Facets with Pre-Auth
Futran Tech Solutions Pvt. Ltd.
Facets With Pre-Auth
Location: Remote
What is in it for you?
As a Facets with pre-Auth you will be a part of an Agile team to build healthcare applications and implement new features while adhering to the best coding development standards.
Responsibilities:
- A Facets UM Consultant is responsible for providing customers with application domain expertise related to Utilization Management rules and processes within the Facets platform. The consultant will analyze and review the existing Pre-Auth/UM rules configuration (both core and custom defined) and conduct requirements discovery sessions with clients to finalize outcomes, KPIs, and operational practices for the modified UM rules in adherence to State mandates
- Review and analyze FACETS Pre-Auth/UM rules for state-specific customization.
- Evaluate rule logic for authorization routing, benefit limits, and medical necessity guidelines.
- Identify gaps affecting intake, determination, and UM workflows. Work closely with UM operations, clinical teams, and configuration groups.
- 5 - 8 years in UM/Pre-Auth configuration within FACETS.
- Familiarity with UM workflows, clinical guidelines, and state mandates.
- Experience working with clinical/utilization management stakeholders.
- Deep understanding of US Healthcare payer operations.
- Ability to analyze complex rules and configurations.
Experience:
8+Years
Educational Qualifications:
Engineering Degree – BE/ME/BTech/MTech/BSc/MSc.
Technical certification in multiple technologies is desirable.
Vacancy posted 1 day ago
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