SUMMARY

• Having 8+ years of experience as EDI Developer/Analyst with diverse knowledge in analysis, design, implementation, development and validation of client/server and web based applications.
• Excellent understanding of Software Development Life Cycle (SDLC) and Software Development Test Cycle (SDLC).
• Experience with EDIFECS Spec builder 8X, EDIFECS XENGINE 8X, EDIFECS Transaction Management (TM) 8X, EDIFECS Application Manager (EAM), Trading Partner Manager.
• Hands on experience with Medicaid and Medicare Encounter Claims and testing, development experience in Health care and Retail domains.
• Experience with EDIFACT, X12, HL7, HIPAA, EANCOM, NCPDP Script transaction sets.
• Worked on Data file validation, Data Migration, Tests data Generation, De - Identification, Dictionary generation, Batching, De-Batching, Guideline Migration.
• Full compliance checking against all HIPAA Implementation guideline rules, as well as trading partner-specific requirements is done using EDIFECS XENGINE.
• Hands on experience with developing Integration Gateway which exchange the EDI messages such as EDIFACT, X12, HL7, NCPDP, and SWIFT.
• Experience creating guidelines, Maps, routes for HL7 Messages and have created ARD, ADT, MDM and MFN messages For HL7.
• Have created Map, Guideline and modified the 837 processing route for 275 transaction process.
• Hands on experience with developing and testing HIPAA transactions: 270, 271, 276, 277, 278, 834, 835, 837(P, I, D), 997/999. Also have a strong knowledge of Medicaid and Medicare transactions.
• Experience in developing, implementing and testing EDI ANSI X12, EcMap (.EMS, .ECS, .MMS files) EDIFECS Spec Builder, UNIX & XML/XSLT/XSD applications.
• Experience in analysis, design, development, and testing and implementation of enterprise applications using various tools including Mercator 6.7 and Datastage TX 7.5, WebSphere Datastage TX 8.0, WebSphere TX 8.1 and middleware tools like MQ Series.
• Experience in development and implementation in EDI ANSI X12 and HL7 using Mercator as an integration tool (Mercator Design Studio, Mercator Integration Broker).
• Experience with requirements gathering, building workflow, inserting business rules, configuration, creating dashboards/reports and testing
• Knowledge and Experience with Oracle SOA Suite, Healthcare X.12 EDI transactions, Java, JavaScript, Spring, JSP, Web Logic, Oracle, J2EE application servers Web Logic, JBoss or Web Sphere
• Aptitude for complex problem analysis/resolution
• Strong experience in performing Gap Analysis and additional side by side changes to the crosswalk.
• Ability to develop database queries using SQL and PL/SQL to assist in testing effort.
• Expertise in setting up migration mapping from older versions to newer versions.
• Excellent business knowledge, ability to work under pressure and good interpersonal skills.

TECHNICAL SKILLS

Industry standards: ANSI X12, EDIFACT, NCPDP, HL7 and HIPAA

SQL Editors: SQL NAVIGATOR, TOAD, SQL ANALYSER

Application Servers: ECMap, Gentran Server 5.1/5.3/6.0/6.1 , GIS 4.2/4.3, Rational Application

EDI Transactions: 204,214,210,810,820, 830, 832,846, 850, 856, 860, 852, 867, 835,837,270,271,276,277,834,940 and 999.

Middleware: EDIFECS, Mercator, WTX, TIBCO, Gentran, BIZTALK,AXWAYEnterprise Application Integration (EAI), IBM Integration Broker (IIB), WebSphere Message Broker (WMB).

Languages: PL/SQL, COBOL, C++, VB script, C#,ASP.NET.

Databases: Oracle SOA ESB, 10g/11g R1, SQL server, MS Access 2003.

Scripting Languages: TSL, JavaScript, Java, VBScript, Shell Script.

Operating systems: UNIX, Windows NT/XP, 2003 Server.

EDIFECS: Specbuilder,EAM,TPM,TM,Xengine, XEserver.

PROFESSIONAL EXPERIENCE

EDI Developer

Confidential, Chicago, IL

Responsibilities:

• Working Experience on TM, TPM, EAM, XEngine, XE Server and routes and Specbuilder.
• Experience in working with EDIx12 standards like 274 health care provider information transactions.
• Experience in working with HL7 messages like MDM - Medical document management, MFN - Master files notification, ORU - Observation result (Unsolicited) messages.
• Updated guidelines, maps for 274 health care provider information, 275 additional information transaction.
• Updated mismatched nodes and functions for the maps.
• Created and Modified 275 Transaction Guideline, map and configured to parse the HL7 segments with 837 I/P claim transactions.
• Good experience with 277 Transaction which is additional request for Claim adjudication and changed the 837 I/P route in Real time and Batch.
• Experience managing, working in or developing and deploying EDIFECS product suite.
• Experience with EDI \ EDIFECS product suit for integration and EDI analysis.
• Experience with Encounter reporting for State and CMS agencies.
• Good knowledge on created 837 claim files in BW and validated the claim using XEngine.
• Working experience interaction between XE and TIBCO BW is done through EMS and then forward the claim files to provider using TIBCO Business Connect palette in BW.
• Worked on Onshore and Offshore model and Coordinated with Offshore TIBCO team from requirement gathering phase to Testing efforts.
• Knowledge on Data mapper tool and it's components like Mapping services Data mapper, Data mapper Builder, Metadata Browser.
• Participated and involved in Data mapper software and its interface with B2Bi.
• Knowledge on EDI Map components like view of an application document (Application View), view of an EDI document (EDI View) and a set of links (mapping direction).
• Participated meetings for Developing XSDs and XPATH transformations using TIBCO Designer and using XMLSPY editor for XEngine validations.
• Involved in gathering requirements, installing, configuring, and overseeing the implementation of Edifecs’ products.
• Information received on difference between ADFs and EDI document descriptions.
• Good knowledge on Creating Application Data Formats (which is ADF) and Editing with ADF Editor.
• Test partner data files against implementation guidelines and provide meaningful error analysis for quick problem resolution.
• Dashboard reports creating or ad-hoc reporting as needed by Business users using Tableau(TABSVC)

Environment: EDIFECS 8X (Specbuilder, EAM, XEserver), AXWAY, HL7, TIBCO, HIPAA, Oracle, Transaction Manager, HIX Operating rules (CAQH Core), ACA Etc. Trading Partner Manager.

EDI Developer (EDIFECS/ WTX)

Confidential, Baton Rouge, LA

Responsibilities:

• Experience in working on Affordable Care Act project and expertise in implementation of EDI modules like 834 enrollment Etc.
• Working experience as a L1 Production Support and acted as a scrum master and\or project coordinator while production deployment time.
• Working Experience on EAM, XEngine, XE Server, Profiles, routes and Specbuilder.
• Experience in working with EDI HIPAA standards like 834,835,837PID, 270/271 and275 transactions.
• Experience in installing and configuring Edifecs Product Suite-XEngine, XEngine Server, Transaction Management and Spec Builder in Standalone and Distributed environments.
• Experience in upgrading HIPAA DB updates, External Code LISTS (ECL) updates, new patches when required.
• Experience working for health plans preferably with Medicaid and Medicare reporting needs.
• Hands on experience with HIPAA X12 EDI transaction 834 for enrollment and Maintenance.
• Modified the routes for Acknowledgement transactions like 277CA, 999 and TA1.
• Experience creating format using Edifecs Specbuilder and Note Pad ++.
• Involved in gathering customer’s requirements, installation of products
• Experience configuration and development of programs, tasks and guidelines, and trading partner setup to implement an Edifecs solution.
• Good knowledge and participated as techno functional resource and worked with the client’s business and technical resources.
• Knowledge on HIX Operating rules (CAQH Core), ACA Etc.
• Experience in creating new profiles and routes in Edifecs XEngine for both Batch and Real-time
• Experience in analyzing inbound and outbound transactions with Customer and Trading Partner
• Production on-call support via cell phone/e-mail and Responding to all P1/P2 issues within 1 hours
• Holding duty phone at all times and responding with in time.
• Experience in System integration testing and User Acceptance testing.
• Bi-weekly reboot of servers and services using appropriate SOP and Coordinating with BizTalk on duty person and Shutdown/restart of each environment when needed as Emergency re-start or reboots and fill out ER Change Requests as needed
• Experience that to test the Integration of external java classes in Spec Builder guidelines of these functionality, I had replaced Java Classes with JavaScript coding.
• Experience working on Spec builder, X-Engine, XE server, EAM, TM, TPM

Environment: EDIFECS Spec builder 8x,EDIFECS XENGINE 8x,EDIFECS,Transaction Management (TM) 8X, EAM, XEserver, XML, SQL Server, SOUPUI, Microsoft Office 2013, WINDOWS, Java, JavaScript, BIZTALK, HIX Operating rules(CAQH Core), ACA, WebSphere MQ, TOMCAT, Tableau reporting, Trading Partner Manager (TPM), Ramp manger.

EDI Developer

Confidential, St Louis, MO

Responsibilities:

• Hands on experience working on EAM, XE server, TM, Spec builder, X-Engine and TPM.
• Created the Map document with the properties which helps to understand the relationship between a source and a target guideline along with any transformation that occurs.
• Experience creating and publishing the Map document with the help of new document wizard.
• Working experience with Map objects, Buffers, Data Views and built logical nodes with defined custom rules between the logical nodes and handled mismatched nodes.
• Experience that to test the Integration of external java classes in Spec Builder guidelines of these functionality, I had replaced Java Classes with JavaScript coding.
• Experience working on map Objects like nodes, Functions, connectors and Hot points
• Good experience with trading partners setup and handling the guidelines without envelope segments.
• Hands on experience working with map builder which is integrated within Spec builder.
• Experience with map builder map workspace which consist of Source Guideline view, Map Area view, Target Guideline view, Details pane view.
• Hands on experience using Jscript, java, .Net Functions to execute relevant custom code, with any of input and result values which can be used in code.
• Working experience EDI transactions like 850, 855, 856, 810, and 997 for the Project.
• Experience with .ECS, .EMS, .MMS, XSD, EDIFECS XML files.
• Using Spec Builder created XSD files by exporting the .ECS Files.
• Good Knowledge in claims and encounters processing, including state requirements for HCFA1500 (non-institutional claims, like physician visits) and UB92 (institutional claims, like hospital stays and outpatient hospital procedures) submissions.
• Good experience working on Map Area Workspace where we connect the parent and child nodes using the seven different function category’s consisting of 20+ functions are used.
• Experience in validation and translation using the .ECS files.
• Using .XSD and BPEL (Backend Process) verified the Payload validation.
• Experience working with all functions for better Mapping and used Auto- linking to connect the child nodes of one parent node from source to a target child node of a parent node using different linking types like exact match, Order Match and Combined.
• Experience using Map debugger function for debugging, the task mainly to collect Map trace History, Monitor values of objects in the system, view the object context and setting breakpoints.
• Good knowledge on implicit connector option to connect two guidelines without having to really build connectors.
• Experience using java script (Jscript) function to execute custom (Jscript) Java script code, with any number of input and result values, which can be used in code.
• Monitored and communicated all EDI mapping and processing changes to the appropriate departments to ensure timely implementation and compliance.
• Provided support to integration test between EDIFECS to WTX.
• Hands on experience in preparing Cross Walk document.
• Experience with complex mappings using appropriate Functions.
• Assisted in creating, monitoring and maintenance of EDI Support processes like BPEL
• Hands and experience using the all functions like Math, Programming, string, copy, and core for developing input and output cards or Maps.
• Enhanced Oracle/SQL scripts as a part of multiple data access projects.
• Created Unix Shell Scripts as part of maintenance and monitoring of processes.
• Produced progress reports and updated to management on a regular basis.
• Worked on preparation of Test Bed 4010 maps (.ECS and .EMS).
• Experience with mapping rules and in corporate in EDIFECS Maps using various Functions.
• Prepared the test data for Unit testing, string testing and validation using various tools like Ultra Edit, XMLSPY, EDIFECS(ORACLE INTEGRATION B2B), ClarEDI and EDISIM.
• Good knowledge of customization of EDI type trees.
• Created test cases to test the Encounter claim mappings.

Environment: EDIFECS Spec builder 8x, WTX, EDIFECS XENGINE 8x, EDIFECS Transaction Management (TM) 8X, HTML, Oracle 11i, Oracle SOA ESB, Quality center 10.0, Microsoft Office 2007, Unix, Java, TIBCO, JavaScript, Spring, JSP, Web Logic, Oracle,, Ramp manger.

EDI Analyst / DEVELOPER

Confidential, Thousand Oaks, California

Responsibilities:

• Worked with EDIFECS XEngine (XEngine, XEngine Server, XEngine Grid, EAM), EDIFECS Transaction Management (TM), FACETS (HIPAA Gateway Trading Partner Management).
• Excellent knowledge of EDI tools like Foresight’s EDIFECS.
• Identified the errors in the partner’s EDI data on a day-to-day basis and reported the same to the partners.
• Sending an Acknowledgment (EDI X12 997 Functional Acknowledgment) to the trading partners.
• Created new Code lists based on the customer requirements.
• Translated the data from XML to ANSI X12 format and vice versa.
• Developed UNIX shell scripts to handle transaction splitting/consolidation by shipment bill of lading number or purchase order number.
• Developed UNIX based FTP routines to successfully deliver data to destinations providing Guaranteed Delivery Layer.
• Created the Enveloping for trading partners.
• Created the work flows to accomplish the Business models in the Business process Models using the BPML in GIS.
• Developed Maps to and fro from trading partners to Internal Order Management applications in supporting Delivery Order, Goods Receipt, and ASN etc.
• Experience in EDI Auditing.
• Developing new maps and modifying existing maps. Developed maps for following transaction sets: 997, 271, 832, 850, 940, 820 and 810.

Environment: WTX 7X,EDIFECS Spec builder 7.0.5, EDIFECS XENGINE 7.0,WTX, EDIFECS Transaction Management (TM) 7.0.7, Unix, Oracle SOA ESB, GIS 4.2/4.3, FTP, SNMP, XSL.

EDI Developer

Confidential, Carson City, NV

Responsibilities:

• Worked with EDIFECS XEngine (TPM, TM, Spec builder, XEngine, XEngine Server and EAM), EDIFECS Transaction Management (TM), FACETS (HIPAA Gateway Trading Partner Management).
• Excellent knowledge of EDI tools like Foresight’s EDISIM.
• Identified the errors in the partner’s EDI data on a day-to-day basis and reported the same to the partners.
• Knowledge on HCFA 1500 (now the CMS 1500) is used for non-institutional claims (like physician visits) Processing, The UB92 (which I think is now the CMS 1450) is used for institutional claims (like hospital stays and outpatient hospital procedures) processing.
• Developed type trees to all the custom based formats and trimmed the EDI type trees based on the vendor specifications.
• Worked on EDI ANSIX12 transactions like 810, 832, 837(I / P/ D), 850.
• Migrated all the Mercator maps from 6.5/7.5.1 to 8.1.
• Created EDIFECS maps for 835 and 837 I / P / D.
• Created, built and deployed a broker archive (bar) file.
• Interacted with the partners for the necessary setup on a daily basis.
• Experience on Map builder, Spec Builder, X-Engine, X-Engine Server and TPM.
• Responsible for creating the scripts and deploying the partners in the production environment.
• Documented process flow for customers, Preparation of unit test case and unit test reports.
• Interacted with developers and users to analyze the user requirements and functional specifications.
• Developed test plans, which include testing overview approach, strategy and complete scope of testing.

Environment: EDIFECS XEngine 6.8, TPM, Specbuilder, Facets, EDI ANSI X12 V4010/V5010, XML, Oracle, SQL Server, Ultra Edit, Windows 2003, PVCS, Merant Tracker, Smart FTP, MS Office Suite, UNIX AIX.