Analyst (Non-Voice)

Role Overview

We are seeking an experienced Facets Config Analyst to support in configuring, maintaining, and optimizing benefit, pricing, and workflow components within the Facets core administration platform. This role requires strong expertise in healthcare claims benefit set up, contract configuration, medical policies, workflow and end-to-end claims testing.

Key ResponsibilitiesFacets Pricing Configuration

ü  Configure, maintain, and support Facets Pricing components including Fee Schedules, Pricing Rules, Provider Contracts (Professional, Institutional, Ancillary), Multiple Procedure Pricing (MPP), Modifiers, Global Periods, and Carve-outs. Ensure accurate implementation aligned with contractual agreements.

ü  Configure pricing logic for Professional, Facility, and Ancillary claims. Implement methodologies including DRG, APC, Per Diem, Case Rates, and Fee-for-Service. Translate business requirements into system configuration.

Medical Policy Configuration & Support

ü  Interpret and implement medical policies into Facets.

ü  Configure edits and ensure alignment with clinical guidelines.

ü  Support updating quarterly code new code update in facets.

ITS Configuration

ü  Configure and support ITS (Inter-Plan Teleprocessing System) scenarios.

ü  Ensure compliance with BlueCard guidelines. Troubleshoot ITS claims issues and validate Host/Home processing.

Workflow

ü  Configure override, pend in workflow module in facets

Claims & Testing

ü  Analyze and troubleshoot configuration issues related to benefit and pricing.

ü  Perform Unit, SIT and UAT testing.

ü  Validate outcomes against contracts, benefits, and policies.

 

Required Qualifications

ü  5+ years of experience in Facets Benefit, Pricing or workflow.

ü  Strong expertise in pricing modules, medical policy, ITS, and workflow module.

ü  Solid understanding of US healthcare claims.

Key Skills

Analytical thinking, attention to detail, strong communication, and stakeholder management.

Work Location

Onshore (USA-based)

Summary

This role ensures implementing correct configuration design by integrating facets benefit, pricing & workflow modules to meet the business requirement.