Remote NetworX Healthcare Solutions Consultant

TechDigital Group; Georgia; Hybrid; USD 120,000 - 180,000; Full time

Job summary

TechDigital Group seeks a Healthcare Product Consultant to provide NetworX domain expertise, lead design sessions, conduct requirements discovery, and configure NetworX applications to meet business needs. This is a remote participation role based in the United States, Georgia region, requiring strong consulting and Facets configuration skills.

The candidate will collaborate with cross-functional teams, develop documentation, train junior staff, and ensure regulatory compliance while delivering

Qualifications

• 10 years of healthcare experience, with 5 years of recent and relevant TriZetto NetworX pricing experience.
• Strong understanding of core NetworX functionality and the use of grouping and pricing.
• Experience with Facets, NetworX Modeler and Facets Integrated NetworX Pricer.
• Strong proficiency in SQL and Facets, NetworX Data Model and in writing and optimizing SQL queries for data manipulation, extraction, and reporting.
• Demonstrated ability to research, analyze, design, and build Facets Provider configuration.
• Demonstrated ability to understand and interpret payer-provider contract terms and implement in configuration.
• Understand and use Optum PPS configuration.
• Strong understanding of healthcare claims processing, provider contracts, fee schedules, and benefits configuration.
• Knowledge of health plan operations for Medicare, Medicaid, Marketplace, LTSS, DSNP (duals) is highly preferred.

Responsibilities

• Conduct requirements discovery sessions and lead design sessions to determine NetworX configurations.
• Provide advanced analysis, problem-solving, and interpretation of application configuration.
• Liaise with business and technical groups to transfer NetworX knowledge.
• Articulate issues and propose alternative solutions, verbally and in writing.
• Collaborate with onshore/offshore resource models.
• Work with cross-functional teams to integrate Facets modules.
• Design, implement, and maintain provider reimbursement configurations and pricing methodologies.
• Test and validate Facets configurations for reliability.
• Develop and maintain documentation for Facets configurations and processes.
• Train and mentor junior team members on Facets functionalities and best practices.
• Analyze and troubleshoot issues related to Facets modules to provide resolutions.
• Gather and understand business requirements from stakeholders.
• Ensure compliance with industry standards and regulations in Facets activities.
• Participate in project planning and reporting on status.
• Seek process improvements to enhance system performance.
• Troubleshoot system and configuration issues with root-cause analysis.
• Adapt to changing environments and handle pressure.

Skills

NetworX pricing

SQL

Facets

NetworX data structures

Healthcare claims processing

Provider configuration

Requirements discovery

Communication

Onshore/offshore models

Tools

Facets Modeler

NetworX Pricer

NetworX Modeler

Job description

TechDigital Group seeks a Healthcare Product Consultant to provide NetworX domain expertise, lead design sessions, conduct requirements discovery, and configure NetworX applications to meet business needs. This is a remote participation role based in the United States, Georgia region, requiring strong consulting and Facets configuration skills.

The candidate will collaborate with cross-functional teams, develop documentation, train junior staff, and ensure regulatory compliance while delivering