Description

• 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

Key Skills

Education

Bachelor's degree