Role and Responsibilities

Development activities.

• Developed Claim balancing in the existing 837_Batch profile using EAM 8.6 balance counter in the existing workflow based on that able to track per day’s total claims received, accepted or rejected and generate a report based on that also used to identify issues if any claim unbalanced.
• Developed/Configured clearing house custom report in the existing workflow (837_Batch_profile), it will generate a daily/weekly/monthly report with total number for snip 7 edits occurred per day with error description, error id, segment/element level details etc.
• Developed/Configured an enhancement called alphanumeric prefix, alphanumeric prefix is an enhancement to handle the alphanumeric prefixed on the subscriber id, based on that specific routing will happen.
• Developed/Configured an enhancement called FTP changes in the existing 837_Batch profile in order to write the Database extract to the FTP location on a daily basis.
• Apart from the POC’s and development activities also involved in TP upgrade on a weekly basis on DEV/SYS/USR environments and also involved in upgrading External code list once in 15 days in DEV/SYS/USR environment and also involved in Java upgrades (JDK) in DEV/SYS/USR environment on a regular basis.

Multiplan

Role and Responsibilities

EDI Analyst

Development activities.

• Creation of Claims OTP Report on a daily basis
• Creation of Claims BMP Report on a daily basis
• Creation of Claims LAB Report on a daily basis
• Creation of PI Report on a daily basis
• Perform United Reason Xwalk testing whenever error occurs
• Preparation of UHN Data whenever error occurs
• Creation of test scenarios for United testing
• Rolling out Claims Otp, BMP, LAB, PI Reports on monthly basis.

Southdakota

Project Objective and Description:

• Performed Research & development on Seebeyond 5.1.3 for developing Translation project for all the HIPAA transactions.
• Developed various translation projects for HIPAA transactions like 276I, 278I, 837-P/D/I, 270I, O, 834O, 835 O, 271 I, O using JCAPS 6.0.
• I have developed various test scenarios, test data’s for the business scenarios and also for unit testing and E2E testing.
• In HIPAA 5010 development team I have developed 278-I translation project using EDIFECS mapbuilder 6.8.

Role and Responsibilities

• I worked on a poc called EDIFECS-HIPAA cloud.
• The EDIFECS HIPAA cloud poc integrates multiple MMIS states to use the same environment and same EDIFECS EAM XEServer and XEngine configurations.
• I have configured and developed a common XEServer profile for Inbound validation/translation and outbound validation/translation.
• Worked on further enhancements on the poc to handle the validation/translation in common Routes in the XEServer profile instead of having multiple routes in a same XEServer profile.
• Created a common EDIFECS-EAM Server/client XEServer, XEngine, and common validation/ translation profiles with common routes to accommodate multiple MMIS states to use the same environment and tools.
• Also done a poc called “EDIFECS as standalone” (validation/translation) without any dependencies on JBOSS application