Facets Developer

Job Title: FACETS Functional Consultant – Healthcare Payer Location: North Carolina -Hybrid Duration: Long Term Contract Job Summary We are seeking an experienced FACETS Functional Consultant with strong expertise in the healthcare payer domain and hands-on experience across FACETS modules, including Claims, Enrollment, Membership and Eligibility, Billing, Benefits and Product Configuration, Provider Configuration, EDI/Interfaces, and Data Analysis. Key Responsibilities FACETS Claims Support FACETS claims configuration, processing, and adjudication. Analyze claim pricing, benefits, provider reimbursement, and member eligibility impacts. Investigate claim denials, pend conditions, adjustments, and processing issues. Support professional, institutional, and dental claims processing. Perform claims testing, validation, troubleshooting, and production support. Enrollment, Membership, and Eligibility Support member enrollment, subscriber and dependent maintenance, and demographic updates. Manage eligibility processing, coverage effective dates, termination dates, and reinstatement activities. Support group, subscriber, and membership setup and maintenance. Support premium billing, billing account setup, invoice generation, and billing cycle processing. Analyze premium calculations based on member, coverage level, product, group, and effective dates. Support payment processing, accounts receivable, credits, adjustments, and refunds. Handle retroactive enrollment changes and related premium recalculations. Perform billing reconciliation between enrollment, premiums, invoices, and payments. Investigate and resolve billing and financial data discrepancies. Benefits and Product Configuration Configure and support healthcare products, plans, and benefit structures. Support configuration of copays, deductibles, coinsurance, coverage limits, and eligibility rules. Support product and benefit changes based on business requirements. Provider Configuration Coordinate with Claims and Benefits teams to resolve provider-related issues. FACETS Configuration Analyze business requirements and translate them into FACETS functional configurations. Support configuration across products, benefits, providers, claims rules, groups, plans, enrollment, and billing. Perform impact analysis for FACETS configuration changes. Participate in system enhancements, releases, upgrades, testing, and implementation activities. Document business requirements, functional specifications, configuration changes, and test scenarios. Required Skills: 8+ years of overall IT/Healthcare experience. 5+ years of hands-on FACETS experience. Strong experience in at least two or more core FACETS modules, with the ability to understand end-to-end payer workflows. Healthcare payer or health insurance domain experience is required. Strong hands-on experience with FACETS in a Healthcare Payer environment. Experience with FACETS Claims and Claim Adjudication. Experience with Enrollment, Membership, and Eligibility. Experience with Premium Billing, Invoice Generation, Payment Processing, and Accounts Receivable. Experience with Benefits, Products, Plans, and FACETS Configuration. Knowledge of healthcare EDI/X12 transactions, especially 834, 837, 835, 270/271, and 276/277. Strong understanding of healthcare payer business processes. Strong SQL, data analysis, data validation, and reconciliation skills. #J-18808-Ljbffr Career Soft Solutions Inc