Description

Configure and maintain complex pricing logic within the TriZetto Facets Integrated NetworX Pricer system, translating managed care provider contracts into precise fee schedules and rate sheets. You will manage configuration workflows, mentor analysts, and coordinate system conversion projects while ensuring absolute claim payment accuracy through comprehensive testing.

This role is remote.

Responsibilities

• Translate provider contract language into system qualifiers, fee schedules, and rate sheets.
• Establish hierarchical system logic to prioritize specific provider agreements over fallback rates.
• Manage day-to-day configuration workflows and coordinate platform conversion projects.
• Direct unit, regression, and end-to-end testing processes to verify claim payment accuracy.
• Monitor and implement quarterly pricing updates to maintain CMS, Medicare, and Medicaid compliance.

Required Skills

• 5+ years of experience with TriZetto Facets Integrated NetworX Pricer.
• Advanced SQL querying and relational database management (Oracle).
• Deep understanding of managed care provider contracts and pricing logic.
• Experience auditing and validating large configuration data batches.
• Knowledge of CMS, Medicare, and Medicaid regulatory rules.
• Bachelor's degree in a relevant field.

Key Skills

Education

Bachelor's degree