Senior EDI Analyst

Tanmay

Kiran Desai

EDI Analyst

Name: Tanmay Kiran Desai

Address: *** ***** **** ** *** 5204

Plano, TX 75074

Phone: 469-***-****

Email: ******.*.*****@*****.***

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Skills

Profound knowledge of EDI X12 standards in healthcare insurance (837, 835, 270/271, 276/277, 999, 277CA), Trading Partner Relationship, Data Interchange and EDI Connectivity Protocols (FTP, SFTP, FTPS, HTTPS/MIME, SOAP+WSDL). Proficient with Microsoft Office Tools such as Outlook, Word, Excel and Powerpoint. Analytical skills. Problem solving skills and attitude. Excellent written and verbal communication skills. ᅳ

Experience

Health Management Systems (HMS) / Sr EDI Analyst

January 08, 2018 – Present; Irving, TX, USA

Job Description

● Map 270/271 files.

● Develop process flow for TMV project for Covered California and CMS

● Analyzed the current procedure of processing 271 files and suggested the necessary improvements for

streamlining the procedure

Wageworks, Inc / Data Integration Engineer

October 23, 2017 – December 29, 2017; Irving, TX, USA Job Description

● Integrate new clients into existing system.

● Map flat files and 834 files for COBRA eligibility. Yosa Technology Solutions Pvt Ltd / EDI Analyst

December 01, 2014 - May 31, 2017; Surat, Gujarat, India Job Description

● Provide support to all EDI production processes; design, develop, maintain and modify all EDI maps to ensure compliance with all business requirements; analyze all EDI implementations and recommend improvements to

processes; coordinate with trading partners to resolve all issues effectively.

● Document all EDI solutions for system development life cycle, maintain all documents, specifications and

develop various transaction specifications as per

requirement.

● Monitor Inbound transactions to identify failed

transactions and suggest the necessary changes to

concerned stakeholder; monitor, identify and log

common failure reasons in order to recognize possible automation opportunities. Prepare implementation steps for developer for automation of failures messages.

● Establish direct connectivity with payers for different transactions (837P/I, 270/271, 276/277, 835) and in the event of no direct connectivity; identify best route

(clearinghouse) for different transaction to minimize the operation cost.

● Analyze monthly invoice to establish priority of payers and transactions that need direct connection or

adjustment of best route.

Projects

Direct Payer Conversion: Gathering technical information from Payer (Insurance Companies), Enrolling Providers, testing for different EDI transaction (837P, 837I, 270/271, 276/277,835) with a motive of direct relationship. Handling Trading Partner Agreement. Moving to production after successful testing. Modifying EDI map to incorporate new payer requirements. Technologies used for Batch transactions: FTP, SFTP, FTPS. Technologies used for Real-time

transactions: SOAP+WSDL, MIME.

Vendor Conversion Projects: Non ANSI services (Reminder services, Claim Scrub service) and other Projects with crucial monetary importance to the company.

ICD-9 to ICD-10 Conversion: Gathering readiness of Payers, volunteering testing program, register/enroll with Payer, participating in testing weeks, meeting (tele-conference) with payers.

Electronic Attachments (ANSI 275 Transaction):

Analysing payer readiness for accepting electronic attachments, meeting with level3 or above analyst from payer, analysing organization's current capabilities in sending 275 transaction and designing methods to facilitate to do so.

Projects handled as part of a role as QA: Claim Scrub(YEI Vendor) Testing, Client to EDI Database Transfer Testing, Claim Status Inquiry Testing, Testing Application Responsible for generating ANSI Claim file from Client Data [EClaims

(Professional/Institutional)]

Fastticket / Customer Service Executive

July 29, 2014 - November 30, 2014; Surat, Gujarat, India Job Description

● Assist customers with their issues related to product or connectivity

● Handle Travel department and Domestic Remittance department single handedly

DIVY Institute / Lecturer

January 01, 2013 - July 25, 2014; Surat, Gujarat, India Job Description

● Prepare students for Entrance test [GATE] for

engineering. Subjects covered Theory of Computation

(TOC), Computer Networks, DBMS, Data Structure,

Quantitative Aptitude, Reasoning, English

Australian Unified Pathway Program (AUPP) / Lecturer July, 2008 - July, 2009; Surat, Gujarat, India

Job Description

● Prepare students going to Australia for studies with the first year curriculum. Subjects covered C, C++, Java, VB.Net.

AARK Infotech / Software Developer

April, 2008 - July, 2008; Surat, Gujarat, India

Job Description

● Gather user requirements, translate to technical specifications, develop softwares and deploy on client machines.

● Technology used: Visual Basic

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Education

National Institute of Technology Karnataka, Surathkal / Master of Engineering - “Coursework Complete”, “Degree Not Yet Conferred”

October 2010 - December 2012; Surathkal, Mangalore, India I have completed the coursework but I have not yet completed the thesis for the completion of master’s degree. Sarvajanik College of Engineering & Technology, Surat/ Bachelor of Engineering (Computer)

August 2003 - May 2007; Surat, Gujarat, India

GPA: 3.0 [equivalent conversion from India]

Degree Awarded: February 26, 2008

Major: Computer Engineering

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