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AI Summary
Position Summary
The Facets NetworX Configuration Analyst is responsible for configuring, maintaining, and supporting provider reimbursement and pricing structures within the TriZetto Facets and NetworX platforms. This role works closely with Provider Contracting, Claims, Pricing, and IT teams to translate provider contract terms into accurate system configurations that support claims adjudication and reimbursement processes. The analyst ensures pricing configurations are compliant, scalable, and aligned with business requirements.
Key Responsibilities
Configure and maintain NetworX pricing components, including:
- Agreements
- Rate Sheets
- Rate Terms
- Fee Schedules
- Qualifier Groups
- Networks
- Provider Rows and Pricing Rules.
Analyze provider contracts and reimbursement methodologies and translate contract language into system configuration requirements.
Build, test, and support provider reimbursement models within Facets and NetworX environments.
Perform configuration updates, maintenance, and enhancements related to provider pricing and contract management.
Collaborate with Provider Contracting, Claims Operations, Provider Data Management, and IT teams to ensure accurate implementation of pricing requirements.
Conduct unit testing, integration testing, and production validation for configuration changes.
Troubleshoot pricing and claims adjudication issues and perform root cause analysis.
Develop and execute SQL queries, data extracts, and reports to support configuration validation and operational analysis.
Create and maintain configuration documentation, workflows, and standard operating procedures.
Participate in system upgrades, implementations, and process improvement initiatives.
Required Qualifications
Bachelor's degree in Information Systems, Healthcare Administration, Business, or related field (or equivalent experience).
3+ years of Facets and NetworX configuration experience.
Hands-on experience building and maintaining provider contracts within NetworX.
Strong understanding of Facets core modules, including:
- Membership
- Provider Management
- Claims Processing
- Billing
- Product/Benefits Configuration.
Experience interpreting provider reimbursement methodologies and contract language.
Proficiency with SQL and data analysis techniques.
Strong analytical, troubleshooting, and problem-solving skills.
Knowledge of healthcare payer operations, claims processing, and provider contracting.
Salary Range
Now, a little about us …
At Tegria, we bring bold ideas and breakthroughs to improve care, technology, revenue, and operations in ways that move healthcare organizations from patient-centered to human-centered. We are helping healthcare put people first—both patients and those who dedicate their lives to delivering care.
And at the very core of this vital work is our incredibly talented people.
People with different backgrounds who welcome challenge and change. People who listen first, ask hard questions, and make decisions to cultivate a culture of equity and inclusion. People who chase after goals, growth, and generosity. We’re real. We’re nimble, and we believe in our mission to humanize healthcare.
Perks and benefits
Top talent deserves top rewards. We’ve carefully curated a best-in-class benefits package, meant to meet you wherever you are in your life and career.
Your health, holistically. We offer a choice of multiple health and dental plans with nationally recognized networks, as well as vision benefits, a total wellness program, and an employee assistance program for you and your family.
Your financial well-being. We offer competitive wages, retirement savings plans, company-paid disability and life insurance, pre-tax savings opportunities (HSA and/or FSA), and more.
And everything in between. Our lifestyle benefits are unrivaled, including professional development offerings, opportunities for remote work, and our favorite: a generous paid-time-off program, giving you the flexibility to plan a vacation, take time away for illness (or life’s important events), and shift your schedule to accommodate those unexpected curve balls thrown your way.
Tegria is an equal employment opportunity employer and provides equal employment opportunities (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. All qualified candidates are encouraged to apply.
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