Summary

• Senior IT resource with over 10 years of experience in IT industry while working as an EDI analyst.
• Sector-wise experience encompasses healthcare, logistics, insurance and services sectors.
• Very good experience working on HIPAA translation based projects and on claim processing systems (claims and encounters).
• Worked EDI projects for incorporating void/replace and NPI functionalities in HIPAA claims.
• Expertise in setting up B2B data transfer scenarios and working with trading partners.
• Design, development and administration experience on JCAPS (e*Gate).
• Rich experience in BPM: modeling, implementing and monitoring Business Processes (BP).
• Knowledge of both new versions of HL7 (version 3.0 – Reference Information Model) as well as HIPAA (5010).
• Experience with HIPAA 5010 migration as well as ICD code conversion.
• Excellent documentation and communication skills.

Education and Training

• Bachelors in Computer Science (BE CS) –
• Masters in Computer Science (MS CS) –

Technical Expertise

• Languages: Java, SQL, HTML, BPEL4WS
• Java Technologies: JDBC, RMI, JNDI, EJB, JMS
• Web Services: XML, SOAP, WSDL, Java EE web services API.
• ASC X12 Sets: X12 (850, 814, 811, 272 )
• HIPAA: 837/835, 270/271, 276/277
• HL7: version 2.x and 3.0 (RIM) – ADT, Orders, Results, Schedules, billing.
• Sun/Seebeyond: JCAPS (5.1.x) , ICAN (5.0.x), v4.5.3 (e*Gate, e*Xchange, e*Insight)
• Platforms: Windows (2000,NT,XP) ,HP Unix, IBM AIX, Sun Solaris.
• Databases: Oracle, SQLServer, ODBC, JDBC, T-SQL , PL/SQL
• Microsoft: Office, Access, Visio, Project.
• IDEs: NetBeans, XML Spy

Confidential Sacramento, CA Oct 07 - Current

• Justified the need of an ESB as a part of their SOA landscape
• Provided suggestions for leveraging the use of ESB and its features.
• Supervised the implementation and testing efforts for individual testing partners in a B2B environment.
• Created a high-level document outlining migration procedure from 4010 to 5010 and ICD-9 to IC-10 migration.
• Created web service definitions for some of their encryption and logging services.
• Conducted impact analysis to identify areas affected due to enhancements.
• Documented the enhancements in the Companion Guide.
• Responsible for maintaining implementation documentation as well as SOP documents and tracking changes in those.
• Identified risks, estimated project duration and allocated proper resources.
• Environment: HIPAA, X12 EDI , SOA Software, Oracle and Weblogic AS.

• As an HIPAA EDI manager involved in reviewing functional and technical specifications for messages.
• Involved in validating mapping of data values from HIPAA to data containers in e-HR system.
• Created initial design document for HIPAA 5010 conversion.
• Overseeing of development efforts and managing programmers. Lead all the technical efforts revolving around NPI implementation and designed the NPI crosswalk logic.
• Responsible for system maintenance and adherence to compliance rules.
• Environment: Java CAPS 5.1.3,SRE, Oracle, Sun Solaris.

Confidential Springfield, IL Nov 05 – Sep 07

EDI Consultant – HIPAA (4010- 837/835, 276/277)

• Worked DMHs 837/835 claiming system enhancement project to implement void and replace functionality.
• Also created initial design for 276/277 transactions for claim status.
• Developed technical specifications for incorporating void and replace functionality into current claiming system.
• Created technical and functional requirements for translation of 837 (P and I) files into proprietary format files.
• Identified key fields to be populated in the 835 outbound transactions for remittance advice to the counties from the EOB.
• Worked with ITWS (.Net) based application which supplied claims from counties.
• Revamped the claims balancing module for matching of various amounts.
• Filtered out unwanted errors encountered in the Claredi tool and incorporated Claredi errors in the overall error schema.
• Environment: e*Gate/e*Xchange 4.5.3, IBM mainframe, MS SQLServer 2004

EDI analyst - HIPAA (4010 - 270/271) HL7 (ADT)

• Worked on interfaces for eligibility request and patient administration messages.
• Involved in mapping of key fields for claim status request/response interfaces.
• Created an SRS document containing all the functional requirements.
• Worked with FacilEDI(Claredi) validation tool to incorporate various edits in order to achieve WEDI level 6 compliance.
• Acted as a liaison between the Montifiore and NY DOH for resolving data issues.
• Designed interfaces and designed end-to-end scenario for processing.
• Conducted a system analysis and suggested message size, component scaling options for optimal performance and high availability.
• Provided an outline of a custom error schema for error and exceptions.
• Acted as a liaison and coordinated all the development efforts.
• Environment: HIPAA 4010, HL7 v2.

B2B analyst and consultant

• Architected the entire B2B solution including network topology and components.
• Placed B2B components in separate DMZ zone and sensitive data behind firewall.
• Created partner profiles in the B2B interface for all the trading partners which included setting up of ISA/IEA, GS/GE and ST/SE envelope information.
• Set up validations scripts for all incoming transactions.
• Designed a PGP encryption interface embedded in the B2B gateway.
• Set-up profiles, protocol (communication and B2B) and envelope structure parameters for all trading partners (TP) and external parties.
• Configured seebeyond eX_schema and eX_ePM component for data routes.
• Used ePM web interface and eXchange database tables to monitor messages.
• Environment: e*Gate/e*Xchange 4.5.3, MS SQL Server 2000, Claredi (FacilEDI).

Seebeyond/e*Gate developer/support

• Developed interfaces for data transfer from mainframe to ERP system.
• Created MM and monk e*Ways, java collaboration rules and JMS IQs.
• Created DB ETDs (tables, prepared statement) and X12 ETDs.
• Used Batch (FTP), HTTP(S), Oracle, Email and JMS eWay connectors
• Worked extensively with SSL : certificates, truststores and keystores using
• Used e*Gate monitor for components, log levels and IQ Administration.
• Environment: e*Gate 4.5.2, IBM AS400, Oracle Financials(9.1), java keytool utility.

Application Developer

• Worked on an n-tier online application for tracking of HIV patients in the state
• Created front end dynamic web pages using HTML and javascript.
• Accessed methods for identity matching remotely using Java RMI technology.
• Connected to back-end Sybase database using JDBC API.

Associate Consultant

• Implemented a POC (proof-of-concept) project which involved creating a palm-pilot based to showcase the features of sybase’s thumbnail database (db for handheld mobile devices).
• Conducted technical presentations and generated technical documentation.