Facets Configuration Analyst || Remote

Job Summary (List Format):

- Hands-on experience with Facets system, specifically in reimbursement, provider payment, or claims pricing functions
- Expertise in NetworX Pricer, including pricing validation, troubleshooting, and managing reimbursement operations
- Ability to interpret Provider Contracts and translate contract terms into reimbursement system configurations
- Strong knowledge of healthcare reimbursement methodologies (e.g., DRG, APC/MAPC, EAPG, RBRVS, Fee Schedules)
- Experience supporting both Commercial and Medicare pricing models
- Skilled in analyzing, validating, and troubleshooting claim pricing outcomes across diverse product lines
- Background in provider payment operations, claims operations, and reimbursement operations within a health plan or TPA environment
- Advanced analytical and problem-solving skills, with the ability to perform root cause analysis of pricing discrepancies
- Proficient in SQL and NetworX backend querying to support pricing investigations and troubleshooting
- Experience supporting configuration testing, pricing audits, release cycles, production migrations, and working collaboratively with Contracting, Claims, and Configuration teams