- What Is Facets Claims Processing System
- What Is Facets Claims Processing
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.
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. Prior to automation, the worker must take the claims from an excel sheet, and process them into the Facets application, and then save the claims using F3 and F4 keyboard shortcuts 02 PROCESSING Running the process with the Facets Screen open will trigger the robot to follow the same steps in the same way that a human worker would.
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.
What Is Facets Claims Processing System
·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.
facets testing facets healthcare facetstesting interview questions what is facets testing
FACETS SYSTEM TESTER (FRONT END) (BBBH1180) Buffalo, New York
Job Description
OPL SI and Smart Pend Project (2 Needed: Systems Testers: Facets)
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
So I uninstall. Realtek high definition audio drivers windows 10 toshiba satellite.
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.
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What Is Facets Claims Processing
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