Suyog Shinde

Software Development Engineer with over 10 years of experience in development using the Microsoft .NET ecosystem. Proficient in creating scalable solutions with .NET technologies and SQL Server.

Well-versed in EDI 834 enrollment.

837 processing (HCFA, UB, DENTAL),999 file generation,277 file generation healthcare claims workflows

Experienced across the Software Development Life Cycle (SDLC) and Agile methodologies, including sprint planning, daily stand-ups, and retrospectives. Focused on writing clean, maintainable code, with a strong emphasis on performance optimization, secure architecture, and team collaboration.

Project: Golem – Healthcare Claim Processing System
Technologies: C# .NET (WinForms), SQL Server, Windows Services
Domain: Healthcare / Insurance

Role & Responsibilities:

• Conducted a detailed requirement analysis and translated business needs into technical specifications
• Designed and implemented an SQL Server database schema optimized for large-scale claim data
• Developed key modules in WinForms to handle HCFA, UB, and dental claims efficiently
• Built backend services to process and track claims in compliance with HIPAA and PHI standards
• Integrated EDI support (837 format) for secure data transmission to clients
• Implemented multi-user access handling with concurrency control
• Developed a QA module to enhance data validation and ensure highly accurate EDI output with minimal errors
• Created reporting and dashboard modules for real-time status tracking and operational insights

Project Summary:
Golem is a robust claim processing system designed to handle various types of healthcare claims. It streamlines claim intake, validation, and EDI output generation while ensuring PHI compliance. The addition of a QA module significantly improved data accuracy and reliability, enabling error-free EDI submissions and reducing rework. The system supports concurrent users and provides end-to-end visibility through a real-time dashboard.

Project: Data Validator & Structural Validator – Healthcare Claims Validator
Technologies: C#, SQL Server, Windows Services
Domain: Healthcare / Insurance

Role & Responsibilities:

• Conducted in-depth requirement analysis and converted business needs into technical specifications
• Designed and implemented robust SQL Server schema for efficient handling and validation of high-volume healthcare claim data
• Developed Windows Services to automate validation workflows and support real-time EDI file processing

Project Summary:
This project focused on validating the structure and syntax of healthcare EDI transactions (primarily 837) to ensure full compliance with ANSI X12 standards and payer-specific implementation guides. Key contributions include:

• Performed detailed validation of EDI segments, loops, elements, and delimiters to identify missing, malformed, or non-compliant data
• Built pre-validation rule sets to ensure data integrity prior to EDI file submission or ingestion
• Ensured HIPAA and trading partner compliance through customized validation logic
• Developed automated tools and scripts to flag structural inconsistencies and reduce manual effort
• Collaborated with EDI developers and analysts to refine rules and resolve mapping mismatches
• Simulated various EDI scenarios for QA and UAT, enhancing system robustness against malformed data
• Contributed to the creation of modular validation engines, reducing claim rejections, and improving first-pass acceptance rates

Project: DocGem & InsightPro – Document and Performance Management Systems
Technologies: ASP.NET MVC 5.1, SQL Server
Domain: Healthcare / Insurance

Role & Responsibilities:

• Performed detailed requirement analysis and translated functional needs into technical design
• Designed and implemented relational database schema for efficient document storage and retrieval
• Developed key modules using MVC 5.1 for document handling, versioning, and user activity tracking
• Implemented multiuser access and concurrency control for simultaneous document interaction
• Contributed to the development of an EDI Editor module to parse and manage EDI healthcare data

Project Summary:
DocGem is a robust document management system designed for secure storage, organization, and tracking of healthcare-related documents. It supports full audit trails, tracks user interactions (view/update), and enables real-time collaboration on documents with concurrent access. The system also includes an EDI Editor module for seamless editing and validation of healthcare EDI files.

InsightPro is a customizable performance management and analytics tool designed to enhance operational efficiency in healthcare organizations. It provides transparency in workforce and inventory management through:

• Real-time performance monitoring
• Quality and training analytics
• Productivity tracking and aging analysis
• Resource utilization and optimization reports

Together, DocGem and InsightPro streamline healthcare administrative tasks, improve compliance, and drive informed decision-making through integrated insights and document control.

Project: CGolem – Web-Based Healthcare Claim Processing System
Technologies: ASP.NET Core, JavaScript, SQL Server 2022, RESTful Web API, Git, Postman, OCR, Azure
Domain: Healthcare / Insurance

Role & Responsibilities:

• Performed end-to-end requirement analysis, database design, and full-stack implementation
• Collaborated with cross-functional Agile teams including QA, product owners, and business analysts

Project Summary:
CGolem is a modern web-based healthcare claim processing system that evolved from a legacy desktop application. The platform is designed to handle high-volume 834/837 EDI transactions securely and efficiently in a multi-tenant environment.

• Revamped the legacy system using ASP.NET Core and OCR technologies, improving claim processing speed by 40%
• Designed and developed EDI 834/837 parsing and validation modules, reducing manual efforts and enhancing data integrity
• Implemented GUID-based session handling for secure, tenant-isolated access control
• Optimized database performance using advanced stored procedures and indexing in SQL Server 2022
• Developed RESTful APIs and structured data models for scalable integration with external systems
• Integrated cloud services such as Azure and explored AWS options to future-proof architecture
• Promoted development best practices through code reviews, CI/CD pipelines, and adherence to clean coding standards
• Maintained technical documentation to support long-term maintainability and team onboarding

Project: MCO PRO – Healthcare Claim Processing & Repricing System
Technologies: C# .NET (WinForms), SQL Server, Windows Services
Domain: Healthcare / Insurance

Role:
Worked on a pre-developed platform, contributing to requirement analysis, database design, and implementation of new enhancements and modules as per evolving business needs.

Project Summary:
MCO PRO is a healthcare claim repricing and processing system built to handle multiple claim types efficiently. The system automates key operations including claim intake, validation, repricing, and EDI output generation (e.g., 837), while adhering to HIPAA and PHI compliance standards.

Key contributions include:

• Enhanced existing features and implemented new modules based on client and regulatory requirements
• Tuned SQL Server performance and updated stored procedures to support high-volume data
• Integrated Windows Services for background processing and automated claim handling
• Ensured secure processing of sensitive health data in accordance with PHI guidelines
• Worked closely with business analysts to translate repricing logic into system logic

• Clear and effective communication
• Analytical problem-solving
• Quick adaptability to new technologies
• Collaboration in cross-functional teams
• High attention to detail
• Initiative in continuous improvement
• Efficient time and task management
• Accountability and ownership