FACETS Solutions Business Architect

Hiring! FACETS Solutions Business Architect - for a contract to hire job opportunity with our direct client. Though this is a 100% remote based job opportunity. Seeking Qualified Candidates with a strong back ground in Healthcare and SME in Claims Adjudication.

Please, no agencies or recruiters, only W2 applicants.

Job requirement:

This position is for a Facets SME that can be responsible for streamlining the data flow and design of batch processes to resolve claims quicker and meet the SLA’s for our providers.

Knowledge of the claims adjudication process is necessary along with experience with data flow refracturing regarding claims.  Facets: Both Legacy and G6 are mandatory.

• Proficiency in innovating ideas and solutions resulting in tangible and measurable business outcomes.
  Mastery in creating architecture solutions within the enterprise architecture future state for technological acceleration of value outcomes, and effectively present and persuade key decision makers to invest in this acceleration.
  Must have recent solution/domain architecture experience with Facets G6 real-time and batch claims processing, pre-adjudication validation, EDI-based transaction data management, claim editing engines, and third-party integrations with partner organizations that provide these services.
  Must have experiential knowledge on how to apply interoperability and integration best practices between Facets G6 and all data producers and data consumers within the enterprise ecosystem surrounding Facets G6.
  Must have experience with enterprise level architecture refactoring to resolve the following for Facets G6 claims processing
  o Architectural simplification and modernization
  o Strengthening controls and resiliency in high-risk processes
  o Reducing unnecessary complexity and integration hops
  o Provider data improvements and rationalization
  o Legacy platform runout and retirement planning
  Must have experience working with claims processing, enrollment, billing & payments, underwriting, partner programs, business operations, and benefit management business functions either in a commercial or government area (both preferred).
  Additional architecture experience in one or more technology platforms (Salesforce Health Cloud/Data Cloud, other Healthcare specific platforms, MuleSoft, Kafka, , Azure Fabric)
  Expertise with two or more architecture domains (enterprise architecture, solution architecture, software development, data, integration, interoperability, cloud, artificial intelligence) and their associated architecture frameworks, standards/patterns, methods and tools. Experience overseeing and driving third-party solution architecture engagements and outcomes.
  Knowledge of healthcare data standards (e.g., HL7, FHIR, X12) and regulatory requirements (HIPAA, CMS, NCQA).
  Experience contributing to portfolio rationalization and/or technical debt remediation initiatives at an enterprise level
  Ability to motivate and influence others so that architecture objectives are met in a timely and consistent manner
  Ability to collaborate with stakeholders to develop high quality, architecture solutions and technical designs based on approved standards.
  Ability to coach peers and team members across multiple business and technology disciplines.
  Ability to provide solution architectural consulting to business leaders, program leaders, product owners, and delivery teams
  Ability to set architectural solutions across multiple initiatives or domains aligned to platform/product roadmaps and facilitate implementation of approved solution.
  Effective organizational/interpersonal/relationship management, analytical/systems thinking, communications (written and verbal) and collaboration across multiple business and IT teams.
  Recent payer or provider healthcare experience a plus.

If you have the strong FACET Claims / Healthcare delivery skills, Select "Apply Now" and a Vega staffing specialist will reach out to you.