Hi, Hope you are doing great!
Please go through the below requirement & if you feel comfortable forward your updated resume so that I can get back to you.
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Please send me your resumes at bill@corpemail.generalconsulting.us or call me at 610-621-1705 for further details
Location: FL
6 month+ contract
Rate - $35/hr
Testing Specialist II - System Testing, DB2, SQL, HP Quality Center
3 to 5 years Health Benefit Structure Fee Schedules Claims Pricing Provider Contracts Data and/or System Conversion Testing ICD-9 Codes and understanding of ICD-10
Problem Statement: The Department of Health and Human Services has directed all health plans and healthcare professionals subject to the Health Insurance Portability and Accountability Act to comply with new code set regulations regarding ICD-10 by Oct. 1, 2013. Healthcare payers and providers, pharmaceutical companies, and their vendors must convert from the current ICD-9 coding system to the ICD-10 coding system by that date. The ICD transition is one of the many paradigms of the healthcare industry that is changing in the complicated processes of healthcare reform and will place heavy financial and operational burdens on payer organizations and impact Payers ability to accurately process and pay claims. Developed in the 1970s, ICD-9 has approximately 13,000 diagnosis and 11,000 procedure codes. This code set has structural restrictions and is limited in its ability to accommodate advances in medical knowledge and techniques. ICD-9 is a dramatic expansion on ICD-9 used today. In its entirety, the ICD-10 code set has just over 155,000 codes68,000 diagnosis codes and 87,000 procedure codes. ICD-9 codes are typically numeric with valid codes of three, four or five digits. Under ICD-10, all codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits. To further complicate matters, systems will need to have the ability to access both ICD-9 codes and ICD-10 codes as the country transitions over the next few years. The 10th revision is the latest in a series which has its origins in the 1850s. It will offer providers and payers a greater level of specificity that will enhance the collection of dataresulting in improved quality, safety and efficacy of care. In addition, enhanced data specificity will support improving claims processing and development of better clinical programs resulting in improved outcomes, while also assisting in the prevention and detection of healthcare fraud and abuse. The revision from ICD-9 to ICD-10 will also facilitate future efforts in medical cost management programs (i.e. member profiling and risk management, new provider reimbursement models, etc.). BCBSFs goal is to achieve compliance in an efficient manner, to maintain medical costs (cost neutrality), and ensure administrative effectiveness. Additionally, overarching strategy is to become ICD-10 capable so that ICD-10 codes are not modified or translated from how they are submitted. As a result, core or strategic systems will be updated to accept and natively process ICD-10. Some systems (e.g., those targeted for retirement) might utilize cross-walks for processing requirements in the short term. This middle ground solution requires systems to be modified to accept and process the new codes without altering the program logic to operate under different business rules than it previously did in an ICD-9 mode. Being ICD-10 capable provides the foundation to becoming ICD-10 enabled. A program has been established to manage the many identified ICD-10 projects required to become efficiently compliant, maintain medical costs, and ensure administrative effectiveness. The key objectives of the ICD-10 program are: Achieve compliance within the mandated timeframe. Achieve medical financial neutrality after implementation. Achieve administrative cost efficiency during the execution of the program, as well as the ongoing maintenance and operations following implementation. Include processes to vet identified opportunities through other and existing opportunity assessment channels, such as Diversification, Office of Health Care Reform, Medical Cost Management, and Capability Planning. Actively seek opportunities to collaborate on compliance objectives with the other entities. Work with Corporate Compliance to develop a process to monitor (not manage) the compliance of subsidiaries such as Capital Health Plan and Florida Health Care Plans. This approach will require a process be established for solution review, project plan reviews, and tracking performance against deliverables. Manage cost and optimize investments. BCBSF must leverage existing work and strengths: o Business Process Owners will be expected to use program and project management disciplines to integrate remediation efforts into core roles and plans and to develop integrated solutions, acting collectively and not independently. o ICD-10 scope that is closely aligned with an existing project on the capability plan will be added to that project. The existing project will assume ownership and the ICD-10 Project Management Office will track as a dependency. Role Description: Testing Specialist (TSs) creates test deliverables (for example, strategies and plans, test cases) and performs hands-on testing for BCBSF internally developed or external purchased products. Types of testing may include functional, technical integration, performance UAT and end-to-end. TSs deploy or execute job streams for creating test beds, assign test scenarios, author test scripts, and track defects to certify that applications meet technical and business requirements. TSs act as advocates for the end-user by analyzing and making specific recommendations on usability/functionality improvements that can be integrated into business processes. TSs participates in development throughout the development life cycle. They are responsible for safeguarding sensitive data and security credentials, including passwords that are exposed to during the testing process.
Job Requirements: Project Specific Experience: American Payer System (Health Claims Institutional and Professional) 3 to 5 years Health Benefit Structure Fee Schedules Claims Pricing Provider Contracts Data and/or System Conversion Testing ICD-9 Codes and understanding of ICD-10 initiative Quality Center 2 years SQL 2 years Accountabilities: Have a familiarity with the clients applications, tools and business processes Develop test scenarios and conditions based on pre-established business and technical requirements Conduct review of scenarios and conditions developed by Stage I Testing Specialist or peers Set up and execute complex scripts independently Document and perform detailed analysis on test results Set up test data beds based on data matching specific test conditions Write/Coordinate resolution of defects. Ensures appropriate hand-offs and re-testing Provide mentoring and guidance to Stage I Testing Specialists by partnering, scheduling day-to-day work and assisting when necessary Participates in requirement gathering sessions or solicits information on incomplete requirements Support Stage III in facilitation and coordination of user acceptance testing Typical Education/Experience: Business Knowledge: Stage II Testing Specialists must have a solid understanding of testing environment concepts and principles based upon a technical and business user perspective. Must possess a solid understanding or have the ability to quickly learn client software environment and hardware. Must be familiar with workflows and business and technical requirements. Must have an in-depth working knowledge of system testing techniques and tools. Technical Skills: Must have strong PC skills and demonstrated proficiency in the MS Office Suite products. Should be familiar with testing management tools and concepts and have a working knowledge of automated testing tools such as SQA and HP Quality Center. Must have the ability to extract data utilizing SQL. Work Experience: 3-5 years of progressive work experience in business and/or system testing. Demonstrated experience in testing applications is preferred. Health care industry, insurance, and managed care environment experience is a plus. Level of Education: Bachelors degree in a related area or equivalent work experience is preferred. CSTE certification is preferred. SQA testing certification is preferred.
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Bill Garry
Technical Recruiter
GENERAL CONSULTING SERVICES
400 East Lancaster Avenue,
Suite # 3, Wayne, PA - 19087
Desk: 610-621-1705
Fax: 610-482-9315
Email: bill@corpemail.generalconsulting.us
Website: www.generalconsulting.us
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