Excellent knowledge of HIPAA (Health Insurance Portability and Accountability Act) transaction 834 (benefit enrolment) with FACET.
Good knowledge on FACETS Eligibility / Enrollment transactions
Experience in writing queries/scripts for data analysis
Well versed with Facets tool
Microsoft certified Technology Specialist in web Applications Development with Microsoft .NET Framework 4.0 (70-515).
Microsoft certified Technology Specialist in Microsoft SQL server 2008 Database Development (70-433).
Comprehensive knowledge of software testing (unit, integration, functional and user acceptance).
Business AnalystCarefirst Inc
Wellmark health insurance project (India).
Carefirst health insurance project (Owings Mills, MD, U.S).
Cardinal health care shopping system (India).
Wellmark health insurance project (India).
eLogistic OTIS project (India).
AE2 Enrollment Supports outbound EDI submissions of HIPAA compliant transactions 834 and 999/TA1 for multiple trading partners.
Submission methods include batch file and real-time transactions through manual upload.
Supports to analyse data in FACET tables to validate specific cases and edit file manually based on the scenario for different trading partners before sending the outbound 834 file to exchanges.
Analyse HIPAA EDI transactions in X12 responses and of 834 and 999 and looked for defects.
Analyse trading partner's weekly/daily error reports to find out the root causes and resend the corrected transactions.
Coordinate with the clients and the internal team to resolve the tickets raised by the EDI trading partners.
Resolve all EDI 834 transaction issues according to specification.
Track daily data transfers and production schedules for different trading partners Automated manual 999 acknowledgments monitoring process.
Carefirst : Health insurance My Account Client: Carefirst (Onsite Assignment) Carefirst is the largest health care insurer in the Mid-Atlantic region, serving 3.4 million members and has more than 577,000 members in the Federal Employees Health Program (FEP).
This application gives CareFirst members the ability to manage their health insurance through their own account.
Member gets enrolled through FACET or NASCO.
Involved to work as a liaison among stakeholders in order to understand the structure, policies, and operations of an organization.
Involved in understanding business change needs, assessing the business impact of those changes, capturing, analyzing and documenting requirements and supporting the communication and delivery of requirements with relevant stakeholders.
Analyses member data, eligibility, plans, incentive in database to resolve the tickets raised by member through service desk.
Used FACET tool to verify member's details, eligibility, plans, claims etc.
Scheduled meetings with stake holders and service desk to discuss member issues and to keep them updated on deployments.
Created SOP's (Standard Operating Procedures) and conducted sessions to educate service desk team On standards issues reported by members which helped to reduce number of incidents.
Involved in the communication of technical information to a non-technical audience (users) and business information to a technical audience (developers).
I was the primary point of contact for the Incident Management team for any business related queries or user concerns.
Technology LeadWellmark Inc
Project: Provider Search Application, Member Portal application Wellmark healthcare is a mutual insurance company owned by its policyholders.
Wellmark provides health insurance in IOWA and South Dakota region Responsibilities: Worked as Technology lead and played key role in developing end to end Provider Finder application where member can find the doctors, agents, Dentists, Facilities in the region Involved in requirement gathering from client.
Also involved in documenting requirements, estimation, and development and providing functional and technical solutions to the client.
Lead team of 4 members.
Also involved in enhancements and defect fixing of Member portal application.
Have extensive knowledge in consuming the WEB API calls in MVC controller to display data on the screen.
Implemented google map functionality as a part of provider's location search.
Technology: ASP.NET 4.5, C#, JQuery, MVC Client: Cardinal Health.
Medical product and services system Cardinal Health is an essential link in the health care supply chain, providing pharmaceuticals and medical products to more than 60,000 locations each day.
The company is also a leading manufacturer of medical and surgical products, including gloves, surgical apparel and fluid management products.
Responsibilities: Key role performed in maintaining and supporting organization's products that are released to customers.
Involved in requirement gathering and providing estimation to the client.
Involved in impact analysis, development, defect fixing and unit testing.
Extensively worked with XML-based technologies and web services including SOAP.
Actively involved in deployment and production support.
Tools used: Service Now, Team foundation server, SOAP UI.
Senior System Engineer
Project: - Member Portal Wellmark is the leading health insurance company in Iowa and South Dakota and covers more than 2 million members.
Blue Cross and Blue Shield is a mutual insurance company owned by its policyholders.
There are two modules in the project.
Involved in requirement gathering and providing the estimation to client for the new requirements as well as change requests.
Understanding the business requirements and translate them into design document and implementation.
Created Impact analysis and low level design documents.
Performed a key role in implementing front-end web applications and backend processing systems.
Involved in low level design document and code review.
Developed various unit test scenarios according to business needs.
Actively involved in all stages of testing (unit, integration and user acceptance testing).
Involved in defect fixing and maintaining weekly reports.
Tools used: Visual source safe, HP quality center and SharePoint.
Client: OTIS Role: Software Programmer Project: - eLogistics eLogistics provides Otis Sales representatives and on-line customers with a global, integrated sales tool leading to revenue growth.
It automates and simplify a number of back-office processes, in order to significantly reduce sales administration cost and workload.
Responsibilities Involved in requirement gathering from customer.
Implemented different functionalities to save purchase orders, estimate, calculations for profit/margins and other functionalities.
Key role played in development of front-end web applications and backend processing systems Performed impact analysis of new change requests.
Developed multiple front end screens using HTML/ASP.NET controls, ADO.NET, JQUERY in dot net framework.
Developed multiple reports using SSRS.
Successfully developed stored procedures, queries, triggers and views for querying the database using ADO.Net Actively involved in all stages of Software testing (Unit, System, Integration, and Functional).
Actively involved in the development and implementation of complex databases objects.
Involved in demo representation to the customer for their better understanding of the product and its functionalities.
Tools used: Team foundation server, HP quality center, SharePoint.
Bachelor of Engineering: ElectronicsIndiaElectronics