Job SummaryThe NetworX Configuration Analyst will be responsible for configuring, maintaining, and modeling complex pricing logic within the TriZetto Facets Integrated NetworX Pricer environment. The role requires strong hands-on experience with NetworX Pricer, translating managed care provider contracts into accurate system configurations, and ensuring claim payment accuracy through comprehensive testing and data validation. The position will also support configuration workflows, system conversion projects, pricing updates, and collaboration across configuration, claims operations, and legal contracting teams.
Key Responsibilities- Configure, maintain, and model complex pricing logic within the TriZetto Facets Integrated NetworX Pricer software system.
- Translate managed care provider contract language into precise fee schedules, rate sheets, and system qualifiers.
- Manage day-to-day NetworX configuration workflows and support configuration activities across platforms.
- Mentor configuration analysts and provide technical guidance on NetworX configuration activities.
- Coordinate system conversion projects across platforms.
- Direct comprehensive unit, regression, and end-to-end testing processes to ensure accurate claim payment.
- Utilize advanced Oracle SQL queries and relational databases to audit, validate, and troubleshoot large configuration data batches.
- Establish hierarchical system logic to correctly prioritize specific provider agreements over standard or regional fallback rates.
- Monitor and implement quarterly pricing component updates to maintain compliance with CMS, Medicare, and Medicaid requirements.
- Act as the primary liaison between Configuration leadership, claims operations, and the legal contracting team.
- Identify and troubleshoot configuration and pricing issues to support accurate claims processing.
- Perform other duties as assigned.
Required Qualifications- 5-6 years of hands-on experience with NetworX Pricer.
- Strong hands-on experience with NetworX Configuration, including Integrated NetworX.
- Strong experience configuring and maintaining pricing logic within NetworX Pricer.
- Strong experience translating provider contract language into system pricing configurations.
- Advanced Oracle SQL skills for data validation, auditing, and troubleshooting.
- Experience with relational databases and large configuration data sets.
- Strong experience with unit, regression, and end-to-end testing of pricing configurations.
- Experience with provider agreements, fee schedules, rate sheets, and system qualifiers.
- Strong understanding of hierarchical pricing logic and provider-specific pricing rules.
- Experience supporting CMS, Medicare, and Medicaid pricing updates.
- Strong analytical, troubleshooting, and configuration management skills.
- Ability to collaborate effectively with configuration, claims operations, and legal contracting teams.
Preferred Qualifications- Experience with TriZetto Facets.
- Experience with Facets Integrated NetworX environments.
- Experience mentoring configuration analysts.
- Experience coordinating system conversion projects across platforms.
- Experience working in healthcare claims and managed care environments.
Years of Experience13+ years of overall experience.
