MMIS Claims Tester

Job Title: MMIS Claims Tester
Location: Remote (25% Travel Required)
 

Job Summary

We are seeking an experienced MMIS Claims Tester with a strong healthcare payer background. The ideal candidate should have extensive experience in Medicare/Medicaid claims processing, healthcare systems, claims adjudication, benefits configuration, and QA/testing within payer environments.

Key Responsibilities

• Test MMIS and healthcare payer applications.
• Validate claims adjudication processes.
• Perform functional, integration, and regression testing.
• Review business requirements and create RTMs.
• Validate CPT, CDT, HCPCS, ICD reference codes.
• Execute SQL queries for backend validation.
• Work closely with Development, QA, Architecture, and Business teams.
• Conduct root cause analysis.
• Support client demonstrations and UAT.
• Create test scenarios, test plans, and documentation.

Required Skills

• Healthcare Payer.
• Medicare & Medicaid.
• Claims Processing.
• Claims Adjudication.
• CPT.
• HCPCS.
• ICD.
• SQL.
• Requirements Traceability Matrix (RTM).
• QA Testing.
• Business Analysis.
• Excellent communication.

Preferred Skills

• Jira.
• Azure DevOps.
• Visio.
• Healthcare QA.
• Web Services.
• Relational Databases.