Job ID: JOB_ID_9413
Job Description
18+ years in Healthcare IT with 5+ years in Facets Pricing / NetworX Pricer. Highly experienced Facets NetworX Pricer Architect with deep expertise across pricing configuration, backend data structures, and .NET-based integrations. This role will drive end-to-end pricing architecture, enabling scalable, accurate, and high-performance claims adjudication solutions within the Facets ecosystem. The ideal candidate will bridge functional pricing strategy with technical implementation, ensuring alignment with payer business needs, regulatory requirements, and enterprise architecture standards.
Key Responsibilities
Pricing Architecture & Strategy
- Design and implement enterprise-wide pricing strategies using Facets NetworX Pricer
- Define reimbursement models (fee schedules, DRG, APC, case rates, value-based pricing)
- Lead pricing transformation initiatives, including migration from legacy pricing systems to NetworX
Facets Configuration (Front-End Expertise)
- Configure and manage: Pricing Plans, Pricing Groups, and Pricing Rules; Provider Contracts and Reimbursement Structures; Fee Schedules and Contract Terms
- Interpret ACT (Add/Change/Terminate) documents and translate them into system configurations
- Ensure pricing alignment with benefit plans and claims adjudication workflows
Backend Facets Tables & Data Expertise
- Deep understanding of Facets data model related to pricing and claims
- Hands-on experience working with: Pricing-related tables (NetworX Pricer schema), Claims adjudication tables, Provider and contract tables
- Perform data analysis, troubleshooting, and performance tuning
- Write complex SQL queries, stored procedures, and data validations
.NET Technical Development & Integration
- Design and develop .NET-based services and APIs for: Pricing integrations, Claims workflow enhancements, External system interactions (UM, EDI, Provider systems)
- Build reusable components for: Pricing rule validation, Data transformation and ingestion
- Support microservices architecture and API-led integrations
Claims Adjudication & Pricing Engine Optimization
- Analyze and optimize pricing logic during claims adjudication
- Troubleshoot pricing discrepancies and ensure accurate EOB generation
- Improve system performance for high-volume claims processing
Stakeholder Collaboration
- Work closely with: Business stakeholders (Pricing, Network, Provider teams), Product owners and SMEs, Offshore delivery teams
- Translate business requirements into technical design artifacts
Governance, Compliance & Best Practices
- Ensure compliance with: CMS guidelines, Contractual obligations, Regulatory requirements
- Establish best practices for pricing configuration and development
- Lead code reviews, design reviews, and architecture governance
Required Skills & Qualifications
Functional (Must-Have)
- Deep expertise in Facets NetworX Pricer
- Strong knowledge of: Healthcare claims lifecycle (EDI, Adjudication, EOB), Provider contracting and reimbursement methodologies
- Experience with ACT documents and contract interpretation
Technical (Must-Have)
- Strong hands-on experience with: Facets backend tables and data model, SQL Server (advanced queries, performance tuning), .NET / C# development
- Experience in: REST APIs / Microservices
- Integration frameworks (EDI, HL7, FHIR – good to have)
Preferred Qualifications
- Experience with Facets upgrades / migrations
- Exposure to: Cloud platforms (Azure preferred), AI/automation in claims/pricing
- Prior experience working with large payers (e.g., Optum, BCBS, Aetna)
Special Requirements
Contract role; Healthcare IT domain; Facets NetworX Pricer expertise; .NET/C# development; SQL Server; REST APIs/Microservices; Azure preferred
Compensation & Location
Salary: $90,000 – $130,000 per year (Estimated)
Location: Remote
Recruiter / Company – Contact Information
Recruiter / Employer: Facets
Email: eshwarsharmacodinix@gmail.com
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