BSA FACETS Provider

Job Description

Role: BSA FACETS Provider - Business Systems Analyst (FACETS Provider)

Location: Seattle, WA

Job Description:

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• Seeking an experienced Business Systems Analyst (BSA).
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• Provider with deep expertise in the TriZetto FACETS Provider platform, including Provider Configuration, Network Management, and Pricing.
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• This role will serve as a Subject Matter Expert (SME) supporting strategic Healthcare Payer initiatives, FACETS implementations, regulatory mandates, system enhancements, and upgrade programs.
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• The ideal candidate will possess strong knowledge of FACETS Provider modules, provider network management, reimbursement and pricing methodologies, batch processes, backend data models, and advanced SQL analysis.
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• The candidate will partner with business stakeholders, provider operations teams, architects, developers, and testing teams to deliver high-quality solutions across the provider domain.
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• Serve as the primary Business Systems Analyst and SME for FACETS Provider, Network, and Pricing initiatives.
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• Gather, analyze, document, and validate business and system requirements related to provider operations and reimbursement processes.
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• Collaborate with business and technical stakeholders to translate provider network and pricing requirements into scalable system solutions.
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• Perform impact analysis for regulatory mandates, enhancements, system upgrades, and modernization initiatives.
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• Analyze end-to-end provider lifecycle processes, including provider setup, credentialing integrations, contracting, network participation, and reimbursement methodologies.
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• Support FACETS implementation, migration, upgrade, and transformation programs.
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• Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documentation.
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• Conduct root cause analysis and recommend solutions for complex provider and pricing-related issues.
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• Partner with development, QA, architecture, and support teams throughout the SDLC lifecycle.
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• Support User Acceptance Testing (UAT), defect triage, deployment validation, and post-production support activities.
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• Facilitate stakeholder meetings, solution workshops, and business process discussions.
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• Provide production support expertise for provider configuration, network management, and pricing-related issues.
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Required Qualifications

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• Experience 10+ years of experience as a Business Systems Analyst or Business Analyst.
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• Minimum 5+ years of hands-on experience with the TriZetto FACETS platform.
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• Extensive Healthcare Payer domain experience.
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• Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade initiatives.
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Required Skills

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• SME-level expertise in:
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• FACETS Provider Module
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• Provider Configuration & Maintenance
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• Provider Network Management
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• Contracting & Reimbursement Models
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• Pricing Configuration
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• FACETS Front-End Functionality
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• FACETS Batch Processing
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• FACETS Backend Data Models
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• Strong understanding of Healthcare Payer provider operations and network management processes.
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• Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design.
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• Experience analyzing provider network, contracting, fee schedule, pricing, and reimbursement business processes.
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• Strong requirements gathering, business process analysis, and solutioning capabilities.
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• Experience creating functional specifications, business rules, gap analysis, and system documentation.
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• Excellent communication, stakeholder management, and facilitation skills.
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• Ability to effectively collaborate with business, operational, and technical teams.
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Preferred Qualifications

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• Business Analysis certifications such as:
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• CBAP (Certified Business Analysis Professional)
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• CCBA (Certification of Capability in Business Analysis)
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• PMI-PBA (Professional in Business Analysis)
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• Experience supporting healthcare regulatory and compliance initiatives.
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• Familiarity with Agile delivery methodologies and tools such as JIRA, Azure DevOps, and ServiceNow.
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• Exposure to Claims, Membership, Billing, and Core FACETS Administration functions.
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Key Competencies:

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• Provider Network Management Expertise
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• Pricing & Reimbursement Knowledge
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• FACETS Subject Matter Expertise
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• Complex SQL & Data Analysis
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• Requirements Elicitation & Documentation
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• Business Process Modeling
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• Solution Design & Validation Stakeholder Management
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• Root Cause Analysis Agile & Waterfall Delivery
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