Program Manager - PRGMGR

Utilize advanced SQL queries and relational databases to audit, validate, and troubleshoot massive configuration data batches. " Direct comprehensive unit, regression, and end-to-end testing processes to ensure absolute claim payment accuracy.

NetworX Configuration Analyst
Max SBR: ***
Remote EST, but HM is flexible if candidate is strong
Potential for extension

Must have hands on experience in NetworX Pricer (5-6 yrs)
Facets is not required, but nice to have
NetworX Configuration (Integrated NetworX)
Oracle SQL
Review contract, Agreement testing, migration, assignment


" 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.