Avani Raiyani

EDI DEVELOPER

Tampa, FL adlqub@r.postjobfree.com

941-***-****

Over 10 years of Experience in the field of Information Technology with emphasis on EDI/B2B Technologies

Experience with the full life cycle of Software Development (Planning, Analysis, Design, Development, Testing, Integration, and Support).

Extensive experience in various Business Applications like Retail, Healthcare, Logistics, Finance.

Expertise on healthcare, retail and logistics EDI transactions such as 834,835,837,850,855,856,810

Expertise in B2B standards, Implementation of Integrated EDI applications for business processes across applications.

Development and implementation experience in EDI ANSI X12, HIPAA, EDIFACT Sterling Integrator (SI) applications.

Experience in Migrating Trading Partner setups with Communication setups to Sterling B2B Integrator 5.1 (GIS) from Gentran Server for Unix.

Experienced in HIPAA(Health Insurance Portability and Accountability Act), Health Care industry providing Business Process Assessment, Requirements Gathering, Gap Analysis, Implementation and Testing. Well versed with EDI and HIPAA transactions.

Worked on Sterling File Gateway for secure file transfer activities.

Demonstrated technical expertise during major system upgrade while maintaining customer and vendor relations related to new EDI requests using current Enterprise Resource Planning (ERP) processing and mapping.

Extensive experience in Business Analysis to Translate EDI Requirements into Functional Specifications and Develop Logical Mapping for Gentran, EC-Mapper, EC-Gateway.

Experience in design, development of internet/intranet sites using JavaScript, HTML.

Experience in developing for Health Insurance industry using C++ or C# and PL/SQL

Expertise in gap analysis of 4010/5010 of all transactions such as 837, 835, 999.

Strong understanding and knowledge of HIPAA, X12, XML standards.

Experience as an EDI analyst performing verification and validation of the EDI transactions.

Expertise in setting up migration mapping from older versions to newer versions.

Worked on various communication protocols and encryption tools like FTP, SFTP, HTTPS, AS2, VAN, SSH, PGP

Gathering requirements for projects, analysis of the impact of requests made by our businesses to each system, and working towards completion of the project, provide update and feedback to the project owners.

Excellent communication skills and written skills

Demonstrated proficiency in MS Excel, Word, PowerPoint, Visio

EDUCATION

Master of Science(M.S.), Biotechnology 2006 – 2008

Saurashtra university, Gujarat, India

Bachelor of Science(B.S.), Biotechnology 2003 – 2006

Christ College, Gujarat, India

JavaScript + Full Stack .NET Program Jan 2017 – May 2017

CoderCamps, Arizona, USA

JavaScript + Full Stack .NET Program is an intensive hands-on project oriented program which covers .NET areas including C#, ASP.NET, SQL, LINQ,

MVC, CSS, HTML5, JavaScript, JQUERY, Agile Project Management

TECHNICAL SKILLS

PROFESSIONAL EXPERIENCE

Continental Benefits - Tampa, FL Sep 2018 - Present

EDI Developer

Built interfaces for updated versions of EDI system through xslt mapping in Pilotfish

Created source file using the TR3 schema for 834 EDI transaction and target file to generate files through xslt mapping using the ETL tool Pilotfish

Created logical maps for specific requirements based on the layouts for the 834 and 837 files provided by the vendors and testing the output data generated through mapping

Mapped the EDI interfaces for 834 and 837 and tested the mapping in the output files

Updating existing maps, troubleshooting and maintaining logs for both the processes

Coding and testing for EDI program and secure transmission of data from server to sftp sites of the vendors and to the module

Provided training to internal employees to build the EDI interfaces in Pilotfish for the third party clients

Coordinate with the internal analyst team to ensure setup and design of data formatting and flow for new client implementations

Developing and testing HIPAA EDI 5010 X12 mapping formats (834,837) as well as industry standard and custom formats using ETL tool PilotFish

Completed testing of the EDI files that are generated through mapping,did the encryption of the files and setup CRLF in the output files as per the requirement of the vendor

Fluency with Microsoft SQL Server, XML, FTP/SFTP, and TCP/IP communications Tools Used: SQL Server 2012, XML, pgAdmin III, PilotFish

Zelis Payments - Clearwater, FL Sep 2016 – Aug 2018

EDI Specialist

Develop and troubleshoot EDI interfaces in a network of billions of dollars of healthcare payments, secure claims and medical records, 270000 healthcare providers, and 130 payers, as follows:

Performed User Acceptance Testing (UAT) to verify integrity of data, changes and updates

Set up FTP,SFTP connections and other interfaces

Gathered business and mapping requirements, worked with the implementations team, business analysts team, and developers team for the implementation of the EDI interfaces

Troubleshooting the issues in the 835 and 837 files, in crystal reports and resolving them in a timely manner

System Admin for desk.com - added/updated users, groups, rules and assigned the cases to users

Performing SNIP level testing of the 835 and 837 files for any Hipaa errors

Created Linq queries in Linqpad to troubleshoot escalated tickets

Created and modified SQL Scripts and ran in the SQL server to update the system

TFS(Team Foundation Server) to submit tickets for any changes in the system

Trained new hires for the ongoing process in the EDI department, added EDI configurations,performed mapping of the codes in the system.

Updated and extracted the data in the database using SSMS

Mapping, documenting and testing conversion and interface

Creating new and manage existing SQL and C# code (without code generators)

Participated in design and code reviews

Provided day-to-day support and maintenance of existing EDI integrations

Implemented new EDI integrations, and supported changes to existing integrations

Verified the EDI errors in the event logs in the database and resolving in a timely manner

Designed and developed maps on IBM Sterling Integrator 5.2

Plansource - Orlando, FL Oct 2015 - Sep 2016

EDI Specialist

Provided internal and external technical support as an Electronic Data Interface resource and as an ongoing technical support contact

Interacted with the customers to create Mapping Specification Documents based on the customer requirements.

Provided research resolution for escalations from internal and external team members, completed special projects as assigned, and interacted with internal contacts and external carriers and vendors

Resolved data discrepancies from interfaces such as 834

Interacted with internal and external parties as the ongoing technical support for interface issues

Maintained internal tracking system with project information

Managed interface project renewals for groups with no changes

Coordinated testing with third parties for interfaces without changes during renewal

Configured complex transmission setup for PlanSource standard files (SFTP, FTP)

Researched escalations from internal development tracking system for ongoing issues

Communicated/coordinated with carriers and internal parties related to interface projects

Completed special projects as assigned (system research, mass updates)

Meet or exceeded Data Exchange Team Service Level Requirements

Completed job-related training courses and/or seminars, which were required for the job

Checked or tested the 834 files through Claredi for any Hipaa errors

Did the clearing house(CH) transformation to create the mapping rules for the files

Worked with the programmers to resolve any issues or bugs in the files

Kuehne And Nagel - Jersey City, NJ Oct 2009 - Sep 2015

EDI Programmer/Specialist

Migrated over 64 Kuehne & Nagel customers from the Old Legacy system to New Legacy system

Gathered new requirements to develop EDI process

Designed and developed logical maps on IBM Sterling Integrator 5.1

Interacted with customers and provided day to day production support for any errors in the files

Monitor, identifying and resolving day to day electronic data interchange operational tasks

Migrated Trading Partner setups with Communication setups to Sterling B2B Integrator 5.1 (GIS) from Gentran Server for Unix

Interacted with Trading Partners to bring them onboard and get the requirements for new maps

Worked with the team to develop Mapping Requirements Document MRD for map development

Worked on EDI ANSIX12 standards and Transactions like 850, 855, 856, 810, 214 and Flatfiles

Analysis of legacy systems and migrating them to new Systems (CIEL to SALOG)

Performed Unit testing and Parallel testing to troubleshoot any issues and resolved them in a timely manner

Involved in CDM(Customer Data Management) setups and KNLogin Production system for the configuration of the OEDI setup

Knowledge of KN Login Visibility and XML

Worked closely with the developers and the operational team to solve any issues or bugs in the mapping

Created Mapping Specification Documents

Performed Unit and system testing on all EDI transactions both inbound and outbound

Involved in KNOPS testing to identify bugs and performed UAT testing for the Go Live Production data to the customer

Worked with Trading Partners EDI Teams, Business Units, Legacy Application Teams to implement EDI

Modified and made changes to map based on MR’s

CVS Pharmacy - Bradenton, FL

Registered Pharmacy Technician March 2008 - Aug 2009

Swiftly and correctly calculate dosages, dispense medications, prepare prescription labels and fill prescriptions for approval by pharmacists

Use the pharmacy’s proprietary computer program to access prescription information including patient and prescriber data, drug selection, prescription interpretation and insurance billing

Research and resolve dosage conflicts, potentially harmful drug interactions, insurance issues and other matters to ensure patient safety/wellness and build customer loyalty

Hands in experience for Drop off, Production, Drive thru and Pick Up

Prescription Processing

Pharmaceutical Calculations

Medical & Pharmaceutical Terminology

Drug Classifications & Safety

Medication Inventory Management

FDA Compliance

Medicare, Medicaid & Insurance Claims Processing

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