Job Summary (List Format):
- Hands-on experience with Facets system, specifically in reimbursement, provider payment, or claims pricing functions
- Expertise in NetworX Pricer, including pricing validation, troubleshooting, and managing reimbursement operations
- Ability to interpret Provider Contracts and translate contract terms into reimbursement system configurations
- Strong knowledge of healthcare reimbursement methodologies (e.g., DRG, APC/MAPC, EAPG, RBRVS, Fee Schedules)
- Experience supporting both Commercial and Medicare pricing models
- Skilled in analyzing, validating, and troubleshooting claim pricing outcomes across diverse product lines
- Background in provider payment operations, claims operations, and reimbursement operations within a health plan or TPA environment
- Advanced analytical and problem-solving skills, with the ability to perform root cause analysis of pricing discrepancies
- Proficient in SQL and NetworX backend querying to support pricing investigations and troubleshooting
- Experience supporting configuration testing, pricing audits, release cycles, production migrations, and working collaboratively with Contracting, Claims, and Configuration teams
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
- Dice Id: 10209652
- Position Id: 2026-227647/12440
- Posted 16 hours ago
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