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

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 days 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 POCs 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.

Development activities. Worked on an enhancement project in existing 837 Professional xml to X12 map. Developed Amount calculation logic in the existing 837 Professional xml to X12 map. Performed unit and integration testing on 837 professional map with various test cases. Gave demo on amount calculation logic in 837 professional map. Found solution for 7.x Edifecs specbuilder installation issue.

Support activities Generating Claims reports, 835 ERA reports/reprocessing, AAA reports, 278 report and reprocessing through EDIFECS. System Monitoring and reporting any partial or rejection file issues using EDIFECS Transaction manager on a daily basis Analysis of failures and exceptions in EDIFECS routes and finding the root cause and fixing on a daily basis Logs monitoring on a daily basis Analysis and fixing of Help desk/fogbugz tickets assigned which are related to EDIFECS Development activities. Developed a EDIFECS real time 837 P/I web services route (Network access model) to accommodate multiple trading partners Developed a EDIFECSArchiving route to archive a trading partner files on a weekly basis Configured a new trading partner 837P/I electronic/paper and creation of TP Agreement/ relationship using EDIFECS TM Updating EDIFECS External code list codes on local, Dev, QA, prod machines on quarterly basis

Involved in the design of mapping document for HIPAA Transactions like 837 P/D/I, 270/271, 276/277, 278I/O, 835, 834, 277CA. Written validation rules using JavaScript in EDIFECS specbuilder ecs files for validating receiver id for all HIPAA inbound transactions (837,270, 276, 278) Written mapping rules in EDIFECS mapbuilder NPI to API copy rule for all inbound transactions (837,270, 276, 278) Configuration of XEServer validation/ translation routes, Selector config file for paper x12 file validation and translation in to irl file.

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

The goal of this HIPAA 5010 project is to use the existing 4010 system for the MMIS state by stepping down the 5010 data to 4010 and translating & loading processing and revert back to 5010. I have developed translation project for 837-P/D/I the conversion is from HIPAA 4010 x12 format in to txt file using mapbuilder. In the HIPAA 5010 Development project, I have developed 837-P/D/I 270/271,835 translation project using the EDIFECS mapbuilder (Specbuilder 7.0.8) (X12 to xml & vice versa). Developed 270/271 maps converting HIPAA x12 format to Cobol copy book& vice versa Apart from map development I have also involved in resolving environment issues such as EAM server/route issues, Transaction management issues. I have closed all open issues in the SIT, UAT environment and the project is currently in production.

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 datas 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.

Worked in production support project in IBM Sterling Gentran for the state of Michigan Fixed various Gentran Maps for the HIPAA transactions like 276I, 278I, 837-P/D/I, 270I, O, 834O, 835 O, 271 I, O Configured/ Updated trading partner setup in gentran for the transactions like 837-P/D/I Created various new gentran maps during enhancement for the hipaa transactions like 837-P/D/I Configured Severityconfig.xml, Xeselectorconfig.xml as per the requirement. Specifications in Xengine for validation purpose for a HIPAA file for all HIPAA transactions. I have developed various test scenarios, test datas for the business scenarios and also for unit testing and E2E testing. I have the ability to develop an inbound/outbound translation project using Gentran also