SUMMARY

• 7.5 Years of experience in the IT industry, involving strong exposure to the EDI Analyst, Consulting and Project Management of Business domains including Confidential (HIPAA), B2B Manufacturing, S&D.
• Extensive domain knowledge on HIPAA 5010, Confidential business and B2B.
• Excellence in mapping paper claims to ANSI X12 837 EDI format.
• ANSI, 4010A1, 835, 270/271, 276/277 & 834 Transaction
• Medicare, Medicaid, BCBS, Commercial, Worker’s Compensation
• Paper claim formats such as CMS /05), UB - 04, UB-92, EOB, COB
• ICD-10 change in the US Confidential industry
• Experienced in handling complex projects of US government as a Technical Architect and Project Manager by MPPM for EDI, Edifecs, HIPAA projects at CMMI Level 5 company’s
• Experience in ISO Audits, CMMI Audits, Process reviews and other software quality aspects at all phases of the project
• Experienced with various aspects of Gentran Integration Suit (GIS) / Sterling Integrator (SI) and EDI giving business solutions to fortune 500 companies
• Skilled in analyzing the HIPAA regulations and documenting the requirements
• In-depth knowledge of Software Development Life Cycle and STLC & Testing Methodologies
• Designed & developed detailed business requirements after thorough analysis of customer service request
• Collaborated with developers for translating business requirements into high level design specifications
• Technical trainer in EDI & various Quality aspects.
• Experience in providing project estimates (as EDI SME), conducting Process reviews and other software quality aspects at all phases of the project.
• Created test claims incorporating business requirements criteria to validate the accuracy of the code developed by the technical team
• Communicating progress, issues and risks to project teams and management on timely basis
• Excellent knowledge of HIPAA standards, EDI (Electronic data interchange) Transaction syntax like ANSI X12, Implementation and Knowledge of HIPAA code sets
• Extensive knowledge of Agile Methodology & Scrum practices.
• Expert in the US Confidential domain with special emphasis in Confidential Claims and Clinical
• Sound knowledge of Medicare, Medicaid, BCBS, Commercial and Worker’s Compensation
• Excellent project management skill. Currently managing the Level 3 Production Support as well as Edifecs Upgrade project having role of Project Manager.
• Trained over 100’s of employee in Confidential world on EDI platform and Edifecs Suits.
• Provided realistic estimates & updates of work which were necessary to complete all relevant deliverables, and all tasks within targeted time frame

TECHNICAL SKILLS

Project Management: MPPM - Tracking the efforts, Initiation, Planning, Execution of project, Monthly Metrics publish, Risks/ Issues, Weekly Status Report Publish, Audit, Project Management Review, Quality ISO Audits, CMMI Audits, Process reviews and other software quality aspects at all phases of the project.

Health Care: HIPAA 5010 transactions (270, 271, 276, 277, 278, 834, 835, 837- Professional, Institutional & Dental), ICD-10, Custom formats

PROFESSIONAL EXPERIENCE

Confidential, Lenexa, KS

Sr. Health Care EDI Data Analyst

Tools: Edifecs Suite (including XEngine, SpecBuilder, TM, MB/MQ, ETL, EAM 6.8.1 / 7.0.8 / 8. *), EDI ANSI X12 HIPAA.

Responsibility:

• Implementation of 27X and 83X - end to end 900 trading partner migration (TM8.8).
• Technical Architecture and Design of the Flow in Edifecs.
• Lead team with Hands on development on Edifecs.
• Worked Directly with the Business and Resolving Gaps in Business Requirements.
• Coordinating with various teams for project design and delivery.
• Responsible for resolving Technical Issues in all the Production and Non-production Environments.
• Responsible for Standing up two new non-Production servers as part of the Project Delivery.
• Leading the team for the daily stand up meetings and serving as SME for various Technical Issues and Problem Solving.
• Updating and reporting to the Management teams on the status of the Project.
• Responsible for Design and Development of java scripts in Edifecs Maps and Groovy Scripts in Edifecs Routes.
• Requirement gathering, analysis, implementation of code and unit testing on client Proprietary tools.
• Developed project related EAM / XEServer documentation and presented to client.
• Prepare the weekly EDI status and present presentation to HP as well end customer.
• Creating Trading Partner setup across the entire work stream.
• Creating relationships for all the Trading Partners (Blue Exchange etc)
• Involved in 834, 835, 837I, 837 P, 820, 270, 271, 276, 277 & 278 transactions.
• Understanding the business requirements of the customer and transforming them into Technical software design.
• Install and configure the Test & Development systems.
• Documenting Implementation guides, desk procedures.
• Creating guidelines (ecs), error severity files (esf) for transaction in Edifecs Perspective.
• Resolve the raised defects on Edifecs 5010 for 834, 835, 837, 820, 270/271, 276/277 & 278-Req/ 278-Res transactions.
• Worked on Edifecs upgrade project. Have been upgraded from Edifecs 6.8.1 to Edifecs 7.0.8.
• Given to EDI Testing and Development team on EDI X12, Edifecs Suits.

Confidential, Chicago, IL

Sr. Health Care EDI Process Analyst

Tools: Pentaho ETL, Edifecs Suite 7.0.8- including XEngine, SpecBuilder, TM, ETL, EAM, EDI ANSI X12 HIPAA.

Responsibility:

• Involved with customer BA’s in requirement gathering and finalizing
• Worked on Technical Design document
• Involved into the development for Petaho integration created the Pentaho Kettle Properties for all the environments
• Handled Pentaho Kettle Jobs and transformation to generate tracking info xml files.
• Handled ENR Datamart new added tables for HIX for member info, coverage info, Audit log, error etc.
• Handled FS Monitor Service and worked on spoon- Data modeling and development tool for ETL developers. It allows the creation of transformations (elementary data flows) and jobs (execution sequences of transformations and other jobs)
• Fixed the all QA found defects / issues while testing.
• Timely reported status to onshore / client.
• Along with this- people management were the one of the good responsibilities in this project.

Confidential

Business Analyst

Tools: Edifecs Suite 7.0.8- including XEngine, SpecBuilder, TM, ETL, EAM, EDI ANSI X12 HIPAA .

Responsibility

• Involved with customer BA’s in requirement gathering and finalizing
• Worked on Technical Design document
• Involved in to the development in Edifecs 7.0.8. Implemented XSL development that will sort the members of xdata using subscriber ID.
• Worked on the ESF change, that will be required for LOA and RESCIND REAPPLY transaction.
• Worked on the validation rules
• This project is successfully moved into production without any issues.
• Having all this, people management were one of the added responsibilities.

Confidential, Princeton, NJ

Data Engineer

Tools: Edifecs Suite (including XEngine, Specbuilder6.8.1, TM, ETL, EAM), SAP BO EDI ANSI X12 HIPAA.

Responsibility

• Developing Software Architecture, Software Design. Diagramming as well documentation.
• Creating Trading Partner setup across the entire work stream.
• Creating relationships for all the Trading Partners (Availity, Blue Exchange etc)
• Involved in 834, 835, 837 I, 837 P, 820, 270, 271, 276, 277 & 278 transactions.
• Understanding the business requirements of the customer and transforming them into Technical software design.
• Install and configure the Test & Development systems.
• Documenting Implementation guides, desk procedures.
• Creating guidelines (ecs), error severity files (esf) for transaction in Edifecs Perspective.
• Unit Test Case Documents for 834, 835, 837, 820, 270/271, 276/277 & 278-Req/ 278-Res transactions.
• Resolve the raised defects on Edifecs for 834, 835, 837, 820, 270/271, 276/277 & 278-Req/ 278-Res transactions.
• Need to work on all the incidents and CQ's raised in Production environment
• Have to send complete note details through IT2B to BCBS Infrastructure Team for performing stopping / restarting the servers in Quality and Production Environment.