NetworX Architect

Job Title:NetworX Architect

Location:Remote EST (HM is flexible for strong candidates)

Tax Term:W2

Job Type:Contract

Duration:Long-Term Contract with potential for extension

Job Description:

We are seeking an experienced NetworX Architect with strong hands-on expertise in NetworX Pricer and Integrated NetworX. The ideal candidate will have extensive experience designing and configuring complex pricing logic, translating managed care provider contract language into system configurations, performing agreement testing and migration, and utilizing Oracle SQL for configuration data validation and troubleshooting. Facets experience is not required but is nice to have.

Roles & Responsibilities

• Configure, maintain, and model complex pricing logic within the TriZetto Facets Integrated NetworX Pricer software system.
• Translate managed care provider contract language into precise fee schedules, rate sheets, and system qualifiers.
• Manage day-to-day configuration workflows and mentor configuration analysts.
• Coordinate system conversion projects across platforms.
• Direct comprehensive unit, regression, and end-to-end testing processes to ensure claim payment accuracy.
• Utilize advanced SQL queries and relational databases to audit, validate, and troubleshoot configuration data batches.
• Establish hierarchical system logic to correctly prioritize specific provider agreements over standard, regional fallback rates.
• Monitor and implement quarterly pricing component updates to maintain compliance with CMS, Medicare, and Medicaid rules.
• Review contracts and perform agreement testing, migration, and assignment activities.
• Act as the primary liaison between Configuration leadership, claims operations, and the legal contracting team.

Required Skills

• NetworX Pricer
• Integrated NetworX
• NetworX Configuration
• Healthcare Claims / Pricing
• Oracle SQL
• Contract Configuration
• Agreement Testing
• Configuration Migration
• Provider Agreements
• Fee Schedules
• Rate Sheets
• System Qualifiers
• Unit Testing
• Regression Testing
• End-to-End Testing
• Claims Payment Validation
• Relational Databases
• CMS
• Medicare
• Medicaid

Preferred Skills

• Facets
• TriZetto Facets
• Facets Claims
• Configuration Analyst Mentoring
• System Conversion
• Managed Care

Qualifications

• 10+ years of overall experience.
• 5 6+ years of hands-on experience with NetworX Pricer is mandatory.
• Strong hands-on experience with Integrated NetworX and NetworX Configuration.
• Strong Oracle SQL experience for configuration data validation, auditing, and troubleshooting.
• Experience translating managed care provider contracts into system pricing configurations.
• Experience with contract review, agreement testing, migration, and assignment.
• Strong understanding of healthcare claims pricing and provider agreements.
• Facets experience is preferred but not required.
• Excellent analytical, communication, and stakeholder management skills.