Facets Claims Processing System Manual

Facets Claims Processing System
Facets Claims Processing System

FACETS SYSTEM TESTER (FRONT END) (BBBH1180) Buffalo, New York

Facets (Trizetto Claims processing system) provides several functionality which is supported under the application group or you can call modules.It helps the organizations to perform their day to day operational work by utilizing any or all of the application groups.

Job Description

OPL SI and Smart Pend Project (2 Needed: Systems Testers: Facets)

Facets-Manual.pdf has the same contents as Facets Help in about 370 printable pages. Facets has all the capabilities described in the Facets User Manual PDF. Minifac has all the capabilities described in the Facets User Manual PDF except that the dataset is limited to 2,000 observations (responses, ratings, data points). Logic within the claims processing system that evaluates information on the claims. The following slides will dive deeper into the individual facets of the process outlined below. Life of a Claim. Claim Origination. Claim Adjudication. Manual and/ or the. Facets Claims Processing System Manual - FC2 The TriZetto Facets Core Administration platform is a modular system integrating Page 5/10. Access Free Facets Claims Processing User Guide consumer, care, claims and revenue management to help organizations meet their business goals. Find out how Facets. Healthcare FACETS Claims processing facts by -Dec 05, 2013 For more information on FACETS Claim processing please visit: Call us: 848-200-0448 Email us - email protected Billing information - MajestaCare - MajestaCare uses the Trizetto QNXT system to process and adjudicate claims. Both electronic and manual claims submissions are accepted.

Aside from what has been identified for the Facets 4.71 upgrade

Testers will be shared across multiple projects, must be able to prioritize workload and handle multiple projects

Tester must understand and have hands on experience with claims and adjustment workflow in Facets

Tester should have experience in Other Party Liabiltiy workflow

Tester should have experience with membership and eligibility in Facets

Tester must have experience with web testing

Tester must be comfortable with ICD-9, CPT Codes and Rev Codes

Required Experience

Web testing

Facets

3-5 years test experience

Facets is a must. subscriber, member and provider modules

Hands on Facets Claims processing experience a must, experience creating test cases, experience reviewing requirements for testability, Quality Center experience preferred

Must have knowledge of the following: white box v. black box, functional v. non-functional, defect reporting standards, how to reproduce test results.

the hands-on Facets claims knowledge must include experience with: to manipulate and adjudicate claims by changing or adding procedure codes, modify pricing, adding overrides. Able to fully navigate Facets. Familiar with claims adjudication process. Able to locate membership or claims in Facets to meet specified criteria for testing. Thorough knowledge of the claims lifecycle.

Able to troubleshoot test failures. Able to create manual test cases. Monitor defects and review for root cause analysis. Must have experience with HP Quality Center. Able to manually create test data by creating a claim and an adjustment using the Claims Module.

ITS and FEP is a plus. SQL Query is a plus.

PLEASE SEND WORD DOC RESUME, MOST COMPETITIVE RATE, AVAILABILITY AND

CURRENT LOCATION.

Facets Testing explained

FacetsTesting is not one of the testing types. But it is purely and most of the time,a type of manual testing which is done on Facets tool that is being used forclaims processing and other healthcare insurance company day to day activitiesare done.

Theseare Typical healthcare manual testing/ tester roles and responsibilitiesespecially in FACETS application in healthcare industry.

·Participatedin requirements meetings to understand the requirements from business people.

·PreparedTest cases and Test scripts from the requirements and Functional, Technicalspecifications.

·Validatedmember eligibility and eligibility inquiry in the facets application to thelegacy application in order to confirm the migration successful or not.

·Experiencein Medical, Pharmacy Plan changes from one plan to other plan with in Group,subgroup, class combinations.

·Experiencewith COB (coordination of benefits) application with in facets, testing ofclaims status for selected subscribers.

·Writingtest cases and test scripts in MS Excel Manually and uploading in Qualitycenter.

·Wellexperienced in benefit coding of different products for various plans of BCBSsuch as Blue preferred, Blue exchange etc..

·Calculatingco-pay, coinsurance, adding single tier, multi tier for different products within a plan.

·Comparingplan and product details in medical module, and reviewing the benefit summaryand feeding them into pivot tables with appropriate co-pay and coinsurance andvalid comments for various codes of vision, maternity etc..

·Testdata entry into FACETS4.7 application in the test environment for creatinggroups, subscribers and family members.

·Experiencein creating new groups, subgroups, subscribers as and when needed which islater used as a test data for testing purpose.

·Experiencein System testing and UAT testing of the facets core application and custommodules as needed.

·Claimsvalidation in Facets application which includes claims pending status, memberstatus, etc..

·Creatingtest cases, test scripts for various modules, and uploading them into qualitycenter.

·Traceabilitymatrix of test cases to corresponding requirements.

·Runningthe test cases and it scripts and executing them thoroughly with pass/failstatus.

·Enteringdefects for failed test cases and assign the defects to appropriate developers.

·Regressiontesting of the application once the defects are fixed and passing the testcases.

Insimple words, Facets testing is not really much different than other types oftesting except the fact that the domian knowledge in healthcare industry is amust and familiarity on facets tool is necessary.

Majorapplications with in the Facets testing that you need to learn /know beforeinterview is, Claims processing, hospital, claims, physician claims, membersubscriber inquiry etc..

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