Facets NetworX Configuration Analyst

Tegria•North Carolina, NC

10d•Remote

About The Position

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.

Requirements

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.

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.