Job Description


  • Minimum of 8+ years of experience in health care experience especially in MMIS domain.

  • In depth understanding of Claims and Claims lifecycle:

  • Claim submission – Paper and EDI X12

  • Adjudication

  • Payment Cycle (Finance)

  • Reporting

  • Encounters and Capitation

  • EDI X12 formats like 837P/I/D

  • X12 formats 835, 834, 270/271, 276/277

  • Familiarity with systems like CMdS, GHS, Facets and etc

  • Ability to validate Test scenarios and test plans, test data.

  • SQL: To validate data in backend tables (e.g., claim status, payment details, find members/providers, Benefit Plan).

  • EDI Tools: Validating X12 files.


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