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Remote

•

6d ago

Job title:Facets with pre-Auth Location: Remote Mandatory Skills:Pre- Auth, Healthcare What id for you? As anFacets with pre-Authyou will be a part of an Agile team to build healthcare applications and implement new features while adhering to the best coding development standards Responsibilities: - A Facets UM Consultant is responsible for providing customers with application domain expertise related to Utilization Management rules and processes within the Facets platform. The consu

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Contract, Third Party

Depends on Experience

FACETS Consultant (with Pre-Auth/UM configuration)

Remote

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4d ago

Position: FACETS Consultant (with Pre-Auth/UM configuration) Location: Remote Employment: Contract Job Description: We are looking for a FACETS UM Consultant with strong experience in Utilization Management (UM) and Pre-Authorization (Prior Authorization) configuration within the FACETS platform. Key Responsibilities: Analyze and review existing FACETS Pre-Auth/UM rules (core & custom) Evaluate rule logic for authorization routing, benefit limits, and medical necessity Identify ga

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Third Party, Contract

$55 - $57

Healthcare Facets UM (pre-Auth) Consultant

Remote

•

Today

As an Facets with pre-Auth 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. Responsibilities: - A Facets UM Consultant is responsible for providing customers with application domain expertise related to Utilization Management rules and processes within the Facets platform. The consultant will analyze and review the existing Pre-Auth/UM rules configuration (both core and custom defined) and

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Contract, Third Party

Facets Developer – Python

Remote

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29d ago

Key ResponsibilitiesDevelop, enhance, and maintain applications using Python in a Facets environment Work extensively on Facets modules such as Claims, Billing, Membership, Provider, and Benefits Design and implement APIs, automation scripts, and backend services for Facets integration Perform Facets configuration, customization, and data mapping Develop ETL pipelines and data processing solutions using Python Collaborate with business analysts and stakeholders to understand healthcare requireme

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Full-time, Third Party

45 - 50

Facets Solution Architect Lead

Remote or Maryland

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Today

Facets Solution Architect Lead Remote Responsibility Configures healthcare systems to support CMS program rules, benefit structures, and operational workflows in alignment with federal requirements. Job Requirement 1)Minimum 10 years Facets Experience 2) Minimum 3 years working experience with CMS work products - MA or Medicaid 3)Excellent communicatiopn skills 4) Proficency in a minimum of 6 Facets modules with 1 being Facets Medical Plan, 1 Being Member ands 1 being Practitioner 5)Must h

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Contract, Third Party

$$85/Hr C2C

Sr.Senior Facets Developer

San Francisco, California

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7d ago

Senior Facets Developer San Francisco, CA Must Have's: Expertise in Facets (Claims , Provider , Members)Expertise in .NET, SQL , API , Cloud (Azure/AWS)Expertise in Facets Core Batch Monitoring Support Key Deliverables : Production Support work (on call), Custom development for Sustainment and Projects Job Description: 10+ years of experience in C#, .NET10+ years of experience in SQL Development10+ years of experience in Facets and good knowledge on Facets Data ModelExperience in database desig

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Contract, Third Party

Depends on Experience

Facets Configuration Analyst

Remote or Maryland

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Today

Facets Configuration Analyst Remote Responsibility Configures and maintains Facets platform rules, benefits, and parameters to support claims adjudication and operational requirements. Role Requirements 1)Minimum 5 years Facets Experience 2) Minimum 3 years working experience with CMS work products - MA or Medicaid 3)Excellent communicatiopn skills 4) Proficency in a minimum of 3 Facets modules with 1 being Facets Medical Plan 5)Must have experience in Facets version 25.1 or greater

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Contract, Third Party

$$75/Hr C2C

Business Systems Analyst(Facets)

Hybrid in Grand Rapids, Michigan

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7d ago

Job Title: Business Systems Analyst 100% Hybrid: Onsite Cadence- Two days per week (Tuesday and second day TBD) Expenses allowed: TBD Equipment to be Provided Must Have Critical thinking skills Effective time management Expert Facets claims processing and configuration knowledge. Extensive medical coding and billing. Moderate clinical edit knowledge. Prior Optum CES or other clinical edit vendor knowledge. Problem solving skillsJob Summary: Under minimal supervision, formulates and defines syste

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Third Party, Contract

Depends on Experience

Business Systems Analyst(Facets)

Hybrid in Grand Rapids, Michigan

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7d ago

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Third Party, Contract

Depends on Experience

Facets Migration SME

Remote or Maryland

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Today

Facets Migration SME Remote Responsibility Executes data conversion strategy, mapping, validation, and reconciliation to support accurate, auditable migration of CMS program data. Role Requirements 1)Minimum 7 years Facets Experience 2) Minimum 3 years working on Facets transformation projects involving data migration 3) Excellent communicatiopn skills 4) Proficency in a minimum of 5 Facets modules with 1 being Practitioner and 1 being Facets Membership 5)Must have experience in Facets ve

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Third Party, Contract

$$80/Hr C2C

Benefits Configuration Analyst - Facets

Remote

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Today

Benefits Configuration Analyst- Facets Role & Responsibilities: Design, analyze, and implement benefit coding change requests with a high level of precision, ensuring alignment with client specifications and regulatory requirements.Gather, interpret, and evaluate complex client requirements to assess the impact of benefit designs on claims processing; effectively communicate tailored benefit setup options to stakeholders and internal teams, thereby advising on optimal solutions.Manage non-standa

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Full-time

$55,000 - $65,000

Facets Benefit Configuration Consultant

Remote or Georgia

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Today

Stellar Consulting Solutions is a boutique business & technology consulting company headquartered in Atlanta, GA. We deliver high quality, agile, and experienced workforce for niche technology projects of any scale. We help forward thinking clients to solve specific problems by understanding their needs and align talent that can move fluidly to match skill supply and demand on a real-time basis. Stellar Consulting has a unique combination of technical and digital skills to recruit, engage, and

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Contract, Third Party

$70

Claims/Adjudication Manual Tester/Validator-FACETS SQL-Hybrid

Hybrid in Elkridge, Maryland

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3d ago

Job Description This position is for a Manual Tester. Please make sure your manual testing experience is included in your resume. Our client is seeking a Claims Adjudication System Tester/Validator to join our clients Testing Department as an FTE employee. This position is responsible for developing system test plans, automated and manual test scripts, and test cases for functional and regression testing for health insurance claims processing systems and other support applications. Although this

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Full-time

90,000 - 93,000

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