Facets / NetworX Reimbursement Specialist

Experience: -

• Hands-on experience working in Facets within reimbursement or pricing functions.
• Strong experience with NetworX Pricer, including operation, validation, and troubleshooting.
• Able to interpret Provider Contract Documents (PDF/ Word formats) accurately
• 5 10 years of experience in reimbursement operations, provider payment operations, or claims pricing for a health plan or TPA.
• Solid understanding of reimbursement concepts such as DRG, APC, fee schedules, cost-share impact, and payment policies.
• Ability to operate with minimal training and produce accurate results quickly.
• Strong analytical, investigative, and problem solving skills.
• Experience working in cross-functional environments.
• Experience supporting Commercial and Medicare pricing models.
• Exposure to provider contract interpretation and claims operations.
• Familiarity with SQL or analytical tools; ability query NetworX back-end for troubleshooting

Prior experience with configuration testing or pricing audits