Description

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

Be part of a team that makes a real difference.

This is a full-time remote position that can be located anywhere in the U.S.

We are seeking an experienced QA Analyst 4 to join our Product Development team as a skilled specialist focusing on our Workers Compensation Medical Bill Review and Utilization Review platforms. In this role, you will leverage your advanced expertise in quality assurance practices, healthcare workflows, API testing, and EDI transaction processing to lead complex testing initiatives and drive quality improvements across our medical billing and utilization management software.

Key Responsibilities

• Lead comprehensive testing strategies for Workers Compensation medical bill review workflows, complex fee schedule calculations, and multi-state regulatory compliance
• Design and execute advanced test scenarios for utilization review processes including complex medical necessity algorithms, prior authorization workflows, and clinical decision support systems
• Architect and validate sophisticated API integration testing for real-time medical provider data exchange, eligibility verification systems, and claims processing workflows
• Lead EDI transaction testing initiatives including X12 837 (Healthcare Claims), X12 835 (Healthcare Claim Payment/Advice), X12 278 (Healthcare Services Review), and X12 270/271 (Eligibility) processing across multiple clearinghouses
• Develop innovative test methodologies and standards for medical billing validation, complex CPT/ICD coding scenarios, API endpoint performance optimization, and EDI compliance validation
• Drive integration testing with medical provider networks, pharmacy benefit management systems, third-party medical review services, and healthcare clearinghouses through API and EDI channels
• Lead root cause analysis for complex defects in medical billing calculations, treatment authorization workflows, API response handling, and EDI transaction processing
• Ensure compliance testing for multi-state Workers Compensation fee schedules, medical treatment guidelines, HIPAA EDI standards, and evolving regulatory requirements
• Design and implement advanced API security testing protocols, authentication mechanisms, and data encryption validation for healthcare information exchange
• Lead EDI acknowledgment processing validation, error handling optimization, and transaction retry logic for complex medical bill submission scenarios
• Create comprehensive product evaluation reports and testing documentation that drives strategic decisions for medical billing accuracy, utilization review optimization, API performance enhancement, and EDI transaction reliability
• Mentor junior QA team members and serve as informal team leader for complex testing initiatives
• Proactively identify systemic issues in medical bill review algorithms, utilization management rules, API architecture, and EDI transaction frameworks
• Collaborate with development engineers, clinical subject matter experts, and product managers to resolve complex problems and drive architectural improvements in medical workflow automation
• Lead code/design reviews for healthcare-specific features, API specifications, and EDI implementation standards

• Experience: Minimum 4-6 years of software quality assurance experience with demonstrated expertise in healthcare, medical billing, or Workers Compensation systems
• Advanced API Testing: Expert-level experience testing REST/SOAP APIs, complex JSON/XML data transformations, microservices architectures, and web services integration
• EDI Expertise: Deep understanding of EDI standards, healthcare transactions (X12 837, 835, 278, 270/271), transaction processing optimization, and compliance validation across multiple trading partners
• Healthcare Domain Knowledge: Strong understanding of medical billing processes, CPT/ICD coding complexities, utilization review concepts, and Workers Compensation medical management
• Integration Leadership: Proven experience leading system-to-system integration testing, data mapping validation, and third-party service connectivity initiatives
• Regulatory Expertise: Advanced familiarity with healthcare compliance requirements, HIPAA EDI standards, and multi-state Workers Compensation regulations
• Leadership: Experience serving as informal team leader and mentoring junior QA professionals
• Strategic Thinking: Ability to understand implications of testing work and make strategic recommendations for quality improvements
• Problem-Solving: Advanced analytical skills to resolve complex testing challenges involving medical billing, API integration, and EDI transaction scenarios
• Initiative: Demonstrated ability to determine methods and procedures for new assignments with considerable judgment and independence
• Communication: Excellent documentation and presentation skills for technical, clinical, and executive audiences

PI277648005