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Claims Systems Tester

2 months ago

Bakersfield, United States KHS Full time

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).

KHS reasonably expects to pay starting compensation for the position of Claims Systems Tester in the range of $26.73-34.70 hourly.

Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.

Definition

This position is responsible for the direct claims testing of all new system implementations, updates to existing systems, and alterations of any kind that impact claims processing in any way. This position will identify criteria needed to find appropriate testing scenarios, plan and activate test cases for the identified situation, determine if testing is a pass or a fail and why, document all test cases and results, communicate with Claims Management as to the results of the test cases and identify potential needs and/or solutions. This position also researches system errors and identifies solutions to implement or correct the system.

Distinguishing Characteristics

This position is responsible for testing all types of system adds, changes, deletes that impact Claims Processing to improve claim outcomes with greater efficiency.

Essential Functions

  • Analyze, perform and validate in the system testing of new contract configuration and enhancements of existing contract configuration of the core claims processing system to ensure they meet the business specifications and needs.
  • Analyze, perform and validate in the functionality testing of any update to the core claims processing system as they relate to the claims department to ensure they are functioning as expected through end to end scenario testing
  • Perform in regression testing of any changes to the core claims processing system to identify any possible impacts caused by changes.
  • Review and update the maintenance and management of test scripts
  • Assist running reports to quantify Claim reported issues
  • Run reports for the overpayment team, once reported issues have been corrected
  • Assist with logs to track reported issues
  • Analyze reports to identify areas that can potentially increase auto adjudication
  • Analyze and recommend corrections to the system functionality based on testing of reported errors.
Other Functions
  • Performs other job-related duties as required.
  • Adheres to all company policies and procedures relative to employment and job responsibilities.


Employment Standards

Education: High school graduate from an accredited school or equivalent.

Experience: Minimum of five (5) years of direct experience in processing medical claims, preferably a Managed Care Organization. Experience in processing all claim types required.

Knowledge of : Personal computer applications: spreadsheet, database, and word processing; methods and procedures utilized in medical claims processing; medical terminology, CPT and ICD-10 coding, Medi-Cal, Medicare, and other regulatory agency requirements with regard to claims processing; all types of claims - professional, institutional, inpatient and outpatient; use of the Medi-cal website, and navigation tools for research. Experience with KHS's Core Claims Processing System and TestRails.

Ability to : Maintain confidentiality. Adapt to a rapidly evolving work environment; work independently as well as a team member; manage multi-task responsibilities; work accurately with strong attention to detail; effectively communicate with a variety of personnel; prepare management reports; must be able to learn and retain multiple guidelines and recognize items that fall outside of those guidelines. Ability to read and interpret Hospital and Professional contracts. Must be highly motivated, organized, flexible, and have good time management skills.

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.