QA Engineer
JD #4: SDET Engineer - Provider data management
Job Description:
Healthcare Domain - Provider data management - directory accuracy, credentialing, prior authorization (278), eligibility (270/271), 835 payment linkage across Medicaid/MA/Duals/TRICARE/Marketplace
Core Skills Needed - Facets (REQUIRED), X12 EDI (278, 270/271, 835), provider data (NPI/TIN/taxonomy), SQL, TOSCA, ADO
Core technical & domain requirements:
Facets
Facets - REQUIRED: provider, contract, and network module testing and configuration validation in Facets
X12 EDI: 278 (Prior Authorization request & response), 270/271 (Eligibility & Benefit inquiry/response)
Provider demographic data validation - NPI, TIN, taxonomy codes, specialty, address, network status
Provider enrollment & credentialing workflow testing (add, update, term, reactivation)
835 remittance linkage to provider payment validation
Provider directory accuracy testing - plan-level, network-tier, accepting-new-patients flags
SQL for provider data cross-validation (provider master ↔ claims ↔ eligibility ↔ directory)
TOSCA or similar automation tools
LOB coverage: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, Marketplace
JD #4: SDET Engineer - Provider data management
Job Description:
Healthcare Domain - Provider data management - directory accuracy, credentialing, prior authorization (278), eligibility (270/271), 835 payment linkage across Medicaid/MA/Duals/TRICARE/Marketplace
Core Skills Needed - Facets (REQUIRED), X12 EDI (278, 270/271, 835), provider data (NPI/TIN/taxonomy), SQL, TOSCA, ADO
Core technical & domain requirements:
Facets
Facets - REQUIRED: provider, contract, and network module testing and configuration validation in Facets
X12 EDI: 278 (Prior Authorization request & response), 270/271 (Eligibility & Benefit inquiry/response)
Provider demographic data validation - NPI, TIN, taxonomy codes, specialty, address, network status
Provider enrollment & credentialing workflow testing (add, update, term, reactivation)
835 remittance linkage to provider payment validation
Provider directory accuracy testing - plan-level, network-tier, accepting-new-patients flags
SQL for provider data cross-validation (provider master ↔ claims ↔ eligibility ↔ directory)
TOSCA or similar automation tools
LOB coverage: Medicaid, Medicare Advantage, Duals/MMP, TRICARE, Marketplace
Responsibilities:
Design provider data, directory-accuracy, and credentialing-workflow scenarios.
Build/maintain automation; test 278 and 270/271 transactions.
Validate 835 payment linkage and lead feature-level triage
Own offshore provider test design across LOBs.
Drive automation coverage and mentor analysts.
Conduct RCA on directory/network and authorization discrepancies.
Design provider data, directory-accuracy, and credentialing-workflow scenarios.
Build/maintain automation; test 278 and 270/271 transactions.
Validate 835 payment linkage and lead feature-level triage
Own offshore provider test design across LOBs.
Drive automation coverage and mentor analysts.
Conduct RCA on directory/network and authorization discrepancies.