messaging Product: JMS, IBM MQ, CEM (Common Enterprise Middleware)

Databases: Oracle 8i/9i/10g, Informix, DB2, SQL SERVER 2008/2012

Version Management Tools: WINCVS, VSS, SVN

PROFESSIONAL EXPERIENCE:

Confidential- Dallas, TX

Senior EDI Systems Analyst / Developer

• Experience in installing and configuring Edifecs Product Suite - XEngine, XEngine Server, Transaction Management, Map Builder, and Spec Builder in DEV/SIT, BIT/QA, and UAT boxes in Standalone and Distributed environments
• Experience in EDI X12 HOpR (HIPAA Operating Rules) Certification Core Phase I, II and III Operating Rules (150-157) EDI 270/271 Batch transactions
• Experience in all the X12 EDI Transactions 837, 834, 270/271, 276/277, 278, 835, 820
• Interacting with Business, Vendors and internal teams for implementation of EDI transactions
• Experience in 277CA and Claim Adjudication system
• Executing CAQH Core Certification scripts using SOAP/WSDL using SOAP UI and HTTP MIME using POSTMAN
• Experience in analysing and creating new EDI data file using Edifecs Spec Builder.
• Experience in adding Member ID demographic information in and adding Service Type Codes in MMIS
• Experience in using Edifecs EDI Mapping tool Map Builder to which visually translate between formats
• Experience in mapping and translations using Edifecs Map Builder
• Import and export data efficiently using Map Builder including XSD, COBOL and SAP Idoc
• Experience in creating and setting up Trading partners, Agreements and Relationships in EDIFECS Transaction Manager
• Create, edit, test and document Edifecs Spec Builder guidelines and Error Severity configuration files
• Experience in maintaining and enhancing existing application programs.
• Monitor and scheduling EDI transactions using Control-M tool
• Experience working with Legacy Systems (AS/400) and Enterprise Systems
• Experience in data manipulation and EDI File analysis
• Interaction with Payer, Trading Partners and Clearinghouses for problem resolution
• Experience in coordinating with Client, business team and EDI Trading partners to re run the failed transactions
• Experience in writing and maintaining java code as and when required
• Experience in writing SQL Queries to insert records in MMIS
• Communicate with external teams, Vendors to provide support and fix EDI issues
• Liaison for internal and external customers (MMIS/Edifecs/Trading Partners)
• Knowledge of SSIS and SSRS
• Trouble shooting for any errors using the EDI, communication, and application software
• Extensive experience testing and debugging business application systems and processes
• Experience in periodical check for transaction changes by CMS

Confidential, Baton Rouge, LA

Senior EDI Business Analyst / Developer

Responsibilities:

• Experience in installing and configuring Edifecs Product Suite - XEngine, XEngine Server, Transaction Management, Map Builder, and Spec Builder in DEV/SIT, BIT/QA, and UAT and PROD boxes in Standalone and Distributed environments
• Updating Edifecs Product Suite with new Patches as and when required
• Experience in installing and configuring HOpR Phase I CORE Operating Rules
• Experience in implementing and maintaining HOpR Phase I CORE Operating Rules
• Experience in validating all the EDI transaction 83x and 27x in Edifecs XEngine and routing them to backend systems
• Experience in creating new profiles and routes in Edifecs XEngine for both Batch and Real-time
• Experience in analysing inbound and outbound transactions with Customer and Trading Partner
• Experience in interpretation of 999, 277CA and TA1 reports
• Experience in handling these 999, 277CA and TA1 reports in Edifecs Transaction Manager and identify claim corrections before resubmission.
• Experience in creating queues and maintaining existing queues for Batch and Real-time
• Experience in creating and maintaining existing scheduled CRON jobs across all the platforms Batch and Real-time
• Experience in Control-M monitoring tool for automating batch job scheduling, file transfer
• Experience in scheduling workloads on a daily, weekly or monthly interval and triggers events on demand through java web services
• Exposure to BMC Remedy force
• Experience in writing java code as per the requirements and maintaining exisiting code
• Experience in code checkin and checkout process using SVN
• Oversees and setup of production cycles in accordance with SLA’s and ensure timely, complete and processing of all production jobs
• Experience in creating and handling tickets using BCSBLA Service Now tool
• Test partner data files against implementation guidelines and provide meaningful error analysis for quick problem resolution
• Experience in System integration testing and User Acceptance testing
• Coordinate all releases of code to non-production and production environments
• Experience in configuring, setup and maintain BCBSLA proprietary TPM sync process using DB2
• Monitor the flow of data through EDI applications to ensure all operational systems are functioning
• Trouble shooting for any errors using the EDI, communication, and application software
• Experience in working DBA to create and maintain partitions using purge scripts once DB fullback is complete
• Experience in upgrading HIPAA DB updates, External Code LISTS (ECL) updates, new patches when required
• Experience in writing and executing SQL Queries and Scripts
• Experience in writing Batch script and Cron jobs for automation purpose
• Interaction with Development, QA and Build and Release teams
• Assist QA in building the test plan, test scenarios and test cases
• Experience in creating routing and ad hoc data reports using Tableau for business processes
• Experience in file transfer protocols FTP, SFTP
• 24x7 on call EDI support through phone and email
• Knowledge of ICD10.

Environment: Edifecs XEngine/XEServer 8.1, Edifecs Transaction Management 7.0.3.8, Edifecs Spec Builder, Edifecs Map builder, Java 6, ANT, Maven, XML, Java, Java script/Groovy, Unix, Windows, Linux, MQSeries/JMS, Tomcat, HIPAA DB, External Code Lists, SQL Server 2008

Confidential, Irvine/SFO, CA

Senior EDI Business Analyst / Developer

Responsibilities:

• Experience in creating HIPAA 5010 EDI version of 834, 837, 835, 270/271, 276, 278 Guidelines.
• Experience in installing and configuring Edifecs Product Suite - XEngine, XEngine Server, Transaction Management, Map Builder, and Spec Builder in DEV/SIT, BIT/QA, and UAT boxes
• Experience in upgrading Edifecs Product Suite with new patches as and when required
• Created inbound maps from EDI ANSI X12 format into Database tables and flat files
• Involved in creating and setting up Trading partners, Agreements and Relationships in Transaction Management
• Coordinated with Trading Partners to resolve inbound and outbound errors
• Document the defects and assigned them for rework.
• Responsible for validating the defects get fix on timely manner.
• Experience in 837x and 27x Transactions.
• Experience in validating 837x and 27x transactions in Edifecs XEngine and routing them to backend systems
• Experience in interpretation of 999, 277CA and TA1
• Experience in handling these 999, 277CA and TA1 reports in Edifecs Transaction Manager and identify claim corrections before resubmission
• Create Business requirement documents and Functional specification documents
• Worked on bringing the EDI applications up and down during monthly maintenance
• Maintaining client's EDI Guidelines which includes internal unit & system testing for new documents and versions as well as active participation with the team in developing rollout and testing strategies
• Experience in working with all the vendors/third-parties involved
• Experience in debugging the defects/issues and fixing them
• Participated in Weekly/Daily Status and Defect Review meetings with Development and QA Teams

Environment: Edifecs XEngine/XEServer 7.0.8, Edifecs Transaction Management 7.0.3.8, Edifecs Spec Builder, Edifecs Map builder, Java 6, ANT, Maven, XML, Java script, Unix, MQSeries/JMS, Tomcat, Web Sphere 6.0, MS SQL Server 2008, HIPAA DB, External Code Lists.

Confidential, Irvine/SFO, CA

EDI Analyst/Developer

Responsibilities:

• Experience in implementing 5010 HIPAA X12 Transactions 270/271, 276/277, 278, 837, 834, 835, and 820 transactions
• Experience in installing and configuring Edifecs Product Suite - XEngine, XEngine Server, Transaction Management, Map Builder, and Spec Builder in DEV/SIT, BIT/QA, and UAT boxes
• Experience in setting up the Edifecs Environment on DEV/SIT, BIT/QA, and UAT boxes
• Experience working with Edifecs XEngine Processes.
• Experience working with Trading Partners
• Experience in handling tickets with Trading Partners and Clearing Houses
• Experience in creating 5010 version of 834, 837, 835, 270/271, 276, 278 Guidelines
• Experience in writing Edifecs custom java scripts code in Guidelines.
• Experience in writing and invoking java code from Guidelines and from SpecBuilder
• Experience in writing and configuring Severity Files
• Experience in writing Split Rules for the Transactions
• Created Excel based script to import bulk trading partners, agreements and relationships in TM application.
• Experience in testing 5010 transactions End to End
• Experience in debugging the defects/issues and fixing them
• Experience in writing SQL Queries
• Experience in building and deploying .ear file using ANT/Maven
• Experience in Sanity Testing once the new Build was deployed
• Experience in Code Checkin and Checkout using Merant Tracker
• Supported Client in fixing defects/issues after the code moved to Production.
• Used Quality Center 8.0 for test documentation management and defect tracking

Environment: Edifecs XEngine/XEServer 6.8.1, Edifecs Transaction Management 7.0.3.8, Edifecs SpecBuilder, Edifecs Map builder, Java 6, ANT, Maven, Java script, MQSeries/JMS, Tomcat, Web Sphere 6.0, MS SQL Server 2008, HIPAA DB, External Code Lists.

Confidential

Java Developer and Production Support

Responsibilities:

• Coordinated with the Business Analysts, Manager to analyze new purposes requirements for Voice wing and STORC modules
• Used HTML and JavaScript for frond-end development
• Used XSLT to covert xml in HTML/XML and XPath to navigate the document
• Work closely with the business stakeholders to extract and secure requirements.
• Collaborate with QA to ensure all set-ups are available and validate results through test cases
• Acquire sign-offs and maintain proper documentation
• Ant scripts were used for building and deploying applications.
• Used Shell Scripting and scheduled cron jobs.
• Unit testing and Integration Testing was done in DIT, SIT, UAT and PROD boxes
• Debugging issues on UAT and Production servers to provide a stable environment

Environment: J2SDK v1.3/1.4, J2EE, Eclipse, Servlets, JSP, JDBC, XML, XSD, XSLT, XPath, Web Services, SOAP, JAXB, Apache Axis API, Oracle 8i/9i/10g, PL/SQL, Shell Scripting, Ant, CVS, Sun One Web Server, Web Sphere 6.1, Web logic 10.0, JMS/MQSeries, Sun Solaris, HP-UNIX, Linux, Windows XP.