Program Manager - PRGMGR

Ipolarity LLC

NetworX Architect
Max SBR: ####
Remote EST, but HM is flexible if candidate is strong
Potential for extension

Design work
Must have hands on experience in NetworX Pricer (5-6 yrs)
Facets is not required, but nice to have
NetworX Configuration (Integrated NetworX)
Oracle SQL
Review contract, Agreement testing, migration, assignment

Configure, maintain, and model complex pricing logic within the TriZetto Facets Integrated NetworX Pricer software system.
Translate managed care provider contract language into precise fee schedules, rate sheets, and system qualifiers.
Manage day-to-day configuration workflows, mentor configuration analysts, and coordinate system conversion projects across platforms.
Direct comprehensive unit, regression, and end-to-end testing processes to ensure absolute claim payment accuracy.
Utilize advanced SQL queries and relational databases to audit, validate, and troubleshoot massive configuration data batches.
Establish hierarchical system logic to correctly prioritize specific provider agreements over standard, regional fallback rates.
Monitor and implement quarterly pricing component updates to maintain strict compliance with CMS, Medicare, and Medicaid rules.
Act as the primary liaison between Configuration of leadership, claims operations, and the legal contracting team.

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Vacancy posted 2 days ago

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