Role summary
Configure, test, and support the FACETS Claims Processing module so healthcare payer clients get accurate adjudication, pricing, and claims workflows.
Key responsibilities
- Configure claims processing rules, pricing methodologies, and adjudication logic within FACETS
- Analyze and resolve claims errors, pends, and exceptions
- Collaborate with business analysts to translate requirements into FACETS configuration
- Support UAT and production claims testing cycles
- Maintain claims-related reference tables and codes (CPT, HCPCS, ICD-10, revenue codes)
Required qualifications
- 3+ years of hands-on FACETS Claims module configuration experience; workflow experience is a must
- Strong understanding of the claims adjudication lifecycle (837/835, EOB/EOP)
- Familiarity with CPT, HCPCS, ICD-10, and revenue codes
- SQL proficiency for claims data analysis
- Healthcare payer domain knowledge (Medicare, Medicaid, or Commercial)
Preferred qualifications
- Experience with FACETS batch cycles and claims auto-adjudication tuning
- Exposure to Xcelys or QNXT (competitor platforms) for comparative context
- Agile/Scrum project experience
- FACETS certification
Rate:
Not specified
Location:
Remote
IR35 Status:
Not specified
Remote Status:
Remote
Industry:
Data & Analytics
Seniority Level:
Mid-Level