The Senior QA Specialist participates in all aspects of 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 serves as the lead facilitator within Business Integration for incoming inquires or reports of errors/configuration requests, researches those requests to ensure appropriate referral to the department, and when not appropriate, facilitates resolution through appropriate business units. This facilitation includes a root cause analysis, facilitation between departments to guide problem resolution, and transfer of issue ownership to appropriate business units.
|
Key Functions/Responsibilities: - Implements a front-end testing plan for large and small system updates
- 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 other departments
- Performs testing (writes, executes and reports on test cases) of SYSTEMS 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 requests.
- Creates & maintains a library of test cases to be used for SYSTEMS configuration changes, both manually executed and for automated testing
- Performs quality assurance and improvement activities under the direction of the Manager of Quality and Testing; i.e. problem solving as it relates to SYSTEMS payment errors and identifying root cause problems. Performs the testing of SYSTEMS enhancements to support operation-wide efficiencies.
- Performs quality audits for agreement setup, benefit & policy implementation under the direction of the Manager of Quality and Testing
- Prepares and submits QA/ QI reports to the Manager of Quality and Testing.
- Serves as a resource and provides information as requested to internal and
external sources on related operations. - Develops test cases from approved requirements
- Designs test data
- Executes test cases utilizing MDE Xpress Claimtest pro
- Analyzes and documents test results
|
|
|
Qualifications: Education Requirements : - Associates Degree or equivalent relevant work experience
Preferred/Desirable: - 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.
- A strong working knowledge of Microsoft Office products
- Ability to write basic SQL queries and analyze the resulting data
- Strong technical, customer service and organizational skills
- Self-motivated, requiring minimal oversight
- Strong work ethic and ability to be innovative
|