NetworX Configuration Analyst

We are seeking a NetworX Configuration Analyst to configure, maintain, and optimize provider pricing and reimbursement logic within the Tri Zetto Facets Integrated NetworX Pricer platform. This role is responsible for translating provider contracts into system configurations, supporting pricing accuracy, ensuring regulatory compliance, and validating complex claims processing. The ideal candidate will have strong expertise in Tri Zetto Facets NetworX Pricer, healthcare claims configuration, provider reimbursement methodologies, SQL, and managed care pricing.

• Configure, maintain, and optimize pricing logic within the Tri Zetto Facets Integrated NetworX Pricer platform.
• Translate managed care provider contract language into fee schedules, rate sheets, pricing rules, and system qualifiers.
• Configure provider reimbursement methodologies and pricing models within the NetworX Pricer application.
• Manage day-to-day configuration activities and support system conversion initiatives.
• Mentor configuration analysts and provide technical guidance on pricing configurations.
• Plan and execute unit, regression, integration, and end-to-end testing to ensure accurate claims payment processing.
• Utilize SQL and relational databases to audit, validate, and troubleshoot configuration data.
• Configure hierarchical pricing logic to prioritize provider-specific agreements over regional or standard reimbursement rates.
• Implement quarterly pricing updates to maintain compliance with CMS, Medicare, Medicaid, and regulatory requirements.
• Collaborate with Configuration leadership, Claims Operations, Provider Contracting, and Legal teams to support pricing initiatives.
• Troubleshoot production issues and implement configuration enhancements.
• Maintain technical documentation, configuration standards, and operational procedures.

• Bachelor's degree in Information Technology, Healthcare Administration, Computer Science, Business, or a related field, or equivalent professional experience.
• Experience configuring Tri Zetto Facets Integrated NetworX Pricer.
• Strong understanding of managed care provider contracts, healthcare reimbursement, and pricing methodologies.
• Experience configuring fee schedules, rate sheets, pricing qualifiers, and provider reimbursement rules.
• Strong SQL and relational database experience.
• Experience performing unit, regression, integration, and end-to-end testing.
  
  Knowledge of CMS, Medicare, and Medicaid reimbursement guidelines.
• Strong analytical, troubleshooting, and problem-solving skills.
• Excellent communication and stakeholder management skills.

• Experience supporting enterprise healthcare payer organizations.
• Experience leading configuration projects and mentoring junior analysts.
• Experience supporting claims operations and provider reimbursement systems.
• Familiarity with healthcare system conversions and pricing modernization initiatives.

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