13 results (4 new)
Remote
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Today
** Ability to create/ update NetworX Pricing data like Agreements, Rate Sheets, Rate Terms, Qualifier Groups, Fee Schedule, Networks, Provider Rows. ** Ability to read Provider Contracts/ Agreements & map to Rate Terms. ** Ability to Automate loading of NetworX Pricing data using C# API/ SQL Scripting.
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Third Party, Contract
Depends on Experience
No location provided
•
Today
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) - Experienc
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Contract, Third Party
Remote
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2d ago
Facets Generalist Job Location Remote Duration- 6+ Months Experience level 10+ years Mandatory Skills Facets Generalist Job Description AFacets Generalistis a healthcare payer professional who possesses functional and technical knowledge across multiple modules of theFacetsplatform rather than specializing in a single area. They support configuration, business analysis, testing, implementation, and production support activities across the Facets ecosystem. Key Responsibili
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Third Party, Contract
Depends on Experience
Hybrid in Dallas, Texas
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Today
Job Title: Trizetto/FACETs Location: Raleigh, NC or Bloomfield, CT or Lafayette, LA or Dallas, TX or Austin, TX (Day 1 Onsite - Hybrid) Duration: Long term FACETs Product knowledge & experience. Provider Business/Structure knowledge & experience. Database experience SQL, Oracle. Should be able to build SQL scripts. Ability to deliver technical insights. Identify automation opportunities. Testing experience functional and technical requirements Experience in all phases of SDLC Trizetto Members
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Contract, Third Party
Depends on Experience
Remote
•
Today
Position: Facets Workflow Consultant Location: Remote Employment: Contract Job Summary: A Facets Workflow Consultant analyses and optimizes claims and benefits workflows within the Facets platform. The role involves reviewing existing workflow rules, identifying customizations, understanding business outcomes, and supporting clients in improving claims and benefits operations. The consultant must have strong Facets knowledge, analytical skills, and the ability to work with crossfunctio
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Contract, Third Party
$55 - $55
Remote
•
15d ago
Hi Professionals, Title:Facets Workflow Consultant Location: Remote JD: A Facets Workflow Consultant analyzes and optimizes claims and benefits workflows within the Facets platform. The role involves reviewing existing workflow rules, identifying customizations, understanding business outcomes, and supporting clients in improving claims and benefits operations. The consultant must have strong Facets knowledge, analytical skills, and the ability to work with crossfunctional teamsoften re
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Contract, Third Party
Depends on Experience
No location provided
•
Today
As a Pre-Auth Consultant you will be a part of an Agile team to build healthcare applications and implement new features while adhering to the best coding development standards . Experience: - 10+Years Location: - Remote USA Responsibilities: - 7 - 10 years in UM/Pre-Auth configuration within FACETS. Familiarity with UM workflows, clinical guidelines, and state mandates. Experience working with clinical/utilization management stakeholders . Deep understanding of US Healthcare payer oper
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Third Party
Remote
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2d ago
Candidate Must have over 10+ years of experience. Must have Healthcare Domain experience 58 years as a Business or System Analyst working with Facets. Strong understanding of claims workflows, provider validation, and benefits administration. Experience reviewing large rule/configuration repositories. Solid knowledge of US healthcare payer operations. Ability to interpret and analyze complex rules and configurations.
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Contract, Third Party
Depends on Experience
Remote
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2d ago
Must have 10+ years of experience in IT Strong experience in Java, Tomcat, and Web Services (SOAP/REST).Hands-on experience with Edifecs (Routing & Mapping).Strong knowledge of EDI X12 transaction processing.Experience with SQL and Stored Procedures.Experience in healthcare payer/provider EDI integrations.Strong analytical and troubleshooting skills.Support and enhance BlueCard sustainment and modernization projects.Design, develop, and maintain EDI Real-time transaction processing solutions.Dev
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Contract, Third Party
Depends on Experience
Mountlake Terrace, Washington
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16d ago
NET Developer with advanced proficiency in SQL and proven expertise in healthcare applications. Hands-on experience in Facets - Member, Claims, Providers, Accum and open access services (web / REST services APIs). Preferability to have experience to design, build, and deploy intelligent systems powered by Generative AI and Agentic AI frameworks. Responsible for designing, developing, and supporting .NET-based solutions that facilitate healthcare workflows and comprehensive data management. This
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Contract
Depends on Experience
Des Moines, Iowa
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Today
Company Description Job Description DUTIES: Wellmark, Inc. seeks a Facets Integration Software Engineer based out of our office at 1331 Grand Avenue, Des Moines, IA 50309. Note, this is a hybrid position whereby the employee will work both from home and from the aforementioned office address. Hence, the employee must live within a reasonable commuting distance of the aforementioned office address. Design, develop, test, implement, maintain, debug, and document complex integration solutions in
Full-time
USD 21.00 per hour
Remote
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9d ago
Hi Professionals, Title: Pre-Auth Consultant (FACETS UM/Pre-Auth) Experience: 10+ Years Location: Remote < data-end="123" data-start="98">Key Responsibilities Configure and manage UM/Pre-Auth processes in FACETS. Work closely with clinical and utilization management stakeholders. Analyze and implement complex authorization rules and configurations. Ensure compliance with clinical guidelines, UM workflows, and state mandates. Support healthcare application enhancements following development
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Third Party, Contract
Depends on Experience
