NetworX Consultant

Job Title: Healthcare Product Consulting - NetworX Consultant

Job Summary: The NetworX Product Consultant is responsible for providing customers with application domain expertise related to TriZetto NetworX functionality. This role involves conducting requirements discovery sessions, leading design sessions, and configuring applications within NetworX to meet defined requirements. The position requires excellent general consulting and NetworX application skills and is remote participation.

Key Responsibilities:

• Conduct requirements discovery sessions and lead design sessions to determine the best configuration of NetworX applications to meet defined requirements.

• Provide advanced analysis, problem-solving, and interpretation of application configuration.

• Liaise effectively with business and technical groups, transferring NetworX application knowledge to customer staff.

• Clearly articulate issues and provide alternative solutions, both verbally and in writing.

• Work effectively with onshore/offshore resource models.

• Collaborate with cross-functional teams to ensure seamless integration of Facets modules.

• Collaborate with IT and business teams to design, implement, and maintain provider reimbursement configurations, contract loading, and pricing methodologies within NetworX.

• Conduct thorough testing and validation of Facets configurations to ensure system 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 timely resolutions.

• Work closely with stakeholders to gather and understand business requirements.

• Ensure compliance with industry standards and regulations in all Facets-related activities.

• Participate in project planning and execution to meet deadlines and deliverables.

• Provide regular updates and reports on project status to management.

• Continuously seek opportunities to improve processes and enhance system performance.

• Troubleshoot system and configuration issues, with a focus on root cause analysis.

• Adapt to a constantly changing environment and handle pressure situations.

Required Skills and Experience:

• Strong understanding of core NetworX functionality and the use of grouping and pricing.

• Understanding of key integration points with Facets agreements is preferred.

• Good knowledge of NetworX data structures.

• 10 years of healthcare experience, with 5 years of recent and relevant TriZetto NetworX pricing experience.

• 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.

• Strong proficiency in reimbursement methodologies and ability to interpret the same through requirements and design.

• 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.

• Demonstrated ability to understand and use Optum PPS configuration.

• Demonstrate 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.

Preferred Qualifications:

• Ability to provide advanced analysis, problem-solving, and interpret application configuration.

• Excellent communication skills, both verbal and written.

• Experience in working with onshore/offshore resource models.

• Maintain comprehensive documentation for system configurations, processes, and procedures.

• Investigate, diagnose, and resolve system-related issues promptly.

• Develop and implement solutions to enhance system performance and reliability.