Job Summary
We are seeking an experienced Business Systems Analyst (BSA) with deep expertise in the TriZetto FACETS Provider platform, including Provider Configuration, Network Management, and Pricing. The role will serve as a Subject Matter Expert (SME) supporting healthcare payer initiatives, FACETS implementations, regulatory mandates, system enhancements, and upgrade programs. The BSA will work closely with business stakeholders, provider operations teams, architects, developers, and testing teams to deliver solutions across the provider domain, with a strong focus on provider network management, reimbursement and pricing methodologies, batch processing, backend data models, and advanced SQL analysis.
Key Responsibilities
• Serve as the primary Business Systems Analyst and SME for FACETS Provider, Network, and Pricing initiatives.
• Gather, analyze, document, and validate business and system requirements related to provider operations and reimbursement processes.
• Collaborate with business and technical stakeholders to translate provider network and pricing requirements into scalable system solutions.
• Perform impact analysis for regulatory mandates, system enhancements, upgrades, and modernization initiatives.
• Analyze end-to-end provider lifecycle processes, including provider setup, credentialing integrations, contracting, network participation, and reimbursement methodologies.
• Support FACETS implementation, migration, upgrade, and transformation programs.
• Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documentation.
• Conduct root cause analysis and recommend solutions for complex provider and pricing-related issues.
• Partner with development, QA, architecture, and support teams throughout the software development lifecycle.
• Support User Acceptance Testing (UAT), defect triage, deployment validation, and post-production support activities.
• Facilitate stakeholder meetings, solution workshops, and business process discussions.
• Provide production support expertise for provider configuration, network management, and pricing-related issues.
Required Qualifications
• 10+ years of experience as a Business Systems Analyst or Business Analyst.
• 5+ years of hands-on experience with the TriZetto FACETS platform.
• Extensive experience in the Healthcare Payer domain.
• Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade initiatives.
• SME-level expertise in the FACETS Provider Module.
• Strong experience with Provider Configuration and Maintenance.
• Strong experience with Provider Network Management.
• Experience with provider contracting and reimbursement models.
• Experience with Pricing Configuration.
• Strong understanding of FACETS front-end functionality, batch processing, and backend data models.
• Strong understanding of healthcare payer provider operations and network management processes.
• Advanced SQL skills, including the ability to write complex queries for analysis, data validation, troubleshooting, and solution design.
• Experience analyzing provider network, contracting, fee schedule, pricing, and reimbursement business processes.
• Strong requirements gathering, business process analysis, and solutioning capabilities.
• Experience creating functional specifications, business rules, gap analysis, and system documentation.
• Excellent communication, stakeholder management, and facilitation skills.
• Ability to collaborate effectively with business, operational, and technical teams.
Preferred Qualifications
• Experience supporting healthcare regulatory and compliance initiatives.
• Familiarity with Agile delivery methodologies.
Certifications
• Preferred business analysis certifications include CBAP (Certified Business Analysis Professional), CCBA (Certification of Capability in Business Analysis), or PMI-PBA (Professional in Business Analysis).
Notes:
Top Mandatory Skills
TriZetto FACETS Provider Module - 5+ years
Provider Configuration & Maintenance - 5+ years
Provider Network Management - 5+ years
Pricing Configuration & Reimbursement Models - 5+ years
Healthcare Payer Domain Experience - 8+ years
Advanced SQL (Complex Queries, Data Analysis, Validation) - 5+ years
FACETS Backend Data Models - 5+ years
FACETS Batch Processing - 3+ years
Business Systems Analysis / Requirements Gathering - 10+ years
FACETS Implementation / Upgrade / Migration Projects - 3+ projects
Ultra-Short Mandatory Skills for Recruiter Screening
FACETS Provider
Provider Configuration
Provider Network Management
Pricing & Reimbursement
Healthcare Payer
Advanced SQL
FACETS Backend Data Models
FACETS Implementations/Upgrades
Must-Have Screening Questions and need answers
How many years of hands-on experience do you have with the TriZetto FACETS Provider Module?
Have you worked on Provider Configuration and Network Management within FACETS?
Describe your experience with Pricing Configuration and Reimbursement Models.
Have you supported FACETS implementation, migration, or upgrade projects? Please provide examples.
What is your level of experience with complex SQL queries and backend FACETS data analysis?
How many years of Healthcare Payer domain experience do you possess?
Have you worked with FACETS batch processing and backend data models?
Have you supported provider contracting, fee schedules, and network participation processes?
Do you have experience supporting regulatory mandates and compliance initiatives?
Have you worked in Agile environments using JIRA, Azure DevOps, or ServiceNow?
Domain Experience (If any ) - Good to have healthcare experience
Must have Certifications -
Location - Seattle, Washington-Onsite
Onsite Requirement - Work model-Onsite
Number of days onsite -
