Facets Networx Pricing Configuration Analyst - 3470

  • location: Dayton, OH
  • type: Contract
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job description

Facets Networx Pricing Configuration Analyst - 3470

job summary:
Lead and define system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools.

Identify, manage and document the status of open issues. Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments, utilizing TriZetto or Optum for research and correction.

Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules.

Plan/implement new software releases including testing and training.

Participate in meetings with business owners and users to achieve a Plan benefit design and Provider Reimbursement. Serve as liaison between IT and business areas to research requirements for IT projects, meet with decision makers to translate IT specifications and define business requirements and system goals.

Lead review of benefits or provider reimbursement as well as identify and design appropriate changes. Lead in the development and execution of test plans and scenarios for all benefit or reimbursement designs and for the core business system and related processes.

Provides detail analysis of efficiencies related to system enhancement/automation. Review, analyze, and document the effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging these systems. Conduct preliminary studies to define needs and determine feasibility of system design.

Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues.

Ensure system processes and documents exist as basis for system logic.

Assists in resolution for potential business risk, including communication and escalation as necessary.

Applies use of tools to define requirements such as data modeling, use case analysis, workflow analysis and functional analysis.

Perform any other job related instructions as requested

Education:

High School Diploma or GED is required

Bachelor's Degree or equivalent years of relevant work experience is preferred

Minimum of three (3) years health plan experience, to include two (2) years of configuration or clinical editing software experience is required

Exposure to Facets

Knowledge/Experience:

Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets

Proven understanding of database relationships required

Understanding of DRG and APC reimbursement methods

Understanding of CPT, HCPCs and ICD-CM Codes

Knowledge of HIPAA Transaction Codes

Critical listening and thinking skills

Decision making/problem solving skills

Enhanced communication skills both written and verbal

Can work independently and within a team environment

Attention to detail

Understanding of the healthcare field

Knowledge of Medicaid/Medicare

Claims processing skills

Proper grammar usage

Time management skills

Proper phone etiquette

Customer service oriented

Facets knowledge/training

Proper claim coding knowledge

Ability to be telecommuter

Broad understanding of business considerations and functionality preferred

 
location: Dayton, Ohio
job type: Contract
work hours: 9am to 6pm
education: Bachelors
 
responsibilities:
Lead and define system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools.

Identify, manage and document the status of open issues. Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments, utilizing TriZetto or Optum for research and correction.

Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules.

Plan/implement new software releases including testing and training.

Participate in meetings with business owners and users to achieve a Plan benefit design and Provider Reimbursement. Serve as liaison between IT and business areas to research requirements for IT projects, meet with decision makers to translate IT specifications and define business requirements and system goals.

Lead review of benefits or provider reimbursement as well as identify and design appropriate changes. Lead in the development and execution of test plans and scenarios for all benefit or reimbursement designs and for the core business system and related processes.

Provides detail analysis of efficiencies related to system enhancement/automation. Review, analyze, and document the effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging these systems. Conduct preliminary studies to define needs and determine feasibility of system design.

Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues.

Ensure system processes and documents exist as basis for system logic.

Assists in resolution for potential business risk, including communication and escalation as necessary.

Applies use of tools to define requirements such as data modeling, use case analysis, workflow analysis and functional analysis.

Perform any other job related instructions as requested

Education:

High School Diploma or GED is required

Bachelor's Degree or equivalent years of relevant work experience is preferred

Minimum of three (3) years health plan experience, to include two (2) years of configuration or clinical editing software experience is required

Exposure to Facets

Knowledge/Experience:

Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets

Proven understanding of database relationships required

Understanding of DRG and APC reimbursement methods

Understanding of CPT, HCPCs and ICD-CM Codes

Knowledge of HIPAA Transaction Codes

Critical listening and thinking skills

Decision making/problem solving skills

Enhanced communication skills both written and verbal

Can work independently and within a team environment

Attention to detail

Understanding of the healthcare field

Knowledge of Medicaid/Medicare

Claims processing skills

Proper grammar usage

Time management skills

Proper phone etiquette

Customer service oriented

Facets knowledge/training

Proper claim coding knowledge

Ability to be telecommuter

Broad understanding of business considerations and functionality preferred

 
qualifications:
Lead and define system requirements associated with Member Benefits, Provider Reimbursement and payment systems requirements definition, documentation, design, testing, training and implementation support using appropriate templates or analysis tools.

Identify, manage and document the status of open issues. Develop and utilize reports to analyze and stratify data in order to address gaps and provide answers to issues identified within the department or by other departments, utilizing TriZetto or Optum for research and correction.

Utilize available tools provided by relevant State or Federal websites to obtain pertinent Fed/State Regulatory Transmittals and Fee Schedules.

Plan/implement new software releases including testing and training.

Participate in meetings with business owners and users to achieve a Plan benefit design and Provider Reimbursement. Serve as liaison between IT and business areas to research requirements for IT projects, meet with decision makers to translate IT specifications and define business requirements and system goals.

Lead review of benefits or provider reimbursement as well as identify and design appropriate changes. Lead in the development and execution of test plans and scenarios for all benefit or reimbursement designs and for the core business system and related processes.

Provides detail analysis of efficiencies related to system enhancement/automation. Review, analyze, and document the effectiveness and efficiency of existing systems and develop strategies for improving or further leveraging these systems. Conduct preliminary studies to define needs and determine feasibility of system design.

Audit configuration to ensure accuracy and tight internal controls to minimize fraud and abuse and overpayment related issues.

Ensure system processes and documents exist as basis for system logic.

Assists in resolution for potential business risk, including communication and escalation as necessary.

Applies use of tools to define requirements such as data modeling, use case analysis, workflow analysis and functional analysis.

Perform any other job related instructions as requested

Education:

High School Diploma or GED is required

Bachelor's Degree or equivalent years of relevant work experience is preferred

Minimum of three (3) years health plan experience, to include two (2) years of configuration or clinical editing software experience is required

Exposure to Facets

Knowledge/Experience:

Advanced computer skills with Microsoft Word, Excel, Access, Visio and abilities in Facets

Proven understanding of database relationships required

Understanding of DRG and APC reimbursement methods

Understanding of CPT, HCPCs and ICD-CM Codes

Knowledge of HIPAA Transaction Codes

Critical listening and thinking skills

Decision making/problem solving skills

Enhanced communication skills both written and verbal

Can work independently and within a team environment

Attention to detail

Understanding of the healthcare field

Knowledge of Medicaid/Medicare

Claims processing skills

Proper grammar usage

Time management skills

Proper phone etiquette

Customer service oriented

Facets knowledge/training

Proper claim coding knowledge

Ability to be telecommuter

Broad understanding of business considerations and functionality preferred

 
skills: Skills Required:

Facets System Configuration

Facets Networx experience

SQL experience

Ability to communicate clearly with team members and customers


Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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