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Name: Raghava Title: EDI Specialist Phone: 248-246-1705 Email: *[email protected]* SKILLS : • Project Management of EDI staff and business processes, responsibility for formal project specifications and project status reporting, personnel work assignments. Assist with system design overview and database requirements. Work with and between trading partners, clients, management, technical and non-technical personnel to define issues and identify solutions. HIPAA EDI resource person (segments, elements, loops, etc.), negotiate with Trading Partners, work on legal issues with corp. attorneys, perform vendor selection. • Utilize Six Sigma's DMAIC approach to data-driven project analysis.Apply six sigma principals to project, including analysis, reporting, and performance matrix. • Responsible for attaining HIPAA EDI validation from Medicare, Medicaid, and other payers or government carriers. Developed HIPAA EDI Transmissions for both government carriers and commercial entities. Work includes complete business cycle management and hands-on production as well. Create EDI Testing process, documentation, and performance matrices. • Completed several HIPAA Projects, leading a number of HIPAA projects for Medicaid Plans, large insurance companies, clearinghouses, and healthcare providers. Companion Guides, legacy system integration, HIPAA code set resolution and payment posting projects, including Claims, Eligibility, Claim Status, Remittance, COB, Explanation Of Benefits (EOB or EOP) and other healthcare IT projects. Work with government carriers and payers to support the provider community, including Institutional, Professional, Dental, and specialty work such as Encounter transmissions, Secondary Payers, and Cross-Over billing. Includes Medicaid MCC / MCO and Medicaid Management Information System ( MMIS ) work: 837 and 824 system design. • Project Scope determination; Corporate interviews to determine the scope of project. Work Flow, WBS (Work Break Down Structure); Trading Partner Selection: Hardware, software, and vendor services are determined after appropriate interviews. Development of Job descriptions, documented in detail, including skills needs, desired experience, and a general description of costs. Production phases are documented as well as a test plan for deployment. • Trading Partner / Vendor Management: Manage the requirements and selection for Trading Partners and Vendors. Schedule conferences, JAD sessions, participate in negotiations, set/create/resolve EDI TP issues and create legal draft points for corporate attorneys. • Gap analysis and Market Research: Trading partner assessment was performed as well as corporate readiness for EDI production. Industry knowledge was shared to assist in long-term goals. Gap analysis was performed to identify changes (as-is and to-be status for six sigma), which was kept within the corp. objectives both financially and objectively. • Technical Specification Creation for EDI. Schedule meetings with technical personnel to determine technical parameters for EDI and other related processes, including communication, security, and privacy. Create transaction sets requirements, usually with Microsoft Excel, for transactions such as: HIPAA 270/271, 276/277, 835, 837-(I,P, &D), 835 Remittances and others. Resource for UB92 and HCFA1500 billing formats, transaction sets requirements, EDI development and Design, X12 protocols through Version 4010A1 and newer, conversion needs and understanding of legacy EDI formats, such as UB92 Versions 4, 5, 6 and NSF. • Work with vendors to set up electronic communications and clearinghouse communications, including protocols such as Frame Relay, FTP, Dial-up, and others. Encryption software was also selected and tested, including SSL, PGP, and encryption keys, both public and private. • Use cases, test plan creation and Companion Guide development: Development or oversee others in developing EDI Specifications, Test plans and/or companion guides for the 837 Institutional, 837 Professional, 837 Dental, 835, 270/271, 276/277, others. Test plan design, from stage to production, including both internal and external requirements. Companion guides and crosswalks were developed using Excel. Insurance and clearinghouse entities were consulted to insure proper integration and compliance, research done on segments and elements as needed. Mapping staff were instructed on EDI issues and management was made aware of systems issues, status, and progress. •Disaster recovery plans. Create Disaster Recover plans, including hot and cold off-site Recovery Procedures and validation processes. Design problem escalation parameters. Work with third party vendors to arrange appropriate communication and data transfer for operation set-up in the event of a disaster. •Worked on Implementation of several ALE transactions and master data transfer, created several custom IDOCs and processing routines. •Experience working on the TLE. 2.11, 3.5, 5.2, 5.3, 5.4.,6.1 •Experience working on the Lansa Integrator and Composer. •Also worked on the Map Force tool. •Developed simple programs on the AS/400 systems for searching for multiple objects or a single object in a library. •Experienced in RPG IV developing basic RPG programs and creating EDI maps. •Worked on shell scripting for basic requirements. •Designed and developed technical mapping specs for various EDI transactions. •Worked on BDC, LSMW, and SAP Script, Smart Forms, BAPI, RFC, User exits and OSS Notes. •Configured workflow to trigger the error notification process in EDI and ALE interfaces. Thank You, Srinivas *Comp Consults Inc ** * ***Best Of Farmington Hills 2009*** *A Certified MWBE Company ** * *[image: cid:[email protected]]** ** * *Recognized Fastest growing private company in America ** * || *E**: *[email protected] || *|| Y*: compconsults.srinivasd ||* **G*: [email protected] || || http://www.linkedin.com/in/bdeforcci || Give trust, and you'll get it double in return -- KEES KAMIES The goal as a company is to have customer service that is not just the best, but legendary. -- SAM WALTON __________________________________________________________________________________________________________________________ *Disclaimer: We respect your Online Privacy. This is not an unsolicited mail. Under Bills.1618 Title III passed by the 105th U.S. Congress this mail cannot be considered Spam as long as we include Contact information and a method to be removed from our mailing list. 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