Facets Configuration SME

Healthcare IS; United States; Sur place; USD 110 000 - 170 000; Plein temps

Résumé du poste

Healthcare IS is seeking a Facets Configuration Subject Matter Expert to lead complex configuration initiatives across claims, benefits, provider, pricing and workflow modules. You will translate contract terms into system-ready specifications and ensure accurate adjudication.

You will collaborate with Claims, Finance, IT and delegated risk teams to maintain configurations, perform UAT and regression testing, and drive configuration optimization across payer, IPA and MSO environments.

Qualifications

• 5+ years of hands-on Facets configuration across multiple subsystems (Benefits, Provider, Workflow, Claims).
• Strong understanding of claims adjudication, benefit interpretation, reimbursement methods.
• Experience in payer, IPA, MSO, or delegated-risk environments.
• Track record supporting upgrades, releases, or new implementations.
• Strong analytical, problem-solving and documentation skills.
• Excellent communication across technical and non-technical stakeholders.

Responsabilités

• Lead end-to-end Facets configuration across Benefits, Provider, Claims, Pricing and Workflow components.
• Translate contract terms and payment models into configuration specs.
• Collaborate with Claims, Finance, Provider Contracting, Delegation Oversight, Enrollment and IT.
• Perform configuration testing: UAT, regression, scenario-based adjudication.
• Support integrations with pricing engines, delegated data exchanges, and reporting datasets.
• Maintain configuration docs, version control, and process playbooks.
• Advise on best practices, strategy and optimization for Facets configurations.

Connaissances

Facets configuration

Claims adjudication

Benefit interpretation

Provider contract logic

Payer/IPA/MSO knowledge

Analytical skills

Documentation

Cross-functional collaboration

Description du poste

Facets Configuration Subject Matter Expert (SME) with deep expertise across core Facets modules. This SME will support complex configuration initiatives across claims, provider/payment arrangements, benefit structures, and financial responsibility allocations. The role plays a critical part in ensuring accurate adjudication, operational efficiency, and compliance across payer, IPA, and delegated models.

Key Responsibilities:

• Lead end-to-end Facets configuration, including Benefits, Provider, Claims, Pricing, and Workflow components, ensuring accurate system behavior and alignment with business rules.
• Interpret and translate contract terms, plan documents, and organizational payment models into system-ready configuration specifications.
• Collaborate closely with internal business teams—Claims, Finance, Provider Contracting, Delegation Oversight, Enrollment, and IT to ensure configuration accuracy, alignment, and traceability.
• Perform configuration testing: UAT, regression, scenario-based adjudication, and impact analysis.
• Support downstream and upstream integrations, including pricing engines, delegated entity data exchanges, and reporting datasets.
• Maintain configuration documentation, version control, job aids, and process playbooks.
• Serve as a senior advisor, offering guidance on Facets best practices, configuration strategy, and optimization.

Required Qualifications:

• 5+ years of hands-on Facets configuration experience across multiple subsystems (e.g., Benefits, Provider, Workflow, Claims).
• Strong understanding of claims adjudication, benefit interpretation, reimbursement methodologies, and provider contract logic.
• Experience working in payer, IPA, MSO, or delegated-risk environments.
• Demonstrated experience supporting system upgrades, release cycles, or new implementation initiatives.
• Strong analytical, problem-solving, and documentation skills.
• Excellent communication skills, with the ability to collaborate across technical and nontechnical stakeholders.