QA - Charge Entry RCM

Job Title: QA - Charge Entry RCM

Job Overview:

We are seeking a highly skilled QA Analyst with expertise in Charge Entry processes within Revenue Cycle Management (RCM). The successful candidate will be responsible for ensuring the quality and accuracy of charge entry workflows, from claim creation through to submission and reimbursement. This role involves reviewing and testing charge data input, verifying compliance with healthcare billing codes, and ensuring that charges are processed correctly to avoid discrepancies in the revenue cycle.

Key Responsibilities:

• Charge Entry Testing & Validation:
• Perform manual and automated testing of charge entry workflows, including accurate input of charge data (CPT, ICD codes, modifiers) into the RCM system.
• Verify that all charges entered into the system are accurate, complete, and comply with coding standards and payer requirements.
• Review and validate the accuracy of charge entry against medical records, ensuring correct coding and appropriate charge amounts.
• Compliance & Standards:
• Ensure that charge entry processes adhere to industry standards, payer rules, and regulatory compliance (e.g., HIPAA, CMS guidelines).
• Stay updated on changes to coding rules (CPT, ICD-10, HCPCS) and billing regulations, and ensure that the system reflects these changes.
• Testing & Reporting:
• Develop and execute test cases to validate the functionality of charge entry processes in the RCM system.
• Identify, document, and report defects related to charge entry, including issues with code validation, billing discrepancies, and system errors.
• Collaborate with the development team to reproduce and troubleshoot defects, ensuring timely resolutions.
• Data Integrity & Reconciliation:
• Conduct audits of charge entries to ensure data integrity and identify discrepancies or errors before claim submission.
• Collaborate with the billing and coding teams to ensure the accuracy of claims and timely submission for reimbursement.
• Cross-functional Collaboration:
• Work closely with RCM teams, including billing, coding, and IT departments, to understand charge entry requirements and system functionality.
• Provide feedback and recommendations to improve charge entry processes and overall system functionality.
• Automation & Process Improvement:
• Assist in the development of automated testing scripts for charge entry processes to improve testing efficiency and coverage.
• Identify areas for process improvement and suggest optimizations to enhance charge entry accuracy and reduce errors.
• Documentation & Reporting:
• Maintain detailed test documentation, including test cases, test scripts, and results, to ensure traceability and compliance.
• Provide regular status updates on testing progress, issues identified, and resolutions to key stakeholders.

Skills and Qualifications:

• Experience:
• Minimum of 3 years of experience in QA testing, with a focus on Charge Entry processes in Revenue Cycle Management (RCM).
• Familiarity with charge entry in healthcare billing systems (e.g., Epic, Cerner, NextGen, or other RCM systems).
• Experience with manual testing and defect management in a healthcare or financial services environment.
• Technical Skills:
• Knowledge of healthcare coding systems (CPT, ICD-10, HCPCS) and billing guidelines.
• Experience with testing tools such as Selenium, JIRA, Postman, or other QA automation and issue tracking tools.
• Proficient in SQL and database testing for validating charge data.
• Soft Skills:
• Strong analytical skills and attention to detail.
• Excellent communication skills for collaborating with cross-functional teams and stakeholders.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

Preferred Qualifications:

• Certifications:
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent healthcare certification.
• Certification in QA (e.g., ISTQB) is a plus.
• Experience in Healthcare RCM:
• In-depth understanding of the Revenue Cycle Management process, specifically related to charge capture, billing, and coding.

Contact - 8438290250

Email - [email protected]

Job Types: Full-time, Permanent

Benefits:

• Provident Fund

Work Location: In person