We are seeking a skilled QNXT Claims Analyst with strong expertise in the QNXT platform and CXT claim edits. The ideal candidate will have in-depth knowledge of US healthcare provider contracting, Medicaid plan configuration, and claims processing, along with experience in software testing and SQL.
Key Responsibilities
- Perform Medicaid claims adjudication using QNXT platform.
- Configure and manage Medicaid healthcare plans for claims processing.
- Apply and maintain CXT claim edits with hands-on expertise.
- Analyze and validate EDI 837 claims transactions.
- Understand and manage US healthcare provider classifications, specialties, and contracting data.
- Design, develop, and execute test plans, test cases, and test scripts.
- Perform manual and automation testing for claims processing workflows.
- Track defects, perform root cause analysis, and ensure timely resolution.
- Prepare test results, reports, and status updates for stakeholders.
- Collaborate with cross-functional teams to ensure quality deliverables.
- Write and execute SQL queries for data validation and analysis.
Required Skills & Qualifications
- Strong experience in Medicaid EDI 837 Claims Adjudication.
- Hands-on expertise in QNXT platform and CXT edits.
- Knowledge of US Healthcare Provider contracting and demographics.
- Experience in Medicaid healthcare plan configuration.
- Proficiency in SQL queries for data validation.
- Solid understanding of software testing methodologies.
- Experience with test management tools such as JIRA and Rational Tool Suite.
- Experience in test planning, execution, and reporting.
- Strong analytical and problem-solving skills.
- Excellent verbal and written communication skills.