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Facets NetworX Pricing Analyst

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portland, or • Posted 1 weeks ago
Onsite Contract Business and Financial Operations Occupations
Overview:
Technical Skills
10+ years of experience in Healthcare Payer Operations and Facets Configuration.
  • NetworX Pricer
  • Provider Pricing Configuration
  • Contract Pricing Setup
  • Claims Pricing Validation
  • Experience performing claims analysis and pricing validation.
  • Working knowledge of:
    • SQL
    • Reporting Tools
    • Data Analysis
  • Experience supporting production incidents and defect resolution.
  • Knowledge of software development lifecycle (SDLC) and Agile methodologies.
  • Strong documentation and requirement analysis skills.
Technical Skills
  • Facets NetworX Pricer (Mandatory)
  • Strong SQL skills for data analysis and validation.
  • Microsoft Access.
  • Advanced Microsoft Excel (Pivot Tables, VLOOKUP/XLOOKUP, Reporting, Data Analysis).
Mandatory Skills
  • Facets NetworX Pricer
  • Provider Pricing
  • Provider Reimbursement Methodologies
  • SQL
  • Excel
  • MS Access
  • Healthcare Payer Domain
Key Responsibilities
  • Collaborate with Provider Services, Network Management, Operations, and business stakeholders to ensure negotiated provider reimbursement arrangements are implemented accurately and timely.
  • Configure, load, and maintain provider pricing and reimbursement rates within Facets NetworX Pricer .
  • Support accurate pricing of professional and institutional claims for contracted providers and healthcare facilities.
  • Analyze provider contracts and translate reimbursement terms into system configurations.
  • Research, analyze, and implement various healthcare provider reimbursement methodologies and pricing strategies.
  • Create and maintain payment exhibits and reimbursement schedules attached to provider contracts.
  • Maintain and update industry-standard coding structures including:
    • CPT
    • HCPCS
    • DRG
    • AP-DRG
    • ICD Codes
    • Per Diem Schedules
  • Research contract and pricing discrepancies that may result in overpayments or underpayments.
  • Recommend corrective actions and coordinate implementation with relevant teams.
  • Conduct impact analysis for provider contract changes and reimbursement updates.
  • Serve as a liaison between internal departments and provider-facing teams to resolve contract and billing-related issues.
  • Support pricing validation, reimbursement testing, and claims adjudication reviews.
  • Develop reports and dashboards to monitor pricing activities and operational performance.
  • Participate in system enhancements, production support activities, and issue resolution.
  • Maintain documentation, desk procedures, and process workflows to support operational excellence.

Skills:
SQL,Reporting Tools,Data Analysis
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