Qualifications:
Experience required: 8 years related experience in a managed care or healthcare organization environment. 5 years experience in processing claims in a managed care environment Knowledge of health plan claims processing, system configuration and testing Comprehensive knowledge of medical terminology as well as CPT4, HCPCS and ICD9 coding sets is required Prior experience in testing, quality assurance and quality improvement practices Preferred/Desirable: 4 years experience as a claims quality reviewer and/or senior claims analyst Competencies, Skills, and Attributes: Excellent attention to detail; sound judgment; initiative; and flexibility. Strong problem solving and analytical skills. Strong interpersonal communication and relational skills. Excellent verbal/written communication skills; ability to interact within all levels of the organization. Ability to effectively present information and respond to questions. Effective collaborative and proven process improvement skills. Detail oriented, excellent proof reading and editing skills. Strong technical, customer service and organizational skills Self-motivated, requiring minimal oversight Strong work ethic and ability to be innovative A strong working knowledge of Microsoft Office products Ability to write basic SQL queries and analyze the resulting data Working Conditions and Physical Effort: Regular and reliable attendance is an essential function of the position. Work is normally performed in a typical interior/office work environment No or very limited physical effort required. No or very limited exposure to physical risk Ability to work OT during peak periods
Responsibilities:
Job Summary: The Senior QA Specialist participates in all aspects of configuration and user acceptance testing. This includes reviewing requirements, writing and executing test cases to ensure applications meet requirements. This position will also develop and execute the automation test suites for the regression of applications as it relates to Facets configuration efforts as well as supporting test procedures for downstream ancillary programs required for transaction processing. The Senior QA Specialist also aids the lead facilitator within Business Integration for coordinating and interpreting the accuracy of the test results.This facilitation includes a root cause analysis, facilitation between departments to guide problem resolution, and transfer of issue ownership to appropriate business units where applicable Key Functions/Responsibilities: Implements a front-end testing plan/strategy for large and small system updates spanning from lights on work to project work Perform functional testing, data validations, and regression testing of applications managed by Business Integration such as Facets, iCES, NetworX, Workflow and DRG. Coordinates User Acceptance Testing with departments internal and external to Business Integration Performs testing (writes, executes and reports on test cases) of configuration changes to ensure proper claims payment to include accurate fee schedules, benefit plans, provider agreements & contract arrangements, clinical editing, authorizations and general system maintenance and update requests. Creates & maintains a library of test cases to be used for testing configuration changes, both manually executed and for automated testing Performs quality assurance and improvement activities under the direction of the Manager of UAT and Configuration testing; i.e. problem solving as it relates to payment errors and identifying root cause problems. Performs the testing of enhancements to support operation-wide efficiencies. Prepares and submits test execution reports to the Manager of UAT and Configuration Testing Serves as a resource and provides information as requested to internal and external sources on related operations. Develops test cases/test sceanrios from approved requirements Designs test data and maintains an inventory of test data required for all test environments Executes test cases utilizing MDE Xpress Claimtest pro Analyzes and documents test results along with conducting results walkthrough for UAT
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Last updated on Apr 1, 2015