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Click here or scroll down to respond to this candidateCandidate's Name Email: EMAIL AVAILABLE
Linkedin: https://LINKEDIN LINK AVAILABLE
Phone: PHONE NUMBER AVAILABLE
PROFESSIONAL OBJECTIVE:
To work in a globally competitive environment on challenging assignments that shall yield
the twin benefits of a steady-paced professional growth and strong contribution to the
ongoing success of the organization.
EXPERIENCE SUMMARY:
Overall, 10 years of work experience in End-to-End Implementations of B2B
integration,which involves Analysis, Design, Development and Implementation of
software applications using EDI for the smooth flow of business.
Expertise in Software Development Life Cycle (SDLC) and Business Process
Reengineering in Health Care Sector with prime focus on claims adjudication, provider,
eligibility and prior authorization for Medicaid and Medicare programs.
Experience in all phases of software development life cycle (SDLC), including
Requirement gathering and documentation, Analysis and Design, Quality Assurance,
Testing and End user support working as Business Analyst mainly in healthcare, Retail
and logistic sectors.
Experience in developing detailed functional specs through JAD sessions, interviews,
on site meetings with business users and development team.
Good Knowledge on GXS tool and IBM Sterling integrator Map editor.
Documentation: BRD (Business Requirement Document), FRD (Functional Requirement
Document) and Non - functional Requirement Document.
Have extensive knowledge in Insurance products like HMO, PPO, POS and HIPAA and
Regulations.
Good experience as EDI proficient with extensive knowledge of analyzing, developing
the EDI mapping requirement specifications for the trading partner guidelines,
implementing EDI maps and procedures with sound familiarity in ANSI X12, EDIFACT,
HIPAA standards.
Developed maps on different transactions for 850, 810, 856, 820,
855,834,835,837,270,271,276,277,278.
Implemented more than 100 transactions on both X12, EDIFACT and HIPAA standard
for Customers like Amazon, Wal-Mart, Sears, Costco, Toysrus, and Walgreens etc.
Good functional understanding and strong experience in EDI procurement transactions
(810, 850, 855, 860,865,856,997,940,945,204,210,214,834,835,837
I/P/D,270,271,276,277,278) and ORDERS, ORDERSP, DESADV, INVOIC
Domain expertise in Business-to-Business Application Support (B2B).
Knowledge on Requirements Traceability Matrix (RTM).
Proficient on Inbound and Outbound processes.
Knowledge on translation mapping of ANSI X12, EDIFACT using IBM Sterling
Integrator Map Editor.
Working experience with major Insurance companies and Business Enterprisers in the
United States to implement new EDI transmissions setups
Strong in analyzing and troubleshooting various EDI related errors like coding errors,
data errors, validation errors, etc.
Provided enhancements to the current EDI design and implementations.
Knowledge on various Industry standard Internet protocols like AS2, FTP/FTPs, SFTP,
FTPS, HTTP/HTTPs.
Have a good exposure in production support activities. Good communication skills.
Demonstrated team leadership responsibilities by mentoring co-workers.
Specializations: US Healthcare, Retail and Supply Chain
Standard/Non Std SAP IDOC, ANSI X12, EDIFACT, Custom XML, HIPAA
Formats:
Supply Chain SAP IDOC: ORDERS05, DELVRY01, INVOIC02
Transactions: X12: 850, 855, 856, 810, 860, 865
EDIFACT: D96A ORDERS, D96A ORDRSP, D96A DESADV,
D96A INVOIC
HIPPA Transactions: X12: 837 I/P/D, 270, 271, 276, 277, 834, 835, 820
Acknowledgements: SAP IDOC: STATUS SYSTAT01
X12: 997, 999, TA1
EDIFACT: CONTRL
Protocols: AS2, FTP/FTPs, SFTP, FTPS, HTTP/HTTPs.
Database: MS SQL Server
Programming JavaScript, XML, SQL
Languages:
Other B2B Tools: Web Methods, Axway Mapping Services, IBM Sterling, GXS
Skills and Expertise: Business Process Implementation, Guideline & Map
Creation, Troubleshooting and Debugging, Builds
Deployment, Customer Trainings, Requirement
Gathering/Analysis, Product Installation, Upgrades,
Patches and Maintenance.
PROJECT PROFILE:
Project 4
Client: Blue Cross Blue Shield Duration: Sept 2021 to Present
Location: Detroit, MI Role: EDI Implementation Consultant
Roles and Responsibilities
Responsible for preparing the Software Requirement Specifications (SRS) document,
Standard Operating Procedures (SOPs) for 1095A project.
Involved in daily scrums and writing meeting notes.
Experienced in running parallel BUU project as lead to Submit Updated BUU template.
Experienced in full process of updated form submitted to OPERA. Responsible for
troubleshooting and resolving errors in 834 and 820 transactions for health insurance
exchanges and performing root cause analysis.
Responsible for projects involving the integration of the new Affordable Care Act rules
into the current Medicaid systems processing for Washington DC, whereby saving time
and resources for the state.
Worked collaboratively with project team including development, business analyst,
and QA resources in Affordable Care Act - FFM Obama Care - Center for Medicare and
Medicaid (CMS), Active participant in Eligibility and Enrollment EE modules
Experience working in ANSI x12 837-835 EDI Transaction.
Involved in configuration of Member and Provider Module in QNXT.
Managed the testing and verification of HIPAA standard transactions, and EDI
messages (837),
Involved in several deep dives to find a solution for roadblocks. Involved in testing the
Web APIs that fetch end user data for Federal Facilitated Marketplace Enrollment
(Affordable Care Act/"Obama Care")
Involved in creating architecture view/BRD/FSD for the ICDN 10 mapping for
Affordable Care Act (ACA) and well versed with ICD10, Facets.
Skilled in knowledge of HICS to close out cases. (Hospital Incident command system).
Involved in training new EDI analyst on project with one-on-one session and using
power point slides.
Troubleshoot any problems found within QNXT and when testing the SQL data
database while validating the business rule.
Actively involved in testing ANSI X12 834 EDI- Benefit Enrollment and ANSI X12
837EDI Health Care Claim EDI
Gathered and documented Requirements on New Obama Care Health Insurance
exchange pool and Laws governing the implementation.
Extensively used SQL queries for data validation in both Medicare/Medicaid and
commercial HIX Expert in reporting bugs using Bugzilla and HP ALM.
Validate the date from EDI transaction. Managed and developed EDI specifications, for
data feeds and mappings for integration between various systems, to follow ANSI X12
4010 formats including 270 Eligibility/Benefit Inquiry, 271 Eligibility/Benefit
Information, 276 Claim Status Request, 277 Claim Status Response, 810 Invoice, 820
Payment Order/Remittance Advice, 834 Benefit Enrollment, 835 Remittance Advice and
837 Claims and Encounter, to meet and exceed HIPAA requirements set forth by the
federal government.
Performed Backend testing by extensively using SQL queries to verify the integrity of
the database. Create internal reports using Dashboard and basic SQL queries in the
tool to track activities of the teams.
Incorporated FDA guidelines (21CFR) and HIPAA (Health Insurance Portability and
Accountability Act).
Created Use Case diagrams using UML and Business Process Models using MS-Visio.
Gathered requirement on FACETS EDI 834 Benefit Enrollment and Maintenance
subsystems.
Responsible for Business Process Management (BPM) for development of various
projects. Created Data Mapping documents for data transfer from Claims Processing
System to EDW (Enterprise Data Warehouse)
Developed Use Cases, Sequence Diagrams, Activity Diagrams and Class Diagrams. ICD
10(Affordable Care Act): Involved in performing gap analysis, mapping, and gathering
requirement for the upgrade of ICD9 to ICD 10.
Analyzed the impacts of HIPPA 5010 project on inbound 837 claims.
Recommend ways and workarounds for HIPAA 5010 (EDI X12 837,834,278,270)
upgrades.
Worked with providers and Medicare or Medicaid entities to validate EDI transaction
sets or Internet web portals. This includes HIPAA 4010; 837, 835, 270/271, and others.
Performed Data Mapping to map the EDI 834 data to XML.
Define and develop process flow charts for all EDI applications.
Analyze EDI -X12 data elements captured by the existing system to validate it against
the data elements required for new system.
Project 3
Client: Fluke Corporation, USA Duration: March 2019 to Sept 2021
Location: Everett, WA Role: EDI Implementation Engineer
Roles and Responsibilities
Analyzing the Implementation guide, the Mapping Specification document and done
the Pre-Map analysis.
Mapping and developing the interfaces as per the specification.
Developed maps for EDI transaction sets like 850,810,856.
Creating Trading Partner Profile for inbound and outbound in IBM Sterling Integrator.
Created code list entries, routing rules.
Modification of existing maps according to Trading Partner Requirement.
Well-read on Light well framework.
Running daily internal status calls with onsite and offshore team members.
Preparing and sending out the weekly status report to the client.
Created communication set ups (FTP, AS2, File System) between trading partners to
facilitate End to End flow.
Handling and resolving inbound and outbound transaction failures with high priority.
Sterling Integrator administration experience includes Services for FTP, SFTP, HTTP,
AS2 trading partners Adapters, Schedulers.
Extensively worked with SAP FI, MM, SD to accomplish various business needs.
Development experience includes working with various EDI standards such as 850, 855,
856, 810, 210, ANSI X12 and EDIFACT standards. Good experience with code lists,
resource management for import/export of resources for migration and configured
public and private keys for trading partners to extract check images from SFTP server.
Extensive experience creating maps for various file formats such as flat files, XML, CSV,
positional files
Experience in debugging and fixes including emergency resolution during peak season
such as Holiday season sales in retail business. Extensive knowledge of logs for
troubleshooting. Handle project development life cycle, business analysis, preparation
of specifications, mapping and testing. Manage daily production support and
development of new business process and maps to onboard new customer.
Developed customized transaction maps and create standard transaction map
templates.
Managed projects within various industries including American Heart Association with
HIPAA compliance, Supply Chain Logistics UPS, Fedex, ABF, Old Dominion Freight,
Sporting Manufacturers Nike, Under Armor, Reebok, Adidas, Easton Bell Sports,
Wilson, etc., School Districts, Energy, while staying in compliance with HIPAA
regulations.
Project 2
Client: Amgen, USA Duration: Oct 2017 to Feb 2019
Location: Thousand Oaks, CA Role: EDI Developer
Roles and Responsibilities
Involving in various map change requests and support related activities.
Developing inbound and outbound maps for various trading partners.
Created maps for 850, 855, 856, 810, 997 X12 transactions and other data formats.
Good Understanding of Retail Business Flow.
Involved in maps conversion of EDI to IDOC, Flat and vice-versa and Performed Unit
testing of the maps.
Understanding of business rules and applying it in map translation.
Update partner data, Trading Partnership Setup, applications, and maps per trading
partner specifications.
Created Trading Partner profiles for inbound and outbound maps.
Correct and retranslate any EDI documents that fail during translation.
Performing Unit testing and handling the trouble shooting issues.
Interacting with onsite coordinator for escalations regarding defect clarifications.
Supported the team in clarifying queries and provided technical and functional
guidance.
Manage daily production support and development of new business process using
BPML, maps to onboard new customers.
Developed customized transaction maps and create standard transaction map
templates Involved in coding customized java applications to accomplish specific
needs that EDI requires on a regular basis.
Sterling Integrator administration experience includes Services for FTP, SFTP, HTTP,
AS2 trading partners Adapters, Schedulers.
Project 1
Client: Mattel Inc Duration: July 2014 to May 2017
Location: Bangalore, India Role: EDI Analyst
Roles and Responsibilities
Involved in developing and maintaining smooth flow of EDI messages, troubleshooting
the EDI messages which do not reach the destination servers.
Responsible for resolving any inbound and outbound data rejects during the EDI
transactions flow which are very critical to the business.
Responsible for the day-to-day production support (24/7), configuration and
monitoring daily error reports and coordinate/perform error resolution.
Monitoring the daily transaction flows, the servers involved are running fine
and to make sure that the processes are complete and error free.
Collaborated with network team and various applications team for smooth EDI
transition in time.
Experience working in mapping changes and file translation using Open Text GXS
Documenting the solutions provided to the respective issues and shared with the
team.
Working in Production Support, Maintain Ticket Systems as Level 2 and 3 Support.
The project aims to handle Supply Chain Transactions for some partners and to
migrate the current implementations.
This project was involved upon 850, 855, 856, 810 and other customer specific
transactions.
Implemented bunch of maps involved during the processing of every
inbound/outbound. Once a transaction completes its processing through the solution,
it is sent to their system or vice versa.
This works as an intermediate between two parties, the buyer, and the seller to
manage millions of transactions in a very efficient way.
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