Configuration Analyst

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