Centers for Medicare and Medicaid Services (CMS), Contract Review, Establish Priorities, Fee Schedule, Health Plan, Information Technology Consulting, Leadership, Legal, Maintain Compliance, Managed Care, Medicaid, Medicare, Mentoring, Multiplatform/Cross-Platform, Oracle Database, Pricing, Product Pricing, Project/Program Coordination, Provider Contracting, Quality Assurance Methodology, Relational Databases (RDBMS), SQL (Structured Query Language), Testing
Our Client, an IT Services and Consultant company, is looking for a NetworX Configuration Architect for their Remote location.
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, mentor configuration analysts, and coordinate system conversion projects across platforms.
- Direct comprehensive unit, regression, and end-to-end testing processes to ensure absolute claim payment accuracy.
- Utilize advanced SQL queries and relational databases to audit, validate, and troubleshoot massive 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 strict compliance with CMS, Medicare, and Medicaid rules.
- Act as the primary liaison between Configuration of leadership, claims operations, and the legal contracting team.
Requirements:
- Must have hands on experience in NetworX Pricer (5-6 yrs)
- NetworX Configuration (Integrated NetworX)
- Oracle SQL
- Review contract, Agreement testing, migration, assignment
- Facets is not required, but nice to have
- 10.00 Years of Experience
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities