This document is a resume for Paul Vinod R. that outlines his professional experience and qualifications. Over 7.5 years of experience in the US healthcare industry is highlighted, including most recently as a Technical Analyst/Software Engineer at Trizetto - A Cognizant Company from 2014 to present. Previous roles include Business/Senior Claims Analyst at Infotech Global India Pvt Ltd from 2010 to 2014 and AR Analyst at Fortune Knowledge Solutions from 2008 to 2010. Relevant skills, responsibilities, and projects are described for each role.

1. Page 1 of 7
PAUL VINOD R.
Phone:7406923024 / 8605330671
Email:paulvinod.r@gmail.com
OBJECTIVE
To take a challengingroleon business operationsas EDI Analystand givean efficient and effective solution that
will help the organization to achievethe best solution in businessand ultimately increaseits productivity in
market. And secure job in a creativeand challengingenvironmentwhere there is an opportunity for professional
growth based upon skill and contributions.
HIGHLIGHTS
 Electronic Data Interchange (US HealthCare)
 FACETS, BizTalk on windows,QNXT, FTP and SFTP transmission Protocol.
PROFESSIONAL SUMMARY
 Overall US Healthcare industry experience of 7.5 Years with about 22 Months as AR Analyst.
 Assertive, industrious and resultoriented.
 Good interpersonal and communication skills.
 Dedicated team player who is comfortableworking with global teams.
 Excellent rapportwith Team members.
 Highly self-motivated, dedicated, honest, sincereand hardworking.
 Capableof managingmultipleprojects simultaneously.
 Flexibility in adaption to a wide range of work environments.
 Belief in team work, dedication,and professional ethics within theworking environment.
 Organized,self-starter,and ability to master new technologies.
 Manage multipletasks whilefollowingthrough from startto completion.

2. Page 2 of 7
KEY SKILLS & RESPONSIBILITIES
Analyst responsibilities
 Medical claimprocessing- HCFA1500 and 1500 (08/05); Hospital claimprocessing -UB92/UB04; Dental
adjudication- ADA 2006.EDI knowledge of 837I,837P & 837D, 835, 997/999,270/271,276/277 EZ-CAP and
NSF.
 Gather Business needs of the clients and do gap analysis againstImplementation Guide EDI 837I,837P, 837D.
 837I/P/D (EDI) electronic ordered/syntactic loops,segments/elements, its fixed attributes, components.
 Testing and Implementation of multipleEDI transactions with Health Plans.
 Importing the multipleformat encounter/claimfiles into system, validateand review the files,analyzethe
errors and provide the feedback to the customers/submitters.
 Analyzingand representing customer business requirements,Perform feasibility analysis
 Proficientin managingand leadingteams for runningsuccessful businessprocessoperations with proven
ability of achievingServiceDelivery
 Good in trainingaboutthe Productfunctionality and Process workflows
 An effective communicator with proven team buildingand management abilities.
 Good knowledge in HIPAA, ClaimAdjudication,Good in Medicare, Medicaid programs,CPT& ICD9 codes,
Facility claims & provider contracts.
 Good knowledge of MicrosoftOffice(Word, Excel, PowerPoint, etc.)
 Analysis and testingof clientfiles,and coordination of product development for all the clients.
 Advanced knowledge for various formats of EDI data is importantfor the implementation and delivery of
Production services for the clientbasewhich includes conversion fromversion 4010 to version 5010 by the
HIPPA mandated date.
 Communicate results of analyses to senior leadership,typically in theform of presentations
 PreparingSOP’s and updating the team on process guidelines.
 Business process mapping;map business processes per established standards,usinga defined toolset.
 Gather national and payer specific claimrequirements from payer companion guides, billingmanuals,payer
trackingetc.
 Review and analysisof various existingdocuments and facilitation of process walk-through and validations.
 Conducted successful projects with the help of teams to achievedeadlines timely and proficiently.
 Experience in User Acceptance Testing, Smoke Testing, Regression Testing, Performance Testing and
Functional Testing.
 Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
 Helps in conducting Gap Analysis (GAP), User Acceptance Testing (UAT), and System Integration testing (SIT).
 Coordinated with QA Team for testing activities across multiplesystems and managed conversion test
execution.
 Used EDI tools to verify mapping to X12 format.
 Recommend changes for system design,methods, procedures, policies and workflows affecting
Medicare/Medicaid claims processingin compliancewith government compliantprocesses likeHIPAA/ EDI
formats and accredited standards ANSI.
 Participatingin the planning,development, coordination and presentation of specific testingneeds as
appropriateto the quality assuranceneeds of the end user.

3. Page 3 of 7
Trizetto – A Cognizant Company, Pune DEC 2014 – Till Date
Role : Technical Analyst / Software Engineer
Project Description:
EDI Hosted - Technical Environment: FACETS, BizTalk on windows, QNXT, FTP and SFTP transmission Protocol,
PGP Decryption and encryption method for securetransmission.
The purpose of this project is to provide 24X7 support and maintenance to the EDI subsystem and makes the
Business more streamline. Trizetto - A Cognizant Company is a product base company providing service and
solutions for the USA healthcare Insurance payers and providers. My team is solely responsible for all kind of
Electronically Data Interchange. On overall we were supporting the transmission of document from outside to the
hosted application on different products. Most of the application is on the open source platform and mostly FTP
and SFTP protocol with encryption and decryption technique used for the data transmission. The EDI-documents I
am dealing with are the ANSI X12 HIPPA transactions (270,271, 278, 835, 837 (P, I & D), 275,276,277,999 & 997).
Providing break fix, workaround, RCA and approved Change request implementation were part of my team
responsibility.
Responsibilities:
 Analyses of FACETS interactivetool application issues and provides solutions to address business needs or
to resolveissues on all environments.
 Responsiblefor working with the State to review on all FACETS HIPAA GATEWAY Job failures.
 Responsible for integrating and supporting various business processes on FACETS Interactive Tool.
 Provides the overall coordination and supportof all internal upgradation for FACETS Clients.
 Involved in testing various ETS and MFT scripts for FACETS clients.
 Based on requirement setting up the tradingpartner for FACETS clients.
 Understandingand generating the ETS scripts for the filetransfers.
 Reporting the project status to management (WSR, MSR , trend analysis report).
 Communicates and coordinates activities with stakeholders.
 Monitoringand controllingday to day operation.
 Interacting with the Client IT Manager to understand the expectation, issues and risks .
 Monitors daily EDI processes and performs troubleshooting, restart and recovery actions as necessary.
 Reviewing CR Tickets on daily basis and providing the resolution/update on given SLA timelines.
 Interact with onsiteresources on daily basis.
Team Size: 18

4. Page 4 of 7
INFOTECH GLOBAL INDIA PVT LTD, Bangalore OCT 2010 – DEC 2014
Role : Business / Sr. Claims Analyst
I was part of the INFOTECH GLOBAL INDIA PVT LTD Operations team who transitioned variousprocesses like MNE-
Connect, Orbit- e - connect and Med - connect (Trans Union) from IGI HEALTH, Piscataway, New Jersey, USA.
1st Transition period: May 13th 2012 to November 6th 2012.
2nd Transition period: February 13th 2013 to May 13th 2013.
3rd Transition period: September 11th 2013 to October 11th 2013.
RCM Project Description:
Project #1 Med- Connect
Med Connect is powered by INFOTECH GLOBAL INDIA PVT LTD ORBIT® Provider Portal. For Providers, one of the
time consuming functions has to manually fill-in the paper claims in order to bill for the service rendered. Filling
paper claims includes information pertinent to patient, insured information, the patient’s relationship to the
insured,diagnosisdetails,information on the type of services provided,rendering physician details, and the billing
provider details.After fillingthe paper claims,the physician has to manually manage the claim submission detail s
such as the number of claims submitted, the payer details, the type of claims (primary, secondary, tertiary), COB
information, resubmitted claim details, and the claim status report (that whether the submitted claim is
approved/rejected by the payer).
Hence, ithas been a tedious work for the physician submittingtheir paper claims and to maintain. That if all these
functions could be taken care of with an electronic claim submission system that would not only speed up the
physician's claim submission, but will ensure the payer efficiency of payment and better care for physicians.
Our Med Connect suite does exactly this. The Med Connect is a highly secure, sophisticated system which enables
the physicians to submit their claims electronically.
Project #2 MN E-Connect
ORBIT® a web based transaction portal which will enable healthcare providers to check member eligibility via the
McKesson, WebMD, Delta Dental and INFOTECH GLOBAL INDIA PVT LTD Networks, automate payment and easy
pay solutions via the Vital Network, process batch and data entry claims bundled through the INFOTECH GLOBAL
INDIA PVT LTD Network and then routed to the clearinghouse for disbursement. Providers will be able to transmi t
transactions in the form of secure EDI files.
This will generate EDI format of basic paper claim (UB04, HCFA 1500 & ADA) form prescribed by many health plans
for claims submitted by physicians and suppliers, and in some cases, for ambulance services. I t is accepted
nationwideby most insuranceentities so you can submit this form as the standard claim form/attending physician
statement for submission of medical claims. Provider registers online.
Health plan receives confirmation of provider registration. Provider enters claims using this online tool, which is
similar to the standard paper forms providers use today. The tool flags any errors that providers can immediately
correct to ensure compliancewith the state and HIPAA requirements Provider clicks send,and health plan receives
compliant electronic claim.

5. Page 5 of 7
Clinical Project Description:
Project #1 Provider Directory for clients (BHS, JFK and Allegiance)
The HealthEC® Provider Directory streamlines the setting up and management of the HealthEC® product suite. The
intuitive, easy-to-use application provides management features like Provider Setup/Configuration, User
Management, and Role Management & Roles based access. It simplifies access to pertinent information including
Provider Details and facilitates Provider Self Registration.
Our comprehensive Provider Directory tracks,and measures physician performance,participation and compliance
with quality metrics to present a provider’s performance in comparison to their peer groups, User access allows
the account administrator to set up additional account users and assign/restri ct module rights, set up provider
information,and edit the accountdetails as needed. This tool also manages provider on-boarding,registration and
payer approvals, while the business rules engine helps manage provider ID cross mapping for accurate file
submissions. Let’s you know immediately when a patient needs to go to ED, and communicates with the hospital
to receive the patient; sends a patient summary for each patient Informs the Provider’s office staff when patients
need to make arrangements for the transition of care Flags important or “out-of-range” results, so you know when
abnormal or important lab/radiology results are available to view for patients
Secure messaging communications are enabled for patients/providers/care coordinators in the network we also
have a robust provider alerts mobile application, which can send real -time alerts to doctors on patients’
admissions or ED visits, patients transferred, patients discharged, and which patients have received lab reports
Project #2 Beneficiary Management Solutions for clients (BHS, JFK and Allegiance)
HealthEC® Claims and Beneficiary Management Solutions: Collaborating electronically with payers, The HealthEC
Claims and Beneficiary Management Solution offers robustelectronic data exchange so providers can transmit and
receive electronic data to and from health plans. It supports institutional, physi cian, pharmacy, dental and
proprietary data formats. There are several reasons why HealthEC Claims and Beneficiary Management solution is
used by so many payers and provider itapplies value-added claims editingand businessrules logic,translation and
routing, to deliver electronic transactions in industry standard and proprietary formats. The sophisticated backend
rules engine (including payer rules) that flags errors before the claim is sent to the payer, thus reducing rejection
rates and ensuring faster payments. It manages Provider on-boarding, registration, payer approvals, and the
business rules engine helps manage provider ID cross map for accurate file submissions.
Our Customer Service Center assists providers with claim rejections, training, forgotten password and other
transaction-related questions. Ithandles all HIPAAtransactions including:Claim (837), Claim Status (276/277), ERA
(835), Eligibility (270/271), Referral/PreAuth (278), Patient Information (275), etc.
Functional Expertise:
Business Analystfor RCM and Clinical ACO projects lines. Responsibilities include having good knowledge on ACO
Concept and HIPPA. A disciplined and self-motivated, with dynamic experience in US healthcare – in the area of
payer, provider, patient care, clearing house, Accountable Care Organization and CMS. Hand on experience in
EMR, PHR and HIPPA transactions. I have worked with 3 ACOs (Barnabas Health Services-BHS, JFK- JF Kennedy
and Allegiance) within New Jersey for about 1 year from the yearly audit to the daily operations of the ACO, and
these ACOs within New Jersey utilizing HEALTHEC’s Population Management Suite of products ranging from
beneficiary attribution, care management, provider directory and more.
Business Analysis Expertise:
Preparation of Requirement Specification, Functional Requirement Specification Wireframes for mock-up screens,
Change Request creation, Test case reviews, coordination with onsite team, and handling Sprint meetings and
Sprint sheet.

6. Page 6 of 7
FORTUNE KNOWLEDGE SOLUTIONS, Bangalore NOV 2008 – OCT 2010
Role : AR Analyst
Duration : 1 Year 11 months
Description: Plan, build and Execute doctor’s end to end medical billing process, Understanding the doctor’s
software processes quickly and implements best knowledge to collect the money as quick as possible, Assigning
medical billing work, manage, mentor and monitor the team on day to day basis, Achieve client revenue targets,
analyze AR performance to include net collection %.
Roles & Responsibilities:
 Analyze the claims beforecalling.
 Prioritizehigh valueclaims ($).
 PrioritizeInsurances thathaveminimum filinglimitto avoid untimely filingdenials.
 Red FlagInsurances / Plans thatrequireAuthorizations / Referrals and notify Providers.
 Analysts Track global issues on a daily basis.
 PreparingSOP’s and updating the team on process guidelines.
 Good knowledge in HIPAA, ClaimAdjudication,Good in Medicare, Medicaid programs,Facility claims &
provider contracts.

7. Page 7 of 7
Personal Profile
EDUCATION
MARITAL STATUS : MARRIED
GENDER : MALE
NATIONALITY : INDIAN
D.O.B : 28:10:1986
PASSPORT NUMBER : K2630849
US B1/B2 VISA : VALID FROM 23APR2012 THRU 18APR2022
PROFECIENCY IN COMPUTER
OperatingSystem : Windows2000 professional,Windows98
Packages : MS-Excel, MS-Word, MS-PowerPoint, MS-Outlook
LANGUAGES KNOWN
English,Hindi,Kannada,Tamil:SPEAK
English & Hindi:READ & WRITE
HOBBIES, INTERESTS & ACTIVITIES
ListeningMusic
Cooking
CURRENT RESIDENCE ADDRESS
Flat No. 701,
Green Aura society,
Near Anand Hospital,Opp to Sai Sadan Society
Rahatni,Pune – 411017
PERMANENT RESIDENCE ADDRESS
# 59, 5th Cross
Aaiya Matha Temple Road, Oil Mill Road
Lingarajapuram,
Bangalore- 560084 (PAUL VINOD.R)
Course Name of Institution Year
B.Com R.B.A.N.M’s First Grade Evening College (2005-06 to 2007-08)
PUC Pre-University of Government College (November 2004)
SSLC B.M. English High School ( March 2001)