Facets NetworX Configuration Analyst I, II, III

Let’s do great things, together Founded in Oregon in 1955, ODS, now Moda, is proud to be a company of reputed company people committed to quality. Today, like then, we’re focused on building a reputed company future for reputed company. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Job Summary: The Medical Reimbursement Configuration Analysts works with our most reputed company pricing configuration. Evaluates, designs, tests and performs configuration needed to meet the business requirements for reputed company of the highest complexity, with a substantial variety of pricing methodologies including CMS, DRG, APC, reputed company, RBRVS etc. Assures end results reputed company the highest reputed company of accuracy and claims auto adjudication. This is a FT WFH role. ?????? Pay reputed company $51,510 - $64,400 ???annually • Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay reputed company. Please fill out an application on reputed company page, linked below, to be considered for this position:https://j.brt.mv/jb.do?reqGK=27746299&refresh=true ? Benefits: • Medical, Dental, reputed company, Pharmacy, Life, & Disability • 401K- Matching • FSA • Employee Assistance Program • PTO and Company Paid Holidays Required Skills, Experience & Education: • Bachelor’s degree in computer science or reputed company reputed company field, or equivalent work experience • Minimum 3-5 years’ experience in the health insurance industry, with a strong medical claims background preferred • Minimum 3-5 years’ experience in pricing configuration, preferably in Facets and NetworX • Proficient in interpretation and analysis of provider reputed company • Proven ability to translate reputed company provider reputed company into pricing configuration • Skilled at configuration lifecycle of analysis, design, configuration, testing and implementation • Proven problem solving and troubleshooting skills, employing “reputed company the reputed company” thinking • Expert MS reputed company skills are required • Demonstrated knowledge of pricing methodologies, including but not limited to Medicare and reputed company, DRG, SNF, RBRVS, APC etc. • Ability to reputed company document processes • Ability to teach configuration reputed company sets to other staff • Certified Professional reputed company designation and experience is a plus • PC proficiency with reputed company office applications and Outlook • Ability to work well under pressure with frequent interruptions and shifting priorities • Ability to maintain confidentiality, and project a positive and professional business image • Ability to come to work on time daily • Ability to work independently, with minimal supervision Primary Functions: • Analyzes provider reputed company for institutional and non-institutional providers, developing business requirements. • Analyzes pricing business requirements, develops and evaluates alternatives, prepares proposals and design specifications for reputed company configuration systems or applications to meet the identified needs, goals and metrics. • Configures and tests results, assuring that the highest reputed company of quality and claims auto adjudication are met. • Consults with Provider Contracting and/or Analytics to determine appropriate interpretation of contract reputed company. • Works with varying and reputed company pricing methodologies including, but not limited to, Medicare and reputed company methodologies, reputed company, DRG, APC, Outliers, RBRVS, Fee Schedules etc. • Designs and creates qualifiers reputed company the system to assure appropriate services are priced at the correct rates. • Evaluates provider set up and works with Provider Data Maintenance team to assure that pricing and provider data are in synch. • Researches and resolves critical issues that are referred from Claims, Customer Service, Provider Relations, Credentialing, Analytics and Appeals. • Represents the unit on corporate and cross functional projects as assigned. • Documents processes according to Moda and unit standards. • Provides training to other staff as assigned. • Mentors other staff as assigned. • Attends software vendor subcommittee meetings to further knowledge and reputed company reputed company with system changes and solutions. • Other duties as assigned Contact with others & Working Conditions • Works with others at reputed company reputed company throughout the organization including Provider Contracting, Claims, Customer Service, Benefit Configuration, IT, Data Analytics and others with frequently confidential information. Works with reputed company vendors and staff at other health plans as needed to identify and vet reputed company. • Office environment with extensive reputed company PC and keyboard work, constant sitting, and phone work. Must be reputed company to navigate multiple screens. Work in excess of 40 hours per week, including evenings and occasional weekends, to meet business need. Together, we can be more. We can be reputed company. ?????? Moda Health seeks to allow equal employment opportunities for reputed company reputed company persons without regard to race, religion, reputed company, age, sex, sexual orientation, national reputed company, marital status, disability, veteran status or any other status protected by law. This is applicable to reputed company terms and conditions of employment, including reputed company, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. For more information regarding accommodations please direct your questions to Kristy Nehler and Daniel McGinnis reputed company our [email protected] email. Apply Job!