Elite Technical is seeking a Healthcare Claims Analyst to join our clients manual testing team as an FTE employee. This position is onsite (Elkridge MD) for training purposes for the first few weeks, then will become primarily a remote position with occasional onsite meetings when necessary.

We are seeking a Healthcare focused Claims Analyst who will perform end-to-end manual validation of healthcare claims processing and insurance data. You will ensure that QNXT configurations and data migrations accurately reflect complex medical coding (ICD, CPT) and business rules. This position is heavy manual testing versus EDI/Automation. This position is responsible for developing system test plans, manual test scripts, and test cases for functional and regression testing for health insurance claims and benefits processing systems and other support applications. Primary responsibilities include:

- Primarily focusing on testing and validation for upgrades, add-ons and continued maintenance of the QNXT claims processing system.
-Verify claims processing, provider contracts, and member enrollment within the QNXT core system.
- Works with Business Analysts (and others as needed) to ensure that test plans and scenarios cover all testable requirements and provides detailed feedback to the Information Technology staff related to application set-up or possible design flaws;
- Maintains detailed testing documentation including screen prints of system set-up and testing results, both good and bad. Documents details of bugs found during testing and notifies affected parties

Required Skills

Required Skills
- 5+ years QA software manual testing experience/testing methodology/practical application in a healthcare environment.
- 3+ years healthcare claims processing
- QNXT is required. Experience navigating QNXT tables and modules (Claims, Utilization Management, or Finance).
-Excellent knowledge in ICD/CPT codes
- Knowledge of Claims Adjudication is required
- SQL Querying experience is required. Ability to write Joins, Subqueries, and Unions to pull data for validation.
- Thorough understanding of all aspects of Healthcare claims processing system - including (but not limited to) claim adjudication, membership and enrollment, eligibility, configuration and benefits, authorizations and payment is required
- This individual will have experience with transactional data including inbound and outbound HIPAA transactions, i.e. 834, 278, 837, 835 as well as proprietary files. Ability to read HIPAA transactions 278; 834; 835; 837I, P, D
- Excellent verbal and written communication skills.

PREFERRED:
- Experience with the UltraEdit
- Experience and proficiency with Claim Test Pro
- Experience with automated test tools / EDI is a plus.
- A.A. degree and professional industry certification preferred.