Functional Lead Cincinnati - OH - Ohio
Listed on 2026-08-04
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Healthcare
Medical Billing and Coding, Healthcare Administration
Must Have Technical Functional Skills
Strong SME knowledge in Healthcare Claims Processing lifecycle
Expertise in EDI formats 837 (PID), 835, 834
Hands-on experience in Facets (Claims + Enrollment modules)
Proficiency in Azure Dev Ops (ADO) for QA tracking
Knowledge of HIPAA compliance and payer systems
8+ years of experience in Healthcare QATesting
4+ years of experience as Test Lead in Facets projects
Deep understanding of Claims Adjudication & Payment workflows
Experience in handling claims denials, adjustments, and reprocessing
Strong exposure to EDI claim and remittance transactions
Experience in mocking and validating EDI files )
Knowledge of ITS claims processing (SF, DF, RF)
Experience in Member Enrollment workflows (Medicaid, Medicare, ACA)
Understanding of Billing lifecycle for member enrollment
Hands-on experience with ADO Test Plans, Test Suites, and Defect tracking
Ability to perform data validation and reconciliation activities
Strong experience in functional and end-to-end testing
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