Facet Configuration Analyst

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.

• 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.
• 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.

• Interpret and implement medical policies into Facets.
• Configure edits and ensure alignment with clinical guidelines.
• Support updating quarterly code new code update in facets.

• Configure and support ITS (Inter‑Plan Teleprocessing System) scenarios.
• Ensure compliance with Blue Card guidelines. Troubleshoot ITS claims issues and validate Host/Home processing.

• Configure override, pend in workflow module in facets.

• Analyze and troubleshoot configuration issues related to benefit and pricing.
• Validate outcomes against contracts, benefits, and policies.

• 5+ years of experience in Facets Benefit, Pricing or workflow.
• Strong expertise in pricing modules, medical policy, ITS, and workflow module.
• Solid understanding of US healthcare claims.

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

Onshore (USA‑based)

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