Hi,

Please find the requirement below and do reply back if you are comfortable.



*Position : Facets Config and Auto-Adjudication Specialist *

Contract : 7 Month Contract-to-hire

Location : Eden Prairie, MN



**Must pass a drug test and background check once offered the position**

Mid-level position working with a team of healthcare professionals
responsible for the creation and evaluation of requirements, solution
creation, selection, and architectural consulting based on established
standards and existing architecture. Drive and oversee the development of
Solutions from inception to deployment and ensure they do not deviate from
the original design. Contribute to project estimation and scheduling by
offering high-level solutions based on brief overviews of client needs.
Utilize detailed knowledge of the Trizetto Facets application in the design
and build of plan/products/benefits. Ability to leveraging existing
configuration components. Be involved in the review and testing of
configurations. Utilize knowledge of both the front end and back end
components of Facets in order to query configurations and other data and
determine approaches required to design and build configurations.

*Qualifications: *

·         Must have a working knowledge of business processes and IT
platforms in the following areas, and be an expert in the first two:

·         Benefit, Pricing and Claim Platform Configuration (expert)

·         Auto-Adjudication (expert)

·         Provider pick and Member pick processes and techniques

·         Claim pend logic, Claim payment logic

·         Contracts and pricing

·         Integrating with pricing and clinical editing engines

·         UM – Authorization matching

·         COB and TPL processing

·         Billing and Payments (Capitation, Claims, Commissions)

·         Expert in Facets Application Architecture and Configurable
components

·         Understands benefit needs, interprets in Facets way and perform
benefit configuration, group structure configuration, etc

·         Working knowledge of multiple claims processing platforms

·         Strong understanding of customer and market dynamics and
requirements

·         Ability to recognize revenue generating opportunities.

·         Ability to develop and deliver presentations to ‘C’ level
executives

 *Job Requirements:*

·         Bachelor’s Degree in Computer Science, Information Systems or
other related field, or equivalent work experience. Master’s degree
preferred.

·         5+ years working in healthcare

·         3+ years platform configuration experience in Facets including
NetworkX (Configuration Architect, Designer, Implementor)

·         1+ years experience functioning in a virtual environment

·         1+ years working in a matrix organization

·         Ability to travel 75% - 100% is required





Thanks & Regards,



*Jessie Parker*

*Phone : **510-358-3393* <510-358-3393>

*Email: *jes...@erpanderp.com <da...@bluecubeit.com> *Gtalk:
**jessiewithstaff...@gmail.com
<jessiewithstaff...@gmail.com>*

*Web :* www.erpanderp.com *LinkedIn ID* :
www.linkedin.com/pub/jessie-parker/97/25b/212



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