lohitha pachava

Master's

Data Science

BlueCross BlueShield of Kansas City Kansas

EDI DEVELOPER

- Worked on HIPAA 5010 EDI versions including 834, 837, 835, 270/271, 276, 277CA, 277U, 278, 820, and 148 First Report of Injury (FROI) transactions - Processed healthcare EDI transactions utilizing QNXT for database management - Managed EDI transactions across multiple file formats including X12, SAP IDOC, flat file, JSON, and CSV - Created and maintained standard specifications for inbound and outbound transactions using ANSI X12, EDIFACT (D93A, D96A), and SAP IDOC standards, interacting closely with trading partners - Utilized Edifecs Spec Builder to create and analyze EDI test files, conducting gap analysis in line with 5010 implementation guides - Integrated and processed pharmacy claims data in compliance with NCPDP standards to ensure precise and efficient claims adjudication, contributing to optimized workflow and regulatory compliance - Identified and implemented EDI workflow improvements using GHX and other platforms, enhancing efficiency and accuracy - Configured AS2, FTP, and SFTP setups for EDI communication, troubleshooting errors and researching inbound/outbound EDI documents - Developed mapping specifications for new trading partners using Tibco-EDISIM - Utilized EDIFECS XEngine (XEngine, XEngine Server, XEngine Grid, EAM), Transaction Management, and FACETS for HIPAA Gateway Trading Partner Management - Implemented error-handling solutions with BizTalk Server and Edifecs Spec Builder, resolving discrepancies to maintain data accuracy - Ensured compliance with healthcare EDI standards (X12, HL7) using EDI Notepad and Altova Map Force, maintaining accurate data translation and smooth communication - Enhanced claims processing efficiency by 20% through precise mapping using IBM Sterling B2B Integrator, GXS Trusted Link, and Healthcare Mapper - Orchestrated seamless EDI integration with MuleSoft and Talend, ensuring HIPAA-compliant, secure data exchanges - Reduced support tickets by 40% by ensuring HIPAA compliance in EDI transactions and safeguarding patient data - Configured XML Gateway for valid XML message exchange between Oracle e-Business Suite and trading partners - Analyzed and modified RPG/RPG ILE programs, ensuring data integrity and efficient EDI transactions. Developed custom reports and interfaces using RPG ILE - Developed and maintained BR100 technical configuration papers, ensuring alignment with business needs for effective EDI processing - Managed 999, 277CA, and TA1 reports in Edifecs Transaction Manager, identifying claim corrections before resubmission - Validated and routed 837x and 27x transactions in Edifecs X Engine to backend systems - Developed onboarding documentation for trading partners and internal teams, ensuring a smooth onboarding experience - Created precise mappings for healthcare transactions using Altova Map Force and IBM Transformation Extender, aligning with BCBS data requirements - Improved BCBS claim processing efficiency by integrating EDI solutions with core systems like SAP and Oracle - Prepared ABAP design documents and specifications, providing clear guidance to developers for effective project execution - Tools and Technologies: BizTalk Server, EDI Notepad, XML Gateway, Oracle e-Business Suite, Healthcare Mapper, IBM Sterling B2B Integrator, GXS Trusted Link, MuleSoft, Talend, Edifecs X Engine, Altova Map Force, Tibco-EDISIM, Edifecs Spec Builder, SAP IDOC. Programming Languages: Java, J2EE, Python, XML, SQL, JavaScript, PowerShell, .Net, RPG, RPG ILE