Facets NetworX Pricing Analyst

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 withinFacets 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.

Required Skills:

SQLReporting ToolsData Analysis