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Edi Consultant Resume

SUMMARY

  • Healthcare IT Professional with over eighteen years of IT and EDI experience.
  • Utilizes EDI expertise to manage B2B and application integration projects.
  • Offers a specialization for EDI services that can reduce implementation cost.
  • Successfully executes account management, project planning and project management for integration projects involving EDI to ERP and EDI to non ERP (e.g. claims systems).
  • Analyzes business use of EDI elements for integration into Oracle Applications, JDE, Infor, SAP, Xpress, HSP and QNXT.
  • Enables and configures ERP e - Commerce Gateways for inbound and outbound transactions.
  • Enables and configures QNXT connect Gateway for inbound and outbound transactions.
  • Integrates e-Commerce Gateway with Gentran:Server, including software installation, configuration, mapping, training and go-live.
  • Configures and implements many communications solutions including AS2, HTTPS, SMTP, FTP on B2BI, Gentran:Server, B-Trade software, Cyclone Commerce and others.
  • Develops many innovative solutions to solve real-world internal issues to process electronic transactions not supported by business applications.
  • Executes successful planning and management.
  • Completes maps for integration with Oracle EDI Gateway, JD Edwards, SAP and other ERP packages.
  • Develops expertise in all phases of EDI implementation.
  • Installs various operating systems and related software packages such as EDI solutions and databases.

TECHNICAL SKILLS

Mapping: ODBC, XML, CSV, FLAT FILE

EDI Transaction Sets: 204,214,270,271,277,810, 850, 856, 997, 820, 823, 824, 830, 832, 834, 835,837, 852, 855, 860, 864, 940, 943, 944, 945, 947,210,211,270,271,277and Edifact equivalents

Software: GIS 5.3, IBM Sterling B2BI 5.2, Extol, MapForce, Liason, EDI/HQ Oracle B2B adapter, SQL Server, Oracle SQL+ and Microsoft Suite

Communications: AS2, SFTP,FTP, MAPI, VAN SOCKETS

PROFESSIONAL EXPERIENCE

Confidential

EDI Consultant

Responsibilities:

  • Provides EDI consulting related to production and development activities for enrollments and claims. Lines of business include Medicare, Medicaid, CHIP, Health Insurance Exchange and Groups (commercial) for 10 million members.
  • Team lead for migration from Premia to HSP. Analyze data and map transformations for the purpose of member and claim conversion from source system to new system.
  • Develop maps and staging tables for 834s and custom enrollment formats using IBM SPE and Gentran server.
  • Develop maps and staging tables for inbound and outbound 837s. Establish solutions for claim validation for WEDI edits 1 -7.

Confidential

EDI Architect

Responsibilities:

  • Manage and develop solutions to interface HIPAA transactions into QNXT system for 834, 835, 837 and 270, 271 and277 for various healthcare plans/clients.
  • Design complete EDI platform to warehouse fee for service, encounter claim information and enrollments.
  • Develop portal for providers to utilize for entering claims.
  • Assist in the development for .NET application to track and reconcile EDI transactions with internal systems.
  • Assist businesses with building requirements for inbound and outbound for the various EDI transaction sets.
  • Develop solutions to enable the transfer of HIPAA compliant claims to CMS.
  • Interface all required electronic transactions to enable a relationship with the state of Texas Star+Plus Medicaid program.
  • Reduce business cost by achieving 98% acceptance rate for claims.
  • Assist with the day to day activities to support EDI interfaces for QNXT, EZCap, MHC and data warehouse for encounter data.
  • Responsible for data mapping of the transactions, along with configuration change requests and process documentation.
  • Develop claim routing program to route claims to various systems based on member criteria.
  • Responsible for migration of 4010 EDI system to 5010.
  • Support actives for QA/UAT and disaster recovery.
  • Participate in daily conference calls, advising on EDI functions related to the business processes.

Confidential

EDI Consultant

Responsibilities:

  • Managed project for implementation of new customers for the 850, 810, 856 and 860.
  • Responsible for mapping and testing of all EDI data.
  • Acted as the lead for QA and Go-live activities for multiple vendors and multiple internal systems.
  • Regarded as the point of contact for trading partners, service providers, suppliers and internal customers.

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