Abhinav Kotla

Healthcare Edifecs developer with 5+ years of experience specializing in Medicare eligibility operations, HIPAA-compliant X12 processing, and payer data integration. Skilled in managing the full lifecycle of 270/271 CMS eligibility files, TIN and MSP file workflows, and CMS compliance validation using Cleo Integration Cloud. Utilized Edifecs SpecBuilder to create and maintain specifications for complex healthcare transactions, resulting in a 30% reduction in processing errors and improved compliance with industry standards. Proven ability to investigate eligibility discrepancies, configure secure SFTP connections, support CMS file audits, and ensure regulatory adherence across Medicare file exchanges. Implemented Edifecs MapBuilder to streamline the mapping of EDI transactions, which enhanced data accuracy by 25% and facilitated smoother audits by providing clear transformation documentation. Hands on experience with SQL, Python, and EDI tools to drive data accuracy, enhance eligibility resolution, and support cross-functional implementation with product and engineering teams. Developed integration solutions using Edifecs XEngine to automate the processing of EDI files, leading to a 40% increase in throughput and significantly reducing manual intervention. Skilled in handling large volumes of healthcare EDI transactions while maintaining SLA performance, audit readiness, and end to end integration documentation. Utilized Azure services to implement a cloud-based data pipeline for EDI transactions, which improved data processing speed by 45% and facilitated better disaster recovery options.