Healthcare Claims Finance Tester

Healthcare Claims Finance Tester
Location: Atlanta, GA or remote but with 25% travel whenever required

Play the role of Finance Domain lead for MMIS health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisions.

• Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.
• Candidate should have hands-on experience on claims processing and Adjudication processes.
• Candidate should have hands-on experience and strong knowledge on processing payouts, Account receivables and Receipts creation.
• Candidate should have hands-on experience of executing payment cycle process and ability to analyze batch job failures.
• Candidate should have hands-on experience of executing payment cycle process and generating Paper RA, 835 and 820 premium payment.
• Good knowledge and Strong hands-on experience on Fiscal pend, budget updates processing.
• Candidate should have hands-on experience generating EFT/Checks.
• Good knowledge and Strong hands-on experience on Airflow batch job scheduler to execute different batch jobs.
• Good knowledge and Strong hands-on experience on 1099 generation process.
• Good Knowledge and Strong hands-on experience on generating Account receivable, 1099 and warrant due letters generation process.
• Good Knowledge and Strong hands-on experience on generating Payouts, AR, Receipts and payment cycle cognos reports.
• Good Knowledge and Strong hands-on experience Financial outbound and Inbound interfaces.
• Good knowledge on Finance reports
• Able to validate Claims payment system to ensure accurate and consolidated reimbursements to payees (provider, member and other) within a defined payment cycle. Knowledge in the following business processes
• Reimbursement of medical and other claims
• EFT set up
• Data exchange between various entities leading to the final payment to payees.
• Must have good experience with claims processing concepts, along with the provider, member enrolment and care management concepts.
• Must have good experience in Reference code/data sets required in Claims adjudication including not limited to CPT, CDT, HCPCS, ICDs.
• Should be able to run queries and perform basic system analysis, RCA etc.,
• Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks

Testing knowledge and E2E Testing:

• Validate the entire flow from claim intake to payment and reporting.
• Interface testing - Test integration points between systems
• Design test case based on business rules, coverage policies, and system configurations.
• Familiarity with test management tools like ADO, JIRA,
• Interface/API testing tools like Postman

Technical Skills

• SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).
• EDI Tools: Validating X12 files.
• Interface Testing: Understanding how data flows between systems and formats and use tools like postman

Preferred skills:

• Minimum of 5+ years of experience in health care experience especially in MMIS domain.
• Capability to think out-of-the-box to create new solutions as needed.
• Ability to validate Test scenarios and test plans, test data.
• Should be able to Review requirements, documentation and create Requirements Traceability matrix (RTM)
• Should have excellent communication (written and spoken ) skills to engage with different stake holders like QA/dev team, clients, end users of Clients and Business Units.
• Ability to assess current functionality available in a product vis a vis market trends, regulatory requirements to be implemented in future version of the product.
• Ability to drive and share the requirements with Technical and Architects regarding product features to be implemented.
• Test Planning & Reporting: Create test plans, test summary reports, and traceability matrices.
• Communication: Collaborate with cross-functional teams including developers, SME s and BA s