NetworX Consultant

About the role

The Networ

X Consultant will work with Facets and Networ

X (both Pricer and Modeler) to support the implementation, enhancement, maintenance, and resolution of issues. This role requires extensive communication, technical configuration, system testing, and collaboration with technical and business teams to ensure alignment with business objectives. The Networ

X Consultant is responsible for configuring, maintaining, and optimizing system software and tools to meet the needs of a fast-growing Health Plan. This role involves analyzing business user requirements, implementing system configurations, troubleshooting issues, and ensuring that system performance aligns with business goals. The ideal candidate combines technical expertise with strong problem-solving, documentation, and communication skills.

• Lead and manage the implementation and configuration of Networ
  
  X pricing agreements to support health plan operations, including assessment and understanding of provider data.
• Serve as a subject matter expert, providing guidance on best practices, troubleshooting, and issue resolution.
• Comprehend contracts, regulations, provider bulletins, and other provider reimbursement-related policies.
• Collaborate with cross-functional teams, including IT, claims, provider services, and business operations, to implement and enhance system configurations.
• Develop, document, and maintain configuration standards, policies, and procedures.
• Analyze and validate system configurations to ensure accurate claim adjudication and provider reimbursement.
• Identify opportunities for system enhancements and automation to improve efficiency and reduce errors.
• Support system testing, upgrades, and implementations to ensure seamless transitions and minimal disruption.
• Conduct system testing and troubleshoot issues to ensure smooth functionality.
• Collaborate with solution architects and technical teams to ensure integration and alignment with business goals.
• Lead and participate in design and configuration review sessions to ensure adherence to standards and best practices.
• Provide clear communication on implementation status, risks, and solutions.
• Provide training and knowledge transfer to internal teams and stakeholders.
• Provide a deep understanding of Agile Scrum processes and working methodology.

We strive to provide flexibility wherever possible. Based on this role’s business requirements, this is a remote position open to qualified applicants in the United States. Regardless of your working arrangement, we are here to support a healthy work-life balance through our various wellbeing programs.

The working arrangements for this role are accurate as of the date of posting. This may change based on the project you’re engaged in, as well as business and client requirements. Rest assured; we will always be clear about role expectations.

• Over 10 years of active and hands‑on experience with Facets, Networ
  
  X Pricer & Modeler, OPTUM Grouper Pricer products, Claims processing, and US Healthcare.
• Over 10 years of experience in a project leadership role, operating in an onsite‑offshore model.
• Over 10 years of experience in building tools and strategies for automation, optimization, and digital transformation.
• Proven experience in configuring and managing implementations, enhancements, and maintenance.
• Expertise in New LOB implementations.
• Expertise in system configuration and strong understanding of the healthcare industry and managed care concepts.
• Proficiency in writing and optimizing SQL queries for data manipulation, extraction, and reporting.
• Proficiency in reimbursement methodologies and the ability to interpret these through requirements and design.
• Demonstrated ability to research, analyze, design, and build Facets Provider configuration.
• Demonstrated ability to understand and use Optum PPS configuration.
• Demonstrated ability to understand and interpret payer‑provider contract terms, develop technical design, and implement them in configuration.
• Demonstrated ability to manage system‑related projects from inception to closure.
• Excellent written and verbal communication…