Encounters Test Lead

Overview

Remote
Up to $110,000
Full Time

Skills

EDI
Lead

Job Details

Role: Encounters Test Lead

Location: Remote

Duration: Long-term/Fulltime

Role Summary

The Senior Team Lead is accountable for all testing activities related to Healthcare Encounters, with required knowledge of Claims and Encounter data flows, and hands-on experience in the Facets and Edifecs (EdFX) ecosystem. The role oversees functional testing, regression testing, and end-to-end (E2E) testing, while driving scrum execution, sprint delivery, and team performance across onshore and offshore teams.

Key Responsibilities

  • Encounters Testing Leadership
  • Lead end-to-end testing execution for Encounters, including Functional, Regression, and E2E testing.
  • Ensure accuracy and compliance of Encounter outputs across creation, validation, reconciliation, and submission workflows.
  • Define test scope, test plans, test cases, acceptance criteria, and traceability for Encounter requirements.
  • Support defect triage and root cause analysis, leveraging knowledge of claims adjudication logic and Encounter rules.

Claims & Encounters Domain Expertise

  • Apply strong understanding of Claims adjudication to validate Encounter accuracy and downstream impacts.
  • Work hands-on with Facets adjudication logic, data extracts, and Encounter generation processes.
  • Leverage expertise in Edifecs (EdFX) for Encounter validation, EDI transformations, editing, and submission workflows.
  • Validate Encounter-related transactions (e.g., 837 Encounters, 999, 277CA, 824, proprietary acknowledgments).

Agile Delivery & Execution Management

  • Manage daily scrums, sprint ceremonies, backlog refinement, and release planning for the Encounters Testing team.
  • Drive on-time sprint commitments, testing cycles, defect turnaround, and release readiness.
  • Monitor velocity, execution progress, and quality metrics, escalating risks proactively.
  • Continuously optimize testing efficiency, coverage, and regression stability.

Team Management

  • Lead and mentor onshore and offshore testers across Functional, Regression, and E2E streams.
  • Allocate work, balance capacity, and ensure clear ownership across testing phases.
  • Provide coaching, performance feedback, and domain knowledge support.
  • Build a high-performing, collaborative, and accountable testing team culture.

Cross-Functional Collaboration

Partner closely with Product Owners, Business Analysts, Developers, and EDI/Operations teams.

Coordinate dependencies across claims, enrollment, provider, pricing/edit engines, Edifecs workflows, and downstream reporting systems.

Provide clear status updates, risk assessments, and delivery communications to leadership.

Required Skills & Qualifications

  • 7 12+ years of healthcare payer IT, QA, or testing experience.
  • Strong expertise in Encounters Testing with required knowledge of Claims processing and Encounter data lifecycle.
  • Hands-on experience with Facets and Edifecs (EdFX) platform components.
  • Proven leadership in Functional, Regression, and E2E testing delivery.
  • Strong Agile/Scrum delivery management experience.
  • Experience leading distributed (onshore/offshore) teams.
  • Strong analytical and SQL/data validation skills.
  • Excellent communication and stakeholder management.

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