Analyst

HCLTech; Rhode Island; On-site; USD 120,000 - 170,000; Full time

Job summary

HCL Technologies Limited in the United States is seeking an experienced Facets configuration expert to implement and maintain pricing, policy, and workflow components. You will ensure pricing rules, provider contracts, and MPP align with contractual agreements while delivering accurate configuration across all facets modules.

The role requires strong analytical skills, attention to detail, and effective stakeholder management to translate business requirements into scalable system settings and

Qualifications

• 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.

Responsibilities

• Configure, maintain, and support Facets Pricing components to reflect contractual agreements.
• Set pricing logic for Professional, Facility, and Ancillary claims; implement DRG/APC/Per Diem pathways.
• Translate business requirements into system configurations within Facets.
• Interpret and implement medical policies; configure edits aligned with guidelines.
• Support ITS scenarios and ensure BlueCard compliance; troubleshoot claims.
• Configure workflow overrides and pendings; perform unit, SIT and UAT testing; validate outcomes.

Skills

Analytical thinking

Attention to detail

Stakeholder management

Strong communication

Tools

Facets pricing system

ITS system

Workflow module

Job description

Key Responsibilities

• 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.

Medical Policy Configuration & Support

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

ITS Configuration

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

Workflow

• Configure override, pend in workflow module in facets

Claims & Testing

• Analyze and troubleshoot configuration issues related to benefit and pricing.
• Perform Unit, SIT and UAT testing.
• Validate outcomes against contracts, benefits, and policies.

Required Qualifications

• 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.

Key Skills

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

Work Location

Onshore (USA-based)

Summary

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