Facets Developer (Claims, Billing, Appeals, Grievances)Location: Mason, OH & Woodland Hills, CA (On-site)FULLTIME & Contact BothJob Description:1 – A technical system analyst with good understanding of the healthcare process flow – Eligibility & Enrollment – Provider contract pricing – Claims adjudication – Billing – Appeals and Grievances2 – Technical understanding of Sql and Dot net – full stack preferable3 – knowledge of Facets platform from a developer point of view – ie data models, architecture and process flow4 – Good experience in working with Business and technical teams to prepare system requirements and Technical and functional documentsMust Have:· Deep expertise in healthcare payer processes: Enrollment, Eligibility, Benefits, Claims Adjudication, Billing, Provider Management· Strong SQL proficiency:o Complex queries, joins, stored procedureso Ability to analyze data across multiple systems/sources· Solid understanding of database design, schemas, and data relationships· Proven ability to analyze, reconcile, and troubleshoot payer data (claims, membership, benefits)· Functional understanding of Facets platform:o Architecture, modules, and capabilitieso How Facets supports core payer workflows· Working knowledge of AI/ML concepts and how they apply to healthcare data (e.g., predictive analytics, automation, insights)· Ability to translate business requirements into functional designs and data mappings· Experience across Commercial, Medicare, and/or Medicaid lines of business· Strong collaboration skills across business, data, and engineering teamsNice to Have:· Experience with Facets configuration or development· Background in Java (Spring Boot / microservices)· Familiarity with React UI applications and front-end workflows· Understanding of API-based integrations and data flow between systems· Hands-on experience in AI/ML projects (e.g.
Facets Developer (Claims, Billing, Appeals, Grievances) in mason at Unknown Company
This position is listed as contract and onsite.