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 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.