CARRER OBJECTIVE

• To secure a challenging and rewarding, position in Health Care IT.

HIGHLIGHTS

• Highly Motivated Professional, Senior Level Architect , over 12 years of IT experience
• Two Successful, large HIPAA Projects Implementation (BSBCNE and DHHS SAC)
• Currently working as Sr.HIPAA/BizTalk/EDI/EAI Architect at DHHS, SACRAMENTO
• Architect and Implement composite Business Process management frameworks for providing real time access to legacy applications.
• Recently worked on BizTalk SOA\\ESB\\CRM Project, CA State Medical Enrollment Healthcare Project.
• Over 9 years of demonstrable experience in HIPAA\\EDI\\EAI\\BizTalk\\Dot Net Framework and Broad range of HealthCare related solutions
• Expert in Healthcare/Pharmacy Billing solutions
• EMR, Pharmacy System Implementation and Integration with Legacy systems using HL7 standard (HL7 2.x/3.0)
• Experienced in BPEL/BPM Object Oriented and Design and Pattern using UML methodologies.
• Orchestrated Framework Design pattern to promote SOA and service reuse
• Excellent problem solving, communication, analytical and mentoring skills. A demonstrated advanced conceptual thinker, can easily move between conceptual thought and concrete implementation
• Proficient in HIPAA regulations and implementation of business processes(BPM) and compliance of the Health Insurance Portability & Accountability Act (HIPAA)
• Independently analyzed business requirements, designed and implemented Complex HealthCare Solutions to Industry and Government agencies
• Designed HealthCare Repository Databases for Reporting, Auditing and Reconciling Claims
• Experience in all phases of the SDLC

TECHNICAL and APPLICATION SKILLS

O/S- UNIX Solaris, Windows 2003/2008
Legacy Systems- Mainframe, AS400, HP3000
Microsoft BizTalk- 2000/2002/2004/2006/R2, VS.NET 2005/2008, SQL Server 2005, SSIS, WCF, MOSS, TFS, Hyper V, MS Build Database MS SQL Server 2005/2008, Oracle 8/8i, DB2 EAI/Middleware- BizTalk, Seebeyond e*Gate 4.5.2 
Languages- C#, T-SQL, PL/SQL, XML, UML, WSDL
CRM- Clarify 10i/10/9/8, Microsoft Dynamics CRM
Applications- EDI/HIPAA, EAI, Pharmacy, EMR, Data Migration, CRM, CCMS, Claim Adjudication, AUSUM, Clinical, RFID, Eligibility, HealthCare Benefits, Web Services, Medical Enrollment, IVR,ECM
Standards- ANSI X12 HIPAA 4010/5010, TCS, HL7 2.4/3.0, NCPDP 5.1, CCOW, CMM-5, DICOM, PACS, UPC, NDC, DSM-IV, ICD9/10 
Architecture- OOD, BI, SOA (ESB), CDA, CMA, SSO
Compliance- JCAHO, NCQA
Tools- Rational Rose, Exceed, Toad, Install Shield, DocumentX!, XML-Spy Studio, Foresight HIPAA Validator/Instream/EDISIM, BizUnit

EDUCATION AND CERTIFICATIONS

Bachelors Degree in Engineering
MCP in BizTalk

PROFESSIONAL EXPERIENCE

April 2008 – Current Confidential, Elk Grove, CA

Role – HIPAA/BizTalk/EDI Consultant

Description: Electronically submitting Benefits Enrollment (HIPAA 834) data to various insurance carriers on behalf of brokers and Employer groups.

Responsibilities:

• Design, Architect BizTalk EDI Interfaces and HIPAA EDI Frame-work components
• Implemented Encryption and Secure Transfer of 834 EDI Enrollment Transactions using BizTalk Adapter
• Manage JAD sessions with developers and business users

Development Environment: BizTalk Server 2006R2, SQL Server 2005, SecureBlackBox (PGP Encryption), SSH, FTPS, SFTP, XSLT/XPATH, XSD, OPENXML, XML-Spy Studio, Foresight HIPAA Validator

Confidential, Sacramento, CA

Description: HIPAA, Revenue Recovery, Pharmacy, EMR, NPI and SEDI (Secure EDI) Projects Implementation for Sacramento County 
Responsibilities:

• Streamlined County Revenue (250 million/Year) process, designed interfaces to bill State agencies for Medi-Cal and Medi-Care Programs electronically (837I/P, Pharmacy Billing /NCPDP 5.1) for services rendered at county (ADP/MH/PH) Divisions.
• Visionary role for defining Technology direction, Coordinating with various projects that build architecture
• Responsible for Implementing BPM integration and deployment with in the County and with trading partners.
• As Solution Architect,Technology Evangelistand Lead Developer, designed HIPAA-Dot NET Framework components, EDI Databases for reporting, auditing components, claims reconciliation modules and various HL7 Interfaces for EMR/Rx3000(Pharmacy) and Legacy System Integration
• Independently worked on Requirements gathering and created Use Cases and Sequence diagrams.
• Implemented SEDI(Secure EDI)/ Automation of claims Processing project for Trading Partner Automation(TPA) using Foresight Instream, BizTalk, MOSS, WCF Adapter and Web Services
• Created various Mapping, Technical Design Documents, and Companion Guides/ Trading Partner documents.
• Created Listener services for HL7 data transfer over TCP/IP using MLLP adapter and worked on batch and real time transactions.
• Worked closely with network team on load balancing EDI transaction processing and giving suggestions on creating different hosts and clustered environment
• Designed HIPAA EDI warehouse database and Business databases to satisfy business objective.
• Enterprise Claims Report strategy, architecture and Implementation
• Analyze content and quality of EDI databases, Perform basic database administration during development
• Involved in Health Care related Systems and Vendor evaluation and User Acceptance testing.
• Production support tasks - Monitoring Claims Processing, Resolving Claims Billing Issues and County Clinic Patient Admission, Discharge and Transfer related data issues(HL7 2.4 version ADT)
• Managing Technical JAD sessions
• Recently worked on Gap Analysis and Business Rules Migration for ANSI X12 HIPAA 5010 and ICD10

Development Environment: BizTalk 2004/2006/R2,VS 2005, SQL Server 2005, SSIS, WCF, MOSS, WSDL, SOAP, XML, XSLT/XPATH, XMl-Spy studio, DB2, AS400, Foresight HIPAA Validator and Instream, VSS, OPENXML, MLLP Adapter for HL7, UML, Use Case , Sequence Diagrams

April 2009 – June 2009 (3 months) Confidential, Rancho Cordova, CA

Role – BizTalk/Healthcare Architect

Description: CA HealthCare Medical Enrollment (DHCS), BizTalk SOA\\ESB Project.

Responsibilities:

• Porting EAI environment to BPM architecture
• Work with functional teams responsible for regression testing to understand and resolve any issues uncovered during testing.
• Modifying BizTalk ESB Components, Testing ESB Processes and give recommendations to improve performance of real time host processing.
• Involved in streamlining ESB Components\\Services integration with Mail House\\Extreme Dialogue and OCR systems.
• Work with Echopass Team (IVR) to resolve outstanding issues on daily basis.

Development Environment: BizTalk Server 2006R2, ESB Management Pack 2.0, Microsoft Dynamics CRM, MS SQL Server 2005/2008, Windows Server 2008, SOA, Web Services, TFS, Hyper V (R2)/Virtualization, Extreme Dialogue(ECM), Echopass (IVR), Hyland (OCR),MS Build, BizUnit, .Net framework 3.0, BRE, SQL Host Adapter, HTTP Adapter, ESB Resolver and Adapter Provider Framework, Itinerary services

May 2000 - March 2004 (over 4 years) Confidential, OMAHA, NE

Role – HIPAA/BizTalk/EDI/EAI Consultant

Description: HIPAA Implementation\\EAI Project,Processing Incoming/Outgoing HIPAA EDI Transactions from PROPAR (Clearing House), and integrating other Health Care Applications/Systems like CCMS, AUSUM
Responsibilities:

• Prepared Interface Design Documents for HIPAA Project
• Developed Class Diagrams, Use Case, Sequence Diagrams and Reverse Engineering of existing Framework Classes using Rational XDE integrated environment in Visual Studio
• Developed HIPAA Business Components/AIC and Infrastructure .Net Components
• BizTalk Mappings for 837I/P/D, 270/271,276/277, 820, 834, 835, NSF, UB92
• X12Repository Design and Development
• Legacy System Integration(mainframe)
• Worked on MSMQ and MQSeries Bridges
• Involved in Creating CCMS and AUSUM Interfaces, IMS Connectivity, Web Integration\\Mainframes, TCP/IP Interfaces between Mainframes and SQLServer using Seebeyond e*Gate, Using Multi Mode eWay, TCP/IP Seebeyond Adapters
• Preparing Install Shield Deployment Projects for daily Builds
• Developed Dot Net applications for generating Test Data for HIPAA Transactions, Socket Programming

Development Environment: BizTalk Server 2000/2002/2004, C#, Seebeyond e *Gate 4.5/4.5.2, XML, XMl-Spy, IMS, Mainframes/CAPS/AUSUM, HP/3000/HMO, HIPAA Validator, SQLServer 2000, MQSeries, BlueExchange, NANT, Rational XDE ,Cobol Copy Book Convertor

Confidential, TX, PLANO

Description: Implementing CRM Functional Areas of Customer Service

Confidential, FL, BOCA RATON

Description: Integrating Logistics (CRM Module) Field Operations with ClearSupport system

Confidential, MA, WALTHAM

Description: Integrating Web Portal Applications with the Clarify CRM system

Apr 1999 - May 1999
Confidential, Merrill Lynch, INDIA

Description: Developing Back office system of the securities transactions.