SUMMARY

• Software Consultant proficient with overall 10 years of development, Testing, Implementation, FHIR, HL7 Interface & EDI Consultant, Application specialist, Scrum Master, Business Analysis, Product Consulting
• Expertise in EDI Mapper / EDI Translators such as Symphonia, TLE, Gentran, MuleSoft (B2B), .Net Suites
• Subject Matter Expertise in EDI implementation, ICD - 10, HIPAA 5010 X12 transactions like 270, 271, 276, 277,278, 834, 835, 837P, 837I, 997, 999.
• Participates in upgrade/maintenance efforts for all legacy applications and Interface Engines and HIPAA validation and transformation tools.
• Reviewed the existing architecture and design documents and created work flows based on the proposed changes.
• Expert in leading the integration efforts, involving transformation and routing of data between disparate applications or systems, including as a subset, Electronic Data Interchange (EDI), as well as business, clinical, and other financial data.
• Participates in analysis and maintenance of the Enterprise Application Integration (EAI) environments and products.
• Extensive experience in EDI Translators, EDI Implementation, HIPAA5010, HL7 ((ADT, MSH, DFT), ICD9, ICD10, DRG, ANSI X12, XML, JSON, various messaging protocols
• Worked extensively in managing security features in the .NET framework like authenticating and authorizing users using Forms based authentication, creating Membership, Profiles and Role Providers.
• Working as a Test Data Manager to handle all the test data needs from various projects and testers
• Create and execute unit tests and perform basic integration, webservices and systems testing
• Experience in creating X12, HL7, Flat files, JSON, XML test files with the help of Data Discovery, Data Profiling, Gold Copy, Data Sub-setting, Data Masking, Synthetic Data Generation, Data Provisioning, Data Reservation and Data Virtualization techniques
• Expertise in creating the test data for unit, functional, volume, and performance testing needs
• Experience in writing stored procedures, views, triggers and SQL Queries in SQL Server 2012/2008 R2 and Oracle 11g/10g.
• EDI schema design, mapping, files review, trouble shooting, coordinating, customization of application based on customer needs
• Experienced in mapping of various Healthcare modules (Patient, Member, Provider, Claims, Authorization) with XML, FHIR, JSONS and various ICD10 codes
• Experience in writing complex SQL queries to understand the billing, claims data, also perform various ad-hoc analyses and data profiling to identify the route causes for data issues.
• Skilled in creating test traceability matrix, test strategy, test plan, test procedures, test cases, test log, automated test scripts, test results and defect reporting.
• Extensive experience in handling enrollment, Medical coding, billing, claims, account reciveables
• Involved in EHR custom application development, Issue analysis & fixing, configuration and Consulting.
• Worked on HIX (Health Insurance Exchange), EMR (Electronic Medical Records), EHR (Electronic Health Record) and healthcare reforms like the Patient Protection and Affordable Care Act (ACA).
• Detailed working knowledge and hands-on experience with HL7 interface technical/business analysis and development of various interfaces including ADT, ORU, ORM, DFT, MDM etc.
• Specialized in Confidential Millennium, Soarian Financials, Soarian Scheduling, Soarian Clinical, MediTech, eClinical works, Facets, Request Validator, Product Implementation, Support Analyst,
• Provide HL7 custom software development for HIE, RIS, LAB, Results, Orders and dot net custom Development. Test and Validate custom inbound and outbound HL7 messages.
• Work collaboratively with Confidential, GE IDX Analysts, EPIC, EClinical works as well as support systems integration and optimization of new and existing clients.
• EDI Schema design, Creating EDI fields mapping documentation, trouble shooting EDI Transactions
• Conduct healthcare data files and analysis and identify issues and recommend and implement solutions
• Proficient in developing, and deploying secured Windows Forms applications, Windows Application Development (Win Forms) using ASP.Net.
• Implemented Report viewer to integrate the SSRS reports with the ASP.Net web forms.
• Experience in using SSIS tools like Import and Export Wizard, Package Installation, and Package Designer
• Install, Test and Validate HL7 ADT, RX Profile, Inbound & Outbound Charges, Inbound & outbound ORM's, ORU's, PACS, Transcription & Dictaphone (MDM's), and SIU's (Scheduling) installation and trouble shoot issues at a high level.
• Review vendor Specs for required fields in HL7 Standards, create Gap Analysis spreadsheet to prepare for upcoming Interfaces.
• Excellent knowledge and work experience in Revenue Cycle Management Services like Charges, Authorizations, Claims, AR Follow up, ICD-10, and Product Testing.
• Experience in working with HL7 version 2.x, and 3.x, EHR, EMR, HIS, ICD, DSM, SNOMEDCT, HIPAA5010, EDIFACT, X12, XML Schemas
• Reviewed and documented business requirements and assessed impact of changes to existing systems increasing the amount of data captured
• Ability to translate the requirements of the customers to the appropriate technical or business team(s) throughout the life of each project ensuring system performance and data integrity.
• Prioritized customer requirements and made improvement through customer feedback and interactions.
• Experience in development and testing with SCRUM, AGILE and Waterfall SDLC models.
• Expertise in performing testing methodologies, Regression, Functional, Manual, GUI, Smoke, Integration, System, Compatibility, White Box, Black Box, Performance, (UAT) Acceptance testing
• Good Experience using in documenting the UML diagrams like class diagrams, sequence diagrams, Use case diagrams, etc

TECHNICAL SKILLS

EDI Translators/BP Engines: EDIFECS, Mirth Connect, Rhapsody, Symphonia, Request Validator, Gentran Integration Suite, IBM Integration Bus, Message Broker, Web Methods

Healthcare Tools & Technologies: HL7, EDI, EHR, EMR, FHIR, OPEN Link, Symphonia, Request Validator

Communication Protocols: FTP, HTTP, SFTP, HTTPS, AS2, VAN, TCP/IP, PGP, SMTP, SNMP, IMAP, JMS, SAP Suite Adapter, SQL*Plus, SQL Loader, MS Visio 2000.

EDI Transaction Sets: ANSI X12 270, 271, 276, 277, 278, 820, 834, 835, 837P, 837I, and 997

Languages: VB.Net, C#, C/C++, ASP, VB SCRIPT, VB6

Web Technologies: HTML, DHTML, CSS, Web Services, SOAP, WSDL, XML, XSLT.

Scripting Languages: SQL, Java Script, UNIX, Shell Scripting, AngularJS/2.0, HTML5, PL/SQL

Databases: SQL Server 2014/2008R2/2005, Oracle 11g/10g/9i, T-SQL, MS Access.

Reporting & ETL: SSIS, SSRS, SSAS, Crystal Reports

Operating Systems: Windows 10/7NT/VISTA, UNIX, Linux, Mac OS X, Windows Server 2002.

Healthcare products: Confidential, Soarian Clinical, Financials, MEDITECH, eClinicalWorks, GE IDX, Office Ally

PROFESSIONAL EXPERIENCE

Confidential

EDI Mapper / EDI Analyst

Responsibilities:

• Worked as Subject Matter Expert / EDI Consultant for VA Claims Modernaization systems (eCAMS) to setup the maps and implement claims adjudication system to process both VA and Non VA Claims
• Worked closely with the VA ( Confidential ) Financial Services center (FSC) management to understand new electronic commerce division (ECD / EDI) initiatives.+
• Supporting all the Healthcare / Logistics and Financial EDI Transactions such 270, 271, 276, 277, 278, 810, 850, 837P, 835, 837I, 837I, 997, 999 etc.
• EDI schema design, mapping, files review, trouble shooting, coordinating, customization of application based on customer needs
• Created requirements specifications, mapping documentation using formal or ad-hoc tools
• Using TLE (Transalator / Mpper) Creation and modification of EDI maps in a variety of formats and standards including; Proprietary, XML, ODBC/JDBC, flat file, X12 and EDIFACT.
• Supporting MCCF-Electronic Data Interchange (EDI) Transactions Application Suite (TAS) - MuleSoft B2B integration, FHIR, NPI HealthShare, E-Payments, Claims modernization, E-Pharmacy, E-Dashboard, Ebiz Reporting, MicroSoft Azure cloud projects
• Creation and modification of business processes and workflows with and without the use of process modelers in comprehensive integration suite environments
• Worked closely with Change HealthCare clearing house for integration testing and set up the new vendors on 837, 277, 278, 835 EDI Transactions
• Trading Partner Testing - Create trading partner profile, communications testing.
• Trading Partner Implementation - Create trading partner profile in production, move resources to production environment.
• Serve as an EDI mapping developer for implementation and deployment of customer and vendor and other partners constituencies EDI implementation.
• Monitor and documents all EDI requests and track all applications and participate in IT meetings on weekly basis and monitor progress for same in coordination with IT director and plan effective solutions.
• Manage IBM Sterling B2B Integrator, which handles all B2B and other internal/external system integrations. This includes EAI and ETL processes for B2B Integration (EDI and non-EDI)
• Monitoring and supporting all EDI processes, including troubleshooting EDI production issues and working with IT and health plans to identify solutions and resolve all issues effectively.
• Identifying and resolving health plan rejections daily along with managing all communication with clearinghouses and health plans.
• Managing all the VA IT Modernization - “Cloud First” policy related proejcts to migrate all the legacy applications to cloud by using MA Cloud and industry leading integration & EDI translators to enhance system interoperability, efficient customer service delivery with reduced infrastructure foot print and reduce the operational and maintenance cost.
• Prioritized customer requirements and maintained continuous improvement through customer feedback and interactions.
• Successfully set up the all the envrionments on cloud machines and migrated projects to MAG cloud
• Worked as Test Data Manger to create all sort of EDI X12 files, HL7, Flat files, XML, JSON, using automated data extraction and data masking, Synthetic Data Generation, Data Provisioning, Data Reservation

Business Analyst

Confidential

Responsibilities:

• Creation of Business requirement documents (BRD), systems requirement specifications (Technical specifications documents) and X12 mapping specification documents.
• Steup the integration between FSC and HealthShare and Vista sites to extract data from various sites
• Working on reporting tools such as Tableau, SSRS, Excel reports
• Created FHIR JSONS, tested messaging flows from TASCore to Rabbit MQ to FSC SQL database and trnalate them to preprocessor and X12 formats to send to vendors
• Perform in depth analysis on the technical and functional requirements for FHIR (HL7) conversions to X12 files and electronic payments.
• Working with FHIR-JSON and HL7 interface and development of various interfaces including ADT, ORU, ORM, DFT, MDM etc
• Created gap analysis document on existing and new requirements for HL7 to proprietary and HL7 - X12 data elements, FHIR JSONs to FSC Proprietary data Formats
• Creating EDI Mapping documents, ICDs, Test files for various transactions such as 270, 271, 276, 277, 278, 810, 837P, 835, 837I, 837I, 997, 999 etc.
• Worked with clients/customers, ECD, FHS, FMBT departments, internal and external business partners and database developers to define, document and review business and system requirements to support report solution development.
• Defined the deliverables pass/fail criteria, Suspension criteria and resumption requirements for all the EDI Testing projects.
• Design test scenarios, test cases and created test data which is required for E-Payments, E-Dashboard, DNC 835 projects
• Created requirements traceability versus test cases Versus defects by using IBM Rational tools such as CM (Change Management), Requirements Management, Quality Management
• Document the progress of all requirements within a weekly Requirements Status Report.
• Guided/mentored the testing team to understand the requirements, tools and test strategies
• Participate in implementation conference calls with customers to discuss client data mapping, claims system interfaces and project plan items
• Provide documentation and traceability of requirements and requirement metrics reporting. Operate and facilitate the requirements management tool, VA Rational Tools Suite, as the repository for all business and technical requirements.
• Provided ANSI X12, EDI, HL7 knowledge transfer sessions to the developers and testers to make them understand all the proposed changes.

Confidential

Progammer Analyst

Responsibilities:

• Worked as business analyst, technical and subject matter expert for initiatives involving member enrollment application processing.
• Responsibile for creating business rules and processes involved in inbound and outbound 837 (Claims), 834 file processing, maintenance of the enrollment data in the core application (Facets),
• Involved in requirements gathering for each trading partner and creation of output files and notifications related to beneifts, enrollment, claims, and premium processing
• Identified specifications for billing and accounts receivable requirements, performed gap analysis and presented information to technical team to identify system requirements.
• Facilitated strategic meetings between Perot technical team and hospital administrators resulting in identifying key differences in clinical systems.
• Wored with Relational databases, MySQL, Sybase, SQL and database access interfaces (ODBC, JDBC, ADO, ADO.NET) and Using Entity Frame work and LINQ to SQL.
• Mainly working of X12 Healthcare Electronic Data Interchange (EDI) transaction sets such as 270, 271, 276/277, 834, 837, 835, 999, by following HIPAA regulations and healthcare administration functions, including claims processing, eligibility verification and preauthorization.
• Provide support to all EDI production processes and develop and modify all maps for trading partners and coordinate with end users to expand all e businesses.
• Participates in workgroups to evaluate and document current state processes. Performs analysis to define opportunities to create improved future state workflows/solutions (end-to-end process flow development)
• Attends state and CMS regulatory meetings on claims, enrollment topics and discussed about various managed care plans (HMO, PPO, EPO, POS) related requirements
• Participates in trading partners and industry user groups
• Assists management and end users in evaluating vendor software applications.
• Participates requirements gathering and design sessions.
• Documentation of all business and functional specifications used for software design and development including software traceability matrices and use case diagrams.
• Conducts requirements reviews to obtain sign-off from project/operational stakeholders.
• Creates task lists/project plans for smaller initiatives. On larger project initiatives completes assignments as defined by the Project Team.
• Reports project status updates to stakeholders and IT Management
• Identifies issues and facilitates problem resolution for manual, batch and online environments.
• Uses metrics and data to lead process improvement initiatives
• Analyzes and queries data; has knowledge of the Facets data models
• Data mapping, including the creation of file specifications; source to target mapping
• Testing, including the creation of test plans, test scenarios, test data and understanding of outcomes
• Provides training and educational assistance to customers when necessary
• Communicates internally and externally with all levels of employees including management
• End-to-end ownership of assigned initiatives - requirements through implementation
• Upto date with industry trends and state/federal compliance initiatives

Confidential

Application Specialist

Responsibilities:

• Evaluates user requests for new or modified HL7 interfaces, cost and time required, compatibility with current system, and computer capabilities.
• Worked on various HL7 Messages including inpatient/clinical side / ADT
• Experience in HL7 system design and configuration, process and workflow design, Implementation, Interfaces Installation, Setup, Configuration, Administration and Trouble-shooting
• Troubleshoot issues related to applications such as CPRS, DocMan, ROI (Release of Information), ADT Filer (HL7 Messaging)
• Confidential EDI Map development and tier II support for GENTRAN Server for Windows version 5.3
• HL7 supporting using C#.Net, VB.Net and SQL server capabilities
• Participated in all the phases of SDLC, including requirements gathering, risk analysis, scheduling, testing, defect tracking, management, and reporting of Web-based and Client/Server Applications.
• Excellent knowledge on patient accounting modules like Charge services, Accounting Management, Billing, Remittance Posting, Workflow, Reporting and Build Tools
• Designed and developed application using HTML, JavaScript, Bootstrap and CSS.
• Providing support to Confidential applications(Power chart, COPE, Revenue cycle, charge services, Registration and scheduling)
• Supporting CCL report writers in development of custom CCL reports for Revenue Cycle Management based on the custom business requirements.
• Works closely with client departments, IT managers and staff to support a full suite of Confidential revenue cycle applications and other technological solutions to meet the organization requirements
• Logging CR (Change request) to Confidential in case any code changes required from Confidential .
• Coordinating with Facilities, Confidential and HEI to resolve issues.
• Owning complete Testing process ( UAT, Integration, Build acceptance testing, Test data preparation, Documenting and reviewing test results, Documenting / Reporting Defects and issues)
• Preparing and designing work flows as per the business requirements
• UML Modelling and Analysis: Created Use Case, Activity, Sequence, Data Flow, Business process modelling (BPM) diagrams using Rational Rose and MS Visio.
• Serves as primary contact between Health Care and providers, Payers (Medicare, Medicaid, Commercials, Managed care), vendors and billing agencies for information, and HIPAA requirements

Environment: HTML 5, J-Query, JavaScript, JSON, C#.Net, LINQ, SQL Server 2008, WPF, ASP.Net, MVC, CCL, Mirth Connect, SSIS, SSAS, SSRS, Crystal Reports, HL7, EDI, ANSI X12

Confidential

Team Leader

Responsibilities:

• Worked as a Project Lead and Scrum Master ensuring that team is following agile/scrum process working with vendors and various internal customers of clinical, financial and patient care to develop new HL7 interfaces
• Demonstrating technical description of HL7 messages supported the HL7 segments and fields and how the HL7 messages relate to the front end application and data base.
• Installed and maintained Interface Developer with Mirth Connect.
• Utilized VPN and SSH servers for installation of connectivity at client and vendor sites.
• Developed and maintained both ADT Incoming and Outgoing Interfaces.
• Supported ADT interface for all Post go-live updates and changes.
• Developed HL7 Interface specifications document and maintained it according to requirements.
• Developed interface error work queues and Work queue Dashboard to monitor progress.
• Maintained HL7 Interface Monitor and configured it to send downtime emails.
• Involved in build and maintenance of Translation tables.
• Updated profile variables and interface specifications as required.
• Worked with vendors for error resolution and troubleshooting of issues.
• Worked on error resolution process, error escalation process of all interface errors.
• Monitored Open Link for any downtime issues and supported to the interface engine for Go-Live.
• Participated in Integration testing and Map record testing for all interface related steps.
• Part of Go-Live support team and supported Health Link go-live support for 3 weeks 24x7.
• Used Web Services (SOAP), HTTP/HTTPS, FTP/FTPS, TCP/IP, LLP, RESTful, SFTP protocols to encode XML files.
• Involved in requirement analysis, database and project design, coding, testing, implementation and maintenance of several applications.
• Prepare documentation for the design plan, review specifications for modifications, integrating components and testing.

Environment: HL7, FHIR,.Net, JavaScript, JQuery, Angular JS, HTML, CSS, XML, XSLT, SOAP, HTTP, HTTPS, REST, POST, Web Services, FTP/FTPS, TCP/IP, LLP, Dr First,Architecture, SAS Model, SQL Server, SVN, ANT, Maven, GIT hub, JIRA, Eclipse, Confluence, EDI Tools

Confidential

Systems Analyst

Responsibilities:

• Evaluates user requests for new or modified HL7 interfaces, cost and time required, compatibility with current system, and computer capabilities
• Worked on various HL7 Messages including inpatient/clinical side / ADT
• Experience in HL7 system design and configuration, process and workflow design, Implementation, Interfaces Installation, Setup, Configuration, Administration and Trouble-shooting
• Troubleshoot issues related to applications such as CPRS, DocMan, ROI (Release of Information), ADT Filer (HL7 Messaging)
• Confidential EDI Map development and tier II support for GENTRAN Server for Windows version 5.3
• HL7 supporting using C#.Net, VB.Net and SQL server capabilities
• Participated in all the phases of SDLC, including requirements gathering, risk analysis, scheduling, testing, defect tracking, management, and reporting of Web-based and Client/Server Applications.
• Excellent knowledge on patient accounting modules like Charge services, Accounting Management, Billing, Remittance Posting, Workflow, Reporting and Build Tools
• Designed and developed application using HTML, JavaScript, Bootstrap and CSS.
• Providing support to Confidential applications(Power chart, COPE, Revenue cycle, charge services, Registration and scheduling)
• Supporting CCL report writers in development of custom CCL reports for Revenue Cycle Management based on the custom business requirements.
• Works closely with client departments, IT managers and staff to support a full suite of Confidential revenue cycle applications and other technological solutions to meet the organization requirements
• Logging CR (Change request) to Confidential in case any code changes required from Confidential .
• Coordinating with Facilities, Confidential and HEI to resolve issues.
• Owning complete Testing process ( UAT, Integration, Build acceptance testing, Test data preparation, Documenting and reviewing test results, Documenting / Reporting Defects and issues)
• Preparing and designing work flows as per the business requirements
• UML Modelling and Analysis: Created Use Case, Activity, Sequence, Data Flow, Business process modelling (BPM) diagrams using Rational Rose and MS Visio.
• Serves as primary contact between Health Care and providers, Payers (Medicare, Medicaid, Commercials, Managed care), vendors and billing agencies for information, and HIPAA requirements

Environment: HTML 5, J-Query, JavaScript, JSON, C#.Net, LINQ, SQL Server 2008, WPF, ASP.Net, MVC, CCL, Mirth Connect, SSIS, SSAS, SSRS, Crystal Reports, HL7, EDI, ANSI X12