Quality Assurance Analyst (Health Edge, Health Rules Payer)

MetroPlusHealth; New York (NY); On-site; USD 70,000 - 100,000; Full time

Job summary

MetroPlusHealth is seeking a Quality Assurance Analyst to review Claims Processing Systems, configuring benefits and reimbursement methodologies. The role requires knowledge of UB04 and CMS1500, plus strong QA testing and documentation skills.

The candidate should have a bachelor’s degree and at least three years in QA with test case creation, analysis, and automation experience in a health care MIS environment. NYC location, full-time position.

Qualifications

• Bachelor degree from an accredited college or university.
• 3 years of progressive QA experience with test scenario and test case creation.
• Working knowledge of UB04 and CMS 1500 claims forms.
• Experience with IT applications and systems analysis methodology.
• Knowledge of Managed Health Care MIS Systems.
• Knowledge of QA automation tools or an equivalent combination of training and experience.

Responsibilities

• Create Test Scenarios and Test Cases based on requirements.
• QA Benefit and Provider Contract Configuration changes in claim systems to meet requirements and business needs.
• Create UB04 and CMS 1500 test claims aligning to requirements.
• Meet with business areas to gather business rules and requirements.
• Meet with Core configuration team to resolve defects.
• Create and maintain documents related to QA.
• Analyze QA processes and recommend improvements.
• Run QA Automation processes.
• Perform other QA tasks as needed.

Skills

Test case creation

QA automation tools

Claims processing knowledge

Analytical ability

Verbal and written communication

Education

Baccalaureate Degree

3 years QA experience

UB04 CMS1500 knowledge

Health care MIS systems knowledge

QA automation tools knowledge

Job description

This Quality Assurance Analyst will be responsible for reviewing the Claims Processing Systems for configured benefits and reimbursement methodologies. Experienced candidates must demonstrate working understanding of claims processing systems and working knowledge of the health care industry.

Scope Of Role & Responsibilities

• Create Test Scenarios and Test Cases based on requirements
• QA Benefit and Provider Contract Configuration changes in claim systems to meet requirements and business needs
• Create UB04 and CMS 1500 test claims aligning to requirements
• Meet with business areas to gather business rules and requirements
• Meet with Core configuration team to resolve defects
• Create and maintain documents related to QA
• Analyze QA processes and recommend improvements
• Run QA Automation processes
• Perform other QA tasks as needed

Required Education, Training & Professional Experience

• A Baccalaureate Degree from an accredited college or university; and
• Three (3) years of progressive, responsible experience in QA involving test scenario and test case creation; and
• Working knowledge of claims both UB04 and CMS1500; and
• Working knowledge and expertise in IT applications and systems analysis methodology; and
• Working knowledge of Managed Health Care MIS Systems; and
• Working knowledge of QA automation tools; or
• A satisfactory equivalent combination of training, education, and experience

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Excellent verbal and written communication skills.
• Excellent analytical ability.
• Excellent interpersonal, customer service and time management skills.

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