Jay Desai

A professional team player with 11 years of IT project implementation and operational readiness experience. Experience in SDLC process for Health Care Individual and Group Products and specialized work with Finance, EMB, Contact and Customer Experience business processes. Excellent verbal and written communication and interpersonal skills with both business and IT stakeholders with proven documented forms such as business requirements specification, user stories, process flows and vendor change requests. Experience in review and assessment of enterprise level business cases for satisfying different segment market gaps.
Strong institutional knowledge of Medicaid; including Medicaid Information Technology Architecture (MITA), and Medicaid Management Information Systems (MMIS)
Development of 820, 834, 837 Claim billing, 276 Status, 834 Enrollment, 835 Claim Payments, 829, 270-278 and many other healthcare maps.
Understanding of EDI business practice and the ability to understand the client's needs.
Strong Experience in Vendor relationships management and integration of new vendor . Experienced with Federal contracts, X12 transactions, health care act, EDI transactions 270, 271, 834, 835, 837.
Wrote BRD, FRD, Mapping doc., test scenarios, test cases for testing the functional and non-functional aspects of both ETL and Reporting jobs.
Worked on different EDI healthcare transactions like 834-Benefit Enrollment and Maintenance and 820-Payment Order/Remittance Advice.
Upgrade mapping for new B2B and existing B2B clients , IBM Sterling B2B integration and IBM Connect Integration( Certification , Authentication and integration )
Involved in Various application Implementation and conversion of 4.21 and also in TriZetto Facets and TriZetto HIPAA Gateway 4.11.
Conducted internal audits and prepared audit reports to ensure compliance with Medicare, Medicaid and other institutions.
Background of documenting HL7 and X12 interface specifications.
Knowledgeable for gap analysis in changing old MMIS data via ETL and testing new MMIS system integration for legacy data to new DB format.
Expertise in Membership Enrollment, Claims, Subscriber/Member, Plan/Product, Claims, Provider, Commissions and Billing Modules of Facets.
Proficient in conducting Business process modeling (BPM), feasibility studies, Impact Analysis, Cost/Benefit analysis, Gap Analysis and Risk analysis.
SQL application management, (added users, created backup and recovery plans, ran SQL scripts) Through knowledge of ICD-9, ICD 10 codes and CPT codes for both Mental and Medical Health.

• Professional Scrum Master
• Powershell
• Agile Scrum Training