SUMMARY:

• 7+ years as a Sr. EDI Analyst with extensive experience as an Enterprise Liaison between End Users and Technical Group and Mainframe developers.
• Demonstrated ability to work actively in different phases of Software Development Life Cycle (SDLC) using Waterfall, Rational Unified Process (RUP) and Agile methodologies.
• Analyzed 5010 EDI healthcare X12 transactions like 837, 835, 834, 820, 270, 271, 276, 277, and 278, along with NPI, ICD 10, NDC, DRG, CPT, and NCPDP codes.
• Developed an implementation plan for Partners for EDI X12 transactions such as 834, 835,837,270,278 and 271
• Worked on Electronic Data Interchange (EDI) transactions in claims & benefits management cycle based on HIPAA guidelines. Medicare & Medical guidelines and documentation.
• Realized the data or content in HIPPA 4010 format (FACET) and worked on documenting EDI transactions for Benefits & Claims Management cycle (FACET).
• Assisted in documentation like Project Charter and ICR. Prepared BRD, FSD, Traceability Matrix, RACI Matrix and diagramming data and process mapping using use cases, activity diagrams, compiling project plans to include resources, deliverables, requirements and milestones.
• Experience with Medicare, Medicaid, and commercial insurances in HIPAA ANSI X12 formats including 270,271,273,278, 834,835, 837 transactions
• Academic Experience in conducting SWOT analysis, Gap analysis, Risk analysis, Net present value (NPV) analysis, Return on investment (ROI) analysis.
• Also worked on documenting EDI transactions for their claims and benefits management.
• Experience in creating Unified Modeling Language (UML) Use Cases, Activity Diagrams, Sequence Diagrams, Class Diagrams, and State Diagrams using MS Visio and Rational Rose to extract business process workflows.
• Manual testing and Knowledge of SQL testing.
• Project management experience involves delegating responsibilities, budgeting, change management, preparing weekly status reports for management, communicating and presenting the reports, and resolving issues and conflicts with Clients.
• Developed plan for data feeds and data mappings for integration between various systems, including XML set and ANSI X12 5010 formats.
• Excellent analytical and problem solving skills with ability to interact with various teams for data requirements and mapping project database.
• Theoretical knowledge of SSIS, data flow, data integration and data manipulation scenarios.
• Exposure in educating internal users on business systems and procedures and working with other analysts and QA team to set priorities and schedules.

PROFESSIONAL EXPERIENCE:

Confidential, St. Louis, Missouri

Sr. Healthcare EDI Analyst

Responsibilities:

• Incorporated and implemented all the HIPAA standards, Electronic Data Interchange (EDI), transaction syntax like ANSI X12, ICD - 9, ICD-10coding and HL7.
• Worked closely with the Enterprise Data Warehouse team and Business Intelligence Architecture team
• Designed and implemented HIPAA 835 Payment Advice Transaction, 837 Health Care Claim Transaction. Populated ICD-9, NDC Disease code sets as per the standards. Experience with transaction sets 835, 837, 270, 271, 276, 277 and 5010.
• Generating complex Transact SQL (T-SQL) queries, Sub queries, Co-related sub queries, Dynamic SQL queries etc.
• Involved with all the phases of Software Development Life Cycle (SDLC) methodologies throughout the project life cycle.
• Validate the SQL Scripts developed in MS SQL Server 2014 prior to moving the codes in to production
• Participated in data modeling; planning, designing, implementation of the data warehouse (ETL) and conducted testing
• Used SQL to test various reports and ETL load jobs in development, QA and production environment
• Created analytical cubes with SQL BIDS 2008 (SSAS) for analysis purposes.
• Facilitated JAD sessions to identify the business flows and determine whether any current or proposed systems are impacted by the EDI X12 Transaction, Code set and Identifier aspects of HIPAA.
• Involved in the full HIPAA compliance lifecycle from GAP analysis, mapping, implementation, and testing for processing of Medicaid Claims.
• Designed state processes for HIPAA 5010 X12 transaction processing EDI's 837, 834 and 835.
• Followed the Business Rules, and ensured that HIPAA compliant Rules are followed to display minimum benefit information that the Provider is required to pass on the EDI transactions.
• Used MS-Visio for flow-charting, Use- Case process model and architectural design of the application.
• Using Shared Containers and creating reusable components for local and shared use in the ETL process.
• Strategized implementation of EDI 837, 835, … … and 834 X12 transactions for the HIPAA 5010 in compliance with the firm's policies and evaluated the modified data manual.
• Writing new COBOL, DB2 programs to handle Claim centre messages (from front end via XML) processed in the Mainframe from the front end system called Claim Centre (CC) using GUIDEWIRE working with SQL SERVER Data.
• Examined, analyzed and model Test plans Use Case Model cases & Test procedures based on RUP methodology.
• Analyzed trading partner specifications and created EDI mapping guidelines
• Created the SQL scripts for demonstrating the prototypes and for verifying the result sets and used SDLC (System Development Life Cycle) methodologies like the RUP and the waterfall.
• Conceptualized primary process flow diagrams using Microsoft Visio and Case Wise tool sets.
• Got involved in designing future state processes for HIPAA 5010 X12 transaction processing EDI's … 270, and 271.
• Developed front-end production entry screen and batch interfaces between remote AS/400s and the corporate mainframe and coordinated various kinds of User Acceptance Testing (UAT) including regression testing, system testing, integration testing, functional testing, alpha & beta testing.
• Designed and created prototypes of reporting tools for data validation & verification initiatives using macros in Ms Excel developed Use Cases in Microsoft Visio along with Activity Diagram to present the workflow in a visual form.

Confidential - Brooklyn, NY

EDI Analyst

Responsibilities:

• Facilitated JAD sessions, introduced use cases into application development methodology and created client approval process for project methodology.
• Develop and maintain EDI maps such as 810, 811, 820, 850, 856, 860, 997 in accordance with the related guidelines, which are in ANSI X12 standards.
• Resolved EDI 811 transaction issues by communicating requirements from the customer to the EDI software vendor and validating that the mapping enhancements are correct.
• Conducted performance tests on EDI and non-EDI applications assessed the application and data stability and provided recommendations.
• Worked on OSS/BSS architectures to support processes such as maintaining network inventory, provisioning services, and configuring network components, managing faults taking orders, processing bills, and collecting payments.
• Coordinate relocations of 62 regional and district offices telecom equipment; including requesting new service and cancellations.
• Extract and perform detailed analyses of customer data via telecom carrier electronic and non-electronic invoicing media.
• Prepared & presented weekly and monthly business operations review before the senior leadership team
• Tested Performance & Accuracy related queries under SQL Server.
• Created bi-weekly reports and conducted client meetings to track the progress and timely delivery of final deliverable.
• Plan, schedule, initiate, and follow up with quality engineering procedures to improve and maintain product quality
• Actively involved in User Acceptance testing (UAT) and Training of the end users.
• Involved in project management using MS Project
• Worked on JIRA for AGILE/ SCRUM Environment of the project Methodology
• Identification and tracking of savings opportunities resulting from billing errors as well as recommend optimizations as it relates to telecom services.
• Designed and implemented a Cassandra noSQL based database and associated Restful web service that persists high-volume user profile data for vertical teams
• Aligned requirement documentation with use of UML for object oriented software development (OOD).
• Managed and maintained multiple telecom rooms, making necessary punch down, cross connections and wire tracing on 110 and 66 block to link multiple floors and buildings within the firm
• Created detailed functional specifications for development team
• Documented the Use Cases and prepared the Use Case, Activity, Logical, Component and Deployment views using MS Visio and Rational Rose for a clear understanding of the requirements by the development team. Coordinated with testers in using Rational Clear Quest for defect tracking
• Reviewed Integration Test Plan for integration between modules.
• Documented project processes and procedures and version controlled them using Rational Clear Case
• Created Artifacts and defined Milestones and iteration plans for Inception and Elaboration phases of SDLC
• Assisted the Account Management people in reviewing the account of the customers.
• Used Test Director with QA team for testing.
• Performed back-end data validation testing by using SQL queries against Oracle, Access, Postures databases.
• Identified and managed issues, risks, constraints and change requests for projects as well as those applications that could affect projects resulting in successful implementations
• Worked independently using a pre-defined project plan and maintained detailed level records for all phases of the application systems and programming activities

Confidential

EDI Business Analyst

Responsibilities:

• Performed Requirement Analysis and developed Use Cases, Activity Diagrams using Rational Rose
• Perform Message Class mapping in EDIFACT and ANSI X12. Coordinated with Trading Partners and IT Staff to resolve communication and system integration issues.
• Maintain and support Oracle EBS Procurement and Supply chain modules
• Developed documentation for POS Systems including Corporate Policies
• Include integrating new chain into existing systems which encompassed, gap analysis, specific brand requirements and full POS integration
• Collaborate with business partners to research and resolve any data quality issues with EDI messages
• Communicate data quality issues with appropriate departments, assist in finding solutions, ensure they are implemented and accurately solve the reported problems
• Communicate customer integration requirements to headquarters and manage the completion of these projects
• Evaluate tenders for EDI requirements and coordinate resources to meet customer expectations m Managed EDI connection with 3rd party vendors for order fulfillment & tracking, reducing transactions errors by 30-40%
• Involved in creating business processes and modeling diagrams using Rational Unified Process (RUP).
• Created use case scenarios and documented work flow and business process using Rational Rose
• Involved in project management using MS Project
• Analyzed trading partner specifications and created EDI mapping guidelines.
• Prepared Business Requirement Documents (BRD’s) after the collection of Functional Requirements from System Users that provided appropriate scope of work for technical team to develop prototype, Use Cases, UML diagrams for overall system.
• Created Test Scripts & Test Scenarios to check report content, layout, and parameters.
• Worked on Report Re-engineering Project and made enhancements to the system flow.