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39510, Paseo Padre Pkwy., #370, Fremont, CA
Fremont, CA, United States

Phone: 201-497-1022
Web Site: www.mmcsystems.com

Company Profile

EDI Quality Analyst


Job ID:



Nashville, TN, United States 




50/hr per hour

Job Views:


Zip Code:


Employment Type:

Contract - Corp-to-Corp, Contract to Hire - W2, Contract - W2, Contract - 1099



Job Description:

DURATION: 06 + Months
LOCATION: Nashville, TN

Job Description
The contract provides Tier Two support for entities engaged in enrolling
individuals in Qualified Health Plans (QHPs) under the Affordable Care Act (ACA).
Testing will include transaction validation of EDI transmissions (X12 820 and 834,
and their XML variants) as well as application testing of Oracle datamarts, Service
Oriented Architecture (SOA) tools, and Open Source Software (OSS) applications in
an Agile/SCRUM development context. The Quality Assurance Analyst will work with a
multi-disciplinary team well-versed in these technologies, many of whom will be
conversant in structured and disciplined test management and change control.
Key Responsibilities:
  • Assist with internal audits of various types of enrollment resolution and reconciliation activities to ensure procedural standards are consistently adhered to by the EDI and Support Analyst staff. Provide feedback to reduce errors, improve processes and performances, and ensure the quality and consistency
  • Conduct necessary research and coordination as necessary for all audit / compliance related activities.
  • Identifying training gaps for enrollment resolution and reconciliation processes or techniques to meet accuracy requirements
  • Ensure all audit reports support the overall Key Performance Indicator (KPI) and Service Level Agreement (SLA) scores of the project and compliance strategies
  • Investigate, record, resolve, maintain and report all member complaints and grievances
  • Support the process of validating workflows and communication tools to best enhance Quality Assurance (QA)
  • Identify, investigate, and report non-conformances related to enrollment resolution and reconciliation processes to management
  • Perform root cause analysis of errors identified (if applicable)
  • Validate audit findings with affected parties and confirm corrected actions
  • Recommend solutions to mitigate/fix the errors noted and review them with affected parties for an agreed upon approach, as appropriate
  • Document work performed and audit results based on pre-determined standards and guidelines
  • May be assigned to work on special projects and business initiatives
  • Create spreadsheets and macros, compile, analyze data in an efficient and effective manner
  • Present data in a detailed and summary level for different level of reviews
  • Provide detailed input to root-cause analysis and resolution for errors identified
  • Perform User Acceptance Testing (UAT) to ensure system changes and/or enhancements are properly tested and acceptable prior to implementation including:
  • Develop test plan based on business requirements
  • Perform regression testing (as applicable)
  • Identify, report defects and assign risks (as applicable)
  • Participation in the development of and implementation of change control and
release strategy policies and procedures
  • Serving as a testing Subject Matter Expert in support of the analysis and
application development and deployment teams
Employee is expected to undertake any additional duties as they are assigned by their Manager.
Minimum Qualifications
  • Bachelor's Degree
  • Experience in healthcare transaction standards
  • Experience with validation tools and technology
  • Experience working with structured testing methodologies and/or tools
  • 1+ year of experience in healthcare membership enrollment systems and maintenance of member data or experience in reconciliation of enrollment and/or premium payment transactions
  • Comprehensive knowledge of manual and computerized measuring tools and devices.
  • Ability to read and interpret process and workflow diagrams and and work instructions.
  • Proficiency in use of Microsoft Excel, Word, Power Point, Vision, Project.
  • Familiarity with one or more of the following; American National Standards Institute (ANSI)/International Organization for Standardization (ISO)/American Society for Quality (ASQ) 9001:2000 quality management system and Level 2 CMMI processes. ISO 9002:200
  • Good written and verbal communication skills and the ability to get along well with others.
  • Experience as an inspector or quality control technician in a manufacturing environment.
  • The ability to manage changing priorities within a highly dynamic environment
  • Ability to work well under deadlines
  • Ability to perform duties with limited oversight
  • Strong organizational skills, able to handle multiple tasks
  • Experience creating functional and technical documentation
  • Strong technical problem solving, writing and verbal skills
  • Solid understanding of the software testing life cycle
  • Knowledge of testing methodology
  • Experience with Federal contracts
  • Experience in the Centers for Medicare and Medicaid Services (CMS)
  • Expedited Life Cycle (XLC), CMS Integrated IT Investment & System Life
Cycle Framework (ILC), or similar Software Development Lifecycle (SDLC)

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